Table Of ContentHenri M. Duvernoy
The Superficial Veins
of the Human Brain
Veins of the Brain Stem and of
the Base of the Brain
With 71 Figures (138 Separate Illustrations)
Springer-Verlag Berlin Heidelberg New York 1975
Professor H. M. DUVERNOY, Universite de Besan<;on, Faculte de Medecine,
Laboratoire d'Anatomie, F-25030 Besan<;on Cedex
ISBN-13: 978-3-540-06876-1 e-ISBN-13: 978-3-642-65929-4
001: 10.1007/978-3-642-65929-4
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© by Spnnger-Verlag Berlm Heidelberg 1975
Softcover reprint of the hardcover 15t edition 1975
Library of Congress Catalogmg m PublicatIOn Data Duvernoy, H M 1931- The superficial veins of the human bram
Bibhography p I Bram-Blood-vessels 2 Vems I Title [DNLM I Bram-Biood supply 2 Vems WL310 D985a]
QM455 D88 612' 82 74-13021
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Typesettmg by Bruhlsche Umversitatsdruckerei, GieBen
To My Father,
Dr. MAURICE DUVERNOY
Former Professor of Anatomy
School of Medicine, Besanfon
Contents
I. Introduction 1
II. Material and Methods 3
1. Techniques of Removal 3
2. Injection Techniques 3
3. Observation Techniques 3
III.The Larger Superficial Veins of the Brain Stem and of the Base of the Brain 5
A. Infratentorial System ...... 5
1. Anterior Venous Drainage System 5
2. Lateral Venous Drainage System 6
a) The Superior Petrosal Vein 6
b) Satellite Veins of the Cranial Nerves 7
3. Posterior Venous Drainage 9
B. Supratentorial System 9
1. The Basilar Vein System . 9
a) Point of Origin of the Basilar Vein 9
b) Ventral Segment of the Basilar Vein 10
c) Laterodorsal Segment ofthe Basilar Vein 12
d) Variations in the Drainage of the Supratentorial Venous Flow 13
e) Anastomoses Linking the Left and Right Basilar Systems 15
C. Anastomoses between the Supra- and Infratentorial Venous Systems 16
1. Anteromedian Anastomosis 16
2. Anterolateral Anastomoses 17
3. Lateral Anastomoses 17
IV. Regional Architecture of the Superficial Veins 19
A. The Superficial Veins of the Medulla 19
1. The Veins of the Anterior Side of the Medulla 19
a) The Longitudinal System ....... 19
b) The Transverse System ....... 19
2. The Veins of the Lateral Sides of the Medulla 20
3. The Veins of the Dorsal Side of the Medulla 22
B. The Superficial Veins of the Pons 23
1. The Longitudinal System 23
2. The Transverse System 23
VII
C. The Superficial Veins of the Ventral Side of the Diencephalon 24
1. The Longitudinal System ...... 25
2. The Transverse System ...... 25
D. The Superficial Veins of the Mesencephalon 26
1. The Superficial Veins of the Dorsal Side of the Mesencephalon 26
a) The Main Venous Drainage of the Dorsal Side ofthe Mesencephalon 26
b) Regional Study of the Superficial Venous Networks . . . . . . . 27
2. The Superficial Veins of the Ventral Side of the Mesencephalon or
Veins ofthe Cerebral Peduncles 27
a) The Longitudinal Peduncular Veins 27
b) The Transverse Peduncular Veins 27
V. Conclusions ..... 30
1. Intrinsic Anastomoses 31
2. Extrinsic Anastomoses 31
a) Extrinsic Infratentorial Drainage 31
b) Extrinsic Supratentorial Drainage 31
References ............................ 33
Illustrations ............................ 35
Subject Index 109
Acknowledgments
Grateful acknowledgment IS due to the teaching staff of the Department of Anatomy
of the University of Besanc;on, and in particular to Dr. G. MONNIER and
Dr. 1. GUYOT, Miss F. LEGARDEUR for her highly competent and devoted technical
assistance, Mrs. J. EUVRARD for her secretarial assistance, Mr. J. PENEY for help
with our day-to-day technical problems, Mr. 1. L. VANNSON for the drawings,
Mr. M. L. CLAY for the translation.
Finally we gratefully acknowledge the help of the Department of Pathology
(Prof. A. OPPERMAN and Prof. G. PAGEAUT) without whose support this research
project could never have been carried out.
VIII
I. Introduction
Interest in a detailed anatomical description our knowledge of the venous system has
of the veins of the human brain is of fairly been advanced more by radiological than by
recent date. The general layout of the dural anatomical methods. This is due to the diffi
sinuses and of the large encephalic veins culty of obtaining a post-mortem display of
that drain into them has long been known, the veins. Injection techniques often give de
but a more detailed study of the venous sys ceptive results; most authors use back-flow
tem has been made necessary by recent ad injection from the larger collecting veins,
vances in neurosurgery and neuroradiology. but this method generally gives very incom
The progress and methods of neurora plete results. The technique we have used is
diology have made it possible to follow the radically different, consisting of an arterial
superficial venous network * further and injection of a solution of indian ink and gel
further. There are obvious practical advan atine. When this injection is successful the
tages in having a detailed knowledge of the arterial, capillary, and venous networks of
venous network and these are not to be de the encephalon are clearly displayed; the re
rived from a knowledge of the arterial net sults are particularly clear in the venous
work: the venous network is in close con network which is visible from the main
tact with the surface of the nervous tissue, veins to their smallest branches.
whereas the arterIal network is more freely The results thus obtained could lead to a
situated in the subarachnoid space (Fig. 1). classification and systematization of the su
Radiography of the superficial veins makes perficial veins of the brain stem and of the
it possible to detect the contour lines and base of the brain. In practice, as previous
anomalies of the encephalon with much research has shown, this is extremely diffi
greater precision. Nevertheless, a close anal cult; it would appear that the main direc
ysis of recent research seems to indicate that tions of the flow of the venous drainage in
the encephalon are extremely variable.
* The term "superfIcial" IS not used conSIS However, the close study of the venous sys
tently m the literature. Authors agree on the ex tem makes it possible to recognize those
tensIOn of the vems of the bram stem but differ features which can be considered to be char
ent criteria are used for dlVidmg the veins of the
acteristic because of their extremely fre
brain mto "superficial" and "deep" systems. Jo
quent occurrence. The most important fea
HANSON (1954) and numerous authors use "su
perficial veins" only for the vems of the surface ture is the relative independence of the path
of the hemIspheres (these vems will not be stud of the superficial veins in relationship to the
Ied here), and consider the veins of the base of path of the arteries; another feature is the
the brain to be part of the deep system, as are
tendency of the superficial veins to follow
the mternal cerebral vems and theIr branches.
the sulci or depressions of the surface of the
We prefer to consider the veins of the base of the
nervous tissue; yet another is the more or
brain to be part of the superfIcial system, as they
he next to the subarachnoid space and are not less evident continuation in the brain stem
covered with nervous tIssue. and even in the base of the brain of a basic
spinal type of superficial drainage made up (infratentorial or posterior fossa flow), the
of longitudinal vessels linked by transverse other above the tentorium cerebelli (supra
vessels. tentorial flow). The following chapter is
The first chapter is concerned with the concerned with the description of the super
main venous flow draining the brain stem ficial venous network of the different ele
and the base of the brain. This can be dI ments of the brain stem (medulla, pons,
vided into two main directions of flow, one mesencephalon) and of the base of the
under the level of the tentorium cere belli brain.
2
II. Material and Methods
Fifty brains taken from the autopsy room to this solution (5 to 10%). It sets as it cools
were used in our research. The average age and retains the colored solution in the
of the 34 male and 16 female donors was 60 larger vessels. A syringe is used to inject the
years. The average time lapse between death solution into one after another of the four
and removal of the brain was 91/2 hours. catheters placed in the arteries. The solution
is injected while the encephalon is in the
running water and this enables us to see
whether the injection is successful. If there is
1. Techniques of Removal
considerable leakage through damaged ves
The encephalon is removed from the cranial sels, the injection is stopped before all the
cavity as follows: when the calvaria has 300 ml has been injected. The encephalon is
been opened the dura mater covering the then thoroughly washed in warm then in
hemispheres is removed with the brain, cold water and immersed in 10% formalde-
whereas the dura mater attached to the base hyde solution for one month.
of the skull is not removed. Care is taken to
cut the tentorium cerebelli along the supe-
rior border of the petrous bone in order to
remove it with the encephalon and so leave 3. Observation Techniques
the straight sinus intact.
The arteries and the veins are dissected un
der the stereoscopic microscope. This is a
long and delicate operation, as all the trabe
2. Injection Techniques
cula of the arachnoid covering the surface of
Catheters are placed in the terminal seg the brain must be cut and removed. The
ments of the internal carotid arteries and of photographs are taken when the ence
the vertebral arteries. The temperature of phalon has been placed in water to avoid
the encephalon is then raised by an injec reflection which would make certain areas
tion of lukewarm saline solution and any unobservable. Distilled water is generally
damaged arteries are ligatured. When the used to aVOId formation of bubbles on the
encephalon has been thoroughly rinsed, the surface of the brain.
brain stem takes on a pearly-white color. In our opinion the technique of total
The brain is then immersed in running injection through the arteries has several
warm water and the colored solution is in advantages. The most important advantage,
jected. Numerous dyes can be used. We as far as this work is concerned, is the excel
continue to use indian mk which has given us lent visual display of the superficial venous
excellent results over fifteen years. The solu network. This display is not normally ob
tion injected (300 ml on average) is made up tained by techniques in which the solution
of indian ink and water and gelatine is added is injected into the large veins against the
3
normal direction of the blood flow, as was ited number of cases. The success of the
always the case in the work reported in the injections may vary for a number of rea
literature. Another important advantage of sons. The age of the donor is an important
this technique is that it enables us to inject factor, but the time lapse between death and
both the arteries and the veins and to study injection is the primary conditioning factor
the relationships between them (Fig. 1). It is and successful injections are rarely obtained
easy to distinguish the arteries from the after a 24-hour time lapse. The cause of
veins; even the finest elements can be distin death can also contribute to the success or
guished, the veins having an intense black failure of the injection. Even in optimum
color because of the thinness of their walls. conditions it is difficult to forecast the out
The veins are nearly always in direct con come, and it is necessary to inject considera
tact with the surface of the nervous tissue; ble numbers of brains in order to obtain a
we later make use of this fact to remove the limited number of good quality injections.
arteries from the surface of the brain with Thus only fifty brains were selected for the
out harming the subjacent veins. The third research work described in this book.
advantage of total injection is that it per Finally, ist must be conceded that the
mits us to study not only the superficial ves technique used does not allow us to give a
sels considered in this work, but also the valid interpretation of the circulation exist
deep vascularization of the nervous tissue. ing in vivo in the superficial venous network.
The deep arteries and veins and the deep The study of the caliber of the different ele
capillary network can be studied by means ments of this network is of doubtful signifi
of thick sections and total transparification cance as far as the direction of flow is con
of a whole area. These techniques, used in cerned. Only the direction of flow in the
the laboratory for studying the vascular ar larger veins draining the encephalon can be
chitecture of circum ventricular organs, are established with the technique in question.
at present used for the study of the capillary Moreover, the terminal points of these
network of the human brain stem (Fig. 2). larger veins in the various venous sinuses of
It must, however, be pointed out that the dura mater are first noted when the en
total injections are obtained in only a lim- cephalon is removed.
4
