Download Surgical anatomy and landmarks for the basal vein of Rosenthal

J Neurosurg 106:900–902, 2007
Surgical anatomy and landmarks for the basal
vein of Rosenthal
R. SHANE TUBBS, M.S., P.A.-C., PH.D.,1,2 MARIOS LOUKAS, M.D., PH.D.,3,4
ROBERT G. LOUIS JR., M.D.,3 MOHAMMADALI M. SHOJA, M.D.,5 CAMERON S. ASKEW, B.S.,6
APRIL PHANTANA-ANGKOOL, B.S.,6 E. GEORGE SALTER, PH.D.,2 AND W. JERRY OAKES, M.D.1
Section of Pediatric Neurosurgery, 2Department of Cell Biology, and 6School of Medicine, University
of Alabama at Birmingham, Alabama; 3Department of Anatomical Sciences, St. George’s University,
Grenada, West Indies; 4Department of Education and Development, Harvard Medical School,
Boston, Massachusetts; and 5Department of Anatomy and Neurosurgery, Tabriz Medical University,
Tabriz, Iran
1
Object. The basal vein of Rosenthal (BV) courses from the premesencephalic cistern, through the ambient cistern,
and terminates in the quadrigeminal cistern. The aim of this study was to describe and quantitate the surgical anatomy
of this structure and specifically to provide landmarks for identifying this vessel along its course. These data may be of
use, for example, to surgeons using subtemporal operative approaches through regions where this vessel is concealed.
Methods. The authors examined 15 latex-injected adult cadaveric brains (30 sides) to delineate the morphological
characteristics of the BV. Dissections of the BV were then performed and measurements were made between this structure and the tentorial incisura at the anterior, middle, and posterior borders of the lateral midbrain.
All specimens were found to have a left and right BV with varying morphological characteristics. The mean distance
between the BV and posterior cerebral artery at the midpoint of the lateral midbrain was 16 mm. The BV was always
found superomedial to the posterior cerebral artery along the lateral aspect of the midbrain, and the BV ranged in diameter from 1 to 5 mm. The BV drained into the vein of Galen in all but two specimens. The mean distances from the tentorial edge to the BV at the anterior, middle, and posterior borders of the lateral midbrain were 11, 13, and 4 mm, respectively. No statistically significant differences were found when comparing left and right sides or male and female
specimens.
Conclusions. The authors hope that these data will help the neurosurgeon operating near the BV to avoid injury to
this important structure.
KEY WORDS • cranium • brain • vasculature • midbrain • anatomy • cadaver
deep venous system of the brain is composed of
the internal cerebral vein, great vein of Galen, the
BV, and their respective tributaries.4 The BV begins
just anterior to the midbrain near the anterior perforated
substance, travels lateral to this structure, and terminates
posteriorly, usually into the great vein of Galen, although it
may drain into the straight sinus or the internal cerebral
veins (Fig. 1).7,9 The BV was first described by Rosenthal
in 1824 and arises from four main vessels: the anterior cerebral vein, formed by the anterior limbic and pericallosal
veins; the medial and inferior frontal veins, of which one
is the olfactory vein; the deep sylvian vein (deep middle cerebral); and the inferior striate veins (Fig. 2).3,9 Other
tributaries to the BV that have been described include the
hippocampal vein, the inferior choroidal vein (which may
be large),2 and the inferior ventricular, posterior thalamic,
peduncular, lateral mesencephalic, pontine, precentral, and
quadrigeminal veins. Several important structures accom-
T
HE
Abbreviation used in this paper: BV = basal vein of Rosenthal.
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pany the BV lateral to the midbrain, including the posterior cerebral and superior cerebellar arteries and the trochlear
nerve.
Materials and Methods
Fifteen formalin-fixed adult cadaveric heads (30 sides) from patients 60 to 88 years of age at death (mean 79 years) were dissected.
Seven specimens were obtained from male cadavers and eight specimens from female cadavers. With each cadaver in the supine position, the carotid sheath was identified and the internal jugular vein
was isolated bilaterally. Blue latex was injected into both the left
and right internal jugular veins. Specimens were allowed to cure for
at least 36 hours prior to dissection. The calvaria and brains were
next removed using an oscillating bone saw, and the basilar sinus
was identified and studied with dissection. Dissections of the BV
were performed using a subtemporal approach and quantitation was
made of its branching pattern. A surgical microscope (Zeiss) was
used for magnification. Measurements were then made between the
BV and the tentorial incisura at the anterior, middle, and posterior
borders of the midbrain (Fig. 3). Microcalipers were used for all
measurements. A statistical analysis of the differences between sides
was performed using chi-square tests (Cramer Phi and Cramer V
tests). Significance was determined to be a probability value less
than 0.05.
J. Neurosurg. / Volume 106 / May, 2007
Basal vein of Rosenthal
FIG. 1. Artist’s illustration of the BV as it travels around the lateral aspect of the mesencephalon.
Results
The BV was identified in all specimens and was found to
be superior and medial to the posterior cerebral artery in all
cases. The distance between the BV and the posterior cerebral artery at the lateral midbrain ranged from 1 to 25
mm (mean 6 standard deviation 16 6 3.5 mm). The BV
ranged in diameter from 1 to 5 mm (mean 2 mm). Tributaries contributing directly into the BV generally measured
0.25 to 0.5 mm. The type and number of these tributaries
are found in Table 1. The BV drained into the vein of Galen
in all but two specimens. On one left side the BV drained
into the ipsilateral internal cerebral vein, and in one specimen both the left and right BV drained into the superficial
pial vessels along the temporooccipital lobes and thus did
not have any connection to the vein of Galen. A left BV in
a female cadaver was found to drain into both the vein of
TABLE 1
Tributaries to the BV observed in 30 cadaveric sides
Tributary
No. of Branches (range)
lamina terminalis
anterior perforated substance
infundibulum
mammillary body
optic tract superficial
optic tract deep
choroidal (temporal horn)
amygdala
uncus
hippocampus/fornix
lateral mesencephalon
lateral geniculate body
pulvinar
pineal
tectal
superior medullary velum
tentorial bridging vein
0–2
0–3
0–5
0–2
1–3
1–3
1–2
0–2
0–2
0–2
2–6
0–3
0–2
0–1
0–3
0–1
1
J. Neurosurg. / Volume 106 / May, 2007
FIG. 2. Upper: Inferior view of the BV after transection of the
mesencephalon. The arrowhead indicates the BV. Lower: Artist’s
illustration of the view shown in the upper panel demonstrating additional tributaries.
Galen and a superior cerebellar vein. This same specimen
was found to have a very prominent lateral mesencephalic
vein that drained inferiorly into the superior petrosal sinus.
The distance ranges from the tentorial edge to the BV at
the anterior, middle, and posterior borders of the midbrain
were 6 to 15 mm (mean 6 standard deviation 11 6 1.1
mm), 5 to 20 mm (13 6 1.3 mm), and 1 to 10 mm (4 6 1.0
mm), respectively (Fig. 3). No statistically significant differences were found when comparing left and right sides
or male and female specimens. No gross intracranial lesions were observed in any cadaver.
Discussion
Padget demonstrated that the BV is a complicated ves5
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R. S. Tubbs et al.
sigmoid sinus via the BV and its indirect connection to the
superior petrosal sinus by the lateral mesencephalic vein.5,6
Additionally, other veins that occasionally drain into the
BV include the internal occipital, splenial, precentral cerebellar, superior vermian, and subependymal veins from the
atrium, and the superior thalamic veins.3
Topographically, Zajgner11 found that the BV crossed the
tentorial notch in three of 23 cases. In a previous study of
the cisternal segment of the trochlear nerve, we found that
the mean distance between this nerve (cisternal segment)
and the BV at a midpoint of the lateral midbrain was 7.5
mm.8 In the present study, we found that the mean distances
from the tentorial edge to the BV at the anterior, middle,
and posterior borders of the lateral midbrain were 11, 13,
and 4 mm, respectively.
FIG. 3. Lateral view of the midbrain demonstrating the distances
measured in this study from the tentorial edge to the BV at the anterior, middle, and posterior borders of the lateral mesencephalon
(arrows).
sel formed when the embryo is approximately 70 mm long
that arises secondarily as a longitudinal anastomotic channel uniting several regional embryologic veins. These components develop as the telencephalic, diencephalic, and
mesencephalic veins when the embryo is between 14 and
18 mm long, and differentiate into the deep telencephalic,
ventral diencephalic, dorsal diencephalic, and mesencephalic veins. Posterior drainage is formed by a connection
between the dorsal diencephalic vein and the internal cerebral vein or a tributary of the vein of Galen. The deep middle cerebral vein and the anterior cerebral veins develop
from the deep telencephalic vein, and the ventral diencephalic vein drains from the primitive tentorial sinus into the
transverse sinus at approximately the 40-mm embryo stage.
Interestingly, in many animals the BV drains into the transverse sinus.10 The ventral diencephalic vein forms a communication between the superior petrosal sinus via the peduncular vein and the anterior pontomesencephalic vein in
addition to the primitive tentorial sinus. The mesencephalic vein forms the lateral mesencephalic vein that connects
the ventral diencephalic vein of one side to the mesencephalic vein (this vein becomes the superior petrosal sinus)
contralaterally. Suzuki and colleagues7 have proposed that
the potential variations of the BV can be classified on the
basis of these five drainage pathways and their anastomoses between the primary primitive veins (deep telencephalic
vein, ventral diencephalic vein, dorsal diencephalic vein,
and mesencephalic vein).
Padget5 postulated that the superficial pial veins of the
cortex may drain into the BV. In fact, one of our specimens
was found to have a bilateral BV that drained not into the
galenic system but rather terminated more laterally into the
pial veins of the temporal and occipital lobes. Browder and
Kaplan1 have reported veins of the medial occipital lobe
draining into the caudal part of the BV. In one specimen, a
right pineal vein was found to drain into the posterior BV.
We found only one other source9 describing pineal veins
(which usually drain into the vein of Galen) draining into
the BV, as seen in two of our specimens. When the great
vein of Galen is occluded, deep drainage can pass into the
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Conclusions
A more accurate knowledge of the anatomy of the BV,
including surgical landmarks, could potentially be helpful
to clinicians and particularly neurosurgeons who deal with
cerebral venous disorders or operate in the vicinity of this
vein.
References
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Manuscript submitted June 9, 2006.
Accepted December 12, 2006.
Address reprint requests to: R. Shane Tubbs, Ph.D., Pediatric
Neurosurgery, Children’s Hospital, 1600 7th Avenue South ACC
400, Birmingham, Alabama 35233. email: [email protected].
J. Neurosurg. / Volume 106 / May, 2007