The Anatomy of the Convergence of Major Deep Cerebral Veins in the Pineal Region: A Computed Tomography Angiography Study

World Neurosurg. 2021 Mar:147:e334-e342. doi: 10.1016/j.wneu.2020.12.057. Epub 2020 Dec 17.


Background: The anatomy of the veins in the pineal region is one of the most complex areas in the brain because all major deep cerebral veins converge there: the internal cerebral veins (ICVs), the great cerebral vein of Galen (GV), the basal veins (BVs), and the internal occipital veins (IOVs). The aim of this study was to comprehensively describe the anatomy of the veins in the pineal region using computed tomography angiography.

Methods: Head computed tomography angiography scans of 250 adult Polish patients were evaluated. We assessed the location of the junction of 2 ICVs and the presence of a narrowing of the GV and arachnoid granulation at the GV-straight sinus junction. We evaluated the presence, appearance, and termination of the BV, and the presence and termination of the IOV.

Results: The study showed that 2 ICVs usually converged posterior to the splenium of the corpus callosum (62.4%). Narrowing of the BV was observed in 51.2% of patients, and the arachnoid granulation was found in 25.2%. The 3 segments of the BV were well visualized in 66% of the studied hemispheres. The BV flowed into the GV in 34.8% of the hemispheres. The IOV was present in 90.2% of the hemispheres and terminated medially in 84.5%.

Conclusions: Because an injury to major deep cerebral veins may result in severe postoperative neurologic deficits, it is essential for neurosurgeons to be familiar with both normal and variant patterns of veins in the pineal region.

Keywords: Anatomy; Basal vein; Pineal; Vascular anatomy; Venous system.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Angiography / methods
  • Cerebellum / anatomy & histology
  • Cerebellum / blood supply
  • Cerebral Veins / anatomy & histology*
  • Cerebral Veins / surgery
  • Computed Tomography Angiography* / methods
  • Corpus Callosum / anatomy & histology*
  • Corpus Callosum / blood supply
  • Corpus Callosum / surgery
  • Cranial Sinuses / anatomy & histology*
  • Cranial Sinuses / surgery
  • Humans
  • Middle Aged
  • Pineal Gland / blood supply*
  • Pineal Gland / surgery