Internal cerebral veins (Gray's illustration)

✓ The literature on the formation of cerebral veins is reviewed to obtain a better understanding of some cerebrovascular anomalies. Clinical observations such as the entry of the superior ophthalmic vein into the cavernous sinus through the inferior rather than the superior orbital fissure, the relative infrequency of middle cerebral vein backflow in the presence of an extensive cavernous fistula, and the relative infrequency of hemorrhage in relation to the inferior petrosal fistula all relate to the persistence of an older venous pathway. The frequent occurrence of hemorrhage in association with the superior petrosal sinus fistula and the frequent failure of the superior petrosal sinus to connect to the cavernous sinus similarly have an embryological explanation. The frequent association of the vein of Galen aneurysm and an absent or deformed straight sinus probably relates to the time at which the paired internal cerebral veins fuse into one channel. It is speculated that the origins of cerebral venous malformations (CVMs) and arteriovenous malformations (AVMs) probably relate to sequential formation and absorption of surface veins, which occur in human embryonic development mainly in the 40- to 80-mm length interval, although persistent AVM growth is possible even after birth. The frequent absence or anomaly of the middle cerebral vein and its failure to communicate with the cavernous sinus in the presence of both CVMs and AVMs are linked to the late development of that vein and to its even later connection to the cavernous sinus.

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Surgical management of pineal region lesions

Oxford Textbook of Neurological Surgery ◽

10.1093/med/9780198746706.003.0037 ◽

2019 ◽

pp. 439-446

Author(s):

Christoph M. Woernle ◽

René L. Bernays ◽

Nicolas de Tribolet

Keyword(s):

Third Ventricle ◽

Pineal Region ◽

Cerebral Veins ◽

Internal Cerebral Veins ◽

Supracerebellar Infratentorial Approach ◽

Occipital Transtentorial Approach ◽

Basal Vein Of Rosenthal ◽

Third Ventricle Tumours ◽

Quadrigeminal Plate ◽

The Brain

Lesions in the pineal region are topographically located in the centre of the brain in the diencephalic-epithalamic region. An area where the brain is bounded ventrally by the quadrigeminal plate, midbrain tectum, and in-between the left and right superior colliculi, dorsally by the splenium of the corpus callosum, caudally by the cerebellar vermis and rostrally by the posterior aspects of the third ventricle. Major anatomical and surgical challenges are the vein of Galen located dorsally, the precentral cerebellar vein caudally, the internal cerebral veins anteriorly and the basal vein of Rosenthal laterally. Most pineal region tumours can be safely removed by both approaches depending on the surgeon’s experience: the occipital transtentorial approach is recommended in presence of associated hydrocephalus or a steep straight sinus and low location of the tumour and the supracerebellar infratentorial approach for posterior third ventricle tumours.

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Spontaneous Resolution of Cavum Veli Interpositi

The Neuroradiology Journal ◽

10.1177/197140090802100609 ◽

2008 ◽

Vol 21 (6) ◽

pp. 805-809

Author(s):

S. Vattoth ◽

Y.S. Kim ◽

E. Norman ◽

G.H. Roberson

Keyword(s):

Case Reports ◽

Third Ventricle ◽

Septum Pellucidum ◽

Spontaneous Resolution ◽

Cerebral Veins ◽

Cavum Septum Pellucidum ◽

Internal Cerebral Veins ◽

Cavum Veli Interpositi ◽

Quadrigeminal Plate ◽

Forward Extension

Cavum veli interpositi is an open CSF space in the roof of the third ventricle that surrounds the internal cerebral veins, and is a forward extension of the quadrigeminal plate cistern. To the best of our knowledge, spontaneous resolution of a cavum veli interpositi has not been reported in the literature to date. Interestingly, case reports of spontaneous resolution of cystic cavum septum pellucidum in three patients and eighteen arachnoid cyst cases has been described in the literature. We describe the spontaneous resolution of a cavum veli interpositi or cyst in cavum veli interpositi in a 35-year-old man and review the literature of spontaneous resolution of cavum septum pellucidum and arachnoid cysts.

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Left occipital craniotomy for resection of falcotentorial meningioma

Neurosurgical FOCUS ◽

10.3171/2017.10.focusvid.17358 ◽

2017 ◽

Vol 43 (videosuppl2) ◽

pp. V9 ◽

Cited By ~ 2

Author(s):

William T. Couldwell

Keyword(s):

Lateral Position ◽

Cerebral Veins ◽

Vein Of Galen ◽

Venous Anatomy ◽

Link Type ◽

Interhemispheric Approach ◽

Internal Cerebral Veins ◽

Cognitive Difficulty ◽

Tumor Debulking

A 49-year-old man presented with headache and cognitive difficulty. MRI demonstrated a meningioma in the falcotentorial region with compression of the internal cerebral veins, basal veins of Rosenthal, and vein of Galen. It was a removed via a left-sided occipital interhemispheric approach, performed with the patient in the lateral position. After tumor debulking and removal of its attachment to the tentorium and anterior falx, the tumor was resected. All venous structures were preserved. The video demonstrates the technical nuances and strategy for removal of tumors in a region with complicated venous anatomy that must be preserved.The video can be found here: https://youtu.be/wKqAn3dYu4E.

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Posterior transcallosal intervenous-interforniceal approach to a periaqueductal tumor

Neurosurgical Focus: Video ◽

10.3171/2019.10.focusvid.19457 ◽

2019 ◽

Vol 1 (2) ◽

pp. V8

Author(s):

David S. Hersh ◽

Katherine N. Sanford ◽

Frederick A. Boop

Keyword(s):

Pilocytic Astrocytoma ◽

Third Ventricle ◽

Pineal Region ◽

Cerebral Veins ◽

Transcallosal Approach ◽

Link Type ◽

Risk Of Injury ◽

Internal Cerebral Veins ◽

Natural Separation ◽

Periaqueductal Tumor

Described by Dandy in 1921, the posterior interhemispheric transcallosal approach provides an operative corridor to the pineal region, posterior third ventricle, and upper midbrain. Intervenous-interforniceal and paravenous-interforniceal variants have been utilized for midline and paramidline pathology, respectively. The intervenous-interforniceal variant capitalizes on the natural separation of the internal cerebral veins, which are found medial to the forniceal crura at this level, to provide a safe corridor to the tumor while minimizing the risk of injury to the fornices. Here, the authors describe a posterior interhemispheric transcallosal approach using the intervenous-interforniceal variant for resection of a periaqueductal pilocytic astrocytoma.The video can be found here: https://youtu.be/mtQKEXEveTg.

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Computed tomography angiography accuracy in brain death diagnosis

Journal of Neurosurgery ◽

10.3171/2019.6.jns191107 ◽

2020 ◽

Vol 133 (4) ◽

pp. 1220-1228

Author(s):

Sergio Brasil ◽

Edson Bor-Seng-Shu ◽

Marcelo de-Lima-Oliveira ◽

Fabio Silvio Taccone ◽

Gabriel Gattás ◽

...

Keyword(s):

Computed Tomography ◽

Brain Death ◽

Computed Tomography Angiography ◽

Circulatory Arrest ◽

Cerebral Veins ◽

Clinical Trial Registration ◽

Bilateral Absence ◽

Internal Cerebral Veins ◽

Cerebral Circulatory Arrest

OBJECTIVEThe present study was designed to answer several concerns disclosed by systematic reviews indicating no evidence to support the use of computed tomography angiography (CTA) in the diagnosis of brain death (BD). Therefore, the aim of this study was to assess the effectiveness of CTA for the diagnosis of BD and to define the optimal tomographic criteria of intracranial circulatory arrest.METHODSA unicenter, prospective, observational case-control study was undertaken. Comatose patients (Glasgow Coma Scale score ≤ 5), even those presenting with the first signs of BD, were included. CTA scanning of arterial and venous vasculature and transcranial Doppler (TCD) were performed. A neurological determination of BD and consequently determination of case (BD group) or control (no-BD group) was conducted. All personnel involved with assessing patients were blinded to further tests results. Accuracy of BD diagnosis determined by using CTA was calculated based on the criteria of bilateral absence of visualization of the internal cerebral veins and the distal middle cerebral arteries, the 4-point score (4PS), and an exclusive criterion of absence of deep brain venous drainage as indicated by the absence of deep venous opacification on CTA, the venous score (VS), which considers only the internal cerebral veins bilaterally.RESULTSA total of 106 patients were enrolled in this study; 52 patients did not have BD, and none of these patients had circulatory arrest observed by CTA or TCD (100% specificity). Of the 54 patients with a clinical diagnosis of BD, 33 met the 4PS (61.1% sensitivity), whereas 47 met the VS (87% sensitivity). The accuracy of CTA was time related, with greater accuracy when scanning was performed less than 12 hours prior to the neurological assessment, reaching 95.5% sensitivity with the VS.CONCLUSIONSCTA can reliably support a diagnosis of BD. The criterion of the absence of deep venous opacification, which can be assessed by use of the VS criteria investigated in this study, can confirm the occurrence of cerebral circulatory arrest.Clinical trial registration no.: 12500913400000068 (clinicaltrials.gov)

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The Enigmatic Psalterium: A Review and Anatomic Study With Relevance to Callosotomy Procedures

Operative Neurosurgery ◽

10.1227/neu.0000000000000747 ◽

2015 ◽

Vol 11 (2) ◽

pp. 322-328 ◽

Cited By ~ 5

Author(s):

R Shane Tubbs ◽

Anand N Bosmia ◽

Tulika Gupta ◽

Kunal Chawla ◽

Marios Loukas ◽

...

Keyword(s):

Fiber Direction ◽

Cerebral Veins ◽

Average Thickness ◽

Vein Of Galen ◽

Posterior Border ◽

Anatomic Study ◽

Internal Cerebral Veins ◽

Mean Width ◽

Velum Interpositum ◽

Adult Cadaver

Abstract BACKGROUND Recalcitrant seizures after callosotomy procedures are challenging to treat. One commissure, the psalterium, has received little attention. OBJECTIVE To review the literature on this structure, and with dissection, better elucidate its morphology and relationships. METHODS Twenty adult cadaver brains underwent microsurgical dissection of the psalterium. Measurements included the size and distance from the splenium of the corpus callosum and posterior border of the hippocampus tail. Observations included the relationships between the psalterium and the vein of Galen and the fiber direction within this structure. RESULTS The psalterium was identified in all specimens. It intimately contacted the undersurface of the splenium superiorly and the velum interpositum inferiorly. It was always in the midline. Just posterior to the psalterium, the internal cerebral veins were found leaving the velum interpositum to drain into the vein of Galen. In most specimens, the psalterium fibers traveled in the same plane as the commissural fibers of the splenium. Mean width of the psalterium was 11 mm; mean length was 13 mm. Average thickness in the midline was 1.4 mm, and at the lateral edges, it was generally thicker as it joined the fornix with an average of 2 mm. In 30%, efferents from the hippocampus were arranged in the form of a sheet bilaterally rather than the normal bundle-like formation forming the posterior crura. CONCLUSION Better understanding of the commissures of the human brain, including the psalterium, might help the neurosurgeon during procedures near this structure.

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Visualization of the Internal Cerebral Veins on MR Phase-Sensitive Imaging: Comparison with 3D Gadolinium-Enhanced MR Venography and Fast-Spoiled Gradient Recalled Imaging

American Journal of Neuroradiology ◽

10.3174/ajnr.a2308 ◽

2010 ◽

Vol 32 (10) ◽

pp. E191-E193 ◽

Cited By ~ 5

Author(s):

J. Sun ◽

J. Wang ◽

L. Jie ◽

H. Wang ◽

X. Gong

Keyword(s):

Cerebral Veins ◽

Mr Venography ◽

Internal Cerebral Veins ◽

Phase Sensitive

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Anatomy of the deep venous system in vein of Galen malformation and its changes after endovascular treatment depicted by magnetic resonance venography

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2018-013789 ◽

2018 ◽

Vol 11 (1) ◽

pp. 84-89 ◽

Cited By ~ 4

Author(s):

Olivia Winkler ◽

Waleed Brinjikji ◽

Heinrich Lanfermann ◽

Friedhelm Brassel ◽

Dan Meila

Keyword(s):

Endovascular Treatment ◽

Venous Drainage ◽

Venous System ◽

Cerebral Veins ◽

Common Phenomenon ◽

Vein Of Galen ◽

Vein Of Galen Malformation ◽

Deep Venous System ◽

Internal Cerebral Veins ◽

Lateral Mesencephalic Vein

Background and purposeIt is classically thought that the internal cerebral veins (ICV) do not communicate with the venous pouch of vein of Galen malformations (VGM). We report on the anatomy of the deep venous system in VGM with special emphasis on the drainage of the ICV and possible changes after endovascular treatment.Materials and methodsWe retrospectively analyzed DSA and 2D time-of-flight MR venograms of 55 children with VGM. We evaluated all pre- and post-operative images for the presence of the ICVs and determined their route of venous drainage.ResultsOf 55 children, pre-operative 2D MRV detected the ICVs in 19 cases (35%) compared with one case (2%) for pre-embolization DSA (2%) (P<0.0001). Of the cases in which the ICVs were seen preoperatively, in 15 cases (78.9%) the ICV drained directly into the VGM while in the other four cases, the ICV used alternative venous drainage routes. On post-operative MRV, the ICVs were seen in 17 cases (31%) on MRV and 10 cases (18.2%) on DSA with drainage into an adult-like vein of Galen in 13 cases (76%), respectively (P=0.08). In four cases normal ICV drainage into the vein of Galen was seen even when the venous sac was closed. In two cases there was a change in ICV drainage from the vein of Galen to the lateral mesencephalic vein.ConclusionThe communication of the ICV with the VGM is a common phenomenon. Different changes of venous drainage routes do occur after treatment and are best seen on MRV.

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