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The Diagnostic Value of the Deep Cerebral Veins in Cerebral Angiography

1955; Radiological Society of North America; Volume: 64; Issue: 2 Linguagem: Inglês

10.1148/64.2.161

1527-1315

Bernard S. Wolf, Charles M. Newman, Benno Schlesinger,

Vascular Malformations Diagnosis and Treatment

Carotid angiography (1) has become an established and increasingly popular procedure in neuroradiology. For diagnostic purposes, most of the emphasis has been placed on changes in the arterial phases. This paper is presented to emphasize the importance of changes in the deep veins of the brain. With serial filming, the deep veins are regularly visualized from four to six seconds after injection. If films are taken at one-second intervals, the deep veins are usually seen in two successive frames. Our present procedure is to take seven films in eight seconds, since the intracranial circulation may be slow in the presence of increased intracranial pressure. Normal Anatomy The normal anatomy of the pertinent deep veins is represented in Figures 1–4. No attempt to describe it in detail will be made. Several venous tributaries seen only occasionally are not illustrated. These include: (1) a posterior epithalamic vein which appears to arise near the pulvinar and joins the internal cerebral vein a short distance in front of the great vein of Galen; (2) an anterior epithalamic vein which joins the internal cerebral vein a short distance behind its origin and may be mistaken for the terminal vein unless both are simultaneously visualized; (3) the posterior callosal vein which outlines the superior and posterior aspects of the splenium and joins the internal cerebral vein posteriorly; (4) the anterior callosal or cerebral vein which outlines the genu and joins the anterior portion of the basal vein. It should be emphasized that the deep veins serve as extraordinarily useful landmarks for the adjacent cerebral structures. The terminal vein (striothalamic vein, vein of the corpus striatum) indicates the interventricular boundary between the thalamus and the caudate nucleus. The septal and caudate veins run immediately beneath the ependyma and indicate the extent of the lateral ventricle (Figs. 5 and 6). This relationship is due to the fact that the intracerebral tributaries of these subependymal veins are, in general, too small to be identified individually. The anterior portion of the terminal vein forms a loop around the anterior tubercle of the thalamus as it passes through the interventricular foramen (or rather canal) to join the internal cerebral vein. This loop has a very characteristic appearance in the lateral phlebogram but does not lie in the sagittal plane. In reality, it is inclined from above laterally to below medially. The internal cerebral vein runs in the roof of the third ventricle. For descriptive purposes, it may be divided into an anterior or horizontal portion and a posterior or descending portion. The point of junction of the paired internal cerebral veins to form the great vein of Galen in the cisterna ambiens cannot be identified (with unilateral opacification). Fortunately, this point is of no diagnostic significance. It is therefore convenient to refer to the combined internal cerebral vein and the great vein by the single designation, “the deep vein of the brain.”