The pontomesencephalic veins have in the past been beautifully demonstrated in roentgenograms of anatomical specimens (2, 3). A few authors have also identified these veins on vertebral angiography performed during life (1, 3–5, 10, 11). The present work is an attempt to investigate the pontomesencephalic venous system in greater detail, using clinical neuroradiological means. The variable roentgenographic appearances of the pontomesencephalic veins, their relationship to the anterior border of the brain stem, and their frequency of visualization on vertebral angiography will be discussed. Anatomy The blood from the major part of the pons and mesencephalon drains in an anterior direction (Fig. 1). Numerous parenchymal veins, on reaching the anterior and anterolateral surfaces of the brain stem, usually empty into larger, longitudinal venous channels which are closely associated with the anterior border of the brain stem (2–4). Occasionally, there may be only a single, midline, longitudinal vein situated between the basilar artery and the brain parenchyma (2). This fact and the frequent impression of seeing only one longitudinal vein in front of the brain stem on lateral roentgenograms of vertebral angiography probably prompted Huang and Wolf (3), for the sake of simplicity, to speak of the “anterior pontomesencephalic vein.” Hassler (2), however, states that anatomically there is generally a plexus of longitudinal veins on each side of the pons, a few millimeters from the midline and fairly parallel to the basilar artery. The venous plexus anterior to the pons is continuous with a similar plexus in the interpeduncular fossa and anterior to the medulla oblongata and spinal cord. The pontomesencephalic veins in most cases drain primarily into (a) the superior petrosal sinuses, mostly through the petrosal veins, and (b) peduncular veins which pass laterally around the upper margins of the cerebral peduncles and empty into the basal veins of Rosenthal or posterior mesencephalic veins. Some drainage also occurs into the inferior petrosal sinuses and through bridging veins into the basilar venous plexus along the clivus (2–4, 6–8, 10, 11). With variation in venous drainage, the pontomesencephalic veins may in part empty into the uncal vein (which usually drains into the cavernous sinus) or the lateral anastomotic mesencephalic vein (3, 11). Material On a review of the 1967–1968 vertebral angiographies performed at Ullevål Hospital, we selected for further study the first 100 examinations encountered with a technically satisfactory demonstration of the posterior cranial fossa veins. Thirty-seven patients were males, and 63 were females. Their ages ranged from five months to seventy-four years (Table I). The lateral views were used as the basis for this screening, which was an inspection of the posterior cranial fossa veins in general.
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