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Deep Cerebral Veins

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TERMINOLOGY

Abbreviations

• Septal, thalamostriate, internal cerebral veins (SV, TSV, ICV)
• Vein of Galen (VofG); basal vein of Rosenthal (BVR)
• Inferior sagittal sinus (ISS); straight sinus (SS)

Definitions

• Cavum veli interpositi: Space within double-layered tela choroidea of 3rd ventricle, communicates posteriorly with quadrigeminal cistern

GROSS ANATOMY

Overview

• Medullary veins

Small, linear veins originate 1-2 cm below cortex

Course toward ventricles, terminate in subependymal veins
• Subependymal veins

SV

– Course posteriorly along septum pellucidum

– Join with TSVs to form ICVs at interventricular foramen

TSVs

– Receive caudate/terminal veins that course anteriorly between caudate nucleus, thalamus

– Curve over caudate nuclei

– Terminate at interventricular foramen (of Monro) by uniting with SVs to form ICVs
• Deep paramedian veins

ICVs

– Paired, paramedian

– Course posteriorly in cavum veli interpositi

– Terminate in rostral quadrigeminal cistern by uniting with each other; BVRs to form VofG

VofG (great cerebral vein)

– Short, U-shaped midline vein formed from union of ICVs, BVRs

– Curves posteriorly and superiorly under corpus callosum splenium in quadrigeminal cistern

– Unites with ISS at falcotentorial apex to form SS

Anatomy Relationships

• Deep veins course under ventricular ependyma, define ventricular margins
• ICVs above 3rd ventricle, pineal gland; under fornices, corpus callosum splenium

Vascular Territory

• ICVs, VofG, and tributaries drain ovoid area surrounding lateral/3rd ventricles
• Caudate nuclei, putamen/globus pallidus, thalamus, internal capsule, deep cerebral (medullary) white matter, medial temporal lobes

IMAGING ANATOMY

Overview

• Medullary veins

On DSA, appear as tiny, relatively uniform, contrast-filled, linear structures that terminate at right angles to ventricular subependymal veins
• Subependymal veins

DSA, lateral view

– “Dots” of contrast at subependymal/medullary vein junction define roof of lateral ventricle

DSA, AP view

– TSV defines size, configuration of lateral ventricle; characteristic double curve appearance

– BVR, tributary of VofG, begins at medial temporal lobe, curves around midbrain, appears as frog leg

T1 C+ MR usually shows TSV, caudate, and SVs; smaller subependymal veins usually inapparent
• Deep paramedian veins

DSA, lateral view

– ICV follows gently undulating posterior course from foramen of Monro to VofG

– VofG forms prominent arc, curving back/up around corpus callosum splenium

DSA, AP view

– ICVs 1-2 mm off midline, seen as ovoid/elliptical collection of contrast

T1 C+ MR, axial view: ICVs seen as contrast-filled, linear, paramedian structures just above 3rd ventricle

CTV/MRV: ICVs, VofG well seen

Normal Variants, Anomalies

• Variations common; true anomalies rare
• VofG malformation

Primitive median prosencephalic vein (MPV) persists as outlet for diencephalic, choroidal venous drainage

Persisting falcine sinus ± absent/hypoplastic SS

ANATOMY IMAGING ISSUES

Imaging Recommendations

• MRV/CTV delineate dural sinuses, large deep veins (e.g., ICV, BVR)
• DSA best for detailed delineation of deep veins/tributaries

EMBRYOLOGY

Embryologic Events

• 5th fetal week: Arterial supply to choroid plexus forms from meninx primitiva
• 7th-8th fetal weeks

Choroid plexus drains via single temporary midline vein (MPV)

MPV courses posteriorly toward developing interhemispheric dural plexus (falcine sinus)
• 10th week

ICVs annex drainage of choroid plexus

MPV regresses, caudal remnant unites with developing ICVs → definitive VofG formed

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Mar 13, 2021 | Posted by admin in NUCLEAR MEDICINE | Comments Off

Main Text

TERMINOLOGY

Abbreviations

GROSS ANATOMY

Overview

IMAGING ANATOMY

Overview

EMBRYOLOGY

Embryologic Events

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Deep Cerebral Veins

Deep Cerebral Veins

Definitions

Anatomy Relationships

Vascular Territory

Normal Variants, Anomalies

ANATOMY IMAGING ISSUES

Imaging Recommendations

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Deep Cerebral Veins

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