Choroidal fissure and choroidal fissure cysts: a comprehensive review

Abstract

In this paper, the authors discuss the embryology and anatomy of the choroidal fissure, as well as the pathophysiology and treatment of cerebrospinal fluid cysts of this structure. Understanding its anatomical relations to nearby structures plays an essential role during brain surgeries. With the advancement and availability of imaging techniques, lesions of the choroidal fissure are often found incidentally. Patients are usually asymptomatic or exhibit symptoms that do not correlate with anatomical location or do not require surgical treatment. The choroidal fissure is a key landmark used during brain surgery. Therefore, a comprehensive understanding of it and nearby anatomical structures is essential. Choroidal fissure cysts can be found incidentally, and well-known key features will allow one to differentiate them from other lesions. Surgical treatment should be reserved for symptomatic patients while asymptomatic patients should be monitored.

Keywords: Arachnoid cyst; Basal cistern; Choroidal fissure; Choroidal fissure cyst; Third ventricle.

Fig. 1

Coronal brain slice (left) noting the ambient cistern (yellow arrow), the choroidal fissure (white arrow), fimbria (red arrow), hippocampus (H) and choroid plexus in the temporal horn (black arrow); The right sagittal image of the brain notes the relationship between the fornix and thalamus from a medial view.

Fig. 2

Schematic drawing of the developing neural tube. As the telencephalic vesicles form from the prosencephalon, note the groove on the dorsal tube at the base of the vesicles, which is the primitive choroidal fissure. Observe that the choroidal vessels are entering and leaving the ventricle via this fissure. ACA, anterior cerebral artery; ICA, internal carotid artery; PCom, posterior communicating artery.

Fig. 3

Axial views of the inferior choroidal vein (left) and posterior lateral choroidal arteries (yellow arrows; right) at the choroidal fissure.

Fig. 4

Schematic drawing of a basal view of the brain (left) noting the choroidal fissure at the point of entrance (inferior choroidal point) of the anterior choroidal artery (yellow arrow) and for reference, the thalamus (blue arrow).

Fig. 5

Sequential dissection of the brain noting the relationship between the pulvinar and choroid plexus and posterior lateral choroidal arteries (white circle). Note that there are usually multiple (average 4) posterior lateral choroidal arteries as seen in this specimen. The P2 and P3 parts of the posterior cerebral artery are labeled.

Fig. 6

Magnetic resonance imaging noting large right and left choroidal fissure cysts.