Microsurgical anatomy of the pineal region

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✓ Thirty cadaver brains were examined under × 6 to 16 magnification in order to define the microsurgical anatomy of the pineal region, particularly the relationship of the pineal body, posterior cerebral artery, superior cerebellar artery, vein of Galen, basal vein of Rosenthal, internal cerebral vein, straight sinus, bridging vein, the size of the tentorial notch, and the third and the fourth cranial nerves. The infratentorial and supratentorial approaches to the pineal region are compared from the viewpoint of microsurgical anatomy.

Article Information

Address reprint requests to: Isao Yamamoto, M.D., Department of Neurosurgery, Nagoya University, 65 Tsuruma-cho, Schowa-Ku, Nagoya, 466, Japan.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    Posterosuperior views of the pineal region after the removal of the corpus callosum, illustrating the relationship of the pineal body to its surrounding structures. Upper Left: Type 1: the pineal vein (PV) empties into the terminal portion of one internal cerebral vein (ICV). Upper Right: Type 2: the PV's empty into the terminal portion of both ICV's. Center Left: Type 3: the PV's drain into the vein of Galen (G). Center Right: Type 4: The PV's drain into one of the ICV's and G. Lower: Type 5: the PV empties into the precentral cerebellar vein (PrCV). The PrCV is seen flowing into either side of the ICV, and the posterior ventricular vein (PVV) drains into the ICV (upper left and lower). The internal occipital vein (IOV) ends in G (upper right and center left). The pineal artery (PA) in both hemispheres supplies the pineal body (P), basal vein of Rosenthal (R), cerebellum (CbII), massa intermedia (M), and medial posterior choroidal artery (MPchA) (center and lower).

  • View in gallery

    The corpus callosum has been removed to expose the terminal portion of the medial posterior choroidal artery (MPchA). Right internal cerebral vein (ICV) has been retracted (left) to expose the pineal artery (PA). The vein of Galen (G), basal vein of Rosenthal (R), internal occipital vein (IOV), posterior ventricular vein (PVV), pineal vein (PV), posterior pericallosal vein (PPV), pineal body (P), and massa intermedia (M) are visualized.

  • View in gallery

    Upper Left: Interior view of the course of the posterior cerebral artery, basilar artery (BA), short circumflex artery (SCiA), long circumflex artery (LCiA), medial posterior choroidal artery (MPchA), lateral posterior choroidal artery (LPchA), anterior temporal artery (ATA), middle temporal artery (MTA), posterior temporal artery (PTA), parieto-occipital artery (POA), calcarine artery (CaA), vein of Galen (G), internal cerebral vein (ICV), basal vein of Rosenthal (R), and precentral cerebellar vein (PrCV). Upper Right: The medial part of the temporal lobe has been removed to expose the LPchA (1, 2, 3, 4), and the hippocampal artery (HiA). Center Left: The ATA and MTA have been removed to expose the thalamogeniculate arteries (ThGA), and the pineal body (P). Center Right: Anterolateral view of the mesencephalon, showing the main arterial trunks, the anterior choroidal artery (AchA), and the posterior communicating artery (PCoA). Lower: Inferolateral view of the mesencephalon, illustrating absence of the HiA branch of the PCA. The AchA supplies the hippocampal formation (Hi). The internal carotid artery (ICA), optic chiasm (OC), and mamillary body (MB) are seen.

  • View in gallery

    Basal views of the mesencephalon illustrating variations of lateral posterior choroidal artery (LPchA). The medial part of the temporal lobe has been removed to expose the choroid plexus (ch.pl.) of the temporal horn. Upper Left: Anterior (1) and posterior branches (2) of the LPchA. Upper Right: Anastomosis is shown between the LPchA and the anterior choroidal artery (AchA) (curved arrow). Lower: The AchA is larger than the LPchA. Other structures seen are: the internal carotid artery (ICA), posterior cerebral artery (PCA), basilar artery (BA), posterior communicating artery (PCoA), medial posterior choroidal artery (MPchA), posterior temporal artery (PTA), calcarine artery (CaA), basal vein of Rosenthal (R), tentorium cerebelli (T), and the mamillary body (MB).

  • View in gallery

    Left: Anterolateral view of the left mesencephalon, showing the arrangement of the main arterial trunks. Also visible are: the basilar artery (BA), superior cerebellar artery (SCA), posterior cerebral artery (PCA), anterior inferior cerebellar artery (AICA), posterior communicating artery (PCoA), medial posterior choroidal artery (MPchA), anterior temporal artery (ATA), middle temporal artery (MTA), posterior temporal artery (PTA), parieto-occipital artery (POA), and the calcarine artery (CaA). Right: Superolateral view of the left cerebellum, showing the course of the SCA. 1: lateral marginal branch, 2: hemispheric branch and 3: superior vermis branch. The cerebellum (Cbll) is also indicated.

  • View in gallery

    Posteroinferior view of the pineal region of the left occipital lobe (Occ L), showing the relationship of the vein of Galen (G) and its tributaries. Precentral cerebellar vein (PrCV) draining into G. The internal occipital vein (IOV) flows into the basal vein of Rosenthal (R). Abbreviations as in previous figures.

  • View in gallery

    Left: The medial part of the temporal lobe has been removed to expose the inferior ventricular vein (IVV), basilar artery (BA) posterior cerebral artery (PCA), posterior communicating artery (PCoA), anterior choroidal artery (AchA), medial posterior choroidal artery (MPchA), lateral posterior choroidal artery (LPchA), and the basal vein of Rosenthal (R). Right: Posterolateral view of the left mesencephalon, illustrating the arrangement of the main arterial and venous trunks, and showing the superior cerebellar artery (SCA), long circumflex artery (LCiA), precentral cerebellar vein (PrCV), superior vermian vein (SVV), lateral mesencephalic vein (LMV), pineal vein (PV), cerebellum (Cbll), occipital lobe (Occ L), and the pineal body (P).

  • View in gallery

    Variations of the terminal portion of the basal vein of Rosenthal (R). Upper Left: Both R's emptying into the vein of Galen (G). The left posterior pericallosal vein (PPV) ends in G and the right PPV ends in the internal occipital vein (IOV). Upper Right: Both R's empty into the internal cerebral veins (ICV). Lower Left: Inferior view of the course of the terminal portion of R, one side of which empties into the ICV (left) and the other side into G (right). Lower Right: Both R's terminate at the posterior portion of G. Structures visualized are: the medial posterior choroidal artery (MPchA), long circumflex artery (LCiA), calcarine artery (CaA), posterior ventricular vein (PVV), pineal vein (PV), pineal body (P), tentorium cerebelli (T), cerebellum (Cbll), and the straight sinus (SS).

  • View in gallery

    Posterosuperior view of the pineal region. The left internal occipital vein (IOV) joins the internal cerebral vein (ICV). The medial posterior choroidal artery (MPchA), basal vein of Rosenthal (R), pineal vein (PV), pineal body (P), cerebellum (Cbll), massa intermedia (M) are seen.

  • View in gallery

    Medial views of a midsagittal section, showing the relationship of the posterior pericallosal vein (PPV) to its tributaries. Left: The PPV enters the vein of Galen (G). Right: The PPV joins the internal occipital vein (IOV) and then flows into G. The medial posterior choroidal artery (MPchA), internal cerebral vein (ICV), posterior ventricular vein (PVV), pineal body (P), and splenium of the corpus callosum (S) can be seen.

  • View in gallery

    Left: Medial view of a midsagittal section, illustrating the medial and lateral atrial veins (MAV, LAV) of the posterior ventricular vein (PVV). Right: The PVV drains into the internal cerebral vein (ICV) as a common trunk. Other structures visualized are the medial posterior choroidal artery (MPchA), posterior cerebral artery (PCA), internal occipital vein (IOV), posterior pericallosal vein (PPV), pineal body (P), vein of Galen (G), and the splenium of the corpus callosum (S).

  • View in gallery

    Left: Posterolateral view of the inferior occipital lobe (Occ L), illustrating the bridging veins between the lateral occipital pole and the transverse sinus (TS). Right: Posterior view of the superior cerebellum (Cbll), illustrating fine bridging veins between the hemispheric cerebellar veins and TS.

  • View in gallery

    Three inferior views of the tentorium, illustrating variations in the interval separating the boundaries of the tentorial notch from the mesencephalon.

  • View in gallery

    Anterolateral view of the right mesencephalon, illustrating that the short circumflex artery (SCiA) penetrates into the bundle of the third cranial nerve (curved arrow). The internal carotid artery (ICA), basilar artery (BA), posterior cerebral artery (PCA), superior cerebellar artery (SCA), posterior communicating artery (PCoA), and mamillary body (MB) can be seen.

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