(Journal of Neurosurgery) Microsurgical Anatomy of The Veins of The Posterior Fossa

J Neurosurg 59:63-105, 1983
Microsurgical anatomy of the veins of the posterior fossa
TOSHIO MATSUSHIMA, M.D., ALBERT L. RHOTON, JR., M.D.,

EVANDRO DE OLIVEIRA, M.D., AND DAVID PEACE~ n . s .
Department oJNeurological Surgery, University of Florida College of Medicine, Gainesville, Florida
~" The microsurgical anatomy of the veins of the posterior fossa was defined in 25 cadavers. These veins are
divided into four groups: superficial, deep, brain-stem, and bridging veins. The superficial veins are divided on
the basis of which of the three cortical surfaces they drain: the tentorial surface, which faces the tentorium
and is exposed in a supracerebellar approach, is drained by the superior hemispheric and vermian veins: the
suboccipital surface, which is below and between the lateral and sigmoid sinuses and is exposed in a wide
suboccipital craniectomy, is drained by the inferior hemispheric and inferior vermian veins; and the petrosal
surface, which faces forward toward the posterior surface of the petrous bone and is retracted to expose the
cerebellopontine angle, is drained by the anterior hemispheric veins. The deep veins course in the three fissures
between the cerebellum and the brain stem, and on the three cerebellar peduncles. The major deep veins in
the fissures between the cerebellum and brain stem are the veins of the cerebellomesencephalic, cerebello-
medullary, and cerebellopontine fissures, and those on the cerebellar peduncles are the veins of the superior,
middle, and inferior cerebellar peduncles. The veins of the brain stem are named on the basis of whether they
drain the midbrain, pons, or medulla. The veins of the posterior fossa terminate as bridging veins, which
collect into three groups: a galenic group which drains into the vein of Galen: a petrosal group which drains
into the petrosal sinuses: and a tentorial group which drains into the tentorial sinuses near the torcula.
KE’,’ WORDS veins 9 posterior fossa 9 cerebellum 9 brain stem

anatomical study
T
HE veins of the posterior fossa have been the most The veins of the posterior fossa have received consid-
neglected of the intracranial vascular structures erable attention in the radiological literature. 4148 We
in the anatomic and neurosurgical literature. In refer our readers to the studies of the veins in the
Gray’s Anatomy, 5~ these veins are handled briefly in posterior fossa by Huang and Wolf. ~4-19 Their work,
one sentence, and none of the individual veins on the although excellent, is presented from the viewpoint of
brain stem or cerebellum are mentioned by name. the radiologist, and is lacking in some of the details
Similarly, in the neurosurgical literature, even when needed during microsurgical operations in the posterior
veins contribute significantly to the operative pathology fossa.
in the posterior fossa, they are often referred to simply
as "veins" rather than by their individual names? 223 Methods
Part of the reason for the lack of specificity in identi- Magnifications ranging from x 3 to 40 were used
fying these veins is the lack of nomenclature applicable to examine the posterior fossa in 25 adult cadavers after
to the clinical situation. The naming of veins in the perfusing the veins with colored latex or acrylic. In
posterior fossa provides an almost bewildering number stepwise sequence, the cerebral hemispheres were re-
of possibilities when one considers that the cerebellum moved and the veins and sinuses in the tentorium and
is composed of nine vermian and eight paired hemi- on the superior surface of the cerebellum were exam-
spheric lobules, and that there are fissures and subdivi- ined from above; the occipital bone between the lateral
sions of each lobule which might be used to further and sigmoid sinuses was removed and the veins and
refine the name. In this study, we have provided a sinuses over the posterior cerebellar surface were ex-
simplified nomenclature readily applicable to the op- amined from posteriorly; and the cerebellum was then
erative approaches to the posterior fossa. The nomen- retracted away from the posterior surface of the petrous
clature is based predominantly on the relationship of bone to expose and examine the veins on the anterior
the veins to the three cortical surfaces of the cerebellum, surface of the cerebellum. Special attention was directed
the three deep fissures between the brain stem and to the identification of all bridging veins during these
cerebellum, the three cerebellar peduncles, and the three initial steps. The cerebellum and brain stem were then
subdivisions of the brain stem in the posterior fossa. removed from the skull, and the deep veins in the three
J. Neurosurg. / Volume 59 ~July. 1983 63

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T. Matsushima, et al.
FIG. 1. Tentorial surface of the cerebellum and the cerebello-

mesencephalic fissure. A: Posterosuperior view. The tentorial sur-
face is the surface that faces the tentorium. The tentorium has been
divided and removed at its attachment (Tent. Edge) to the petrous
ridges posterior to the middle cranial fossae (Mid. Fossa). The
classical nomenclature applied to the vermian and hemispheric subdivisions of the tentorial surface is on the right side and our
simplified nomenclature is on the left side. The fissure dividing the tentorial surface into anterior (Ant. Part) and posterior parts
(Post. Part), the tentorial fissure (Tentorial Fiss.) in our nomenclature, is the primary tissue (Primary Fiss.) in the older
nomenclature. This fissure separates the hemispheric surface between the quadrangular and simple lobules and the vermis between
the declive and culmen. The culmen and quadrangular lobules correspond to the anterior part (Ant. Part) of the tentorial surface,
and the declive and simple lobule and part of the superior (Sup.) semilunar lobule correspond to the posterior part (Post. Part) of
the tentorial surface. The anterior vermis is the most superior part of the tentorial surface. This surface slopes downward to its
posterior and lateral margins. The vermian subdivisions of this surface are rostral to their corresponding hemispheric parts. The
superomedial part of this surface surrounds the posterior half of the midbrain. The fissure between the midbrain and the
cerebellum, the cerebellomesencephalic fissure (Cer. Mes. Fiss.), has also been called the precentral cerebellar fissure (Percent.
Cer. Fiss.). The anterior margin of the cerebellum which separates the tentorial and petrosal surfaces has a medial and lateral part:
the lateral part is the anterolateral margin (Ant. Lat. Margin), which separates the hemispheric part of the two surfaces and is
parallel to the superior petrosal sinus; and the medial part is the anteromedial margin (Ant. Med. Margin), which separates the
vermis part and faces the brain stem along the cerebellomesencephalic fissure. The posterior margin of the cerebellum, which
separates the tentorial and suboccipital surfaces, also has medial and lateral parts: the lateral part is the posterolateral margin
(Post. Lat. Margin), which separates the hemispheric part of the two surfaces and is parallel to the lateral sinus; and the medial
part is the posteromedial margin (Post. Med. Margin), which separates the vermic part and faces the posterior cerebeUar incisura.
The lateral angle (Lat. Angle) of the cerebellum is situated at the junction of the anterolateral and posterolateral margins. The
anterior angle (Ant. Angle) is located at the junction of the anterolateral and anteromedial margin of the cerebellum. The notch
where the brain stem fits into the anterior surface of the cerebellum, the anterior cerebellar incisura (Ant. Cer. Incisura), is located
at the anteromedial margin, and the notch where the falx cerebelli fits into the posterior surface, the posterior cerebellar incisura
(Post. Cer. Incisura) is located on the posteromedial margin. The oculomotor nerves (III) arise from the midbrain between the
cerebral peduncles (Ped.). The trocblear nerves (IV) arise below the inferior colliculi (Inf. Coll.) and encircle the midbrain in the
cerebellomesencephalic fissure. The trigeminal nerves (V) arise from the midpons and pass anteriorly. The superior surfaces of
the middle cerebellar peduncles (Mid. Cer. Ped.) are caudal to the posterior edges of the cerebral peduncles. The postclival fissure
(Postclival Fiss.) separates the simple and superior semilunar lobules. B: Anterosuperior view. The superior part of the cerebellum
has been removed to expose the brain-stem side of the cerebellomesencephalic fissure. This fissure extends inferiorly between the
cerebellum and the mesencephalon. The rostral part of the fissure has the midbrain, the inferior colliculi, and the trochlear nerves
on its anterior margin, and the culmen and the central lobule on its posterior margin. Deeper into the fissure, the medial part of
the anterior surface is formed by the lingula of the vermis, which overlies the superior medullary velum, and the lateral parts are
formed by the posterior surface of the superior cerebellar peduncles (Sup. Cer. Ped.) and the rostral surface of the middle cerebellar
peduncles. The interpeduncular sulcus (Interped. Sulc.) separates the superior and middle cerebellar peduncles and at its upper
margin joins the pontomesencephalic sulcus (Pon. Mes. Sulc.) between the midbrain and pons and the lateral mesencephalic
sulcus (Lat. Mes. Sulc.) dorsal to the cerebral peduncles. The facial (VII) and vestibulocochlear (VIII) nerves extend laterally below
the middle cerebellar peduncles. The trigeminal nerves arise by passing through the fibers of the middle cerebellar peduncles.
fissures between the brain stem and cerebellum near venous structures, and from 10 o f each o f the unpaired
the r o o f o f the fourth ventricle were examined after midline venous structures.
removing the cerebellum on the outer wall o f these
fissures.
These stepwise microsurgical dissections were per- Results
formed on 25 heads. Detailed measurements o f the The veins in the posterior fossa are divided into four
diameter of the veins were obtained in 10 heads to groups: 1) superficial veins; 2) deep veins; 3) veins o f
provide measurements from 20 o f each o f the paired the brain stem; and 4) bridging veins or draining groups.
64 J. Neurosurg. / Volume 59 ~July, 1983
Veins of the posterior fossa
FIG. 1. C: The left half of the superior part of the roof of the fourth ventricle (4V), and the upper part of
the middle and the superior cerebellar peduncles have been removed to expose the caudal half of the roof of
the fourth ventricle. The fastigium is at the junction of the superior and inferior half of the roof. The inferior
medullary velum (Inf. Med. Vel.) arises on the surface of the nodule and spreads laterally toward the lateral
recesses. The superior medullary velum (Sup. Med. Vel.) is on the inner surface of the lingula. Choroid plexus
(Ch. PI.) arises on the ventricular surface of the inferior half of the roof. The superior limb (Sup. Limb) of the
cerebellopontine fissure (Cer. Pon. Fiss.) opens into the inferior part of the cerebellomesencephalic fissure.
These groups will be reviewed briefly before beginning superficial tonsillar veins are also included in this group.
the detailed discussion of the neural relationships of the
individual veins. Deep Veins
The deep veins course in the three deep fissures
Superficial Veins between the cerebellum and brain stem near the roof
The superficial veins drain the cortical surfaces of the and walls of the fourth ventricle and on the three
cerebellum (Table 1). They are divided on the basis of cerebellar peduncles which course within these fissures
which of the three cortical surfaces they drain and (Table 2 and Figs. 1 to 3). The fissures formed by the
whether they drain the hemisphere or vermis. The three folding of the cerebellum over and around the adjacent
surfaces are: 1) the tentorial or superior surface, which parts of the mesencephalon, pons, and medulla are the
faces the tentorium and would be retracted in a supra- cerebellomesencephalic fissure, which extends inferi-
cerebellar approach; 2) the suboccipital or posterior orly between the cerebellum and mesencephalon and is
surface, which is below and between the lateral and intimately related to the superior half of the roof of the
sigmoid sinuses and would be exposed in a wide bilat- fourth ventricle; the cerebellomedullary fissure, which
eral suboccipital craniectomy; and 3) the petrosal or extends superiorly between the cerebellum and the me-
anterior surface, which faces forward toward the pos- dulla and is intimately related to the inferior half of
terior surface of the petrous bone, and would be re- the roof; and the cerebellopontine fissures, which are
tracted to expose the cerebellopontine angle (Figs. 1 to formed by the folding of the cerebellum around the
3). The tentorial surface is drained by the superior lateral sides of the pons and are intimately related to
hemispheric and the superior vermian veins; the suboc- the lateral walls of the fourth ventricle. 29 The vein of the
cipital surface is drained by the inferior hemispheric cerebellomesencephalic fissure arises in the cerebello-
and the inferior vermian veins; and the petrosal surface mesencephalic fissure, and is intimately related to the
is drained by the anterior hemispheric veins. In addi- superior half of the roof; the vein of the cerebello-
tion, selected cortical veins are named on the basis of medullary fissure courses in the cerebellomedullary fis-
the vermian or hemispheric lobule which they drain, or sure, and is intimately related to the inferior half of the
on the basis of the fissure in which they course. The roof of the fourth ventricle; and the vein of the cerebel-

J. Neurosurg. / Volume 59 ~July, 1983 65
FIG. 2. Suboccipital surface of the cerebellum and
the cerebellomedullary fissure. A: Suboccipital sur-
face. The classical nomenclature applied to this surface
is shown on the right side, and our simplified nomen-
clature is on the left side. The suboccipital surface is
below and between the sigmoid and lateral sinuses, and
is the surface that is exposed in a wide bilateral suboc-
cipital craniectomy. The vermis sits in a large medial
depression, the posterior cerebellar incisura (Post. Cer.
Incisura), between the cerebellar hemispheres. The ver-
mohemispheric fissures (Ve. He. Fiss.), whicn are also
called the paravermian sulci (Paravermian Sulc.), sep-
arate the lateral margins of the vermis from the hemi-
spheres. According to classical nomenclature, the por-
tions of the vermis within the incisura from above to
below are the folium, tuber, pyramid, and uvula. The
parts of the hemispheric surface from above to below
are the superior (Sup.) and inferior (Inf.) semilunar and
the biventral lobules and the tonsils. These lobules
extend beyond the suboccipital surface to the adjacent
surfaces of the cerebellum. The suboccipital surface is
divided into superior (Sup. Part) and inferior (Inf. Part)
parts by the suboccipital fissure (Suboccipital Fiss.).
The suboccipital fissure has a hemispheric part, the
prebiventral fissure (Prebivent. Fiss.), which separates
the inferior semilunar and the biventral lobules and a vermic part, the prepyramidal fissure (Prepyramidal Fiss.), between the
pyramid and tuber. The intrabiventral fissure (Intrabivent. Fiss.) divides the biventral lobule into its superior and inferior parts
and joins the postpyramidal fissure (Postpyramidal Fiss.) between the pyramid and uvula medially. From below to above the
corresponding vermian and hemispheric parts are the uvula and the tonsils, the pyramid and the biventral lobules, the tuber and
the inferior semilunar lobules, and the folium and the superior semilunar lobules. The petrosal fissure (Petrosal Fiss.), the most
prominent fissure on the petrosal surface, also called the "horizontal fissure" (Horizontal Fiss.), extends onto the suboccipital
surface and divides the superior half of the suboccipital surface between the superior and inferior semilunar lobules. The
cerebellomedullary fissure (Cer. Med. Fiss.) extends superiorly between the cerebellum and medulla. The fissure between the
tonsil and the biventral lobule that we call the tonsillobiventral fissure (Ton. Bivent. Fiss.) has also been called the secondary
fissure (Secondary Fiss.). The foramen of Magendie (F. Magendie) opens into the fourth ventricle (4V) between the tonsils. The
posterior margin of the cerebellum which separates the tentorial and suboccipital surfaces has a medial and a lateral part: the
posteromedial margin (Post. Margin) separates the vermic part; and the posterolateral margin (Post. Lat. Margin) separates the
hemispheric part of the two surfaces. The inferior margin which separates the suboccipital and petrosal surfaces also has a medial
and a lateral part: the lateral part is the inferolateral margin (Inf. Lat. Margin), which separates the hemispheric part of the two
surfaces; and the medial part is the inferolateral margin (Inf. Med. Margin), which separates the part of the two surfaces facing
the brain stem. B: Enlarged view. The fight tonsil and the adjacent part of the biventral lobule have been removed to expose the
lower part of the roof of the fourth ventricle and the cerebellomedullary fissure. The nodule, uvula, inferior medullary velum (Inf.
Med. Vel.), and the tela (Tela) choroidea form the lower part of the roof. The uvula is a uvular-shaped part of the vermis that
projects inferiorly between the tonsils, thus mimicking the situation in the oropharynx. The nodule is hidden rostral to the uvula.
The tela choroidea is attached along small ridges, the taeniae, at the inferolateral margin of the floor. Choroid plexus (Ch. PI.)
protrudes from the foramen of Magendie in the midline and outward through the lateral recesses (Lat. Recess) and the foramina
of Luschka (F. Luschka) below the flocculi and dorsal to the glossopharyngeal (IX), vagal (X), and accessory (XI) nerves. The
inferior medullary velum arises on the surface of the nodule, drapes across the superior pole of the tonsil, and blends into the
peduncle of the flocculus (Ped. of Flocculus). The inferior medullary velum and the peduncle of the flocculus are all that remain
of the connection between the flocculus and the nodule that form the flocculonodular lobe of the cerebellum. The junction
between the inferior medullary velum and the tela choroidea is called the telovelar junction. The rhomboid lip is a sheet-like layer
o(neural tissue attached to the lateral margin of the floor, which extends posterior to the glossopharyngeal and vagus nerves and
joins the tela choroidea to form a pouch at the outer extremity of the lateral recess. The inferior cerebellar peduncles (Inf. Cer.
Ped.) pass upward on the dorsolateral surfaces of the medulla.

FIG. 2. C." Both tonsils and the medial part of the biventral lobules have been removed to expose the
inferior medullary velum and the tela choroidea on both sides. Each peduncle of the flocculus blends into the
inferior medullary velum medially and the flocculus laterally. Choroid plexus protrudes from the foramina of
Luschka into the cerebellopontine angles. The rhomboid lip extends posterior to the glossopharyngeal and
vagus nerves. The superior pole of the tonsil is separated from the inferior medullary velum and the tela
choroidea by a narrow cleft, the telovelotonsillar cleft, a rostr~extension of the cerebellomedullary fissure.
The cerebellomedullary fissure communicates around the flocculus with the inferior limb (Inf. Limb) of the
cerebellopontine fissure (Cer. Pon. Fiss.). D: The tela choroidea has been removed. The superior cerebellar
peduncles (Sup. Cer. Ped.) are located in the superior part of the roof rostral to the inferior medullary velum.
The inferior medullary velum blends into the peduncles of the flocculi laterally, and the surface of the nodule
medially. The inferior cerebellar peduncles course upward on the posterolateral medulla and form part of the
anterior and rostral margins of the lateral recesses. Many of the veins in the cerebellomedullary fissure pass
rostrally in the inferior limb of the cerebellopontine fissure to reach the cerebellopontine angle.
lopontine fissure courses in the cerebellopontine fissure, ented veins running in the sulci at the junctions of the
and is intimately related to the lateral walls. pons and mesencephalon and the pons and medulla are
The major veins on the surface of the three cerebellar the veins of the pontomesencephalic and the ponto-
peduncles also course within these fissures: the vein of medullary sulci. The transverse pontine and transverse
the superior cerebellar peduncle courses on the posterior medullary veins course across the anterior and lateral
surface of the superior cerebellar peduncle in the cere- surfaces of the pons and medulla, and the peduncular
bellomesencephalic fissure; the vein of the inferior cer- veins pass around the cerebral peduncles.
ebellar peduncle ascends on the posterior surface of the
inferior cerebellar peduncle in the cerebellomedullary
fissure; and the vein of the middle cerebellar peduncle Bridging Veins and Major Draining Groups
ascends on the lateral surface of the middle cerebellar The terminal end of veins draining the brain stem
peduncle in the anterior part of the cerebellopontine and cerebellum form bridging veins that cross the
fissure. The deep tonsillar veins are also included in subarachnoid and subdural spaces to reach the ven-
this group. ous sinuses in the dura. 4’8,39,41-43,49,53 These bridging
veins collect into three groups: 1) a superior or galenic
Veins of the Brain Stem group which drains into the vein of Galen; 2) an anterior
The veins of the brain stem are named on the basis or petrosal group which drains into the petrosal sinuses;
of three characteristics: 1) the subdivision of the brain and 3) a posterior or tentorial group which drains into
stem drained (mesencephalon, pons, or medulla); 2) the the sinuses converging on the torcula (Figs. 4 and 5).
surface of the brain stem drained (median anterior, An outline of the veins is as follows (Fig. 6):
lateral anterior, etc.); and 3) the direction in which they I: Superficial Veins
drain (transverse or longitudinal) (Table 3 and Figs. A. Tentorial surface
1 to 3). 1. Superior vermian veins
The longitudinally oriented veins are the median 2. Superior hemispheric veins
anterior pontomesencephalic and the median anterior B. Suboccipital surface
medullary veins, which course in the midline; the lateral 1. Inferior vermian veins
anterior pontomesencephalic and the lateral anterior 2. Inferior hemispheric veins
medullary veins, which course on the anterolateral sur- 3. Retrotonsillar veins
face of the brain stem; and the lateral medullary and 4. Medial and lateral tonsillar veins
the lateral mesencephalic veins, which course on the C. Petrosal surface
lateral surface of the brain stem. The transversely ori- 1. Anterior hemispheric veins
FIG. 3. Brain stem and the petrosal surface of

the cerebellum. A: Anterior view. The petrosal sur-
face faces forward toward the petrous bone, and is
the surface that is retracted to expose the cerebello-
pontine angle. The classical nomenclature applied
to this surface is on the right side and our simplified
nomenclature is on the left side. The major fissure
on the petrosal surface is the petrosal fissure (Pe-
trosal Fiss.), also called the "horizontal fissure"
(Horizontal Fiss.), and divides this surface into su-
perior (Sup. Part) and inferior (Inf. Part) parts. The
superior part is formed by the quadrangular, simple,
and superior semilunar lobules. The inferior part is
formed by the inferior semilunar and biventral lob-
ules. The cerebellopontine fissures (Cer. Pon. Fis-
sure) are V-shaped fissures formed where the cere-
bellum wraps around the ports and middle cerebellar
peduncles (Mid. Cer. Ped.). These fissures have a
superior (Sup. Limb) and an inferior (Inf. Limb)
limb which meet at a lateral apex. The petrosal fissure joins the apex of the cerebellopontine fissure. The oculomotor nerves (III)
arise from the midbrain just above the pontomesencephalic sulcus (Pon. Mes. Sulc.) on the medial surface of the cerebral
peduncles (Ped.) in the lateral walls of the interpeduncular fossa (Interped. Fossa). The trigeminal nerve (V) arises from the ports.
The abducens nerves (VI) arise in the medial part of the pontomedullary sulcus (Pon. Med. Sulc.) rostral to the medullary
pyramids. The facial (VII) and vestibulocochlear (VIII) nerves arise just rostral to the foramina of Lusehka (F. Luschka) near the
flocculi at the lateral end of the pontomedullary sulcus. The hypoglossal nerves (XII) arise anterior to the olives, and the
glossopharyngeal (IX), vagus (X), and accessory (XI) nerves arise posterior to the olives. Choroid plexus (Ch. P1.) protrudes from
the foramina of Luschka posterior to the glossopharyngeal and vagus nerves just inferior to the flocculi. The basilar sulcus (Bas.
Sulc.) is a shallow longitudinal groove on the anterior surface of the pons. The fourth ventricle lies deep to the pons and
medulla. B." Anterolateral view. Right cerebellopontine fissure. The cerebellopontine fissure is a V-shaped fissure formed where
the cerebellum wraps around the pons and the middle cerebellar peduncle. The fissure has a superior and an inferior limb which
meet at a lateral apex. The petrosal fissure extends laterally from the apex. The superior and inferior limbs of the fissure separate
anteriorly to expose the middle cerebellar peduncle. From the apex, the superior limb is directed rostromedial and is continuous
above with the cerebellomesencephalic fissure (Cer. Mes. Fissure); the inferior limb is directed caudomedial and is continuous
below with the cerebellomedullary fissure (Cer. Med. Fissure). The trigeminal nerve arises below the medial end of the superior
limb and the lateral extent of the pontomesencephalic sulcus. The structures located along the inferior limb near the lateral end
of the pontomedullary sulcus are the facial and vestibulocochlear nerves, the flocculus, and the choroid plexus protruding from
the foramen of Luschka. The flocculus projects laterally from the inferior margin of the middle cerebral peduncle dorsal to the
facial and vestibulocochlear nerves. The choroid plexus is posterior to the glossopharyngeal and vagus nerves. The trochlear nerve
(IV) passes forward in the cerebellomesencephalic fissure. The postclival fissure (Postclival Fiss.) separates the simple and inferior
semilunar lobules.

FIG. 3. C: Enlarged view of right cerebellopontine angle. Choroid plexus protrudes from the foramen of Luschka caudal to
the facial and vestibulocochlear nerves and dorsal to the glossopharyngeal and vagus nerves. The structures attached along the
medial end of the inferior limb of the cerebellopontine fissure are the flocculus, choroid plexus protruding from the foramen of
Luschka, and the facial, vestibulocochlear, glossopharyngeal and vagus nerves. The lateral anterior medullary sulcus (Lat. Ant.
Med. Sulc.) is also called the "preolivary sulcus" (Preolivary Sulc.); it marks the anterior margin of the olive. The retro-olivary
sulcus (Retro-olivary Sulc.) is located along the dorsal margin of the olive. The median anterior medullary sulcus (Med. Ant.
Med. Sulc.) extends inferiorly between the pyramids from the inferior foramen cecum (Inf. For. Cecum). The supraolivary fossette
is a depression just rostral to the olive. D: The left half of the brain stem has been removed to expose the interior and roof of
the fourth ventricle (4V). The roof is divided at the fastigium into its superior and inferior parts. The medial part of the superior
portion of the roof is formed by the superior medullary velum (Sup. Med. Vel.) which has the lingula on its outer surface. The
lateral parts of the superior half of the roof are called the lateral walls. The rostral part of each lateral wall is formed by the
superior cerebellar peduncle (Sup. Cer. Ped.), and the caudal part is formed by the inferior (Inf. Cer. Ped.) and middle cerebellar
peduncles. The caudal part of the roof below the fastigium is formed by the nodule, inferior medullary velum (Inf. Med. Vel.),
tela choroidea (Tela), and the choroid plexus attached to the tela choroidea in the inferior half of the roof. The medial segments
of the choroid plexus (Ch. P1.-Med. Seg.) extend caudally near the tonsils and the lateral segments (Ch. P1.-Lat. Seg.) extend below
the cerebellar peduncles through the lateral recesses into the cerebellopontine angles near the facial and vestibulocochlear nerves
and the flocculi. The rhomboid lip is a sheet of neural tissue attached to the lateral margin of the floor which joins the tela
choroidea to form a pouch at the outer extremity of the lateral recess, through which the foramen of Luschka opens into the
cerebellopontine angle. The inferior medullary velum stretches from the surface of the nodule across the superior poles of the
tonsils. The floor of the fourth ventricle is posterior to the pons and upper part of the medulla. The superior and inferior medullary
vela are continuous at the level of the fastiglum. The cranial margin of the tela choroidea is attached to the inferior medul-
lary velum.
II: Deep Veins 3. Lateral

A. Cerebellomesencephalic fissure a. Lateral mesencephalic vein
1. Vein of superior cerebellar peduncle b. Lateral medullary and retro-olivary
2. Vein of cerebellomesencephalic fissure veins
3. Pontotrigeminal vein B. Transverse Veins
4. Tectal veins 1. Peduncular vein
B. Cerebellomedullary fissure 2. Posterior communicating vein
1. Vein of cerebellomeduUary fissure 3. Vein of pontomesencephalic sulcus
2. Vein of inferior cerebellar peduncle 4. Transverse pontine vein
3. Supratonsillar veins 5. Vein of pontomedullary sulcus
4. Choroidal veins 6. Transverse medullary vein
C. Cerebellopontine fissure IV: Bridging Veins (Major Draining Groups)
1. Vein of cerebellopontine fissure A. Galenic group (to vein of Galen)
2. Vein of middle cerebellar peduncle B. Tentorial group (to torcula and tentorial sin-
III: Veins of the Brain Stem UseS)
A. Longitudinal veins C. Petrosal group (to petrosal sinuses)
1. Midline D. Other bridging veins.
a. Median anterior pontomesencephalic
Superficial Veins
vein
b. Median anterior medullary vein The superficial veins drain the tentorial, suboccipital,
2. Anterolateral and petrosal surfaces (Table 1). Each surface has the
a. Lateral anterior pontomesencephalic vermis in the midline and the hemispheres laterally,
vein and is divided by a major fissure n a m e d on the basis of
b. Lateral anterior medullary vein the surface which it divides (Figs. 1 to 3 and 6 to 9).
J. Neurosurg. / Volume 59/July, 1983 69

TABLE 1
Summary of superficial veins examined in 10 posteriorfossae*
Frequency Terminal
Hemispheric Veins (% & Size Area of Origin Most Common Termination
no./total) (mm)$
superior hemispheric veins
anterior group 100% 0.2-1.3 anterior portion of hemispheric part of superior vermian, pontotrigeminal, & lateral
20/20 (0.6) tentorial surface mesencephalic veins, & vein of cerebello-
mesencephalic fissure
lateral groupt 100% 0.5-1.3 lateral portion of hemispheric part of superior petrosal & pontotrigeminal veins &
20/20 (0.9) tentorial surface vein of cerebellopontine fissure
posterior group 100% 0.5-1.9 posterior portion of hemispheric part tentorial sinus, inferior hemispheric vein, &
20/20 (1.1) of tentorial surface vein of postclival fissure
inferior hemispheric veins
superomedial group 100% 0.7-2.1 superomedial portion of hemispheric torcula, tentorial sinus, vein of petrosal
20/20 (1.5) part of suboccipital surface fissure, & superior hemispheric, inferior
vermian, & declival veins
inferomedial group 80% 0.4-1.6 inferomedial portion of hemispheric inferior retrotonsillar & inferior vermian
16/20 (0.8) part of suboccipital surface veins
superolateral group 100% 0.5-2.1 superolateral portion of hemispheric tentorial sinus, superior hemispheric vein, &
20/20 (1.1) part of suboccipital surface vein of petrosal fissure
inferolateral group 95% 0.3-1.2 inferolateral portion of hemispheric inferior group of anterior hemispheric vein
19/20 (0.7) part of suboccipital surface
anterior hemispheric veins
superior group 45% very superior part of petrosal surface vein ofcerebellopontine fissure & anterior
9/20 small lateral marginal vein
middle group 95% 0.5-1.9 middle portion of petrosal surface vein of cerebellopontine fissure
19/20 (1.0)
inferior group 95% 0.9-2.0 inferior portion of petrosal surface vein of cerebellopontine fissure
19/20 (1.3)
vermian veins
superior vermian vein 100% 0.6-2.4 rostral part of vermis near apex of vein of Galen, internal cerebral vein, & vein
lO/lO (1.7) cerebellum of cerebellomesencephalicfissure
supraculminate vein 90% 0.5-1.2 lower part of tentorial surface of superior vermian vein
9/10 (0.9) culmen
inferior vermian vein 100% 0.9-3.0 superior & inferior retrotonsillar veins straight & tentorial sinuses & the torcula
20/20 (1.8)
tonsinar veins
superior retrotonsillar vein 95% 0.5-1.4 cortex on & near superior pole of inferior vermian vein
19/20 (0.8) tonsil
inferior retrotonsillar vein 85% 0.5-1.5 cortex on & near inferior pole of tonsil inferior vermian vein
17/20 (0.9)
medial tonsillar vein 75% 0.3-1.1 medial tonsillar surface superior & inferior retrotonsillar vein
15/20 (0.7)
lateral tonsillar vein 70% 0.2-0.9 lateral surface of tonsil & biventral inferior retrotonsillar vein
14/20 (0.5) lobule
* Provides data from 20 of each of paired and 10 of midline unpaired venous structures.
t In 60% (12 of 20 specimens) the group converged to form the anterior lateral marginal vein.
:~Range of sizes; the average size is given in parentheses.
The three surfaces are separated b y borders which are surface, a n d those on the suboccipital surface overlap
parallel to the m a j o r v e n o u s sinuses s u r r o u n d i n g the o n t o the inferior part o f the petrosal surface.
cerebellum. T h e tentorial a n d petrosal surfaces are sep- T h e cortical surfaces are d r a i n e d by a m i x t u r e o f
arated by the anterior b o r d e r which parallels the supe- longitudinal a n d transverse veins. O n s o m e surfaces the
rior petrosal sinus; the tentorial a n d suboccipital sur- p r e d o m i n a n t drainage is transversely oriented along the
faces are separated by the posterior b o r d e r which interfolial fissures, a n d on others the m a j o r drainage is
parallels the lateral (transverse) sinus; a n d the suboccip- longitudinally oriented at fight angles to these fissures.
ital a n d petrosal surfaces are separated b y the inferior T h e veins within the interfolial fissures m a y n o t be
b o r d e r which parallels the course o f the sigmoid sinus. visible on the cortical surface.
T h e veins from a d j o i n i n g surfaces frequently j o i n near
these borders to form t r u n k s which t e r m i n a t e in a d u r a l
sinus. The veins f r o m a d j o i n i n g surfaces often anasto- Tentorial Surface
m o s e across these borders. These anastomoses often The tentorial surface d r a i n e d by the superior h e m i -
take place in the fissures between the folia, which are spheric a n d superior v e r m i a n veins, c o n f o r m s to the
c o n t i n u o u s from one surface to the other. The h e m i - lower surface o f the t e n t o r i u m . T h e a n t e r o m e d i a l part
spheric lobules a n d interfolial fissures on the tentorial o f this surface, the apex, is the highest p o i n t on the
surface overlap o n t o the superior part o f the petrosal cerebellum. This surface slopes d o w n w a r d from its an-

teromedial to its posterolateral edge. Deep notches, the culmen; the preculminate vein, which originates in the
anterior and posterior cerebellar incisuras, groove the fissure between the central lobule and the culmen; the
anterior and posterior edges of the tentorial surface in vein of the cerebellomesencephalic fissure, to be de-
the midline. The brain stem fits into the anterior cere- scribed later; the tectal veins from the quadrigeminal
bellar incisura and the fah cerebelli fits into the poste- plate; and the hemispheric branches from the medial
rior incisura (Fig. 1). part of the hemisphere.
The anterior border, separating the tentorial and The posterior, or descending, branches originate in
petrosal surfaces, has a lateral part (the anterolateral the tentorial fissure, course posteriorly on the declive
margin) which is parallel to the superior petrosal sinus toward the torcula, and drain into the torcula or into
and separates the hemispheric part of the tentorial and the inferior vermian veins near the torcula. The major
petrosal surfaces, and a medial part (the anteromedial tributaries of this group, the declival veins, drain the
margin) which faces the brain stem and separates the declive. The veins arising in the medial part of the
vermic part of the two surfaces. The anterior angle postclival fissures converge on the upper end of the
formed by the junction of the anterolateral and antero- posterior cerebellar incisura and join the declival veins
medial margins is directed anteriorly above the origin near where they formed bridging veins to the torcula.
of the posterior root of the trigeminal nerve. The pos- Superior Hemispheric Veins. These veins are di-
terior border between the tentorial and the suboccipital vided into anterior, lateral, and posterior groups (Figs.
surfaces also has a lateral and a medial part: the lateral 6 and 7). The veins in the anterior group drain the
part (the posterolateral margin) is parallel and adjacent anterior part of the hemispheric surface, and join the
to the lateral sinus and separates the hemispheric part superior vermian vein or the veins in the cerebellome-
of the suboccipital and tentorial surfaces; and the short sencephalic fissure. The largest part of this area is
medial part (the posteromedial margin) faces the pos- drained by the one to three hemispheric veins that join
terior cerebellar incisura and separates the vermic part the superior vermian vein. The other veins in the an-
of the two surfaces. The lateral angle, formed by the terior group cross the anteromedial margin of the cere-
junction of the anterolateral and posterolateral margins, bellum and dip into and join the veins coursing in the
is located at the junction of sigmoid, lateral, and pe- cerebellomesencephalic fissure. The veins in the lateral
trosal sinuses (Fig. 4). Veins often converge on the group originate on the lateral part of the tentorial
anterior and lateral angles. surface and drain directly into the superior petrosal
The hemispheric part of the tentorial surface includes sinus or one of its tributaries, commonly the pontotri-
the quadrangular, simple, and superior semilunar lob- geminal vein, or the veins of the cerebellopontine fis-
ules, and the vermian part includes the culmen, declive, sure, or the middle cerebellar peduncle. These veins
and folium. The vermian and the related hemispheric often converge on the anterolateral margin to form a
parts from above to below in sequence are the culmen trunk, the anterolateral marginal vein, which courses
and the quadrangular lobule, the declive and the simple toward the anterior angle before entering the superior
lobule, and the folium and the superior semilunar lob- petrosal sinus or its tributaries. The veins in the poste-
ule. On the tentorial surface, the transition from the rior group drain the posteromedial part of the tentorial
vermis to the hemispheres is smooth and not marked surface. They are usually composed of both longitudinal
by the deep fissures seen on the suboccipital surface. veins which join the inferior hemispheric veins from
The tentorial surface is divided at the site of its major the suboccipital surface to form bridging veins which
fissure, the tentorial fissure, into anterior and posterior enter the torcula, or the superior petrosal, lateral, or
parts. This fissure, located between the quadrangular tentorial sinuses, and also transversely oriented veins,
and the simple lobules on the hemisphere and the including the vein of the postclival fissure, which drain
culmen and the declive on the vermis, has also been medially toward the vermian veins or laterally toward
called the primary fissure. The postclival fissure sepa- the veins in the lateral group.
rates the simple and the superior semilunar lobules.
The interfolial fissures on this surface pass anterolater- Suboccipital Surface
ally from the midline and are continuous with the The suboccipital surface, drained by the inferior hem-
fissures on the superior half of the petrosal surface. ispheric and inferior vermian veins and some of the
Superior Vermian Veins. The veins that drain the tonsillar veins, is the most complex of the three surfaces
vermian part of the tentorial surface are divided into (Figs. 2, 6, and 8). It has a deep vertical depression, the
an anterior group, which ascends toward the vein of posterior cerebellar incisura, which contains the falx
Galen, and a posterior group, which descends toward cerebelli. The vermis is folded into and forms the cor-
the torcula (Figs. 5 to 7). The anterior, or ascending, tical surface within this incisura. The lateral walls of
branches originate near the primary fissure, course su- the incisura are formed by the medial aspects of the
periorly on the culmen, and join near the apex of the cerebellar hemispheres. Deep clefts, the vermohemi-
cerebellum to form the superior vermian vein which spheric fissures, separate the vermis from the hemi-
crosses the quadrigeminal cistern to reach the vein of spheres. The vermian surface within the incisura has a
Galen. The major tributary of the anterior group, the diamond shape. The upper half of the diamond-shaped
supraculminate vein, drains the superior surface of the formation has a pyramidal shape and is composed of
culmen. Its other tributaries are the intraculminate vein, the pyramid. The folium and the tuber, superior to the
which originates in the sulci between the folia of the pyramid, form the apex of the suboccipital part of the

FIG. 4. Dural venous sinuses. A: Left superolateral view. Venous sinuses surrounding the tentorial surface of the cerebellum.
The tentorial surface is located below the straight sinus (Str. Sinus) between the lateral (Lat. Sinus) and superior petrosal sinuses
(Sup. Petrosal Sinus). The straight sinus passes above the vermis. The straight and superior sagittal sinuses (Sup. Sag. Sinus) join
the lateral sinuses at the torcula. The lateral sinuses course along the posterolateral margin of the cerebellum parallel to the
junction of the tentorial and suboccipital surfaces. The superior petrosal sinus passes along the petrous ridge parallel to the
anterolateral margin of the cerebellum at the junction of the petrosal and tentorial surfaces. It joins the junction of the lateral and
sigmoid sinuses (Sig. Sinus) posteriorly and the cavernous sinus (Cav. Sinus) anteriorly. The internal cerebral (Int. Cer. V.) and
the basal veins (Bas. V.)join to form the vein of Galen (V. of Galen). The vein of the cerebellomesencephalic fissure (V. of Cer.
Mes. Fiss.) is formed by the union of the veins of the superior cerebellar peduncle (V. of Sup. Cer. Ped.), and ascends to join the
superior vermian vein (Sup. Ve. V.) which also enters the vein of Galen. The tributaries of the superior petrosal sinus are referred
to as the superior petrosal veins (Sup. Petrosal V.). In this case, the transverse pontine (Trans. Pon. V.) and pontotrigeminal veins
(Pon. Trig. V.), and the vein of the cerebellopontine fissure (V. of Cer. Pon. Fiss.) join to form one of the superior petrosal veins.
The superior vermian veins ascend on the vermis, and the superior hemispheric veins (Sup. He. V.) cross the hemispheric surface.
The cerebellomesencephalic fissure (Cer. Mes. Fiss.) extends inferiorly between the midbrain and cerebellum, and has the inferior
colliculus (Inf. Coll.) on the rostral part of its anterior margin. Both the trochlear (IV) and abducens (VI) nerves enter the posterior
wall of the cavernous sinus. The trigeminal nerve (V) exits the midpons. The facial (VII) and vestibulocochlear (VIII) nerves arise
anterior to the flocculus. The oculomotor nerves (III) arise along the medial surfaces of the cerebral peduncles (Ped.) and enter
the roof of the cavernous sinus posterior to the internal carotid arteries (Int. Car. A.). The optic nerves (Optic N.) are anterolateral
to the pituitary stalk (Stalk.). B: Anterosuperior view. The basal and internal cerebral veins join to form the vein of Galen. The
superior petrosal sinuses join the cavernous sinuses anteriorly and the lateral sinuses posteriorly. The straight and superior sagittal
sinuses join at the torcula and give rise to the lateral sinuses. The superior petrosal veins enter the superior petrosal sinuses. The
median anterior pontomesencephalic vein (Med. Ant. Pon. Mes. V.) courses on the anterior surface of the pons and the peduncular
vein (Ped. V.) passes around the cerebral peduncle. The trochlear nerves enter the medial edges of the tentorium (Tent. Edge)
near the posterior margin of the cavernous sinuses. C. Posterior superior view. The straight sinus passes above the vermis and
joins the lateral sinuses at the torcula. The lateral sinuses and the torcula receive tentorial sinuses (Tent. Sinus) formed by the
convergence of veins from the cerebellum. The superior petrosal sinuses course parallel to the anterolateral margins of the
cerebellum and mark the posterior border of the middle cranial fossa (Mid. Fossa). Inferior hemispheric veins (Inf. He. V.) cross
the posterolateral margin of the cerebellum and enter the tentorial sinuses with the superior hemispheric veins.

FIG. 4. D." Posterior view. The straight sinus joins the

lateral sinuses at the torcula. The superior petrosal and lateral
sinuses join at the site of origin of the sigmoid sinus. The
suboccipital surface of the cerebellum is located below the
lateral and between the sigmoid sinuses. The tentorial surface
is located below the straight and between the superior petrosal
and lateral sinuses. Superior hemispheric and superior ver-
mian veins pass across the tentorial surface. Inferior hemi-
spheric veins cross the suboccipital surface. E: Posterior
inferior view showing the sinuses surrounding the suboccipital
surface. A marginal sinus (Marg. Sinus) courses in the dura at
the level of the foramen magnum. Occipital sinuses (Occ.
Sinus) often ascend on the medial portion of the suboccipital
surface in the posterior cerebellar incisura or at the junction
of the vermis and hemisphere. The marginal, occipital, and
sigmoid sinuses and the condylar emissary veins (Con. Em.
V.) converge on the jugular bulbs and the internal jugular
veins (Int. Jug. V.). The vertebral venous plexus (Vert. Venous
Plexus) anastomoses with the internal jugular vein. F." Posterior view showing venous sinuses on the anterior wall of the posterior
cranial fossa. The petrosal surface of the cerebellum and the brain stem faces the posterior surface of the petrous and occipital
bones which form the anterior wall of the posterior fossa. The basilar sinus (Bas. Sinus), dorsal to the clivus, interconnects the
posterior margin of the cavernous sinuses. The superior petrosal sinuses join the posterior margin of the cavernous sinuses
anteriorly and the sigmoid sinuses posteriorly. The inferior petrosal sinuses (Inf. Petrosal Sinus) interconnect the posterior margin
of the cavernous sinuses and the jugular bulbs. The sigmoid sinuses descend on the posterior surface of the petrous bones to reach
the jugular bulb at the jugular foramen. The glossopharyngeal (IX), vagus (X), and accessory (XI) nerves enter the jugular foramen.
The facial and vestibulocochlear nerves enter the internal acoustic meatus (Acoustic Meatus). The abducens nerves enter the dura
and pass through the basilar sinus. Each trigeminal nerve enters Meckel’s cave, and passes forward below the superior petrosal
sinus. The hypoglossal nerves (XII) enter the hypoglossal canals. The basal plexus (Bas. Plexus) interconnects the inferior petrosal
and basilar sinuses. The venous sinuses in the dura below the marginal sinus surround the vertebral arteries (Vert. A.) and connect
superiorly with the jugular bulb (dotted lines). The oculomotor nerves enter the dura lateral to the posterior clinoid processes
(Post. Clin. Process.) near the edge of the tentorium (Tent. Edge). The trochlear nerves course within the medial edges of the
tentorium just posterior to the posterior clinoid processes.
vermis. The lower half of the diamond-shaped forma- the superior semilunar lobules; the tuber and the infe-
tion, the uvula, projects downward between the tonsils, rior semilunar lobules; the pyramid and the biventral
thus mimicking the situation in the oropharynx. The lobules; and the uvula and the tonsils.
rostromedial margin of the tonsils borders the taper- The suboccipital surface is divided at its major fis-
ing edges of the uvula. The nodule, the lowermost sub- sure, the suboccipital fissure, into superior and inferior
division of the vermis, is hidden deep to the uvula. parts. The suboccipital fissure separates the tuber and
Inferiorly, the posterior cerebellar incisura is continu- the pyramid on the vermis and the biventral and infe-
ous with the vaUecula cerebelli, an opening between the rior semilunar lobules on the hemispheres. The petrosal
tonsils that leads through the foramen of Magendie into fissure, the major fissure on the petrosal surface, extends
the fourth ventricle. from the petrosal surface onto the suboccipital surface,
The hemispheric portion of the suboccipital surface and separates the superior and inferior semilunar lob-
is formed by the superior and inferior semilunar and ules laterally and the folium and the tuber medially.
the biventral lobules and the tonsils, and the vermic The biventral lobule is divided into superior and infe-
portion is formed by the folium, tuber, pyramid, and rior parts by the intrabiventral fissure. The tonsillo-
uvula. The vermian and the related hemispheric parts, biventral fissure, also called the "secondary fissure,"
in sequence from above to below, are: the folium and separates the tonsil and the biventral lobule.

FIG. 5. The vein of Galen and its tributaries. A:

Right posterolateral view. The vein of Galen (V. of
Galen) was exposed by removing the posterior part
of the right cerebral hemisphere. The removal ex-
poses the tentorium (Tent.), lateral ventricles (Lat.
Vent.), and thalamus. The splenium of the corpus
callosum was divided in the midline, and the fornix
was divided at the level of the crus. The fight half of
the tentorium posterior to the tentorial edge (Tent.
Edge) was opened and reflected laterally to expose
the cerebellomesencephalic fissure (Cer. Mes. Fiss.)
which extends inferiorly below the inferior colliculi
(Inf. Coll.) between the cerebellum and midbrain.
The vein of the cerebellomesencephalic fissure (V.
Cer. Mes. Fiss.) joins the superior vermian vein (Sup.
Ve. V.) near the vein of Galen. The straight sinus
(Str. Sinus, dotted lines) courses in the junction of
the tentorium and the falx. The internal cerebral (Int. Cer. V.) and basal veins (Bas. V.) converge to form the vein of Galen. The
internal cerebral veins course in the roof of the third ventricle below the fornix on the superolateral margin of the pineal body
(Pineal) and between the layers of the tela choroidea (Tela). The basal veins pass around the midbrain near the tentorial edge.
The superior vermian vein passes from the superior part of the vermis and receives the vein of the cerebellomesencephalic fissure
before entering the vein of Galen. The supraculminate vein which drains the tentorial surface of the culmen joins the main trunk
of the superior vermian vein. The splenial vein (Splenial V.) passes from the dorsal surface of the splenium to the vein of Galen.
The pulvinar (Pulv.) of the thalamus is exposed in the trigone of the lateral ventricle. The choroidal fissure (Chor. Fiss.) located
between the fornix and the thalamus is the site of attachment of the choroid plexus (Ch. PI.) in the lateral ventricle. A superior
choroidal vein (Sup. Ch. V.) courses on the surface of the choroid plexus. The thalamostriate vein (Thal. Str. V.) courses posteriorly
in the groove between the thalamus and caudate nucleus. The thalamostriate, superior choroidal, and direct lateral veins (Dir.
Lat. V.) enter the internal cerebral vein. The posterior thalamic (Post. Thal. V.) and pineal veins (Pineal V.) drain into the vein
of Galen. A superior hemispheric vein (Sup. He. V.) courses toward the cerebellomesencephalic fissure. B." Enlarged view of the
convergence of the internal cerebral, basal, and superior vermian veins on the vein of Galen. The vein of the cerebellomesencephalic
fissure joins the superior vermian vein. The lateral mesencephalic vein (Lat. Mes. V.) connects rostrally with the basal vein near
the medial geniculate body (Med. Gen. Body) and caudally below the tentorial edge with the pontotrigeminal vein (Pon. Trig.
V.). The oculomotor nerve (III) arises just above the medial part of the pontomesencephalic sulcus (Pon. Mes. Sulc.). The basal
vein passes around the midbrain below the pulvinar. The veins converging on the vein of Galen are the splenial, tectal (Tectal
V.), internal cerebral, pineal, superior vermian, and basal veins. The internal occipital vein (Int. Occ. V.) was divided near its
termination. One of the anterior group of superior hemispheric veins (Sup. He. V.-Ant.) courses toward the cerebellomesencephalic
fissure. The trochlear nerve (IV) courses near the tentorial edge. C: Tributaries of the basal vein. The lateral aspect of the brain
stem, the tentorial edge, and the temporal horn (Temp. Horn) of the lateral ventricle, its choroid plexus, and the hippocampus
(Hippo.) were exposed by removing the lateral part of the temporal lobe (Temp. Lobe). The optic tract (Optic Tr.) passes
posteriorly above the oculomotor nerve. The insular veins (Insular V.) drain inferiorly over the insula. The deep middle cerebral
(Deep Mid. Cer. V.), anterior cerebral (Ant. Cer. V.), and olfactory veins (Olf. V.) join in the region of the anterior perforated
substance (Ant. Perf. Subst.) to form the basal vein which drains posteriorly along the medial surface of the temporal lobe and
around the midbrain. The median anterior pontomesencephalic vein (Med. Ant. Pon. Mes. V.) joins the medial end of the
peduncular veins (Ped. V.). The peduncular veins drain posteriorly to enter the basal vein. The lateral anterior pontomesencephalic
vein (Lat. Ant. Pon. Mes. V.) ascends to join the basal vein. The lateral mesencephalic vein joins the basal vein in the region of
the medial geniculate body. A vein draining the anterior part of the insula (Ant. Insular V.) enters a venous sinus in the tentorial
edge.

FIG. 5. D: The remaining part of the temporal horn has been elevated. The veins converging on the basal
vein in the region of the anterior perforated substance, lateral to the optic tract, pituitary stalk (Stalk), and
mammillary bodies (Mare. Body) include the olfactory, anterior cerebral, peduncular, and lateral anterior
pontomesencephalic veins. The inferior ventricular vein (Inf. Vent. V.) leaves the medial part of the temporal
horn along the choroidal fissure and enters the midportion of the basal vein near the lateral geniculate body
(Lat. Gen. Body). The lateral mesencephalic vein enters the basal vein near the medial geniculate body. E:
The free edge of the tentorium, which was preserved, is elevated to show the junction of the vein of the
cerebellomesencephalic fissure with the superior vermian vein. A tectal vein drains from the region of the
inferior and superior colliculi (Sup. Coll.). The supraeulminate vein is a major tributary of the superior vermian
vein. F." Inferior view of the tentorium and the tentorial incisura with the cerebellum removed at the level of
the cerebellar peduncles. The superior (Sup. Cer. Ped.), middle (Mid. Cer. Ped.), and inferior cerebellar
peduncles (Inf. Cer. Ped.) form part of the lateral wall of the fourth ventricle (4V) and the rostral margin of
the lateral recess (Lat. Recess). Tentorial sinuses (Tent. Sinus) join the torcula and the lateral sinuses (Lat.
Sinus). The straight sinus drains into the torcula. The veins converging on the vein of Galen include the
internal cerebral veins which pass on the superolateral margin of the pineal body, the basal veins which encircle
the midbrain, and the vein of the cerebellomesencephalic fissure which is formed by the union of the paired
veins of the superior cerebellar peduncle (V. Sup. Cer. Ped.) and ascends to join the superior vermian vein.
The trochlear nerve passes forward below the inferior colliculus. The posterior inferior cerebellar arteries
(P.I.C.A.) pass posteriorly between the glossopharyngeal (IX), vagus (X), and accessory (XI) nerves near the
lateral recess. G: Enlarged inferior view of the venous relationships at the posterior part of the tentorial
incisura. The veins of the superior cerebellar peduncles join above the lingula of the vermis to form the vein
of the cerebellomesencephalic fissure, which joins the superior vermian vein. The internal occipital veins drain
into the internal cerebral veins. The internal cerebral veins are more medial than the basal veins since they
pass forward near the midline in the roof of the third ventricle and the basal veins encircle the brain stem.
There are two i m p o r t a n t confluences o f fissures u p o n Each tonsil is an ovoid structure in the inferomedial
which n u m e r o u s veins converge. O n e is the v e r m o - part o f the suboccipital surface which is attached along
tonsillobiventral notch, a confluence o f the tonsillobi- its superolateral b o r d e r to the r e m a i n d e r o f the cerebel-
ventral, intrabiventral, a n d v e r m o h e m i s p h e r i c fissures. lum. The inferior pole a n d posterior surface b o t h face
The other is located at the u p p e r end o f the posterior the cisterna m a g n a a n d are visible inferomedial to the
cerebellar incisura where the postclival, petrosal, a n d r e m a i n d e r o f the suboccipital surface. T h e lateral sur-
v e r m o h e m i s p h e r i c fissures meet. face o f each tonsil is covered with the biventral lobule.

FIG. 6. Veins of the posterior fossa. The veins in the posterior fossa collect into three groups: a galenic group (green) which
drains into the vein of Galen; a petrosal group (blue) which drains into the petrosal sinuses; and a tentorial group (brown) which
drains into the sinuses near the torcula. A: Tentorial surface, superior view. The tentorium has been removed except in the area
of the tentorial sinuses. B: Suboccipital surface, posterior view. The right tonsil and the medial part of the biventral lobule have
been removed to expose the structures on the ventral wall of the cerebellomedullary fissure.
FIG. 6. A-F: The inferior sagittal sinus (Inf. Sag. Sinus) joins the straight sinus (Str. Sinus) at the apex of the tentorium. The
superior sagittal sinus (Sup. Sag. Sinus) joins the straight sinus at the torcula. The superior petrosal sinus (Sup. Petrosal Sinus)
passes along the petrous ridge and joins the junction of the lateral (Lat. Sinus) and sigmoid sinuses (Sig. Sinus) posteriorly and
the cavernous sinus (Cav. Sinus) anteriorly. The veins converging on the tentorium join to form tenorial sinuses (Tent. Sinus)
which drain into the straight, lateral, and superior petrosal sinuses and the torcula. The marginal sinus (Marg. Sinus) courses in
the dura at the level of the foramen magnum above the rostral attachment of the dentate ligament (Dentate Lig.). The emissary
vein passing through the condylar foramen (Con. Em. V.)joins the junction of the jugular bulb and the internal jugular vein (Int.
Jug. V.). The vertebral venous plexus (Vert. Venous Plexus) anastomoses with the internal jugular vein. Bridging veins (Br. V.)
pass from the surface of the cerebellum and brain stem to the dural sinuses.
The superior hemispheric veins are divided into three groups: an anterior group (Sup. He. V.-Ant.) which drains toward the
vein of Galen (V. of Galen); a posterior group (Sup. He. V.-Post.) which drains into the veins converging on the straight sinus,
FIG. 6. C." Petrosal surface and left side of the brain stem, anterolateral view.
torcula, and medial part of the lateral sinus; and a lateral group (Sup. He. V.-Lat.) which drains into the superior petrosal sinus,
the anterolateral marginal vein (Ant. Lat. Marg. V.), and the lateral part of the lateral sinus. The superior vermian veins drain the
tentorial part of the vermis. The veins on the superior part of the tentorial surface of the vermis ascend toward the superior
vermian vein (Sup. Ve. V.) and those on the inferior part of the tentorial surface of the vermis descend toward the torcula. The
tributary of the superior vermian vein draining the tentorial surface of the culmen has been called the supraculminate vein
(Supraculm. V.). The declival vein (Declival V.) drains the declive and joins the inferior vermian vein (Inf. Ve. V.) or the torcula.
The vein of the postclival fissure (V. of Postclival Fiss.) courses in the postclival fissure. The superior petrosal veins are divided
into medial (Sup. Petrosal V.-Med.), intermediate and lateral (Sup. Petrosal V.-Lat.) groups, depending on whether they enter the
lateral, intermediate, or middle one-third of the superior petrosal sinus. The inferior hemispheric veins (Inf. He. V.) drain the
hemispheric part of the suboccipital surface and the inferior vermian veins drain the vermian part of the suboccipital surface. The
inferior vermian veins drain toward the tentorium and enter the torcula or a tentorial sinus. The inferior hemispheric veins cross
the posterior margin of the cerebellum to reach the tentorial surface, where they often join the superior hemispheric veins before
terminating in the tentorial, lateral, or superior petrosal sinuses or the torcula. The inferior vermian vein is formed on the posterior
surface of the tonsil by the union of the superior (Sup. Retroton. V.) and inferior retrotonsillar veins (Inf. Retroton. V.). The
medial (Med. Ton. V.) and lateral tonsillar veins (Lat. Ton. V.) pass to the retrotonsillar or the inferior vermian veins. The vein
of the petrosal fissure (V. of Petrosal Fiss.) passes along the petrosal fissure. The anterior hemispheric veins which drain the
petrosal surface of the cerebellum and are divided into superior (Ant. He. V.-Sup.), middle (Ant. He. V.-Mid.), and inferior (Ant.
He. V.-Inf.) groups depending on whether they drain the superior, inferior, or middle one-third of the petrosal surface. The
anterior hemispheric veins converge on the lateral cerebellar incisura and join to form the vein of the cerebellopontine fissure (V.
of Cer. Pon. Fiss.) which ascends to enter the superior petrosal sinus.
The major veins related to the superior half of the roof of the fourth ventricle are the veins of the cerebellomesencephalic
fissure (V. of Cer. Mes. Fiss.), and the superior cerebellar peduncle (V. of Sup. Cer. Ped.); the major veins related to the inferior
part of the roof are the veins of the cerebellomedullary fissure (V. of Cer. Med. Fiss.) and the inferior cerebellar peduncle (V. of
Inf. Cer. Ped.); and the major veins in the region of the lateral recesses and lateral walls are the veins of the cerebellopontine
fissure and the middle cerebellar peduncle (V. of Mid. Cer. Ped.). In the cerebellomesencephalic fissure (Cer. Mes. Fiss.), the
paired veins of the superior cerebellar peduncle ascend lateral to the lingula and the superior medullary velum (Sup. Med. Velum)
and join to form the vein of the cerebellomedullary fissure which ascends to join the superior vermian vein. The internal cerebral
(Int. Cer. V.), basal (Bas. V.), and superior vermian veins enter the vein of Galen. The lateral mesencephalic (Lat. Mes. V.) and
the pontotrigeminal veins (Pon. Trig. V.) course in the cerebellomesencephalic fissure. The lateral mesencephalic vein courses in
the lateral mesencephalic sulcus. The pontotrigeminal vein arises on the superior and middle cerebellar peduncles, and passes
rostral to the trigeminal nerve. The tectal veins (Tectal V.) arise in the region of the colliculi. The vein of the cerebellomedullary
fissure arises on the lateral side of the uvula and nodule, and passes laterally through the cerebellomedullary fissure, either dorsal
or ventral to the flocculus to join one of the veins in the cerebellopontine angle. The vein of the cerebellomedullary fissure receives
the medial (Med. Supraton. V.) and lateral supratonsillar veins (Lat. Supraton. V.), which pass along the medial and lateral edge
of the inferior medullary velum (Inf. Med. Vel.) above the superior pole of the tonsil. The dentate nucleus is drained by the
supratonsillar veins and the vein of the cerebellomedullary fissure. The median posterior medullary vein (Med. Post. Med. V.)
ascends on the posterior medulla and divides just below the obex into the paired veins of the inferior cerebellar peduncle. The
veins of the inferior cerebellar peduncle ascend on the inferior cerebellar peduncles and join the lateral medullary veins. The
choroidal veins (Ch. V.) draining the tela choroidea (Tela) and choroid plexus are tributaries of the veins of the inferior cerebellar
peduncle and the cerebellomedullary fissure. The peduncular veins (Ped. V.) arise in the interpeduncular fossa and pass laterally
to join the basal veins (Bas. V.). The posterior communicating vein (Post. Com. V.) interconnects the medial ends of the
peduncular veins. The longitudinally oriented veins in the midline on the anterior surface of the brain stem are the median

FIG. 6. D: Deep cerebellum and fourth ventricle, posterior view. The right cerebellar hemisphere and the part of the left
cerebellar hemisphere posterior to the dentate nucleus and tonsil have been removed to show the roof of the fourth ventricle and
the cerebellomesencephalic and cerebellomeduilary fissures. E." Midsagittai section of cerebellum and fourth ventricle. Left
lateral view. The left half of the cerebellum has been removed to expose the fourth ventricle.
anterior medullary vein (Med. Ant. Med. V.) which ascends on the medulla, and the median anterior pontomesencephalic vein
(Med. Ant. Pon. Mes. V.) which ascends in the midline on the pons and midbrain. The median anterior pontomesencephalic vein
does not usually extend the full length of the pons. The ends adjoining the absent segment often join the transverse pontine veins
(Trans. Pon. V.). The transversely oriented veins coursing in the sulci between the subdivisions of the brain stem are the veins of
the pontomesencephalic (V. of Pon. Mes. Sulc.) and the pontomedullary sulci (V. of Pon. Med. Sulc.). Each vein of the middle
cerebetlar peduncle arises in the region of the foramen of Luschka near the flocculus and ascends on the middle cerebellar
peduncle to join the vein of the cerebellopontine fissure or one of the superior petrosal veins. The lateral anterior medullary vein
(Lat. Ant. Med. V.) courses along the preolivary sulcus near the hypoglossal nerve. The lateral anterior pontomesencephalic vein
(Lat. Ant. Port. Mes. V.) passes along the anterolateral margin of the ports and medulla. The transverse medullary veins (Trans.
Med. V.) pass transversely across the medulla. The retro-olivary vein (Retro-olivary V.) courses hlong the posterior margin of the

FIG. 6. F: Brain stem. Anterior view. The part of the tentorium between the temporal lobe and the cerebellum has been
preserved.
olive, and the lateral medullary vein (Lat. Med. V.) courses slightly dorsal to the olive, along the origin of the rootlets arising from
the dorsolateral surface of the medulla. There are diffuse anastomoses between the veins ventral to the diencephalon and third
ventricle and those draining the mldbrain. The deep middle cerebral (Deep Mid. Cer. V.) and the anterior cerebral veins (Ant.
Cer. V.)join the basal vein in the region of the anterior perforated substance.
The olfactory tract (Olf. N.) passes posteriorly above the optic nerve (Optic N.). The oculomotor nerves (III) arise between the
cerebral peduncles. The trochlear nerves (IV) arise below the colliculi and encircle the midbrain. The trigeminal nerves (V) arise
from the midpons. The abducens nerves (VI) arise from the medial part of the pontomedullary sulcus, and the facial (VII) and
vestibulocochlear nerves (VIII) arise at the lateral ends of the pontomedullary sulcus above the foramina of Luschka. The
hypoglossal nerves (XII) arise anterior to the olives and the glossopharyngeal (IX), vagus (X), and accessory (XI) nerves arise
posterior to the olives. The flocculi are attached to the brain stem dorsal to the vestibulocochlear nerves along the rostral margins
of the foramina of Luschka.
The medial and anterior surfaces and the superior pole the fourth ventricle and join the vein of the cerebello-
of each tonsil all face, but are separated from, other medullary fissure. There are frequent anastomoses be-
neural structures by narrow fissures. The anterior sur- tween the two groups. The former group is reviewed
face of each tonsil faces and is separated from the with the superficial veins and the latter group is consid-
posterior surface of the medulla by the cerebellomedul- ered with the deep veins.
lary fissure. The medial surfaces of the tonsils face each
other across a narrow cleft, the vallecula, that leads into
the fourth ventricle. The ventral aspect of the superior Inferior Vermian Veins. The inferior vermian veins
pole of each tonsil faces the inferior half of the roof of drain the vermis, and the adjacent portion of the hem-
the fourth ventricle. The dorsal aspect of the superior isphere, including part of the tonsil (Figs. 6 and 8).
pole faces the uvula medially, and the biventral lobule These paired veins are usually formed by the union of
laterally. the superior and inferior retrotonsillar veins near the
The veins coursing around the tonsil are divided into vermotonsillobiventral notch. They ascend along the
two groups: a superficial group, composed of the retro- vermohemispheric fissures and terminate in the straight
tonsillar and the lateral and medial tonsillar veins which or transverse sinuses or the torcula either directly or
converge on the posterior surface of the tonsil and join through a short tentorial sinus. They may course on the
to form the inferior vermian vein; and a deep group, vermis or adjacent part o f t b e hemisphere before reach-
the supratonsillar veins, which course in the cerebello- ing the vermohemispheric fissure. In a few cases, one
medullary fissure along the inferior part of the roof of inferior vermian vein will cross the vermis to terminate

FIG. 7. Tentorial sinuses and the veins of the tentorial surface of
the cerebellum. A: Superior view. The cerebral hemispheres have
been removed to expose the tentorium (Tent.) and middle cranial
fossae (Mid. Fossa). The internal carotid arteries (Int. Car. A.) are
anterolateral to the pituitary stalk (Stalk). The oculomotor nerves
(III) pass forward and enter the dura lateral to the posterior clinoid
processes. The internal cerebral (Int. Cer. V.) and basal veins (Bas. V.) converge on the vein of Galen. The trochlear nerves (IV)
course below the basal veins. The layer of dura over the venous sinuses has been removed. The straight sinus (Str. Sinus, dotted
line) courses in the junction of the tentorium and the falx, and joins the lateral sinuses (Lat. Sinus) at the torcula. The superior
petrosal sinuses (Sup. Petrosal Sinus) course along the attachment of the tentorium to the petrous ridges. The tentorial sinuses
(Tent. Sinus) on the right pass to the superior petrosal and lateral sinuses and the torcula and those on the left join the torcula
and the lateral sinus. The posterior part of the third ventricle (3V) is between the cerebral peduncles (Ped.). B: The tentorium
has been removed except in the area of the venous sinuses to show the relationship of the straight and tentorial sinuses to the
tentorial surface of the cerebellum. The straight sinus receives the vein of Galen and passes posteriorly to the torcula. The superior
petrosal veins are divided into medial (Sup. Petrosal V.-Med.), intermediate (Sup. Petrosal V.-Int.), and lateral groups, depending
on the level at which they enter the superior petrosal sinus. The medial group enters the sinus medial to the level of the internal
acoustic meatus, the intermediate group enters the sinus above the meatus, and the lateral group enters the sinus lateral to the
meatus. There are usually more veins in the medial group. The superior hemispheric veins are divided into three groups: an
anterior group (Sup. He. V.-Ant.), which drains toward the vein of Galen; a posterior group (Sup. He. V.-Post.), which drains into
the veins converging on the straight sinus, torcula, and medial part of the lateral sinus; and a lateral group (Sup. He. V.-Lat.),
which drains into the lateral part of the lateral sinus and the superior petrosal sinus. Inferior hemispheric veins (Inf. He. V.) also
cross the posterior part of this surface. They drain the suboccipital surface and cross the posterolateral margin of the cerebellum
adjacent to the lateral sinus and enter the tentorial sinuses near the junction of the middle and posterior thirds of the tentorial
surface. The trigeminal nerves (V) arise from the midpons. The trochlear nerves encircle the midbrain below the colliculi. C."
The tentorial sinuses have been removed to show the veins converging on them. Four inferior hemispheric veins arise on the
suboccipital surface, and cross the posterior part of the tentorial surface to join superior hemispheric veins near the postclival
fissure (Postclival Fiss.) before entering a tentorial sinus. The postclival fissure separates the simple and the superior semilunar
lobules. D: The straight sinus has been removed to show the superior vermian veins (Sup. Ve. V.) entering the vein of Galen (V.
of Galen) and the inferior vermian veins (Inf. Ve. V.) entering the torcula. The inferior hemispheric veins cross the posterior one-
third of the tentorial surface and often join the posterior group of superior hemispheric veins before entering a tentorial sinus.
The lateral mesencephalic vein (Lat. Mes. V.) courses in the lateral mesencephalic sulcus. The tributary of the superior vermian
vein draining the tentorial surface of the culmen has been called the supraculminate vein (Supraculm. V.) and the superior
vermian vein draining the declive has been called the declival vein (Declival V.). The tentorial fissure (Tentorial Fiss.), which has
also been called the primary fissure, divides the tentorial surface into anterior and posterior parts. The pineal body (Pineal) and
inferior colliculi (Inf. Coll.) are anterior to the vein of Galen.
FIG. 7. E: Stepwise dissection of the tentorium in another

specimen. A large tentorial sinus on each side enters the torcula.
A tentorial sinus on the left side passes to the anterior edge of the
tentorium. The superior petrosal sinuses open into the posterior
margin of the cavernous sinuses (Cav. Sinus). The oculomotor
nerves enter the dura lateral to the posterior clinoid processes
(Post. Clin. Process) and posterior to the internal carotid arteries.
The left basal vein, rather than joining the vein of Galen as is
usual, joins a tentorial sinus in the tentorial edge (Tent. Edge).
The internal cerebral veins pass along the superolateral borders
of the pineal body. F." The dura has been removed to show the
relationship of the tentorial sinuses to the tentorial surface of the
cerebellum. On the right side, the posterior group of superior
hemispheric veins are joined by an inferior hemispheric vein to
form a common trunk which enters a tentorial sinus. The anterior
group of superior hemispheric veins pass toward the vein of
Galen and the lateral group of superior hemispheric veins pass
toward the superior petrosal sinus. G: The tentorial sinuses have
been removed to show the veins converging on the sinuses. The
superior and inferior hemispheric veins converge on the posterior
group of tentorial sinuses near the postclival fissure. The vein
which courses in the postclival fissure has been referred to as the
vein of the postclival fissure (V. of Postclival Fiss.) The internal
occipital veins (Int. Occ. V.) join the internal cerebral veins. A
pineal vein (Pineal V.) arises on the surface of the pineal body.
in the inferior vermian vein on the opposite side. There

is often an anastomotic vein which crosses obliquely or uvula, the lateral uvular vein, with the veins in the
tranversely from one inferior vermian vein to the other. cerebellomedullary fissure.
Some interconnect the veins after they leave the surface Inferior Hemispheric Veins. The inferior hemi-
of the cerebellum to form bridging veins. 2~’48 spheric veins from the hemispheric part of the suboc-
The tributaries of the inferior vermian vein, begin- cipital surface are oriented longitudinally or trans-
ning caudally, include veins from the tonsil (the supe- versely (Figs. 6 and 8). The majority of the longitudinal
rior and inferior retrotonsillar and the medial and the veins ascend and cross the posterolateral margin of the
lateral tonsillar veins), the adjacent part of the vermis cerebellum to join the posterior group of superior hem-
and hemisphere, and the posteromedial part of the ispheric veins near the postclival fissure before entering
tentorial surface including the declival veins. The largest the inferior vermian vein, or a sinus in the tentorium.
tributaries are the declival and retrotonsillar veins, and Some longitudinal veins course inferomedially to join
the anastomotic branch between the paired inferior the lower part of the inferior vermian vein. The trans-
vermian veins. The veins coursing medially on the versely oriented veins course along the fissures between
lateral walls of the posterior cerebellar incisura form the folia. The largest transverse veins course in the
the hemispheric tributaries of the inferior vermian petrosal, suboccipital, and intrabiventral fissures. They
veins. The inferior vermian veins may anastomose drain into the inferior vermian vein medially and the
through a longitudinal vein on the lateral surface of the anterior hemisphere veins laterally.
J. Neurosurg. / Volume 59~July, 1983 81

FIG. 81 Veins of the suboccipital surface of the cerebellum. A:
Posterior view. The skull covering the dura and the venous sinuses over
the suboccipital surface has been removed. The lateral (Lat. Sinus) and
sigmoid sinuses (Sig. Sinus) mark the lateral and superior margins of
the suboccipital surface. The superior sagittal sinus (Sup. Sag. Sinus)
joins the lateral sinuses at the torcula. Several occipital sinuses (Occ.
Sinus) course in the dura near the junction of the vermis and the
hemispheres. The b o n e posterior to the jugular foramen has been
removed to expose the junction of the sigmoid and occipital sinuses,
and the emissary vein passing through the condylar foramen (Con. Em.
V.) with the jugular bulb and the internal jugular vein (Int. Jug. V.).
The vertebral venous plexus (Vert. Venous Plexus) anastomoses with
the internal jugular veins. B: The dura over the suboccipital surface of the cerebellum has been removed except in the region of
the venous sinuses. The lateral sinuses course rostral to suboccipital surface, and the sigmoid sinuses mark the lateral borders of
the suboccipital surfaces. The occipital sinuses course near the junction of the vermis and the hemispheres. The inferior hemispheric
veins (Inf. He. V.) drain the hemispheric part of the suboccipital surface. A median posterior medullary vein (Med. Pos. Med. V.)
ascends on the medulla in the midline below the fourth ventricle (4V). The vertebral artery (Vert. A.) passes around the atlas,
enters the dura, and ascends anterior to the medulla. A bridging vein (Br. V.) crosses below the left tonsil. The accessory nerve
(XI) ascends toward the jugular foramen. C: The dura over the suboccipital surface has been removed. The vermian part of the
surface is composed of the folium, tuber, pyramid, and uvula, and the hemispheric part is formed by the superior (Sup.) and
inferior (Inf.) semilunar and biventral lobules (Bivent. Lobule) and the tonsils. The major fissure on this surface, the suboccipital
fissure (Suboccipital Fiss.), divides this surface between the inferior semilunar and the biventral lobules. The petrosal fissure
(Petrosal Fiss.) extends from the petrosal surface to divide the suboccipital surface between the inferior and superior semilunar
lobules. The tonsillobiventral fissures (Ton. Bivent. Fiss.) separate the biventral lobules from the tonsils. The torcula and tentorium
(Tent.) are above. The inferior hemispheric and inferior vermian veins (Inf. Ve. V.) drain toward the tentorium and enter the
torcula or a tentorial sinus (Tent. Sinus). The inferior retrotonsillar veins (Inf. Retroton. V.) arise at the inferior pole of each tonsil
and ascend to join the superior retrotonsillar veins near the junction of the uvula and the pyramid to form the inferior vermian
veins. The more medial of the inferior hemispheric veins cross the posterior margin of the cerebellum bordering the lateral sinus
to reach the tentorial surface where they terminate in the straight or a tentorial sinus or the torcula. The inferior hemispheric
veins infrequently enter directly into the lateral sinus. A superior hemispheric vein (Sup. He. V.) from the tentorial surface on the
left side joins an inferior hemispheric vein to form a venous trunk which enters a tentorial sinus. The marginal sinus (Marg. Sinus)
courses in the dura at the level of the foramen magnum. The cerebellomedullary fissure (Cer. Med. Fiss.) extends rostrally between
the cerebellum and medulla. D: The tentorium has been elevated to expose the site at which the declival veins (Declival V.)
from the tentorial surface and the inferior vermian veins enter the straight sinus near the torcula. The inferior retrotonsillar vein
ascends in the tonsillobiventral fissure and joins the superior retrotonsillar vein (Sup. Retroton. V.) to form the inferior vermian
vein, which ascends along the vermohemispheric fissure (Ve. He. Fissure). Choroid plexus (Ch. P1.) protrudes from the foramen
of Magendie (F. Magendie).

FIG. 8. E: The superior pole of the tonsil has been retracted

to expose the junction where the superior and inferior retroton-
sillar veins join to form the inferior vermian vein. A fissure
crossing the biventral lobule has been opened to show where the
vein in this fissure joins the inferior vermian vein. The copular
point (Copular Pt.) is located at the junction of the superior and
inferior retrotonsillar veins with the inferior vermian vein. F:
The left petrosal fissure, which arises on the petrosal surface and
divides the suboccipital surface between the inferior and superior
semilunar lobules, has been opened. The vein of the petrosal
fissure (V. of Petrosal Fiss.) on the right side joins the inferior
vermian veins. In this case, the major hemispheric veins on the
suboccipital surface ascend at right angles to this transversely
oriented fissure rather than coursing within it as shown in G. G:
The petrosal fissure of another hemisphere has been opened. In
this case, the major hemispheric veins course parallel to the
transversely oriented fissures rather than at fight angles to them
as shown in F. The large vein in the petrosal fissure joins the
inferior vermian vein medially and an anterior hemispheric vein
(Ant. He. V.) laterally.
The inferior hemispheric veins are divided into four veins on the petrosal surface. The veins in the infero-
groups: the superomedial, inferomedial, superolateral, lateral group drain the lateral part of the biventral
and inferolateral veins, based on the part of the suboc- lobule, and pass around the inferior margin of the
cipital surface which they drain. The veins in the su- hemisphere to join the anterior hemispheric veins. The
peromedial group are usually the largest. The major vein coursing in the intrabiventral fissure is the largest
veins in this group usually run longitudinal and drain member of this group.
into the torcular, a tentorial sinus, or the inferior ver- Retrotonsillar Veins. The superior and inferior re-
mian vein. The transverse veins in this group, if they trotonsillar veins drain the superior and inferior poles
are well developed, converge on the vein of the petrosal and the posterior surface of the tonsils (Figs. 6 and 8).
fissure, which drains into the torcula or the inferior They receive tributaries from the medial and lateral
vermian vein. The inferomedial group consists of two tonsillar surfaces and the adjacent part of the vermis
or three small veins that originate near the medial part and hemisphere. The superior retrotonsillar vein arises
of the suboccipital fissure and course inferiorly on the from small tributaries near the superior pole of the
biventral lobule to join the inferior retrotonsillar or the tonsil and courses posteriorly to join the inferior retro-
inferior vermian veins. The veins in the superolateral tonsillar vein to form the inferior vermian vein. The
group usually pass superolaterally across the posterior inferior retrotonsillar vein arises from small tributaries
margin of the hemisphere and drain either directly or near the caudal pole of the tonsil, and courses superiorly
through a tentorial sinus into the superior petrosal or on or near the tonsillobiventral fissure. It joins the
lateral sinuses or into the lateral part of the vein of the superior retrotonsillar vein and other tributaries from
petrosal fissure, which courses around the inferior mar- the biventral lobule and the lateral and medial tonsillar
gin of the hemisphere to join the anterior hemispheric surfaces to form the inferior vermian vein.

FIG. 9. A: Veins entering the superior petrosal sinus. Right

superolateral view. The tentorium and cerebral hemispheres have
been removed to show the veins that converge on the superior
petrosal sinus (Sup. Petrosal Sinus). The superior petrosal sinus
courses along the petrous ridge at the posterior margin of the
middle cranial fossa (Mid. Fossa) and joins the lateral sinus (Lat.
Sinus) at its posterolateral end and the cavernous sinus at its
anteromedial end. The superior petrosal veins are the terminal end
of the bridging veins that pass from the surface of the brain stem
and cerebellum to the superior petrosal sinus. Some oftbe superior
petrosal veins are formed by the terminal end of a single vein from
the cerebellum or brain stem, and others are formed by the union
of numerous veins. The superior petrosal veins are divided into
medial, intermediate, and lateral groups. The lateral group of
superior petrosal veins (Sup. Petrosal V.-Lat.) enter the superior
petrosal sinus lateral to the internal acoustic meatus and the facial
(VII) and vestibulocochlear (VIII) nerves; the medial group (Sup.
Petrosal V.-Med.) enters the sinus medial to the internal acoustic
meatus near the trigeminal nerve (V); and the intermediate group
enters the sinus above the internal acoustic meatus. The intermediate group is absent in this case. The largest vein in the lateral
group is formed by the union of one of the lateral group of superior hemispheric veins (Sup. He. V-Lat.) with an inferior
hemispheric vein (Inf. He. V.). The large vein in the medial group is formed by a trunk which receives the transverse pontine
(Trans. Pon. V.) and pontotrigeminal veins (Pon. Trig. V.) as well as the vein of the middle cerebellar peduncle (V. of Mid Cer.
Ped.). One of the anterior group of superior hemispheric veins (Sup. He. V.-Ant.) drains into the vein of Galen (V. of Galen). Fhe
internal cerebral (Int. Cer. V.) and basal (Bas. V.) veins join to form the vein of Galen. The oculomotor nerve (III) enters the dura
posterior to the internal carotid artery (Int. Car. A.). The basal vein passes around the cerebral peduncle (Ped.). The rostral end
of the lateral mesencephalic vein (Lat. Mes. V.) joins the caudal surface of the basal vein. The trochlear nerves (IV) arise below
the inferior colliculi (Inf. Coll.) in the cerebellomesencephalic fissure (Cer. Mes. Fissure). A superior vermian vein (Sup. Ve. V.)
ascends toward the vein of Galen. The superior hemispheric veins are divided into an anterior group (Sup. He. V.-Ant.) which
drains toward the cerebellomesencephalic fissure; a lateral group (Sup. He. V.-Lat.) that drains toward the superior petrosal sinus;
and a posterior group which drains toward the torcula. B: Another specimen with the brain stem displaced posteriorly to show
the veins that converge on the superior petrosal sinuses. The oculomotor nerves have been divided between the midbrain and the
cavernous sinus (Cav. Sinus). The trochlear nerves exit the cerebellomesencephalic fissure at the pontomesencephalic junction.
The trigeminal nerves exit the midpons and enter Meckel’s cave below the medial part of the superior petrosal sinus. The abducens
nerves (VI) exit the brain at the pontomedullary junction and pass lateral to the basilar artery (Bas. A.) near the anterior inferior
cerebellar arteries (A.I.C.A.) before entering the posterior wall of the cavernous sinuses. The left AICA splits the fascicles of the
left abducens nerve into two bundles. The pituitary stalk (Stalk) was divided in removing the cerebral hemispheres. The medial
group of superior petrosal veins enter the sinus medial to the internal acoustic meatus. The peduncular veins (Ped. V.) arise in
the interpeduncular fossa and pass laterally around the cerebral peduncle to join the basal vein. The two peduncular veins are
united across the midline by the posterior communicating vein (Post. Com. V.). The vein of the pontomesencephalic sulcus (V.
of Pon. Mes. Sulc.) courses below the oculomotor nerves and below the peduncular vein. The pontotrigeminal veins arise in the
cerebellomesencephalic fissure near the junction of the superior and middle cerebellar peduncles. Both pontotrigeminal veins are
very large. The pontotrigeminal vein on the right side receives the vein of the cerebellopontine fissure which forms one of the
superior petrosal veins (not visible in this view). The vein of the middle cerebellar peduncle on the right side and a transverse
pontine vein join to form a trunk which enters the superior petrosal sinus. On the left, the pontotrigeminal vein is joined by the
vein of the cerebellopontine fissure (V. of Cer. Pon. Fiss.) and one of the transverse pontine veins to form a common trunk at the
site of its entrance into the petrosal sinus. The median anterior pontomesencephalic vein (Med. Ant. Pon. Mes. V.) joins the
peduncular vein rostrally and the transverse pontine vein caudally. C: Superolateral view of the veins and arteries near the
medial part of the right superior petrosal sinus in the same specimen prior to removal of the cerebellar arteries. The posterior
cerebral (P.C.A.) and superior cerebellar arteries (S.C.A.) arise from the basilar artery and pass around the brain stem near the
pontomesencephalic junction. The large basal vein courses rostral to the trochlear and oculomotor nerves and above the superior
cerebellar artery. The basal vein anastomoses with the large pontotrigeminal vein. A transverse pontine vein and the vein of the
middle cerebellar peduncle join to form one common trunk and the vein of the cerebeUoponfine fissure and the pontotrigeminal
vein join to form another common trunk before entering the superior petrosal sinus.

FIG. 9. D: Enlarged view of the same specimen with the arteries

removed and the trigeminal nerve divided. The flocculus is posterior to
the facial and vestibulocochlear nerves. The lateral mesencephalic vein
joins the pontotrigeminal vein caudally and the basal vein rostrally. A
superior hemispheric vein joins the vein of the middle cerebral peduncle.
The vein of the cerebellopontine fissure joins the pontotrigeminal vein
to form one of the intermediate group of superior petrosal veins (Sup.
Pet. V.-Int.), and a transverse pontine vein and the vein of the middle
cerebellar peduncle join to form one of the medial group of superior
petrosal veins. E: Superolateral view of the left side of the same
specimen shown in B. The transverse pontine and pontotrigeminal
veins and the vein of the cerebellopontine fissure join to form one of
the medial group of superior petrosal veins. The vein of the cerebello-
pontine fissure receives the vein of the middle cerebellar peduncle prior
to passing above the facial and vestibulocochlear nerves to form a
common stem with the pontotrigeminal vein. The pontotrigeminal vein,
which commonly arises in the cerebellomesencephalic fissure from the
surface of the superior (Sup. Cer. Ped.) and middle cerebellar peduncles
(Mid. Cer. Ped.) is very large and anastomoses through the vein of the
superior cerebellar peduncle (V. Sup. Cer. Ped.) with the vein of the
cerebellomesencephalic fissure (V. of Cer. Mes. Fissure). The lateral
mesencephalic veins course longitudinally in the lateral mesencephalic
sulcus. Transverse pontine veins pass both above and below the tri-
geminal nerve. The facial and vestibulocochlear nerves enter the internal
acoustic meatus (Meatus). F." Enlarged superior view of the left side
of a superior petrosal vein formed by the union of four veins: a transverse
pontine vein which passes rostral to the trigeminal nerve; the pontotri-
geminal vein, which arises on the rostral surface of the superior cerebellar peduncle; the vein of the middle cerebellar peduncle,
which ascends on the middle cerebellar peduncle; and the vein of the cerebellopontine fissure, which receives one of the anterior
hemispheric veins (Ant. He. V.) and the vein of the cerebellomedullary fissure (V. of Cer. Med. Fiss.). The lateral mesencephalic
vein anastomoses with the pontotrigeminal and passes rostrally in the lateral mesencephalic sulcus.
Medial and Lateral Tonsillar Veins. The medial

tonsillar veins originate on the tonsillar surface facing Petrosal Surface
the other tonsil and the lateral tonsillar veins arise on This surface, drained by the anterior hemispheric
the lateral side of the tonsil in the tonsillobiventral veins, faces the posterior surface of the petrous bone
fissure (Figs. 6 and 8). These veins usually course pos- (Fig. 3). The major fissure on the petrosal surface, the
teriorly and drain into the superior or inferior retroton- petrosal fissure, also called the "horizontal fissure,"
sillar or the inferior vermian veins. The lateral tonsillar splits the petrosal surface into superior and inferior
vein may course anteriorly to anastomose with the vein parts and extends onto the suboccipital surface. The
of the cerebellomedullary fissure near the dentate superior and inferior parts of the petrosal surface wrap
impression, and the medial tonsillar vein may infre- around the pons and middle cerebellar peduncle to
quently anastomose with the medial end of the vein of form the cerebellopontine fissure.
the cerebellomedullary fissure near the lateral edge of The right and left petrosal surfaces are not connected
the uvula. from side to side by an uninterrupted strip of vermis,

FIG. 9. G: Anterolateral view. Veins converging from the left side

of the brain stem and the petrosal surface of the cerebellum on the
superior petrosal sinus. The anterior hemispheric veins, which drain the
petrosal surface of the cerebellum, are divided into superior, middle
(Ant. He. V.-Mid.) and inferior (Ant. He. V.-Inf.) groups. These veins
converge on the cerebellopontine fissure (Cer. Pon. Fiss.), formed where
the cerebellum folds around the superior and inferior margin of the
middle cerebellar peduncle (Mid. Cer. Ped.). This fissure has a superior
limb (Sup. Limb) between the superior part of the middle cerebeUar
peduncle and the superior half of the petrosal surface, and an inferior
limb (Inf. Limb) between the inferior half of the petrosal surface and
the inferior part of the middle cerebellar peduncle. The trigeminal nerve
arises near the anteromedial part of the superior limb. The facial and
vestibulocochlear nerves, the flocculus, the foramen of Luschka (F.
Luschka), and the choroid plexus (Ch. P1.) protruding from it, and the
glossopharyngeal (IX), vagus (X), and accessory (XI) nerves all arise
near the anteromedial part of the inferior limb. The anterior hemispheric
veins converge on the apex of the cerebellopontine fissure and join to
form the vein of the cerebellopontine fissure which ascends toward the
superior petrosal sinus. The vein of the middle cerebellar peduncle is
formed at the inferior margin of the middle cerebellar peduncle by the
union of the veins of the cerebellomedullary fissure and the ponto-
medullary sulcus (V. of Pon. Med. Sulc.) and the lateral medullary vein
(Lat. Med. V.). The vein of the cerebellomedullary fissure leaves the
cerebellomedullary fissure (Cer. Med. Fiss.) between the flocculus and foramen of Luschka. The vein of the middle cerebellar
peduncle ascends between the facial and vestibulocochlear nerves and joins the vein of the cerebellopontine fissure. The vein of
the cerebellopontine fissure receives a large transverse pontine vein below the trigeminal nerve. The transverse pontine vein and
the vein of the cerebellopontine fissure join to form one of the medial group of superior petrosal veins. The median anterior
medullary vein (Med. Ant. Med. V.) ascends on the anterior surface of the medulla. Several of the anterior hemispheric veins join
near the apex of the cerebellopontine fissure to form one of the lateral group of superior petrosal veins. The petrosal fissure
(Petrosal Fiss.) extends laterally from the apex of the cerebellopontine fissure. The hypoglossal nerves (XII) arise anterior to the
olives. H: Enlarged view of the cerebellopontine fissure. The veins draining this area ascend to form one of the medial group of
superior petrosal veins. The vein of the cerebellomedullary fissure passes between the foramen of Luschka and the flocculus to
join the vein of the middle cerebellar peduncle. The vein of the middle cerebeUar peduncle is formed at the lower margin of the
middle cerebellar peduncle by the union of the veins of the pontomedullary sulcus and the cerebellomedullary fissure and the
lateral medullary vein. The vein of the pontomedullary sulcus courses the pontomedullary sulcus (Pon. Med. Sulc.). The anterior
hemispheric veins converge on the apex of the cerebellopontine fissure above the flocculus to form the vein of the cerebellopontine
fissure. The lateral medullary vein ascends anterior to the glossopharyngeal, vagus, and accessory nerves. The cerebellomedullary
fissure which extends between the cerebellum and medulla is continuous with the inferior limb of the cerebellopontine fissure at
the level of the foramen of Luschka. It is through this communication between the fissures that the vein of the cerebeUomedullary
fissure reaches the lateral side of the brain stem. I." The anterior part of the biventral lobule and tonsil on the left side have been
removed to show the course taken by the vein of the cerebellomedullary fissure to reach the veins draining into the superior
petrosal sinus. The vein of this cerebellomedullary fissure passes from the cerebeUomedullary fissure around the foramen of
Luschka to the inferior limb of the cerebellopontine fissure where it joins the vein of the middle cerebellar peduncle. The opposite
tonsil is seen through the exposure created by the removal of the biventral lobule and tonsil. The rhomboid lip is a thickened
layer of neural tissue attached to the lateral margin of the floor of the fourth ventricle which joins the tela choroidea to form a
pouch at the outer extremity of the lateral recess. The anterolateral marginal veins (Ant. Lat. Marg. V.) course along the
anterolateral margin of the cerebellum which marks the junction of the petrosal and tentorial surfaces.

FIG. 9. J." Left anterolateral view of another brain stem showing another course taken by the vein of the cerebellomedullary
fissure upon exiting the cerebellomedullary fissure. It passes dorsal rather than ventral to the flocculus to join the inferior group
of anterior hemispheric veins. The vein of the middle cerebellar peduncle is formed by the union of the vein of the pontomedullary
sulcus and the lateral medullary vein, and ascends dorsal to the facial and vestibulocochlear nerves to join the vein of the
cerebellopontine fissure. The vein of the cerebellopontine fissure is formed by the union of the middle and inferior groups of
anterior hemispheric veins. The superior group of anterior hemispheric veins (Ant. He. V.-Sup.) joins the vein of the cerebello-
pontine fissure. The veins from this region ascend to form trunks, the superior petrosal veins, which enter the superior petrosal
sinus. A superior and inferior hemispheric vein (Inf. He. V.) join to enter a tentorial sinus (Tent. Sinus). K: The anterior part of
the biventral lobule and tonsil have been removed in another specimen to show the vein of the cerebellomedullary fissure leaving
the fissure to pass dorsal to the flocculus and join one of the anterior hemispheric veins. The vein of the middle cerebellar
peduncle is formed by the union of the veins of the pontomesencephalic sulcus and inferior cerebellar peduncle and the lateral
medullary vein, and passes rostrally between the vestibulocochlear nerve and the flocculus rather than between the facial and
vestibulocochlear nerves as shown in the last specimen (J). The vein of the middle cerebellar peduncle joins one of the transverse
pontine veins to form one of the medial group of superior petrosal veins. The vein of the cerebellopontine fissure ascends and
unites with the pontotrigeminal vein to form one of the intermediate group of superior petrosal veins.
as are the suboccipital and tentorial surfaces, because perior, middle, and inferior groups (Figs. 6 and 9). The
of the interposition of the fourth ventricle between the veins in the inferior group arise on the inferior part of
superior and inferior parts of this surface. The hemi- the petrosal surface and converge on the caudal part of
spheric surface is formed by the wing of the central the cerebellopontine fissure to form a common trunk.
lobule and the anterior surface of the quadrangular, The vein of the cerebeUomedullary fissure, if it passes
simple, biventral, and superior and inferior semilunar dorsal to the flocculus, joins the common trunk of the
lobules, the tonsils and the flocculi. The median or inferior group. The veins in the middle group drain the
vermal components rostral to the fourth ventricle are middle portion of the petrosal surface and converge on
the lingula, central lobule, and the culmen, and those the apex of the cerebellopontine fissure. The c o m m o n
caudal to the fourth ventricle are the nodule and uvula. trunk of the inferior group joins the c o m m o n trunk of
The vermian and related hemispheric parts are: the the middle group near the flocculus to form the vein of
central lobule and the wings of the central lobule; the the cerebellopontine fissure, which passes to the supe-
culmen and the quadrangular lobules; the nodule and rior petrosal sinus. In a few cases, the c o m m o n trunk
the flocculi; and the uvula and the tonsils. Another of the middle group does not join the c o m m o n trunk
major fissure on this surface, the postclival fissure, of the inferior group but ascends to the anterolateral
divides the superior part of the petrosal surface between margin and drains into the superior petrosal sinus be-
the simple and superior semilunar lobules and extends hind the anterior angle. The largest members of the
onto the tentorial surface. middle group are the veins coursing in the postclival
and petrosal fissures. In some cases, a vein crosses the
Anterior Hemispheric Veins. These veins arise near entire length of the petrosal and postclival fissures in-
the border that separates the petrosal surface from the terconnecting the vermian veins on the tentorial and
suboccipital and tentorial surfaces, and pass anteriorly suboccipital surfaces with the vein of the cerebellopon-
to converge on the cerebellopontine fissure and the tine fissure on the petrosal surface. The superior group,
middle cerebellar peduncle. They are divided into su- the smallest of the three groups, drains the rostral part

TABLE 2
Summary of deep veins examined in I0 posterior fossae*
Fre-
Termi-
Name of Vein quency
(% & nal Size Area of Origin Common Tributaries Common Termination
no./total) (mm)i
vein ofcerebellomesen- 100% 1.0-1.9 just below colliculi vein of superior cerebellar pe- superior vermian vein or vein
cephalic fissure 10/10 (1.40) duncle of Galen
vein of superior cerebel- 100% 0.4-1.3 caudolateral margin ofsu- parenchymal cerebellar veins vein of cerebellomesencephalic
lar peduncle 20/20 (0.86) perior cerebellar pedun- including dentate veins fissure
cle
pontotrigeminal vein 100% 0.4-1.8 near interpeduncular sul- parenchymal cerebellar & lat- superior petrosal vein or sinus
20/20 (1.03) cus eral mesencephalic veins
vein of cerebeUomedul-
lary fissure
medial part 65% 0.3-1.1 lateraledge of nodule, in- medial & lateral supratonsil- anterior hemispheric veins,
13/20 (0.56) ferior medullary velum lar, dentate, nodulouvular, vein of cerebellopontine fis-
lateral part 95% 0.7-1.9 & dentate nucleus & choroidal veins sure, &/or lateral medullary
19/20 (1.17) vein
vein of inferior cerebellar 100% 0.3-1.0 posterolateral medulla small veins on posterolateral median posterior medullary,
peduncle 20/20 (0.57) along inferior cerebellar medulla & choroidal veins lateral medullary veins, &
peduncle veins of pontomedullary sul-
cus & middle cerebellar pe-
duncle
medial supratonsillar 55% 0.3-0.8 deep nuclei & white matter parenchymal eerebellar veins vein of cerebellomedullary fis-
vein 11/20 (0.50) of cerebellum including dentate veins sure or lateral uvular vein
lateral supratonsillar vein 100% 0.2-1.0 deep nuclei & white matter parenchymal cerebellar veins vein of cerebellomedullary fis-
20/20 (0.56) of cerebellum including dentate veins sure
vein of cerebellopontine 90% 1.1-2.6 lateralcerebellar incisura inferior & middle groups of superior petrosal vein or sinus
fissure 18/20 (1.63) & petrosal surface anterior hemispheric veins
& vein of cerebellomedul-
lary fissure
vein of middle cerebellar 1 0 0 % 0.3-2.1 supraolivary fossette & veins of pontomedullary sul- superior petrosal vein or sinus,
peduncle 20/20 (1.11) pons below trigeminal cus & inferior cerebellar pe- vein of cerebellopontine fis-
nerve duncle, & lateral medullary sure, & transverse pontine
vein vein
* Provides data from 20 of each of paired and l0 of midline unpaired venous structures.
t Range of sizes; the average size is given in parentheses.
of the superior half o f the petrosal surface. These veins extends inferiorly between the cerebellum and the mid-
course anteriorly or posteriorly to join either the vein brain, is V-shaped when viewed from superiorly. The
o f the cerebellopontine fissure, the anterolateral mar- dorsal half of the midbrain sits within the limbs o f the
ginal vein, or one o f the superior hemispheric veins. V-shaped notch. The cisternal or inner wall o f the fissure
which forms the outer surface o f the superior part o f
Deep Veins the r o o f is composed in the midline o f the superior
The deep veins course in the fissures between the medullary velum and the lingula, and laterally by the
brain stem and the cerebellum near the r o o f and lateral dorsal surfaces o f the superior cerebellar peduncles and
walls o f the fourth ventricle (Table 2 and Figs. 1 to 3, the rostral surface o f the middle cerebellar peduncles.
6, and 9 to 12). The r o o f o f the fourth ventricle is The superior medullary velum is a thin lamina o f white
divided at its apex, the fastigium, into superior and substance, which spans the interval between the supe-
inferior parts. The veins most intimately related to the rior cerebellar peduncles and has the lingula, a thin
superior part of the r o o f are those that course in the tongue o f vermis, on its outer surface. The superior
cerebellomesencephalic fissure; the veins most inti- medullary velum is continuous at the fastigium with
mately related to the inferior part o f the r o o f are those the inferior medullary velum. The superior cerebellar
that course in the cerebellomedullary fissure; and those peduncles form smooth longitudinal prominences on
most intimately related to the lateral wall and cerebel- each side o f the lingula before disappearing into the
lopontine angle are those that course in the cerebello- midbrain beneath the colliculi. The rostral surface o f
pontine fissure. The structures ventral to the floor o f the middle cerebeUar peduncles appears to wrap around
the fourth ventricle are drained by the veins o f the brain the caudal margin o f the superior cerebellar peduncles.
stem, which are considered in a separate section. A shallow groove, the interpeduncular sulcus, marks
the junction o f the superior and middle cerebeUar pe-
Cerebellomesencephalic Fissure duncles. The interpeduncular sulcus is continuous an-
The structures in the superior part o f the r o o f o f the teriorly with the pontomesencephalic sulcus, a trans-
fourth ventricle form the anterior wall o f the cerebel- verse groove between the pons and midbrain, and
lomesencephalic fissure (Fig. 1). This fissure, which superiorly with the lateral mesencephalic sulcus, a lon-

gitudinal fissure dorsal to the cerebral peduncle. Nu- Tectal Veins. The small tectal veins originate on or
merous veins anastomose at the confluence of these near the superior and inferior colliculi and course up-
three sulci. The major veins in the cerebellomesence- ward in the quadrigeminal cistern to drain into the vein
phalic fissure are the veins of the cerebellomesence- of the cerebellomesencephalic fissure, the superior ver-
phalic fissure and the superior cerebellar peduncle, and mian or internal cerebral vein, or the vein of Galen
the pontotrigeminal and lateral mesencephalic veins (Figs. 5, 6, and 10). These veins often anastomose with
(Figs. 6 and 10). the vein of the superior cerebellar peduncle and the
Vein of the Superior Cerebellar Peduncle. The pineal, lateral mesencephalic, and basal veins. 47
paired veins of the superior cerebellar peduncle origi-
nate deep in the cerebellomesencephalic fissure near Cerebellomedullary Fissure
the caudolateral margin of the superior cerebellar pe-
The inferior part of the roof of the fourth ventricle
duncles from tributaries draining the dentate nuclei,
superior cerebellar peduncles, and the walls of the cere- slopes sharply ventral and slightly caudal from the
bellomesencephalic fissure. They first course medially fastigium and forms the ventral wall of the cerebello-
across the peduncles and then upward on the peduncles medullary fissure, one of the most complex fissures in
just lateral to the lingula. They join near the rostral tip the brain (Fig. 2). The dorsal wall of the fissure is formed
of the lingula to form a single trunk, the vein of the by the uvula in the midline and the tonsils and biventral
cerebellomesencephalic fissure. In a few cases, the lobules laterally, and the ventral wall is formed by the
paired veins do not join but form two separate veins of tela choroidea and inferior medullary velum, except in
the cerebellomesencephalic fissure. Each vein of the su- the rostral midline where it is formed by the nodule
perior cerebellar peduncle frequently anastomoses with and uvula. This fissure extends superiorly between the
the pontotrigeminal and lateral mesencephalic veins. cerebellum and medulla to the level of the lateral re-
cesses, and communicates around the foramen of
Vein of the Cerebellomesencephalic Fissure. This Luschka with the cerebellopontine angle, around the
vein arises deep in the cerebellomesencephalic fissure superior poles of the tonsils with the cisterna magna,
from the union of the veins of the superior cerebellar and through the foramen of Magendie with the fourth
peduncle. It crosses the quadrigeminal cistern anterior ventricle.
to the central lobule to drain either directly or through Removal of the tonsils exposes the wall of the fissure
the superior vermian vein into the vein of Galen (Figs. formed by the inferior medullary velum and tela cho-
5, 6, and 10). Its tributaries are from the posterior roidea (Fig. 2). The inferior medullary velum is a thin
aspect of the midbrain and the walls of the cerebello- bilateral semitranslucent butterfly-shaped sheet of
mesencephalic fissure, and occasionally include the tec- neural tissue that blends into the ventricular surface of
tal and preculminate veins. the nodule medially and stretches laterally across but is
Huang and Wolf16 called the fissure between the separated from the superior pole of the tonsil by a
central lobule and the lingula the "precentral cerebellar narrow rostral extension of the cerebellomedullary fis-
fissure," and they named the complex formed by the sure. The inferior medullary velum blends into the
paired veins of the superior cerebellar peduncle and the dorsal margin of each lateral recess and forms the
vein of the cerebellomesencephalic fissure, the "pre- peduncle of each flocculus. It is all that remains of the
central cerebellar vein." In Huang and Wolf’s study, ~6 connection between the nodule and the flocculus that
the precentral cerebellar vein was divided into three forms the flocculonodular lobe of the primitive cere-
segments: the vein of the superior cerebellar peduncle bellum. It is continuous at the level of the fastigium
corresponds to the first segment and the vein of the with the superior medullary velum, and inferiorly with
cerebellomesencephalic fissure corresponds to the sec- the tela choroidea. The tela choroidea consists of two
ond and third segments. thin semitransparent membranes, each having a thick-
Pontotrigeminal Vein. This vein arises on the sur- ness comparable to arachnoid, between which is sand-
face of the middle cerebellar peduncle near the inter- wiched a vascular layer composed of the choroidal
peduncular sulcus, passes above the trigeminal nerve, arteries and veins. The choroid plexus projects from the
and drains directly into the superior petrosal sinus or ventricular surface of the tela choroidea into the fourth
its tributaries (Figs. 6, 9, and 10). It is often formed by ventricle.
the union of two trunks: one arising rostrally near the The flocculus and the lateral recess are in the lateral
junction of the lateral mesencephalic, the pontomesen- part of the cerebellomedullary fissure at the junction of
cephalic, and the interpeduncular sulci, and the other the cerebellomedullary and cerebellopontine fissures.
originating caudally in the lower part of the interpedun- The lateral recess extends outward from the lateral angle
cular sulcus. The two trunks join just rostral to the of the fourth ventricle and opens through the foramen
origin of the posterior trigeminal root from the pons. of Luschka into the cerebellopontine angle. The ventral
Its proximal end frequently anastomoses inferomedially wall of each lateral recess is formed by the floor of the
with the vein of the superior cerebellar peduncle and fourth ventricle, and the rhomboid lip, a sheet-like layer
superomedially with the lateral mesencephalic vein. of neural tissue that extends laterally from the floor and
Some of the superior hemispheric and transverse pon- unites with the tela choroidea to form a pouch at the
tine veins drain into the pontotrigeminal vein. outer extremity of the lateral recess. The rostral wall of

FIG. 10. Veins of the cerebellomesencephalic fissure. A: Lateral view of the cerebellum, upper brain stem, and venous sinuses.
The tentorium (Tent.) was removed except in the area of the venous sinuses and at the sites where the hemispheric veins join the
tentorial sinuses (Tent. Sinus). The cerebeUomesencephalic fissure (Cer. Mes. Fiss.) extends inferiorly between the cerebellum and
the midbrain. The vein of Galen (V. of Galen) is formed by the union of the internal cerebral (Int. Cer. V.) and basal veins (Bas.
V.). The internal occipital vein (Int. Occ. V.) joins the internal cerebral vein. The straight sinus (Str. Sinus.) receives the vein of
Galen, passes above the culmen and declive, and joins the lateral sinus (Lat. Sinus) at the torcula. The superior vermian vein
(Sup. Ve. V.) receives the vein of the cerebellomesencephalic fissure (V. of Cer. Mes. Fiss.) and joins the vein of Galen. The
internal cerebral veins course on the superolateral surface of the pineal body (Pineal). The trochlear nerve (IV) encircles the brain
stem and passes above the trigeminal nerve (V). The veins on the tentorial surface of the culmen have been called the
"supraculminate veins" (Supraculm. V.) and the veins on the declive have been referred to as the "declival veins" (Declival V.).
The superior hemispheric veins, which drain the tentorial surface, are divided into an anterior group (Sup. He. V.-Ant.), which
drains into the vein of Galen; its tributaries a lateral group which drains into the superior petrosal and adjacent part of the lateral
sinuses and, a posterior group (Sup. He. V.-Post.) which drains into tentorial sinuses which converge on the straight sinus and
torcula. Some of the inferior hemispheric veins (Inf. He. V.) which drain the suboccipital surface cross the posterior part of the
tentorial surface to form common trunks with the superior hemispheric veins as they enter a tentorial sinus. A tectal vein (Tectal
V.) passes from the region of the superior (Sup. Coll.) and inferior colliculi (Inf. Coll.) to the vein of the cerebellomesencephalic
fissure. The lateral mesencephalic vein (Lat. Mes. V.) courses in the lateral mesencephalic sulcus and joins the basal vein. B:
The right half of the culmen and central lobule has been removed to expose the ventral wall of the cerebellomesencephalic fissure
and the vein of the cerebellomesencephalic fissure. The paired veins of the superior cerebellar peduncle (V. of Sup. Cer. Ped.)join
to form the vein of the cerebellomesencephalic fissure. Each vein of the superior cerebellar peduncle crosses the superior cerebeUar
peduncle (Sup. Cer. Ped.) from lateral to medial, and then ascends lateral to the lingula. It anastomoses laterally with the inferior
end of the lateral mesencephalic vein and the medial end of the pontotrigeminal vein (Pon. Trig. V.). The vein of the
cerebellomesencephalic fissure joins the superior vermian vein which enters the vein of Galen. The interpeduncular sulcus
(Interped. Sulc.) separates the superior and the middle cerebellar peduncles (Med. Cer. Ped.). The pineal vein (Pineal V.) arises
on the pineal body. The oculomotor nerves (III) pass forward from the medial surface of the cerebral peduncles (Ped.). The
pontotrigeminal and transverse pontine veins (Trans. Pon. V.)join with the vein of the cerebeUopontine fissure (V. of Cer. Pon.
Fiss.) to form a superior petrosal vein (Sup. Petrosal V.). The tentorial fissure (Tentorial Fiss.), which is also called the primary
fissure, divides the tentorial surface into its anterior and posterior parts. The trochlear nerve enters the medial edge of the
tentorium (Tent. Edge).
each lateral recess is formed by the caudal margin of ventral to the flocculus to reach the cerebellopontine
the cerebellar peduncles. The peduncle of the fiocculus angle (Figs. 6 and 11). If it courses dorsal to the floc-
crosses in the dorsal margin of the lateral recess. The culus, it terminates in the anterior hemispheric veins
caudal wall is formed by the tela choroidea that stretches arising on the petrosal surface of the biventral lobule or
from the lateral part of the taenia to the peduncle of in the vein of the cerebellopontine fissure (Fig. 9J and
the flocculus. The flocculus is superior to the outer K). If it courses ventral to the flocculus, it passes
extremity of the lateral recess. between the flocculus and the foramen of Luschka and
The major veins in the cerebellomedullary fissure are joins the lateral medullary vein or the veins of the
the veins of the cerebellomedullary fissure and the inferior cerebellar peduncle or the pontomedullary sup
inferior cerebellar peduncle. 3 Both of these veins drain cus to form the vein of the middle cerebellar peduncle
into the cerebellopontine angle through the communi- (Fig. 9H and I). The vein of the cerebeUomedullary
cation between the cerebellomedullary and cerebello- fissure frequently connects with its mate on the opposite
pontine fissures. side through the transverse nodulouvular vein and/or
Vein of the Cerebellomedullary Fissure. This vein with the inferior vermian vein through the anastomotic
originates on the lateral edge of the nodule and uvula, lateral uvular vein (Fig. 11). The medial part of the vein
courses laterally near the junction of the inferior med- of the cerebeUomedullary fissure is sometimes hypo-
ullary velum and tela choroidea, and passes dorsal or plastic or absent.

FIG. 10. C."Enlarged anterosuperior view. The pontotrigeminal vein passes above the trigeminal nerve. The vein of the superior
cerebellar peduncle originates and anastomoses with the lateral mesencephalic and pontotrigeminal veins in the region of the
interpeduncular sulcus, courses medially across the peduncle, and then ascends to join its mate from the opposite side just rostral
to the lingula to form the vein of the cerebellomesencephalic fissure. The branch of the superior vermian vein, which courses
between the folia of the culmen, is referred to as the "intraculminate vein" (Intraculm. V.), and the vein which courses in the
sulcus between the culmen and the central lobule has been called the "preculminate vein" (Preculm. V.). D: Superior view. Part
of the culmen and central lobule has been removed on both sides. The veins of the superior cerebellar peduncle do not join but
ascend separately to form duplicate veins of the eerebellomesencephalic fissure (Dup. V. ofCer. Mes. Fiss.). On the left side, four
veins (the transverse pontine and pontotrigeminal veins, and the veins of the cerebellopontine fissure and middle cerebellar
peduncle) join to form one of the superior petrosal veins. The facial (VII) and vestibuloeoehlear (VIII) nerves on the right side are
inferolateral to the trigeminal nerve. The pontotrigeminal vein commonly arises from two stems as shown on the right side: one
that anastomoses superiorly with the lateral mesencephalic veins, and one that anastomoses medially with the vein of the superior
cerebellar peduncle.
Its tributaries drain the inferior medullary velum, the vein of the pontomedullary sulcus either directly or
tela choroidea and attached choroid plexus, periven- by first connecting with the lateral medullary vein. It
tricular white matter, dentate nuclei, anterior-inferior often receives the vein of the cerebeUomedullary fissure
surface of the biventral lobule, and the inferior vermis. near the lateral end of the pontomedullary sulcus. These
The largest and most constant tributary is the lateral veins, converging on the lateral end of the ponto-
supratonsillar vein. The medial supratonsillar vein usu- medullary sulcus, join to form the vein of the middle
ally drains into the medial part of the vein of the cerebellar peduncle. If the lateral medullary vein is
cerebellomedullary fissure if the latter is present. Most small, the vein of the inferior cerebellar peduncle passes
of the dentate veins course caudally to drain into the between the foramen of Luschka and the origin of the
lateral supratonsillar vein, but some drain into the glossopharyngeal and vagus nerves to join the vein of
medial supratonsillar vein. An infrequently occurring the pontomedullary sulcus after receiving the lateral
vein, the vein of the inferior medullary velum, origi- medullary vein. If the lateral medullary vein is large,
nates on either the internal or external surface of the the vein of the inferior cerebellar peduncle first drains
velum, and runs inferiorly and laterally to drain into into the lateral medullary vein near the origin of the
the lateral supratonsillar vein or the vein of the cere- vagus and accessory nerves, and the latter vein then
bellomedullary fissure. Huang and Wolf, 17 emphasizing joins the vein of the pontomedullary sulcus. The vein
the relationship of the vein of the cerebellomedullary of the inferior cerebellar peduncle drains the posterior
fissure to the lateral recess, called it the "vein of the and lateral aspects of the medulla, the tela choroidea,
lateral recess," although it courses constantly outside choroid plexus, the inferior part of the floor of the
the lateral recess. fourth ventricle, the lateral recess, and the glossophar-
Vein of the Inferior Cerebellar Peduncle. This vein yngeal and vagus nerves. This rostral part of the vein
courses on the restiform body parallel and several milli- often anastomoses with the inferior part of the sigmoid
meters caudal to the curved inferolateral margin of sinus through a bridging vein which passes along the
the fourth ventricle (Figs. 6, 8, and 11). Its caudal part rootlets of the vagus nerve.
is visible on the posterior surface of the medulla lateral Supratonsillar Veins. The supratonsillar veins
to the foramen of Magendie, but its superior portion is course in the cerebellomedullary fissure near the supe-
hidden in the cerebellomedullary fissure. Inferiorly, the rior pole of the tonsil (Figs. 6 and 1 l). The name
veins from each side join below the obex to form a "supratonsillar" suggests that these veins drain the ton-
single channel, the median posterior medullary vein. sil; however, they course on and drain the opposite side
Superiorly, it passes below the lateral recesses and joins of the cerebellomedullary fissure from the tonsil. They

FIG. 11. Veins of the tonsils and the cerebellomedul-

lary fissure. A: Posterior view. The cerebellomedullary
fissure (Cer. Med. Fiss.) extends superiorly between the
cerebellar tonsils and the medulla, dorsal to the caudal half
of the roof of the fourth ventricle (4V) and around the
superior poles of the tonsils. The glossopharyngeal (IX),
vagus (X), and accessory (XI) nerves pass from the medulla
toward the jugular foramen. The hypoglossal nerves (XII)
arise ventral to the vagus nerves. The medial posterior
medullary vein (Med. Post. Med. V.) ascends on the pos-
terior surface of the medulla and divides into the paired
veins of the inferior cerebellar peduncle (V. of Inf. Cer.
Ped.) which ascend on the surface of the inferior cerebellar
peduncles (Inf. Cer. Ped.). The right vein of the inferior
cerebellar peduncle crosses the peduncle and anastomoses
with the lateral posterior medullary vein (Lat. Post. Med.
V.), which gives rise to a bridging vein (Br. V.) that passes
laterally toward a marginal sinus (Mar. Sinus) in the dura
at the level of the foramen magnum.The left vein of the
inferior cerebellar peduncle gives rise to a bridging vein
which passes to the jugular bulb before ascending in the
cerebellomedullary fissure. The left inferior vermian vein
(Inf. Ve. V.) is formed on the posterior surface of the tonsil by the union of the superior (Sup. Retroton. V.) and inferior
retrotonsillar veins (Inf. Retroton. V.). A medial tonsillar vein (Med. Ton. V.) passes over the posterior surface of the right tonsil
toward the tonsillobiventral fissure (Ton. Bivent. Fiss.). The upper end of the dentate ligaments (Dent. Lig.) attaches to the dura
anterior to the accessory nerves. Inferior hemispheric veins (Inf. He. V.) cross the medial part of the hemispheres above the
tonsils. B: The right tonsil and the medial part of the biventral lobule have been removed to expose the structures along the
ventral wall of the cerebellomedullary fissure. These structures include the inferior medullary velum (Inf. Med. Vel.) and the tela
choroidea (Tela) which form the inferior half of the roof of the fourth ventricle and cover the lateral recesses (Lat. Recess). The
inferior medullary velum stretches from the lateral margin of the nodule of the vermis to the flocculus, and is all that remains of
the connection between the nodule and flocculus which forms the flocculonodular lobe of the primitive cerebellum. Choroid
plexus (Ch. PI.) protrudes from the foramen of Magendie (F. Magendie). The vein of the cerebellomedullary fissure (V. Cer. Med.
Fiss.) courses laterally across the inferior medullary velum and passes rostral to the flocculus to reach the cerebellopontine angle.
The lateral supratonsillar vein (Lat. Supraton. V.)joins the medial end of the vein of the cerebellomedullary fissure. The medial
supratonsillar vein (Med. Supraton. V.) courses along the margin of the uvula on the medial part of the inferior medullary velum.
The inferior vermian vein on the right is smaller than the one on the left but the most medial of the inferior hemispheric veins
on the right side is larger than usual. The inferior vermian veins ascend near the vermohemispheric fissures (Ve. He. Fiss.) toward
the torcula. C: The tonsils have been removed in another specimen to expose both veins of the cerebellomedullary fissure. The
choroid plexus protruding from the foramina of Luschka (F. Luschka) projects into the cerebellopontine angles below the flocculi
and dorsal to the glossopharyngeal and vagus nerves. The taeniae are small ridges at the site of attachment of the tela choroidea
to the inferolateral margins of the fourth ventricle. The rhomboid lips are a thickened layer of neural tissue which joins the tela
choroidea to form a pouch at the outer margin of the lateral recesses, through which the foramina of Luschka open into the
cerebellopontine angle. The vestibulocochlear nerves (VIII) enter the internal acoustic meati rostral to the flocculi. The lateral
supratonsillar veins course along the lateral margin of the inferior medullary velum, and the medial supratonsillar veins course
along the junction of the inferior medullary velum and the uvula. Both the medial and lateral supratonsillar veins on the left side
join the vein of the cerebellomedullary fissure. On the right side, the medial part of the vein of the cerebellomedullary fissure
which corresponds to the segment between the medial and lateral supratonsillar veins is absent, and the medial supratonsillar vein
joins the lateral uvular vein (Lat. Uvular V.). The lateral supratonsillar vein on the right side is larger than the one on the left side
and drains into the origin of the vein of the cerebellomedullary fissure. The lateral uvular vein ascends near the junction of the
uvula and inferior medullary velum to anastomose with the lateral supratonsiUar and the inferior vermian veins. Each tonsil is
attached to the remainder of the cerebellum by a bundle of white matter called the "tonsillar peduncle" (Ton. Ped.). Choroidal
veins (Ch. V.) drain the tela choroidea and choroid plexus.

F1G. 11. D." Enlarged view with part of the uvula removed
to show the nodulouvular vein (Nodulouvular V.) which passes
through the nodulouvular fissure. It interconnects the vein of the
cerebellomedullary fissure on the left side with the lateral uvular
vein and the inferior vermian vein on the right side. The stump
of the lateral tonsillar vein (Lat. Ton. V.) on the left side joins
the vein of the cerebellomedullary fissure. E: Enlarged view of
a vein of the cerebellomedullary fissure on the right side. The
medial part of the vein of the cerebellomedullary fissure, which
normally interconnects the medial and lateral supratonsillar
veins, is absent. The small medial supratonsillar vein joins the
lateral uvular vein and the larger lateral supratonsillar vein joins
the medial end of the vein of the cerebellomedullary fissure. The
vein of the cerebellomedullary fissure crosses the peduncle of the
flocculus (Ped. of Flocculus) and ascends rostral to the flocculus
to reach the cerebellopontine angle, where it joins the vein of the
cerebellomedullary fissure (V. ofCer. Pon. Fiss.). Several anterior
hemispheric veins (Ant. He. V.) enter the junction of the veins
of the cerebellomedullary and cerebellopontine fissures. The vein
of the inferior cerebellar peduncle ascends on the inferior cere-
bellar peduncle. The copular point (Copular Pt.), an angiographic landmark, is located where the retrotonsillar veins join the
inferior vermian vein and is usually located at the lateral part of the junction of the uvula and the pyramid. F: Enlarged view of
the area rostral to the flocculus where the vein of the cerebellomedullary fissure and two anterior hemispheric veins join the vein
of the cerebellopontine fissure.
originate in the deep nuclei and white matter of the choroidea (Figs. 2 and 3). Each paired fringe has a
cerebellum and drain the inferior half of the roof of the medial and a lateral segment. The medial segments are
fourth ventricle rather than the tonsil. The medial located in the roof near the midline, and extend anterior
supratonsillar vein courses inferiorly along the medial to the tonsils from the level of the nodule to the level
margin of the inferior medullary velum near the nodule, of the foramen of Magendie. The lateral segments are
and drains into the origin of the vein of the cerebel- attached to the rostral end of the medial segments and
lomedullary fissure. The lateral supratonsillar vein extend through the lateral recesses and foramina of
courses inferolaterally along the lateral margin of the Luschka into the cerebellopontine angles. The choroi-
inferior medullary velum and joins the midportion of dal veins drain the tela choroidea and the attached
the vein of the cerebellomedullary fissure. If the medial choroid plexus, and are tributaries of the veins of the
half of the vein of the cerebellomedullary fissure is cerebellomedullary fissure and the inferior cerebellar
hypoplastic or absent, the medial supratonsillar vein peduncle. The medial half of the vein of the cerebello-
drains into the lateral uvular vein which joins the infe- medullary fissure drains the rostral part of the medial
rior vermian vein, or it anastomoses with the proximal segment and the medial part of the lateral segment. The
part of the lateral supratonsillar vein along the dorsal lateral half of the vein of the cerebellomedullary fissure,
margin of the inferior medullary velum (Fig. I 1B to E). and the rostral part of the vein of the inferior cerebellar
peduncle drain the lateral part of the lateral segment.
Choroidal Veins. The choroid plexus of the poste- The caudal part of the vein of the inferior cerebellar
rior fossa is composed of paired inverted L-shaped peduncle receives the drainage of the caudal part of the
fringes that arise on the ventricular surface of the tela medial segment (Figs. 6 and 11).

FIG. 11. G, H, and/: Another specimen showing

the course taken by the vein of the cerebellomedullary
fissure in reaching the superior petrosal sinus. G: Both
tonsils have been removed. The vein of the cerebello-
medullary fissure courses rostral to the flocculus and
ascends above the facial (VII) and vestibulocochlear
nerves toward the left superior petrosal sinus. A dentate
vein (Dentate V.) joins the lateral supratonsillar vein.
The trigeminal nerve (V) crosses obliquely above the
facial nerve. A lateral medullary vein (Lat. Med. V.)
courses along the origin of the vagus and accessory
nerves. Choroidal veins draining the tela choroidea and
the choroid plexus join the vein of the cerebellomedul-
lary fissure. H: Oblique posterior view. The biventral
lobule has been retracted to expose the cerebellopontine
angle. The view of the cerebellomedullary fissure as-
cends rostra] to the flocculus in the inferior limb (Inf.
Limb) of the cerebellopontine fissure (Cer. Pon. Fiss.)
and joins several of the inferior group of anterior hem-
ispheric veins (Ant. He. V.-Inf.) to form the vein of the
cerebellopontine fissure which passes dorsal to the tri-
geminal and vestibulocochlear nerves and receives the
vein of the middle cerebellar peduncle (V. of Mid. Cer. Ped.) and the middle group of anterior hemispheric veins (Ant. He. V.-
Mid.) prior to entering the superior petrosal sinus (Sup. Petrosal Sinus) as one of the medial group of superior petrosal veins (Sup.
Petrosal V.-Med.). The vein of the pontomedullary sulcus (V. of Pon. Med. Sulc.) courses around the pontomedullary junction.
The middle cerebellar peduncle (Mid. Cer. Ped.) is above the flocculus. I: Anterosuperior view. The veins of the cerebellome-
dullary and cerebellopontine fissures ascend rostral to the flocculus and the facial and vestibulocochlear nerves, and join the
medial group of superior petrosal veins. The vein of the cerebellopontine fissure receives the pontotrigeminal (Pon. Trig. V.) and
anterior hemispheric veins, and the veins of the cerebellomedullary fissure and the middle cerebellar peduncle. A transverse
pontine vein (Trans. Pon V.) medial to the trigeminal nerve receives tributaries from the region of the pons, cerebral peduncle
(Ped.), and pontomesencephalic sulcus (Pon. Mes. Sulc.). A superior hemispheric vein (Sup. He. V.) enters a tentorial sinus (Tent.
Sinus). The abducens nerve (VI) ascends anterior to the pons. The vein of the petrosal fissure (V. of Petrosal Fiss.) drains into the
anterior hemispheric veins.
Cerebellopontine Fissure apex. The lateral recess and the foramen of Luschka
The cerebellopontine fissure is a V-shaped fissure open into the medial part of the inferior limb. Other
formed by the folding of the petrosal surface around structures located along the inferior limb are the floc-
the lateral side of the pons and the middle cerebellar culus, rhomboid lip, choroid plexus, and the glosso-
peduncle (Fig. 3). It has a superior limb between the pharyngeal and vagus nerves. The trigeminal nerve
rostral half of the middle cerebellar peduncle and the arises from the pons near the superior limb of the
superior part of the petrosal surface, and an inferior fissure. The superior limb of the cerebellopontine fis-
limb between the caudal half of the middle cerebellar sure communicates above the trigeminal nerve with the
peduncle and inferior part of the petrosal surface. The lateral part of the cerebellomesencephalic fissure, and
area between the superior and inferior limb, that is, the the inferior limb communicates with the lateral part of
lateral cerebellar incisura, has the middle cerebellar the cerebellomedullary fissure at the level of the lateral
peduncle in its floor. The apex of the fissure is located recess. The flocculus projects into the cerebellopontine
laterally where the superior and inferior limbs meet. angle at the confluence of the cerebellopontine and
The petrosal and postclival fissures also meet at the cerebellomedullary fissures. The vestibulocochlear and

TABLE 3
Summary of veins of the brain stem examined in 10 posteriorfossae*
Frequency Terminal
Name of Vein (% & Size Area of Origin Common Connecting Vein
no./total) (mm)t
median anterior pontomesen- 100% 0.4-1.5 midbrain& pons near midline veinof pontomesencephalic& pontomedullarysulci,
cephalic vein 10/10 (1.05) transverse pontine, peduncular, median anterior
medullary, & posterior communicatingveins
median anterior medullary 100% 0.4-1.2 medulla near midline median anterior pontomesencephalic& transverse
vein 10/10 (0.84) medullary veins, & vein of pontomedullary sulcus
lateral mesencephalicvein 100% 0.3-1.8 near medial geniculate body & basal, tectal, & pontotrigeminal veins, & vein of pon-
20/20 (0.72) along lateral mesencephalic tomesencephalicsulcus
sulcus
lateral medullary vein 95% 0.3-0.9 dorsolateral medulla veins of middle cerebellarpeduncle, pontomedullary
19/20 (0.56) sulcus, & inferior cerebellarpeduncle, & transverse
medullary veins
peduncular vein 100% 0.3-1.8 cerebralpeduncle basal, posteriorcommunicating, & median anterior
20/20 (0.88) pontomesencephalicveins
posterior communicating 90% 0.2-1.1 superomedialto origin of ocu- peduncular & median anterior pontomesencephalic
vein 9/10 (0.70) lomotornerve veins
vein of pontomesencephalic 90% 0.2-0.9 junctionof pons& midbrain median anterior pontomesencephalic,lateral mesen-
sulcus 18/20 (0.46) cephalic, & pontotrigeminal veins
transverse pontine vein 90% 0.4-1.6 bellyof pons median anterior pontomesencephalic& pontotrige-
18/20 (1.05) nfinal veins, veins of cerebellopontine fissure&
middle cerebellarpeduncle, & superior petrosal
veins & sinus
vein of pontomedullary 100% 0.3-1.1 junction of pons & medulla median anterior pontomesencephalic,median ante-
sulcus 20/20 (0.49) rior medullary & lateral medullaryveins, & vein of
middle cerebellarpeduncle
* Provides data from 20 of each of paired and 10 of midline unpaired venous structures.
t Range of sizes; the averagesize is given in parentheses.
facial nerves enter the brain stem anterosuperior to the surface of the middle cerebellar peduncle near the base
flocculus, and the ilia of the glossopharyngeal and the of the cerebellopontine fissure to reach the area poste-
vagal nerves cross anteroinferiorly to it. The major veins rior to the origin of the trigeminal nerve. It drains
arising in this region are the veins of the cerebellopon- directly into the superior petrosal sinus or joins other
tine fissure and the middle cerebellar peduncle. veins to form one of the c o m m o n trunks that drain
Vein o f the Cerebellopontine Fissure. This is the into the superior petrosal sinus. Its initial part passes
largest vein draining the petrosal surface. It is formed either between the flocculus and the origin of the ves-
just rostral or caudal to the flocculus by the union of tibulocochlear nerve or between the origins of the ves-
the stems of the inferior and middle group of anterior tibulocochlear and the facial nerves.
hemispheric veins (Figs. 6, 9, 11, and 12). It is longer if The vein of the middle cerebellar peduncle receives
the inferior and middle trunk of the anterior hemi- the drainage of the rostral half of the medulla, the
spheric veins join below rather than above the flocculus. inferior half of the fourth ventricle, and the lateral
It courses on the middle cerebellar peduncle rostral to surface of the pons. It often receives the drainage of the
the flocculus in or near the superior limb of the cere- veins of the cerebellomedullary fissure and inferior
bellopontine fissure, or on the superior part of the cerebellar peduncle, some of the transverse pontine
petrosal surface near the anterolateral margin. It crosses veins, and the veins draining the origins of the facial
the subarachnoid space rostral to the facial, vestibulo- and the vestibulocochlear nerves. It is large if the vein
cochlear, and trigeminal nerves, and drains into the of the cerebellomedullary fissure courses ventral to the
superior petrosal sinus either directly or after forming flocculus to join it rather than passing dorsal to the
a c o m m o n stem with other veins draining into the flocculus to join the anterior hemispheric veins or the
superior petrosal sinus. The vein of the middle cerebel- vein of the cerebellomedullary fissure.
lar peduncle and the pontotrigeminal vein often join
the vein of the cerebellopontine fissure to form one of Veins of the Brain Stem
the trunks that drain into the superior petrosal sinus The brain stem in the posterior fossa is composed of
near the trigeminal nerve. The vein of the cerebello- the mesencephalon, pons, and medulla (Table 3 and
medullary fissure, if it passes dorsal to the flocculus, Figs. 1 to 3). The mesencephalon consists of the cerebral
may drain into the vein of the cerebellopontine fissure. peduncles, the tegmentum, and the rectum. It is de-
Vein o f the Middle Cerebellar Peduncle. This vein marcated superiorly from the diencephalon by the sul-
originates in the supraolivary fossette by the union of cus between the optic tracts and the cerebral peduncles,
the vein of the pontomedullary sulcus with the lateral and inferiorly from the pons by the pontomesencephalic
medullary vein or the vein of the inferior cerebellar sulcus. The interpeduncular fossa, a wedge-shaped
peduncle (Figs. 6, 11, and 12). It ascends on the lateral depression between the cerebral peduncles, has the pos-

terior perforated substance in its floor. The rootlets of tomose rostrally with the medial end of the peduncular
the oculomotor nerves arise in the depths of the inter- veins and the lateral ends of the posterior communicat-
peduncular fossa and form the fossa’s walls lateral to ing vein. The small veins exiting the posterior perfo-
the posterior perforated substance. A small depression, rated substance often join this confluence. A bridging
the superior foramen cecum, is located in the caudal vein may arise in the interpeduncular fossa and pass to
part of the interpeduncular fossa. The pontomesence- the tentorial edge. The paired mesencephalic segments
phalic sulcus runs from the superior foramen cecum join several millimeters below the superior foramen
around the cerebral peduncles to join the lateral mes- cecum on the upper surface of the pons to form the
encephalic sulcus, a vertical sulcus between the tegmen- pontine segment. If the superior part of the ponfine
turn and the cerebral peduncles. segment is absent, the mesencephalic segment divides
The belly of the pons is convex from side to side, as to connect inferiorly with the lateral anterior ponto-
well as from top to bottom, and is continuous on each mesencephalic vein or the vein of the pontomesence-
side with the middle cerebellar peduncles. It has a phalic sulcus.
shallow midline groove, the basilar sulcus, which ex- The pontine segment, which connects caudally with
tends from its superior to its inferior border. The pos- the median anterior medullary vein and the vein of the
terior root of the trigeminal nerve emerges from the pontomedullary sulcus, is subdivided into superior,
upper portion of the middle cerebellar peduncle just middle, and inferior parts. One of the three parts is
below the anterior angle of the cerebellum. The pons is usually absent. If the superior portion is absent, the
demarcated inferiorly from the medulla by the ponto- middle portion anastomoses superiorly with a trans-
medullary sulcus which extends laterally from the in- verse pontine vein, and the caudal part is continuous
ferior foramen cecum (a midline dimple) to the supra- inferiorly with the median anterior medullary vein. If
olivary fossette (a depression located rostral to the the middle part is absent, the caudal end of the superior
olive). The rootlets of the facial and the vestibulococh- part and the cranial end of the inferior part anastomose
lear nerves arise superior to this fossette and the rootlets with the transverse pontine or the lateral anterior pon-
of the glossopharyngeal and the vagal nerves originate tomesencephalic veins. The pontine segment may de-
dorsal to it. viate to one side away from the basilar sulcus, especially
The medulla has paired elongated elevations, the if the transverse pontine vein gives rise to a large
pyramids, on its ventral surface which are separated in bridging vein to a petrosal sinus.
the midline by the anterior median fissure. Smooth oval
Median Anterior Medullary Vein. This vein courses
elevations lateral to the pyramids, the olives, are sepa-
in the median anterior medullary fissure between the
rated from the pyramids by the anterolateral (preoli-
medullary pyramids (Figs. 6 and 12). It connects supe-
vary) sulci. The rootlets of the hypoglossal nerves arise
riorly with the median anterior pontomesencephalic
in the anterolateral sulci. The posterolateral (retro-
vein and the vein of the pontomedullary sulcus at the
olivary) sulci on the dorsal margin of the olives give
level of the inferior foramen cecum, and inferiorly with
rise to the accessory nerves and are continuous cranially
the anterior spinal vein. It may join the lateral anterior
with the supraolivary fossettes. The abducens nerves pontomesencephalic vein rostrally if the inferior part of
emerge from the pontomedullary sulcus rostral to the
the median anterior pontomesencephalic vein is absent.
pyramids. A bridging vein may connect the median anterior med-
The veins of the brain stem are divided into two ullary vein with the sinuses around the jugular foramen.
groups based on whether they course longitudinally or
transversely (Fig. 12). The longitudinal veins are the Lateral Anterior Pontomesencephalic Vein. This
median anterior pontomesencephalic, median anterior vein on the anterolateral aspect of the brain stem is
medullary, lateral anterior pontomesencephalic, lateral rarely continuous from the midbrain to the lower pons
anterior medullary (preolivary), lateral mesencephalic, (Figs. 6 and 12). At the mesencephalic level it may
lateral medullary, and retro-olivary veins. The trans- anastomose with the basal and peduncular veins and
verse veins are the veins of the pontomesencephalic and the vein of the pontomesencephalic sulcus, and at the
the pontomedullary sulci, and the transverse pontine, pontine level it anastomoses with the transverse pontine
transverse medullary, peduncular, and posterior com- veins. Caudally, it joins the vein of the pontomedullary
municating veins. sulcus near the abducens nerve. It deviates medially to
connect with the median anterior pontomesencephalic
Longitudinal Veins or the median anterior medullary veins, if the lower
Median Anterior Pontomesencephalic Vein. This part of the median anterior pontomesencephalic vein is
vein runs in or near the midline on the anterior surface absent. It may give rise to a bridging vein to the inferior
of the mesencephalon and the pons (Figs. 6, 9, and 12). petrosal sinus.
It has a mesencephalic segment which courses in the Lateral Anterior Medullary Vein (Preolivary Vein).
interpeduncular fossa, and a pontine segment which This vein courses in the anterolateral sulcus between
runs in or adjacent to the basilar sulcus. The mesence- the pyramid and the olive, and is partly hidden by the
phalic segment of this vein is usually composed of the roots of the hypoglossal nerve (Figs. 6 and 12). Only
two veins, which are frequently asymmetrical in size half of the specimens studied coursed along the entire
and course near the oculomotor nerves on the lateral lateral border of the pyramid. It connects superiorly
walls of the interpeduncular fossa. They usually anas- with the vein of the pontomedullary sulcus and inferi-

orly with the lateral medullary or transverse medullary the rostral ends of the median anterior pontomesence-
vein. The median and lateral anterior medullary veins phalic veins (Figs. 6 and 12). It usually courses in the
are linked together by the transverse medullary veins interpeduncular cistern, bridging over rather than
which cross the pyramids at various levels. coursing on the floor of the interpeduncular fossa. Small
veins exiting the interpeduncular fossa frequently join
Lateral Mesencephalic Vein. This vein runs in or
the posterior communicating vein.
adjacent to the lateral mesencephalic sulcus, and usually
drains into the basal vein near the medial geniculate Vein of the Pontomesencephalic Sulcus. This vein
body (Figs. 5, 6, and 10). It drains the posterolateral is usually small, and does not extend the entire length
aspect of the midbrain and sometimes receives a branch of the pontomesencephalic sulcus from the superior
from the quadrigeminal plate. Its inferior end is located foramen cecum to the lateral mesencephalic sulcus
near the junction of the lateral mesencephalic, ponto- (Figs. 5, 6, and 12). It passes below the oculomotor
mesencephalic, and the interpeduncular sulci, where it nerves and anastomoses with the median and lateral
anastomoses with the pontotrigeminal vein and the vein anterior pontomesencephalic veins in most cases. The
of the pontomesencephalic sulcus. It sometimes receives lateral mesencephalic and pontotrigeminal veins may
a superior hemispheric or tectal vein. 2’52 anastomose with the lateral end of this vein near the
Lateral Medullary and Retro-Olivary Veins. confluence of the pontomesencephalic, lateral mesen-
There are usually two longitudinal veins between the cephalic, and interpeduncular sulci.
lateral border of the olive and the foramen of Luschka Transverse Pontine Veins. This is a group of veins
(Figs. 6 and 12): a smaller ventral vein (the retro-olivary that cross the anterior surface of the pons at various
vein), and a larger dorsal vein (the lateral medullary levels (Figs. 6, 9, and 12). They interconnect the median
vein). The lateral medullary vein courses slightly dorsal anterior pontomesencephalic vein and the veins on the
to the retro-olivary sulcus along the rootlets of the lateral surface of the pons. The most prominent trans-
accessory, vagus, and glossopharyngeal nerves. It re- verse pontine veins are located at the midpons. Those
ceives the retro-olivary vein from its ventral side and on the upper and lower thirds of the pons are usually
the vein of the inferior cerebellar peduncle from its small and only infrequently transverse the full width of
dorsal side, and joins the vein of the pontomedullary the pons. Those on the midpons are usually present
sulcus in the supraolivary fossette to form the vein of bilaterally, and anastomose medially with the median
the middle cerebellar peduncle. This vein and the vein anterior pontomesencephalic vein; they course laterally
of the inferior cerebellar peduncle often give rise to a above or below the trigeminal nerve to drain into the
bridging vein (the vagal vein) near the foramen of superior petrosal sinus, the pontotrigeminal vein, or the
Luschka, which courses along the rootlets of the vagal veins of the cerebellopontine fissure or the middle cer-
nerve and joins the venous sinuses around the jugular ebellar peduncle. They sometimes give rise to a bridging
foramen. vein to the inferior petrosal sinus. If the middle third of
The retro-olivary vein usually courses along the ros- the median anterior pontomesencephalic vein is absent,
tral two-thirds of the retro-olivary sulcus slightly ventral the ends adjoining the absent segments drain into the
to the lateral medullary vein. Although small, it may transverse pontine veins.
rarely replace the lateral medullary vein. It often anas-
tomoses near the lower edge of the olive with the caudal Vein of the Pontomedullary Sulcus. This vein
part of the lateral medullary vein and in the supraoli- courses in or near the pontomedullary sulcus from the
vary fossette with either the vein of the pontomedullary inferior foramen cecum to the supraolivary fossette and
sulcus or the rostral end of the lateral medullary vein. connects with the longitudinally oriented veins on the
anterior aspect of the pons and medulla. After reaching
the supraolivary fossette, it joins the lateral medullary,
Transversely Oriented Veins or retro-olivary veins or the vein of the inferior cere-
Peduncular Vein. This vein arises in the interpedun- bellar peduncle to form the vein of the middle cerebellar
cular fossa and courses laterally around the cerebral peduncle (Figs. 6, 9, and 12). It may give rise to a
peduncle below the optic tract toward the basal vein bridging vein to the sinuses around the jugular foramen.
(Figs. 5, 6, and 12). It anastomoses medially with the
Transverse Medullary Veins. These veins cross the
posterior communicating vein, which links the medial
anterior and lateral surfaces of the medulla at the level
ends of the peduncular veins, and with the upper end
of the medullary pyramid or below. They interconnect
of the median anterior pontomesencephalic vein. Its
the median anterior medullary vein with the veins on
medial end is located on the superomedial surface of
the lateral surface of the medulla. They rarely cross the
the origin of the oculomotor nerve. The lateral end of
full distance from the median anterior medullary vein
the vein drains into the basal vein or one of its tribu-
to the lateral medullary vein, but usually consist of one
taries. In a few cases it drains through a bridging vein
or two shorter veins passing transversely across the
into a sinus in the edge of the tentorium (Fig. 13E).
medullary pyramid or the olive. The largest transverse
Posterior Communicating Vein. This vein courses medullary veins are usually situated at the level of the
transversely across the interpeduncular fossa on the middle one-third of the pyramid. They sometimes give
superomedial surface of the oculomotor nerves, inter- rise to a bridging vein to the sigmoid or marginal
connecting the medial ends of the peduncular veins and sinuses.

FIG. 12. Veins of the brain stem. A: Anterior view

of the midbrain, pons, and medulla.The oculomotor nerves
(III) arise between the cerebral peduncles (Ped.) near the
pontomesencephalic sulcus (Pon. Mes. Sulc.). The trigem-
inal nerves (V) arise from the midpons. The abducens
nerves (VI) arise from the medial part of the pontomedul-
lary sulcus (Pon. Med. Sulc.) and the facial (VII) and
vestibulocochlear (VIII) nerves arise at the lateral ends of
the pontomedullary sulcus above the foramina of Luschka
(F. Luschka). The hypoglossal nerves (XII) arise anterior
to the olives, and the glossopharyngeal (IX), vagus (X),
and accessory (XI) nerves arise posterior to the olives. The
flocculi are attached to the brain stem dorsal to the vestib-
ulocochlear nerves along the rostral margins of the fora-
mina of Luschka. Choroid plexus (Ch. P1.) protrudes from
the foramina of Luschka below the facial nerves and dorsal
to the glossopharyngeal and vagus nerves. The peduncular
veins (Ped. V.) arise in the interpeduncular fossa and passes
laterally to join the basal veins (Bas. V.) which encircle the midbrain. The posterior communicating vein (Post. Com. V.)
interconnects the peduncular veins and passes above the oculomotor nerves. The longitudinally oriented veins in the midline are
the median anterior medullary vein (Med. Ant. Med. V.), which ascends on the medulla, and the median anterior pontomesen-
cephalic vein (Med. Ant. Pon. Mes. V.), which ascends in the midline on the pons and midbrain. The median anterior
pontomesencephalic vein does not extend the full length of the pons but joins the transverse pontine vein (Trans. Pon. V.) at its
caudal margin. The transverse pontine veins converge on the area rostral or caudal to the trigeminal nerves and join other veins
to form some of the superior petrosal veins (Sup. Petrosal. V.). The latter are the group of veins that enter the superior petrosal
sinus. The transversely oriented veins coursing in the sulci between the subdivisions of the brain stem are the veins of the
pontomesencephalic (V. of Pon. Mes. Sulc.) and the pontomedullary sulci (V. of Pon. Med. Sucl.). Each vein of the middle
cerebellar peduncle (V. of Mid. Cer. Ped.) arises in the region of the foramen of Luschka near the flocculus and ascends on the
middle cerebellar peduncle (Mid. Cer. Ped.) to join the vein of the cerebellopontine fissure (V. of Cer. Pon. Fiss.) or one of the
superior petrosal veins. Each vein of the cerebellopontine fissure passes from caudolateral to rostromedial where it joins a superior
petrosal vein. A lateral anterior medullary vein (Lat. Ant. Meal. V.) courses along the preolivary sulcus near the hypoglossal nerve.
A bridging vein (Br. V.) passes ventral to the right vagus nerve. B: Another brain stem showing the marked variation from the
venous pattern shown in A. There are interconnecting median anterior medullary and median anterior pontomesencephalic veins
which ascend along the midline from the medulla to the midbrain. A lateral anterior pontomesencephalic vein (Lat. Ant. Pon.
Mes. V.) courses on the pons above the trigeminal nerve. Numerous transverse pontine and transverse medullary veins (Trans.
Med. V.) are present. The superior petrosal veins that enter the superior petrosal sinus medial to the level of the internal acoustic
meatus form the medial group of superior petrosal veins (Sup. Petrosal V.-Med.), and those lateral to it form the lateral group of
superior petrosal veins (Sup. Petrosal V.-Lat.). Some of the anterior hemispheric veins (Ant. Hem. V.), draining the left petrosal
surface of the cerebellum, converge on the middle cerebellar peduncle and cerebellopontine fissure to form the vein of the
cerebellopontine fissure, which also receives the vein of the middle cerebellar peduncle. A bridging vein passes along the right
vagus nerve. C." Enlarged view of the region of the right lateral recess, foramen of Luschka, and pontomedullary sulcus in
another specimen. The facial and vestibulocochlear nerves arise rostml to the foramen of Luschka and the glossopharyngeal and
vagus nerves, which have been reflected ventrally, arise dorsal to the olive anterior to the foramen of Luschka. The petrosal fissure
(Petrosal Fiss.) extends laterally from the apex formed where the superior (Sup. Limb) and inferior limbs (Inf. Limb) of the
cerebellopontine fissure (Cer. Pon. Fiss.) meet. The anterior hemispheric veins join at the apex of the cerebellopontine fissure to
form the vein of the cerebellopontine fissure, which ascends near the superior limb of the cerebellopontine fissure to reach the
superior petrosal sinus. The vein of the cerebellopontine fissure receives the vein of the middle cerebellar peduncle. The vein of
the inferior cerebellar peduncle (V. of Inf. Cer. Ped.) ascends to join a bridging vein which enters the inferior petrosal sinus and
thus is called an inferior petrosal vein (Inf. Petrosal V.). The veins coursing along the anterior and posterior margin of the olive,
the preolivary (Pre-olivary V.) and retro-olivary veins (Retro-olivary V.), course among the nerve rootlets arising adjacent to the
olive.

FIG. 12. D: The anterior surface of the pons is drained

predominantly by veins which pass longitudinally on the
anterolateral surface rather than in the midline. The ten-
torium (Tent.) between the temporal lobe (Temp. Lobe)
and the cerebellum has been preserved. The optic nerves
(Optic N.) join the optic chiasm (Chiasm). The pituitary
stalk (Stalk) and the mammillary bodies (Mam. Body) are
in the interval between the optic tracts (Optic. Tr.) and the
oculomotor nerves. The basal vein courses medial to the
temporal lobe and the parahippocampal gyrus (Parahippo.
Gyr.). The left peduncular vein anastomoses medially with
the vein of the pontomesencephalic sulcus and laterally
with the basal vein. The paired veins of the cerebellopon-
tine fissure are the largest veins crossing the pons. A
rudimentary median anterior pontomesencephalic vein is
on the lower pons. A bridging vein passes along the left
vagus nerve. The olfactory nerves (Olf. N.) pass below the
frontal lobes (Fr. Lobe). The trochlear nerves (IV) pass
below the medial edge of the tentorium. E: Enlarged view
of the pontomesencephalic junction and the inferior sur-
face of the diencephalon. There are diffuse anastomoses
between the veins ventral to the diencephalon and third ventricle and those draining the midbrain and pons. The deep middle
cerebral (Deep Mid. Cer. V.) and the anterior cerebral veins (Ant. Cer. V.) join the basal vein in the region of the anterior
perforated substance (Ant. Perf. Subst.). The veins of the cerebellopontine fissure pass near the trigeminal nerves, and toward the
superior petrosal sinuses. Each gyrus rectus (Gyr. Rectus) is medial to the olfactory nerve. The pituitary stalk arises from the tuber
cinereum (Tuber). F: Enlarged view of the region of the mammillary bodies. The posterior communicating vein interconnects
the two peduncular veins in the midline just rostral to the oculomotor nerves. The veins draining the Sylvian fissures and anterior
perforated substance interconnect through the basal veins with the veins draining the diencephalon and midbrain. The interpe-
duncular fossa (Interped. Fossa) between the oculomotor nerves has the posterior perforated substance (Post. Perf. Subst.) in its
base. The premammillary veins (Premam. V.) drain into the basal vein.
Major DrainingGroups and the superior half of the roof of the fourth ventricle;
The terminal end of the veins draining the brain stem the petrosal group drains the petrosal surface, the cere-
and cerebellum form bridging veins that collect into bellomedullary and cerebellopontine fissures, the infe-
three groups: 1) a galenic group which drains into the rior half of the roof of the fourth ventricle and the
vein of Galen; 2) a petrosal group which drains into the lateral recesses, and the anterior and lateral sides of the
petrosal sinuses; and 3) a tentorial group which drains pons and medulla; and the tentorial group drains the
into the sinuses converging on the torcula (Tables 4 and suboccipital surface. Other less frequent bridging veins
5 and Figs. 3 to 13). The galenic group drains the pass to the cavernous, marginal, basilar, and sigmoid
tentorial surface, the cerebellomesencephalic fissure, sinuses and the jugular bulb.

FIG. 13. Bridging veins. A: Posterior view. Anterior

wall of the posterior cranial fossa after removing the cere-
bellum and brain stem. The tentorium was removed by
dividing it along the petrous ridge just posterior to the
middle cranial fossae (Mid. Fossa). Each trigeminal nerve
(V) enters Meckers cave. The trochlear nerves (IV) course
within the medial edge of the tentorium (Tent. Edge). The
medial edges of the tentorium extend forward lateral to
the oculomotor nerves (III) to attach to the posterior
clinoid processes (Post. Clin. Process) in the area lateral to
the internal carotid arteries (Int. Car. A.). The facial (VII)
and vestibulocochlear (VIII) nerves enter the internal
acoustic meati (Acoustic Meatus). The glossopharyngeal
(IX), vagus (X), and accessory (XI) nerves enter the jugular
foramina. The abducens nerves (VI) enter the dura cover-
ing the clivus. The hypoglossal nerves (XII) enter the
hypoglossal canals. A bridging vein (Br. V.) passes with the
left trigeminal vein into Meckel’s cave, before entering the
superior petrosal sinus. Another bridging vein enters the
inferior petrosal sinus inferomedial to the right trigeminal
nerve. Two bridging veins join the right jugular bulb, one
above the glossopharyngeal nerve, and one lateral to the vagus nerve. Another bridging vein enters the left jugular bulb below the
accessory nerve. B: Left side of the posterior cranial fossa in another specimen. Two bridging veins, one on each side of the
trigeminal nerve, enter the dura and pass to the superior petrosal sinus. Two other bridging veins enter the jugular bulb near the
glossopharyngeal and accessory nerves. The vertebral artery (Vert. A.)-enters the dura anterior to the upper attachment of the
dentate ligament (Dentate Lig.). The medulla was divided at the level of the foramen magnum. The subarcuate fossa (Sup. Arc.
Fossa) is superolateral to the acoustic meatus. C." Posterior view of the medulla and right jugular foramen. The biventral lobule
and tonsil have been elevated to expose the right lateral recess (Lat. Recess) and the facial and vestibulocochlear nerves. The vein
of the inferior cerebellar peduncle (V. of Inf. Cer. Ped.) on the right side gives rise to a bridging vein which courses posterior to
the vagus nerve to enter the jugular bulb at the jugular foramen. Another bridging vein arises on the lower medulla from the
median posterior medullary vein (Med. Pos. Med. V.) and passes posterior to the hypoglossal and accessory nerves to enter a
marginal sinus (Marg. Sinus) in the dura at the level of the foramen magnum. Choroid plexus (Ch. P1.) protrudes from the fourth
ventricle (4V).
Galenic Draining Group veins; the deep group includes the vein of the cerebel-
This group formed by the veins converging on the lomesencephalic fissure and the paired veins of the
vein of Galen includes the superficial veins which drain superior cerebellar peduncle; and the brain-stem group
the tentorial surface, the deep veins which drain the includes the peduncular, posterior communicating, and
superior part of the roof of the fourth ventricle and the tectal veins and the rostral portions of the medial and
cerebellomesencephalic fissure, and the brain stem lateral anterior pontomesencephalic and the lateral
veins which drain the midbrain) ~ Most of these veins mesencephalic veins. All of these brain-stem veins,
drain through the superior vermian and basal veins to except for the tectal vein, join the basal vein which
reach the vein of Galen (Figs. 4 to 6 and 10). The drains into the vein of Galen. The tectal veins join the
superficial group includes the superior vermian vein superior vermian vein or the vein of the cerebello-
and the anterior group of the superior hemispheric mesencephalic fissure.

FIG. 13. D: Anterior view. The skull and

dura anterior to the pons and medulla were
removed to provide this exposure of the brain
stem and right cerebellopontine angle. The me-
dian anterior medullary vein (Med. Ant. Med.
V.) and the lateral (Lat. Ant. Pon. Mes. V.) and
medial anterior pontomesencephalic veins (Med.
Ant. Pon. Mes. V.) are on the anterior surface of
the pons and medulla. The vein of the ponto-
medullary sulcus (V. of Pon. Med. Sulc.) courses
at the j.unction of the pons and medulla. A bridg-
ing vem passes from the pontomedullary junc-
tion anterior to the vagus nerve to the inferior
petrosal sinus above the jugular foramen. The
bridging veins entering the inferior petrosal sinus
are called inferior petrosal veins (Inf. Petrosal
V.). The facial nerve is anterior to the vestibulocochlear nerve. The vein of the middle cerebellar peduncle (V. of Mid. Cer. Ped.)
ascends on the middle cerebellar peduncle anterior to the flocculus and posterior to the vestibulocochlear nerve. E: Superior
view of the midbrain and tentorial incisura. A bridging vein arises between the cerebral peduncles (Ped.) at the junction of the
median anterior pontomesencephalic (Med. Ant. Pon. Mes. V.), posterior communicating (Post. Com. V.), and the peduncular
veins (Ped. V.), and passes forward above the posterior cerebral (P.C.A.) and posterior communicating arteries (Post. Com. A.) to
enter the roof of the cavernous sinus near the tentorial edge. The basal (Bas. V.), internal occipital (Int. Occ. V.), internal cerebral
(Int. Cer. V.), and pineal veins (Pineal V.) are posterior to the midbrain. The basilar artery (Bas. A.) ascends anterior to the
midbrain and bifurcates into the posterior cerebral arteries just above the origin of the superior cerebellar arteries (S.C.A.). The
pituitary stalk (Stalk) was divided in removing the cerebral hemispheres. The optic nerves (Optic N.) are anterior to the internal
carotid arteries. The posterior part of the third ventricle (3V) is below the pineal body (Pineal) and posterior commissure (Post.
Comm). F." Superior view. A bridging vein arises anterior to the cerebral peduncle and passes forward to enter a tentorial sinus
(Tent. Sinus) which crosses the tentorium (Tent.) to drain into the superior petrosal sinus (Sup. Petrosal Sinus). The oculomotor
nerve passes forward between the posterior cerebral and superior cerebellar arteries and enters the dura just posterior to the
internal carotid artery. The mammillary bodies (Mam. Body) are above the bifurcation of the basilar artery.
Tentorial Draining Group

and superior vermian veins. The inferior hemispheric
The tentorial draining group includes the veins that veins and the posterior group of the superior hemi-
drain into the straight and lateral sinuses and the tor- spheric veins often join before entering the tentorial
cula, either directly or through a tentorial sinus (Figs. sinuses, which drain into the torcula or into the straight
4, 6, and 7). It is composed of the superficial veins or lateral sinuses near the torcula.
draining the suboccipital surface and the posterior part The tentorial sinuses also receive the inferior cerebral
of the tentorial surface. The veins from the suboccipital veins, the vein of Labbr, and the bridging veins to the
surface include the inferior vermian veins and the su- tentorial edge. The tentorial sinuses can course directly
peromedial and inferomedial groups of inferior hemi- medially to drain into the midportion of the straight
spheric veins. The veins from the tentorial surface sinus, posteromedially to drain into the torcula or the
include the posterior groups of superior hemispheric straight or lateral sinus near the torcula, immediately
J. Neurosurg. / Volume 59 / July, 1983 101

TABLE 4 veins of the cerebellopontine fissure and the middle
Superior petrosal veins: distance from selected points to cerebeUar peduncle. The superior petrosal veins are
entrance into superior petrosal sinus (mm) subdivided into a lateral, intermediate, and medial
Type of Petrosal Vein group based on the relationship of their site of entry
SelectedPoint* into the superior petrosal sinus to the internal acoustic
Medial Inter- Lateral
mediate meatus. The intermediate group drains into the sinus
above the internal acoustic meatus; the medial group
center of Meckel’s 2.0 medial-9.0lat- 7.5-13.0 14.0-26.0 drains into the sinus medial to the meatus, and the
cave eral (4.4 lateral) (10.5) (19.1)
entranceto tro- 2.3 medial-19.0lat- 17.0-19.0 20.0-34.0 lateral group drains into the sinus lateral to the meatus
chlear nerve eral (12.0 lateral) (17.8) (26.4) (Table 4). Of 20 superior petrosal sinuses examined,
into dura eight received one superior petrosal vein, 10 received
tip of posteriorcli- 12.5-32.0 (26.3) 30.0-34.0 36.0-51.0 two, and two received three. Of the 34 superior petrosal
noid process (31.7) (40.6)
veins, 22 (64.7%) were of the medial type, three (8.8%)
* All measurements(in mm) are lateralto this point unlessother- were of the intermediate type, and nine (26.5%) were
wise specified. Measurementsare given as ranges, with averages in
parentheses. of the lateral type. Nineteen of 20 (95%) sinuses ex-
amined had veins of the medial type, three (15%) had
veins of the intermediate type, and nine (45%) had
posteriorly to drain into the middle one-third of the veins of the lateral type. The medial group of superior
lateral sinus, or posterolaterally to drain into the lateral petrosal veins is usually a common trunk formed by
and superior petrosal sinuses at or near the confluence the union of two or three of the following veins: trans-
of the two sinuses. Some sinuses were formed by the verse pontine veins, pontotrigeminal veins, and the
union of veins draining the tentorium itself.~ veins of the cerebellopontine fissure and the middle
cerebellar peduncle. The latter veins may also enter the
Petrosal Draining Group sinus without joining another vein. Two of the three
intermediate superior petrosal veins were formed by a
The petrosal draining group includes the veins
single vein, the vein of the cerebellopontine fissure. The
draining into the petrosal sinuses2~ (Table 4 and Figs.
most common veins in the lateral group are the com-
4, 9, and 12). This draining group includes the superfi-
mon stem formed by the union of superior and inferior
cial veins which drain the lateral part of the cerebellar
hemispheric veins and the vein of the cerebellopontine
hemisphere; a deep group which drains the cerebello-
fissure.
pontine and cerebellomedullary and the lateral part of
the cerebellomesencephalic fissures, and the inferior Other Bridging Veins
part of the roof and the lateral wall of the fourth
ventricle; and a brain-stem group which drains much The major bridging veins have been discussed above
of the brain stem. The cortical group includes the lateral (Table 5 and Fig. 13). Other less frequent bridging veins
group of the superior hemispheric veins, the supero- ran from the basal vein to a sinus coursing in the
lateral and inferolateral group of inferior hemispheric tentorial edge; from the peduncular vein to a sinus in
veins, and the anterior hemispheric veins. The deep the tentorial edge or the cavernous sinus; from the
group includes the pontotrigeminal and the lateral mes- lateral or medial anterior pontomesencephalic or a
encephalic veins, which are related to the lateral portion transverse pontine vein to the posterior portion of the
of the cerebellomesencephalic fissure; it also includes cavernous or the adjoining part of the inferior petrosal
the veins of the cerebellomedullary fissure and the sinuses just below Meckel’s cave; from the veins of the
inferior cerebellar peduncle, which course toward the pontomedullary sulcus and the inferior cerebellar pe-
cerebellopontine angle to join the veins of the cerebel- duncle or the lateral medullary vein along the glosso-
lopontine fissure and middle cerebellar peduncle which pharyngeal and vagus nerves to the sigmoid and inferior
ascend to the superior petrosal sinus. The lateral mes- petrosal sinuses near the jugular foramen or to the
encephalic vein also forms a part of the galenic draining jugular bulb; from the vein of the pontomedullary
group because it drains into the basal vein rostrally. sulcus, and the lateral anterior, lateral, and transverse
The brain-stem group includes most of the veins related medullary veins to a marginal sinus at the level of the
to the anterior and lateral aspect of the brain stem. foramen magnum or to the veins in the hypoglossal
The petrosal veins are divided into superior and canal which communicates with the marginal sinuses.
inferior petrosal veins based on whether they enter the The bridging vein which courses along the glossopha-
superior or inferior petrosal sinus. The superior petrosal ryngeal and vagus nerves has been called the glosso-
veins are among the largest and most frequent veins in pharyngeal or the vagal vein.
the posterior fossa. The inferior petrosal veins are rep-
resented by a few small bridging veins. The superior Discussion
petrosal veins may be formed by the terminal segment The infrequent reports of adverse sequelae following
of a single vein or by the common stem formed by the the intraoperative occlusion of veins in the posterior
union of several veins. The most common tributaries fossa is probably due to the diffuse anastomosis between
of the superior petrosal veins are the transverse pontine the veins. It is not surprising that more severe sequelae
and pontotrigeminal veins, the common stem of the have occurred after occlusion of bridging veins than
lateral group of the superior hemispheric veins, and the after occlusion of veins on the surface of the cerebellum,
TABLE 5
Summary of bridging veins to sinuses near clivus in 10 cadavers
Present
Site of Terminationon Clivus Vein of Origin of BridgingVein*
No. Percent
junction cavernous& inferiorpetrosal sinuses 3 12.5 transverse pontine vein (3)
inferior petrosal sinus near jugular foramen 2 8.3 vein of pontomeduUarysulcus (2)
lateral anterior medullaryvein (1)
inferior part of sigmoid sinus 9 37.5 lateral medullaryvein (7)
vein of inferiorcerebellarpeduncle(5)
vein of pontomedullarysulcus (2)
vein of cerebellomedullaryfissure(1)
transverse medullaryvein (1)
marginal sinus around foramen 10 41.7 vein of pontomedullarysulcus (1)
transverse medullaryvein (2)
lateral anterior medullaryvein (2)
lateral medullaryvein (3)
lateral posteriormedullaryvein (1)
medial posteriormedullaryvein (1)
* Some bridgingveins arose from the confluenceof two or three veins. Numbers in parenthesesindicate the number of specimenswith this
origin.
since the bridging veins are formed by the terminal end of superior petrosal veins; however, we have seen two
of numerous surface veins. The veins crossing the cer- patients with a transient cerebeUar disturbance due to
ebellopontine angle to reach the petrosal sinuses are the a venous infarction with hemorrhagic edema following
ones most frequently occluded in the course of opera- the intraoperative occlusion of these veins lateral to the
tions in the posterior fossa. Bridging veins are more trigeminal nerve.
frequently exposed and sacrificed in the rostral part of The exposure of lesions such as acoustic neuromas
the cerebellopontine angle during operations near the in the central part of the cerebellopontine angle near
trigeminal nerve than during operations in the central the lateral recess, by retracting the petrosal surface of
or caudal part near the nerves entering the internal the hemisphere away from the sigmoid sinus, can usu-
acoustic meatus and the jugular foramen. Exposure of ally be completed without sacrificing a single bridging
the trigeminal nerve through a suboccipital craniectomy vein. If a vein is obliterated during acoustic tumor
commonly requires the sacrifice of one or more bridging removal, it is usually one of the superior petrosal veins
veins, while exposure of the nerves entering the internal which is sacrificed near the superior pole of the tumor
acoustic meatus infrequently requires sacrifice of even during the later stages of the removal of a large tu-
a single bridging vein. mor. 26’31’32Smaller tumors can often be removed with-
In 1929, Dandy, 7 pointed out that the petrosal vein out sacrificing a petrosal vein. The large vein encoun-
should receive special attention during posterior fossa tered around the superior pole of an acoustic neuroma
operations on the trigeminal nerve. His illustration is the vein of the cerebellopontine fissure, which passes
showed a vein which coursed in the cerebellopontine from the petrosal surface and cerebellopontine fissure
angle near the rostral aspect of the trigeminal nerve to above the facial and vestibulocochlear nerves to the
drain into the superior petrosal sinus. Later, this com- area above the trigeminal nerve. This vein has been
mon stem came to be known either as the superior occluded during acoustic neuroma removal without
petrosal vein, or simply as the petrosal vein. 5"6’33’45’46No causing a deficit. 25’26
consideration has been given in the surgical literature Compression of the trigeminal nerve by the sur-
to the identification of the trunks which unite to form rounding veins is postulated to be a cause of trigeminal
the petrosal veins, and to the size of the area drained neuralgia.3’12’23 In 41 1 operations for trigeminal neural-
by their tributaries. The veins converging on the tri- gia, Jannetta 23 found veins compressing the nerve in
geminal nerve to form the superior petrosal veins are 153; however, none of the veins involved in this
the transverse pontine and the pontotrigeminal veins, compression was listed by name. Compression of the
and the veins of the cerebellopontine fissure and the facial and glossopharyngeal nerves by veins has also
middle cerebellar peduncle. The largest vein contribut- been postulated to be a cause of hemifacial spasm and
ing to the formation of the petrosal vein near the glossopharyngeal neuralgia. 24 The venous relationships
trigeminal nerve is the vein of the cerebellopontine of the trigeminal nerve where numerous bridging veins
fissure which drains most of the petrosal surface of the converge on and cross the subarachnoid space near the
cerebellum and much of the lower brain stem and the posterior root is distinctly different from those in the
cerebellopontine and cerebellomedullary fissures. Al- region of the facial and vestibulocochlear nerves, where
though superior petrosal veins can be located at any the predominant veins are on the side of the brain stem
point along the superior petrosal sinus, most are located and in contact with the nerves at their junction with
just lateral to the trigeminal nerve. Adverse sequelae the brain stem. The veins coursing on or near the
only infrequently follow occlusion of this medial group junction of the facial and vestibulocochlear nerves with
T. Matsushima, et aL
the brain stem are the veins of the middle cerebellar but into the internal cerebral or great vein. In the
peduncle, the cerebellomedullary fissure, and the pon- transtentorial approach the tentorium is divided adja-
tomedullary sulcus. There are no large veins intermin- cent to and parallel to the straight sinus beginning at
gling with the nerves at or within the acoustic meatus the free edge and extending posteriorlyY ’27’4~The ten-
as occurs with the arteries. The major veins near the torial sinuses in the anterior part of the tentorium are
glossopharyngeal and vagus nerves also course near the smaller and less frequent than those in the posterior
origin of the nerves on the surface of the brain stem, part of the tentorium. Most of the tentorial sinuses
although there are small bridging veins that course along found in the posterior one-third of the tentorium are
these nerves to the venous sinuses near the jugular bulb. formed by the cerebellar hemispheric veins. The tento-
The lateral medullary, retro-olivary, and transverse rial sinuses formed by the cerebral veins on the superior
medullary veins and the vein of the inferior cerebellar surface of the tentorium are small and infrequent. The
peduncle course near the origin of the rootlets of the tentorial sinuses course posteromedially, posterolat-
glossopharyngeal and vagus nerves. erally, or straight posteriorly from their origin. The
Bridging veins are more frequently encountered in sinus in the anterior part of the tentorium usually
exposing the tentorial surface of the cerebellum than in receives only small bridging veins from the midbrain,
exposing the suboccipital or petrosal surfaces of the but in rare cases the basal vein may terminate as a large
cerebellum. The bridging veins from the suboccipital bridging vein which enters the anterior part of the
surface are often encountered on the posterior part of tentorium. The anteromedial edge of the tentorium
the tentorial surface because the hemispheric veins from posterior to the petrosal sinus may be sectioned through
the suboccipital surface uniformly ascend to the tento- a subtemporal craniectomy to expose the trigeminal
rial surface before forming bridging veins which pass to nerve and the surrounding petrosal venous complex
the venous sinuses in the tentorium. Most of the veins from their superolateral side. This provides excellent
from the petrosal surface pass to the vein of the cere- exposure of the pontotrigeminal and transverse pontine
bellopontine fissure and not directly to a venous sinus. veins passing above the trigeminal nerve, but some of
The veins from the tentorial and suboccipital surface the transverse pontine and bridging veins may be hid-
which enter the sinuses in the tentorium are obstacles den below or medial to the nerve in this exposure.
in the supracerebellar approaches. In the infratentorial
supracerebellar approach to the pineal region it may be
necessary to divide numerous bridging veins entering
References
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rise to a bridging vein which drains into the occipital 5. Bull J, Kozlowski P: The angiographic pattern of the
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and lateral surfaces of the medulla will give rise to diology 1:20-26, 1970
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Partial section of the sensory root at the pons. Arch Surg
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in either the occipital transtentorial, 22’27’3~ or the delberg/New York: Springer-Verlag, 1977, pp 6-24
infratentorial supracerebellar approaches) 3"28’35’44 In 10. Duvernoy HM: The Superficial Veins of the Human
Brain: Veins of the Brain Stem and of the Base of the
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can often be retracted away from the falx and tentorium 1974, pp 5-32
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from the occipital lobe near the straight sinus to the sinuses, in Newton TH, Potts DG (eds): Radiology of the
torcula, lateral, straight, and superior sagittal sinuses. Skull and Brain, Vnl II. St Louis: CV Mosby, 1974, Book
The vein of Labbe, which drains into the lateral portion 3, pp 1851-1877
12. Haines SJ, Jannetta PJ, Zorub DS: Microvascular rela-
of the lateral sinus, is usually lateral to this exposure tions of the trigeminal nerve. An anatomical study with
and the internal occipital vein, which must be divided clinical correlation. J Neurosurg 52:381-386, 1980
to reach the pineal region, drains not into a dural sinus, 13. HandaH, Yamashita J: [Surgicaltreatment ofthe tumors
in the pineal region.] No Shinkei Geka 5:1319-1324, 34. Page LK: The infratentorial-supracerebellar exposure of
1977 (Jpn) tumors in the pineal area. Neurosorgery 1:36-40, 1977
14. Huang YP, WolfBS: Angiographic features of brain stem 35. Pendl G: Infratentorial approach to mesencephalic tu-
tumors and differential diagnosis from fourth ventricle mors, in Koos WT, Brck FW, Spetzler RF (eds): Clinical
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Neuroradiology 1:4-19, 1970 point of view. J Neurosurg 17:402-412, 1960
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Brain, Voi II. St Louis: CV Mosby, 1974, Book 3, pp 40. Rhoton AL Jr, Yamamoto I, Peace DA: Microsurgery of
2155-2216 the third ventricle: Part 2. Operative approaches. Neuro-
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1965 Berlin/Heidelberg/New York: Springer-Verlag, 1976, pp
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24. Jannetta PJ, Abbasy M, Maroon JC, et al: Etiology and tumors. Radiology 89:834-840, 1967
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27. Lazar ML, Clark K: Direct surgical management of moid sinuses. Arch Otolaryngol 39:307-312, 1944
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2:17-21, 1974 delphia: WB Saunders, 1980, p 1044
28. Matsumura H, Makita Y, Someda K, et al: Arteriovenous 51. Wilner HI, Crockett J, Gilroy J: The galenic venous
malformations in the posterior fossa. J Neorosurg 47: system: a selective radiographic study. AJR 115:1-13,
50-56, 1977 1972
29. Matsushima T, Rhoton AL Jr, Lenkey C: Microsurgery 52. Wolf BS, Huang YP, Newman CM: The lateral anasto-
of the fourth ventricle: Part 1. Microsurgical anatomy. motic mesencephalic vein and other variations in drainage
Neurosurgery 11:631-667, 1982 of the basal cerebral brain. AJR 89:411-422, t963
30. Naffziger HC: Brain surgery. With special references to 53. Woodhall B: Anatomy of cranial blood sinuses with
exposure of the brain stem and posterior fossa; the prin- particular reference to the lateral. Laryngoscope 49:
ciple of intracranial decompression, and the relief of 966-1010, 1939
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46:240-248, 1928 the pineal region. J Neurosurg 53:205-221, 1980
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393-403, 1978
32. Numaguchi Y, Kishikawa T, Ikeda J, et al: Angiographic Manuscript received November 3, 1982.
diagnosis of acoustic neurinomas and meningiomas in This work was supported in part by the R. D. Keene Family
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33. Padget DH: The cranial venous system in man in refer- Address reprint requests to: Albert L. Rhoton, Jr., M.D.,
ence to development, adult configuration, and relation to Department of Neurosurgery, Box J-265, University of Florida
the arteries. Am J Anat 98:307-355, 1956 College of Medicine, Gainesville, Florida 32610.


(Journal of Neurosurgery) Microsurgical Anatomy of The Veins of The Posterior Fossa

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J Neurosurg 59:63-105, 1983

Microsurgical anatomy of the veins of the posterior fossa

TOSHIO MATSUSHIMA, M.D., ALBERT L. RHOTON, JR., M.D.,

KE’,’ WORDS veins 9 posterior fossa 9 cerebellum 9 brain stem

J. Neurosurg. / Volume 59 ~July. 1983 63

FIG. 1. Tentorial surface of the cerebellum and the cerebello-

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FIG. 3. Brain stem and the petrosal surface of

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II: Deep Veins 3. Lateral

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FIG. 4. D." Posterior view. The straight sinus joins the

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FIG. 5. The vein of Galen and its tributaries. A:

74 J. Neurosurg. / Volume 59 ~July, 1983

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FIG. 7. E: Stepwise dissection of the tentorium in another

in the inferior vermian vein on the opposite side. There

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FIG. 8. E: The superior pole of the tonsil has been retracted

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FIG. 9. A: Veins entering the superior petrosal sinus. Right

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FIG. 9. D: Enlarged view of the same specimen with the arteries

Medial and Lateral Tonsillar Veins. The medial

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FIG. 9. G: Anterolateral view. Veins converging from the left side

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FIG. 11. Veins of the tonsils and the cerebellomedul-

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FIG. 11. G, H, and/: Another specimen showing

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FIG. 12. Veins of the brain stem. A: Anterior view

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FIG. 12. D: The anterior surface of the pons is drained

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FIG. 13. Bridging veins. A: Posterior view. Anterior

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FIG. 13. D: Anterior view. The skull and

Tentorial Draining Group

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