Subarachnoid cisterns as surgical corridors: Integrating microsurgical anatomy and neuroimaging for intracranial navigation

Background: The subarachnoid space comprises a complex system of cerebrospinal fluid (CSF)-filled compartments known as cisterns, which contain critical neurovascular structures and serve as essential anatomical corridors in neurosurgery. Despite their importance, current literature often lacks integrated descriptions correlating microsurgical anatomy with modern neuroimaging, limiting their applicability in surgical planning and intraoperative navigation. Methods: A comprehensive narrative review of the supratentorial, tentorial, and infratentorial subarachnoid cisterns was performed, integrating detailed microsurgical anatomical descriptions with radiological correlation using computed tomography cisternography and high-resolution magnetic resonance imaging sequences, including T2 and fast-imaging employing steady-state acquisition. Emphasis was placed on clinically relevant cisterns and their relationships with adjacent neurovascular structures. Results: Subarachnoid cisterns were systematically categorized according to their anatomical location and surgical relevance. Each cistern demonstrates distinct boundaries, contents, and patterns of communication, forming a continuous network that facilitates CSF dynamics and provides natural pathways for surgical access. Correlation with neuroimaging allows precise identification of these compartments and enhances understanding of their role in pathological conditions such as subarachnoid hemorrhage, tumors, and hydrocephalus. Key cisterns, including the Sylvian, carotid, interpeduncular, ambient, quadrigeminal, and cerebellopontine cisterns, were highlighted for their relevance in common neurosurgical approaches. Conclusion: A thorough understanding of subarachnoid cistern anatomy, combined with accurate interpretation of neuroimaging, is essential for safe and effective neurosurgical practice. The integration of anatomical and radiological perspectives enhances surgical planning, facilitates identification of operative corridors, and may improve outcomes in intracranial procedures.