This document provides an overview of cerebral vein anatomy and pathology. It describes the external cortical veins that drain into the superior sagittal sinus and internal veins like the vein of Galen. Common pathologies involving cerebral veins include thrombosis of the superior cerebral veins which can cause seizures or bleeding. Malformations of the vein of Galen like aneurysms can cause heart failure in newborns or neurological issues in older children.

1. CEREBRAL
VEINS
THE
ESSENTIAL
AND
MORE
Anatomy
Exemples
of
diseases
JFIM
2013
F
HERAN
Fonda=on
ROTHSCHILD
PARIS

2. CEREBRAL
VENOUS
SYSTEM
ANATOMIC
REMINDERS
Veins,
cor=cal
or
deep
è
pierce
the
arachnoid
membrane
and
the
inner
(meningeal)
layer
of
the
dura
mater
è venous
sinuses
No
valves,
absence
of
muscular
=ssue,
thin
walls
MORPHOLOGICAL
ADAPTATION
Asymmetries
and
anatomic
varia=ons
Impaired
in
many
pathological
situa=ons

3. CEREBRAL
VEINS
EXTERNAL
(CORTICAL)
VEINS
Superior
Cerebral
Veins
(SCV)
8
to
12
è
Superior
sagiBal
sinus
(SSS)

4. PATHOLOGY
Seizure,
fiever
SCV
thrombosis
Another
cause
of
superficial
bleeding:
reversible
vasospasm

5. Middle
Cerebral
Veins
(MCV)
Lateral
surface
of
the
hemisphere,
along
the
lateral
cerebral
fissure
è
Cavernous
sinus
(CS)
or
the
sphenoparietal
sinus.
Great
anastomoQc
vein
of
Trolard
è
SCV
è
SSS
Posterior
anastomoQc
vein
of
Labbé
(temporal
lobe)
è
Transverse
Sinus
(TS)
Inferior
Cerebral
Veins
(ICV)
Small
size,
drain
the
under
surfaces
of
the
hemispheres,
join
anterior,
middle
or
basal
veins.

6. Vein
of
Labbé
Vein
of
Trolard

7. INTERNAL
(DEEP)
VEINS
Internal
Cerebral
Veins
(veins
of
Galen)
=
thalamo
striate
+
choroid
veins
near
the
interventricular
foramen
è
Backward
between
the
layers
of
the
tela
chorioidea
of
V3
èReceive
the
corresponding
Basal
Vein
(Rosental
vein)
è
Unite
beneath
the
splenium
of
the
corpus
callosum
è
Great
cerebral
vein
(great
vein
of
Galen)
around
the
splenium
of
the
corpus
callosum
è
Anterior
extremity
of
the
straight
sinus
SS
Praying
man6s
SS
ICV
GGV
BV

8. TSV
ICV
CV
BV
GV
SS

9. INTERNAL
(DEEP)
VEINS
Basal
veins
(Rosenthal
vein)
=
anterior
cerebral
vein
+
deep
MCV
+
inferior
striate
veins
è
backward
around
the
cerebral
peduncle
è
internal
cerebral
vein
(vein
of
Galen)

10. PATHOLOGY

11. PATHOLOGY
Vein
of
Galen
aneurysmal
malformaQon
Boy
>
girl
New
born:
Heart
failure,
(shut)
Baby:
macrocrania,
Child:
seizures,
focal
neurological
impairment,
mental
retarda=on

12. USUAL
VENOUS
DRAINAGE
DV
SCV
MCV
ICV

13. CEREBELLAR
VEINS
On
the
surface
of
the
cerebellum.
3
major
drainage
systems
Superior
cerebellar
veins
across
the
superior
vermis
è SS
and
ICV
Anterior
cerebellar
veins
Petrosal
vein
è Superior
Petrosal
Sinus
(SPS)
Posterior
cerebellar
veins
(tentorial)
large
size
è TS,
SPS,
Occipital
Sinus
(OS)

14. Superior
cerebellar
veins
Posterior
cerebellar
veins
Superior
vermian
vein
Precentral
vein
Inferior
vermian
vein
Anterior
pontomesencephalic
vein
Tonsillar
vein

15. Anterior
cerebellar
veins
Petrosal
vein
Petrosal
vein
Superior
petrosal
sinus
(SPS)
Petrosal
vein

16. TRANSCEREBRAL
VEINS
Very
frequent,
thin
Through
the
white
ma_er
or
through
the
basal
ganglia.
Detected
if
pathology
venous
hyperpression:
thrombosis,
AVM
malforma=on:
développemental
(DVA),
Sturge
Weber
disease.

18. Cavernoma
8
%
of
the
DVA,
bleeding
Sturge
Weber

19. TS
Thrombosis
Follow
up
Increased
visibility
of
transcerebral
veins

20. SINUSES
OF
THE
DURA
MATER
Venous
channels
Beetween
the
two
dural
layers
(perioteal
outside,
dura
mater
inside)
Devoid
of
valves,
Triangular
or
round
in
sec=on,
size
ì
from
front
to
back
Lined
by
endothelium
ó
veins.
Fenestrated
,
septated,
mulQchanneled
Contain
arachnoid
granulaQons
(CSF
è
venous
circula=on)
Receive
cerebral
veins
which
drain
the
blood
from
the
brain
Communicate
with
extracranial
veins
directly
(diploic
veins,
emissary
veins
through
basilar
foramina)

21. POSTERO-­‐SUPERIOR
SINUSES
Superior
sagiBal
sinus
(SSS)
(superior
longitudinal
sinus)
A_ached
margin
of
the
falx
cerebri
Deviates
to
one
or
other
side
(R>L)
è corresponding
TS
through
the
torcular
Herophili,
ó
contralateral
TS
Drains
external
veins
(SCV,
veins
from
the
diploë,
dura
mater
and
pericranium)
è
irregularly
shaped
venous
spaces
(venous
lacunæ)
with
arachnoid
granula=ons
(pacchionian
bodies)

23. SSS
SSS
SS
LTS
RTS

24. SSS
SSS
SS
RTS
RTS
SS
LTS

25. PATHOLOGY
Venous
thombosis
Diffusion

26. Inferior
sagiBal
sinus
(longitudinal
sinus)
Posterior
half
or
two-­‐thirds
of
the
free
margin
of
the
falx
cerebri.
cylindrical
form,
size
ì
from
front
to
back
è
SS
Receives
several
veins
from
the
falx
cerebri,
the
medial
surfaces
of
the
hemispheres

27. Straight
sinus
(SS)
Junc=on
falx
cerebri
-­‐
tentorium
cerebelli.
Triangular
in
sec=on,
size
ì
from
front
to
back
end
of
the
ISS
to
the
TS
Receives
the
great
cerebral
vein
(great
vein
of
Galen)
and
the
superior
cerebellar
veins.

28. Transverse
sinuses
(TS)
Internal
occipital
protuberance
Curve
along
the
petrous
por=on
of
the
temporal
bone
è
internal
jugular
vein
Receive
the
superior
petrosal
sinuses,
the
petrosquamous
sinus,
some
inferior
cerebral
and
inferior
cerebellar
veins,
and
some
veins
from
the
diploë
ó
veins
of
the
pericranium
(mastoid
and
condyloid
emissary
veins)
SSS
è right
TS
(larger)
(70
%
cases)
SS
è
lef
TS
(agenesia
20
%
cases)
TS
stenosis
:
Pacchioni
granulaQon
(30
%
normal
subjects),
trabeculaQon
(30
%
normal
subjects,
(medial
or
lateral
third
of
the
right
TS)
Note:
=
sigmoid
sinus
groove
on
the
mastoid
part
of
the
temporal
.
Occipital
sinus
Smallest,
around
the
margin
of
the
foramen

31. PATHOLOGY
Thrombosis
BRAIN
HEMATOMA
THINK
VEINS

32. Be
carefull
with
the
signal
of
the
veins
!
Thrombosis
?
Veins
need
injecQon
!

33. ANTERO-­‐INFERIOR
SINUSES
Cavernous
sinuses
(CS)
Re=culated
structure,
numerous
interlacing
filaments.
Dural
pouch
on
either
side
of
the
body
of
the
sphenoid
bone
Superior
orbital
fissure
è
apex
of
the
petrous
por=on
of
the
temporal
bone.
Contain
internal
caro=d
artery,
caro=d
plexus
(∑),
VI,
III,
IV,
V1
and
V2
Receive
the
superior
and
inferior
ophthalmic
veins,
some
of
the
cerebral
veins,
the
sphenoparietal
sinus
(de
Brechet)
which
courses
along
the
under
surface
of
the
small
wing
of
the
sphenoid

34. Angular
vein
Angular
vein
Superior
ophthalmic
vein
Sphenoparietal
sinus

35. PATHOLOGY
Caro=do-­‐cavernous
fistula

36. Drains
toward
è Superior
petrosal
sinus
ó
TS
è Inferior
petrosal
sinus
ó
TS
(sigmoid
sinus)
è Anterior
and
posterior
intercavernous
sinuses
(sinus
coronaire)
ó
contralateral
CS
CS
and
these
3
sinuses
=
Basilar
plexus
è
internal
jugular
vein
è Pterygoid
venous
plexus
High
pression
è
Superior
ophthalmic
vein
ó
angular
vein

37. Superior
petrosal
sinus
(SPS)
CS
Posterior
intercavernous
sinuses
CS

38. Inferior
petrosal
sinus
(IPS)
SPS
Vein
of
Labbé
IPS

39. CS
Pterygoid
venous
plexus
Inferior
petrosal
sinus

40. CEREBRAL
VEINS
?
SO
EASY
!