Functional Anatomy of the Cerebral Veins(<SPECIAL ISSUE>Complication Avoidance: Anatomical Practice as Operative Training (2))

Abstract

Development of the cerebral veins does not parallel that of the cerebral arteries. Paired primary head veins that develop at both sides of the neural tube collect blood from the primitive dural plexuses. After the closure of the neural tube, initial choroidal drainage to the median vein of prosencephalon is transferred to the paired internal cerebral veins and the great vein of Galen. Dorsolateral enlargement of the cerebrum requires development of the tentorium cerebelli. The tentorial sinus within the tentorium initially receives blood transversely from the telencephalon, diencephalon, and mesencephalon, and transfers its role to the longitudinally formed basal vein (basal vein capture). Superficial cerebral veins (Sylvian, Trolard, and Labbe) establish enough cortical anastomoses to each other. Subsequently, the superficial Sylvian vein draining to the tentorial sinus is captured to the cavernous sinus to a variable degree following distal regression of the tentorial sinus. Variations of drainage patterns of the basal vein, cavernous sinus capture, collateral at the base of the brain (Trolard circle), and the development of transcerebral medullary veins provide various clinical pictures in cerebral venous pathologies. An understanding of the functional anatomy of the cerebral veins is essential for the interpretation of the pathophysiology of the cerebral venous diseases and for administering safer treatment.