Tentorial Venous Anatomy: Cadaveric and Radiographic Study with Discussion of Origin and Surgical Significance

World Neurosurg. 2019 Nov:131:e38-e45. doi: 10.1016/j.wneu.2019.06.232. Epub 2019 Jul 9.


Background: Described variations of tentorial venous anatomy impact surgical sectioning of the tentorium in skull base approaches; however, described configurations do not consistently explain postoperative complications. To understand the outcomes of 2 clinical cases we studied the tentorial venous anatomy of 2 cadavers.

Methods: The venous anatomy of the tentorium isolated in 2 uninjected fresh cadaver head specimens with preserved bridging veins was observed by transillumination before and after methylene blue injection of the dural sinuses and tentorial veins. Our findings in cadavers were applied to explain the clinical and radiologic (magnetic resonance imaging and computed tomographic venography) findings in the 2 cases presented.

Results: A consistent transtentorial venous system, arising from transverse and straight sinuses, communicating with supra- and infratentorial bridging veins was seen in the cadaver and patient radiography (magnetic resonance imaging and computed tomographic venography). Our first patient had a cerebellar venous infarct from compromise of the venous drainage from the adjacent brain after ligation of a temporal lobe bridging vein to the tentorium. Our second patient suffered no clinical effects from bilateral transverse sinus occlusion due to drainage through the accessory venous system within the tentorium.

Conclusions: Herein, we elaborate on transtentorial venous anatomy. These veins, previously reported to obliterate in completed development of the tentorium, remain patent with consistent observed configuration. The same transtentorial venous system was observed in both cases and provided insight to their outcomes. These findings emphasize the importance of the transtentorial venous system physiologically and in surgical approaches.

Keywords: Cadaver; Development; Tentorial sinuses; Transtentorial approaches; Venous anatomy.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Aged
  • Brain Infarction / diagnostic imaging
  • Brain Neoplasms / surgery
  • Cadaver
  • Cerebellar Diseases / diagnostic imaging
  • Collateral Circulation*
  • Computed Tomography Angiography
  • Cranial Sinuses / anatomy & histology*
  • Cranial Sinuses / diagnostic imaging*
  • Cranial Sinuses / embryology
  • Female
  • Glioma / surgery
  • Humans
  • Lateral Sinus Thrombosis / diagnostic imaging
  • Magnetic Resonance Imaging
  • Male
  • Phlebography
  • Postoperative Complications / diagnostic imaging
  • Sagittal Sinus Thrombosis / diagnostic imaging