22 VEINS: SUPERFICIAL CEREBRAL, MENINGEAL, DIPLOIC, AND EMISSAR

98



Overview of the Nervous System

Optic (II) nerve

Intercavernous (circular) sinus and pituitary gland

Internal carotid artery

Cavernous sinus

Sphenoparietal sinus

Superficial middle cerebral vein

Oculomotor (III) nerve

Trochlear (IV) nerve

Trigeminal (V) nerve

Middle meningeal vein

Abducens (VI) nerve

Superior petrosal sinus

Petrosal vein

Facial (VII) nerve and nervus intermedius

Vestibulocochlear (VIII) nerve

Glossopharyngeal (IX) nerve

Vagus (X) nerve

Jugular foramen

Sigmoid sinus

Accessory (XI) nerve

Hypoglossal (XII) nerve

Transverse sinus

Great cerebral vein (of Galen)

Opening of an inferior cerebral vein



Falx cerebri (cut)

Superior ophthalmic vein

Basilar plexus



Cavernous sinus



Tentorial artery



Superior and

inferior

petrosal

sinuses



Tentorium cerebelli

Straight sinus

Falx cerebri (cut)

Confluence of sinuses

Superior sagittal sinus

Falx cerebri

Inferior sagittal sinus

Great cerebral vein (of Galen)

Sphenoparietal sinus

Intercavernous sinus

Superior petrosal sinus

Straight sinus

Inferior petrosal sinus

Sigmoid sinus

Jugular foramen

Transverse sinus

Confluence of sinuses

Occipital sinus



7.23  VENOUS SINUSES

The falx cerebri and tentorium cerebelli, protrusions of fused

inner and outer dural membranes, confine the anterior, middle, and posterior fossae of the skull. Outer )>>superior sagittal)

and inner )>>inferior sagittal) venous channels, found in split

layers of the dura, drain blood from the superficial and deep

regions of the central nervous system, respectively, into the

jugular veins. The great cerebral vein of Galen and the straight

sinus merge with the transverse sinus into the confluence of

sinuses to drain the deep, more posterior regions of the central

nervous system. Infection can be introduced into the cerebral

circulation through these sinuses. Venous sinus thrombosis

can cause stasis )>>a backup of the venous pressure), which results in inadequate perfusion of the regions where drainage

should occur. The protrusions of dura, such as the tentorium

cerebelli and falx cerebri, are tough, rigid membranes through

which portions of the brain can herniate when intracranial

pressure increases.



CLINICAL POINT

Venous sinus thrombosis commonly occurs with infection. �Cavernous

sinus thrombosis can occur as the result of infection in the �paranasal

sinuses or middle ear or following a furuncle in the region of the face.

Anterior cavernous sinus thrombosis can result in severe pain and

headache, ipsilateral visual loss, exophthalmos )>>protrusion of the eyeball), edema of the eyeball )>>chemosis), and palsies of the extraocular

nerves )>>III, IV, VI) and V1 )>>ophthalmic division) that traverse the

�sinus. This lesion can expand to cause hemiparesis and can involve the

interconnected cavernous sinus of the other side, the superior petrosal

sinuses, and other venous structures.

The petrosal sinuses can undergo a process of thrombosis caused

by the spread of infection in the middle ear. An inferior petrosal sinus

thrombosis may cause damage to the VI )>>abducens) nerve; a superior petrosal sinus thrombosis can result in damage to the semilunar

ganglion, producing facial pain. If the transverse sinus is thrombosed,

cranial nerve deficits in nerves IX, X, and XI may occur.



Vasculature



99



Longitudinal fissure

Anterior cerebral veins

Rostrum of corpus callosum

Septum pellucidum

Anterior septal vein

Head of caudate nucleus

Anterior terminal (caudate) vein

Caudate veins

Interventricular foramen (of Monro)

Columns of fornix

Thalamostriate vein

Superior choroidal vein and choroid plexus of lateral ventricle

Thalamus

Tela choroidea of 3rd ventricle

Direct lateral vein

Posterior terminal (caudate) vein

Internal cerebral veins

Basal vein (of Rosenthal)

Great cerebral vein (of Galen)

Inferior sagittal sinus

Straight sinus

Tentorium cerebelli

Transverse sinus

Confluence of sinuses

Superior sagittal sinus



A. Dissection from Above

Uncal vein

Anterior cerebral vein

Superficial middle cerebral vein (draining to sphenoparietal sinus)

Deep middle cerebral vein

Cerebral peduncle



Inferiorcerebral veins



Basal vein (of Rosenthal)

Lateral geniculate body

Medial geniculate body

Pulvinar

Splenium of corpus callosum

Great cerebral vein (of Galen)

Inferior anastomotic vein (of Labbé)



B. Dissection from Below



7.24  DEEP VENOUS DRAINAGE OF THE BRAIN

A, This superior view of the thalamus and basal ganglia reveals the venous drainage of deeper forebrain regions into the

posterior venous sinuses. B, This basal view of the brain with



the brain stem removed illustrates the drainage of forebrain

and mesencephalic venous blood into the great cerebral vein

of Galen, heading toward the straight sinus.



100



Overview of the Nervous System



Subependymal Veins

Superior choroidal vein

Caudate veins

Lateral ventricle

Thalamostriate vein

Anterior terminal (caudate) vein

Anterior septal vein

Genu of corpus

callosum



Veins on lateral wall of ventricle

Veins on medial wall and floor of ventricle

All other veins



Posterior septal vein

Direct lateral vein

Posterior terminal (caudate) vein (posterior part of thalamostriate vein)

Interior cerebral vein

Medial atrial vein

Lateral atrial vein

Splenium of corpus callosum

Inferior sagittal sinus

Posterior pericallosal vein

Interior occipital vein

Great cerebral vein

(of Galen)

Post horn of

lateral ventricle



Interventricular

foramen (of Monro)



Straight sinus



Superior thalamostriate veins

Anterior commissure

Interthalamic adhesion

3rd ventricle

Anterior cerebral vein

Optic chiasm

Deep middle cerebral vein

Inferior thalamostriate veins

Basal vein (of Rosenthal)

Inferior horn of lateral ventricle

Posterior mesencephalic vein

Hippocampal and inferior ventricular veins

Cerebral aqueduct



7.25  DEEP VENOUS DRAINAGE OF THE BRAIN:

RELATIONSHIP TO THE VENTRICLES

Subependymal regions of the central nervous system drain

venous blood into the inferior sagittal sinus superiorly or

into the great cerebral vein of Galen inferiorly, both of which

drain into the straight sinus. Occlusion of a vein in this region

causes a blockage of drainage and a backup of perfusion, with

resultant ischemia of the tissue in the regions of drainage.



Cerebellum

4th ventricle

Median aperture (of Magendie)

Lateral aperture (of Luschka)



CLINICAL POINT

Venous thrombosis can occur following an infectious process, especially in the nearby sinuses, middle ear, or adjacent facial areas. Noninfectious causes of venous thrombosis include dehydration, cancer,

polycythemia vera and other hyperviscosity syndromes, inflammatory

conditions, and other disorders. The symptoms vary according to the

affected focal territory and the spread of the underlying pathological

process; they include severe headache, nausea and vomiting, weakness

and sensory losses, sometimes aphasia, and sometimes coma.



Vasculature



101



Subependymal and Superficial Veins Opacified

A. Lateral projection

Caudate vein



Posterior terminal (caudate) vein



Anterior terminal (caudate) vein



Superior anastomotic vein (of Trolard)

Superior sagittal sinus

Inferior sagittal sinus



Internal cerebral vein

Great cerebral vein (of Galen)

Straight sinus



Anterior septal vein

Thalamostriate vein



Interior

jugular

vein



Superior choroidal vein



B. Frontal projection



Transverse sinus

Inferior anastomotic vein (of Labbé)

Basal vein (of Rosenthal)

Superior sagittal sinus



Thalamostriate vein



Straight sinus



Superficial cortical veins

Transverse sinus



Inferior jugular vein

Basal vein (of Rosenthal)



7.26  CAROTID VENOGRAMS: VENOUS PHASE

These lateral and anterior venous-phase angiograms illustrate

the superior sagittal sinus, the inferior sagittal sinus, and the

great cerebral vein of Galen draining into the straight sinus,



Internal cerebral vein

Great cerebral vein (of Galen)



the transverse sinus, the basal vein of Rosenthal, and the internal jugular, through which the venous blood of the brain

drains back to the heart.