Advertisement

Anatomy of the Insular Veins

  • Servet Celik
  • Okan Bilge
  • Mehmet Turgut
  • Canan Yurttaş
Chapter

Abstract

Information on the insular veins is less extensive than information on the insular arteries in the recent literature. To add to this information, cadaver dissections and observations of the insular veins are presented, and these veins are systematized in light of the recent literature.

Venous drainage of the insula affects its functionality, and this drainage is associated with many diseases, such as arteriovenous malformations, varices and tumours of the insula. In insular drainage, the deep and superficial insular veins drain into the deep and superficial middle cerebral veins. We depict and discuss the capsulo-insular vein and deep veins of the insula and present the venous drainage regions of the insular gyri and sulci with clear review illustrations.

Keywords

Insular vessels Insular vein Sylvian vein Deep middle cerebral vein Superficial middle cerebral vein Capsulo-insular vein 

Abbreviations

AAr

Anterior arcuate branch of the central insular vein

AC

Anterior cerebral vein

Ag

Accessory gyrus

AI

Anterior insular vein

ALg

Anterior long gyrus

ALs

Anterior limiting sulcus

Am

Arachnoid membrane

An

Anastomosis of arcuate veins

Ang

Branch to angular gyrus

APo

Anterior pole of the insula

APr

Anterior parietal artery

aPx

Pial arterial plexus

ASg

Anterior short gyrus

ATm

Anterior temporal branch

B

Basal vein

Both

Transitional or mixed vascular area

cdH

Head of the caudate nucleus

CIV

Capsulo-insular vein

Cla

Claustrum

CN

Caudate nucleus

Cn

Central sulcal artery

CnI

Central insular vein

Cns

Central insular sulcus

Cs

Confluence of insular veins

CT

Common trunk of insular veins

D

Dura mater

DMC

Deep middle cerebral vein

EC

External capsule

FSy

Frontosylvian vein

GP

Globus pallidus

IA

Inferior anastomotic vein (Labbe)

IC

Internal capsule

ILs

Inferior limiting sulcus

IT

Inferior trunk of middle cerebral artery

L

Limen of the insula

LOF

Lateral orbitofrontal artery

LSSV

Lateral superior striate vein

LV

Lateral ventricle

MCA

Middle cerebral artery

MSg

Middle short gyrus

MT

Middle temporal vein

MTm

Middle temporal branch

PAr

Posterior arcuate branch of central insular vein

PI

Posterior insular vein

PLg

Posterior long gyrus

PlTm

Polar temporal artery

PPo

Posterior pole of the insula

PreCn

Precentral sulcal artery

PreCnI

Precentral insular vein

PreCns

Precentral insular sulcus

PreF

Prefrontal artery

PSg

Posterior short gyrus

PstCns

Postcentral insular sulcus

PTm

Posterior temporal branch

Pt

Putamen

SA

Superior anastomotic vein (Trolard)

SLs

Superior limiting sulcus

SMC

Superficial middle cerebral vein

Spf

Superficial rami of insular vein

Spf*

Superficial rami of insular vein; e.g., the postcentral insular vein

ST

Superior trunk of middle cerebral artery

SW-MRI

Susceptibility-weighted phase-sensitive magnetic resonance imaging

T

Study of Tanriover et al. 2004 [1]

TCV

Transverse caudate tributaries

Th

Thalamus

Th1

Group (1) thalamic veins that flow superomedially

Th2

Group (2) thalamic veins that flow superiorly

Th3

Group (3) thalamic veins that flow inferiorly

TSy

Temporosylvian vein

V

Study of Varnavas and Grand 1999 [2]

VIC

Vein of the internal capsule

VEC

Vein of the external capsule

vPx

Pial venous plexus

*

Tip of the gyrus

1v

One vein

2v

Two veins

≥3v

Three or more veins

References

  1. 1.
    Tanriover N, Rhoton AL Jr, Kawashima M, Ulm AJ, Yasuda A. Microsurgical anatomy of the insula and the Sylvian fissure. J Neurosurg. 2004;100(5):891–922.  https://doi.org/10.3171/jns.2004.100.5.0891.CrossRefPubMedGoogle Scholar
  2. 2.
    Varnavas GG, Grand W. The insular cortex: morphological and vascular anatomic characteristics. Neurosurgery. 1999;44(1):127–36. discussion 36-8.CrossRefPubMedGoogle Scholar
  3. 3.
    Ono M, Rhoton AL Jr, Peace D, Rodriguez RJ. Microsurgical anatomy of the deep venous system of the brain. Neurosurgery. 1984;15:621–57.  https://doi.org/10.1097/00006123-198411000-00002.CrossRefPubMedGoogle Scholar
  4. 4.
    Rhoton AL Jr. The cerebral veins. Neurosurgery, 51. 2002;(4 Suppl):S159–205.  https://doi.org/10.1097/00006123-200210001-00005.
  5. 5.
    Standring S. Chapter 19: Vascular supply and drainage of the brain. In: Standring S, editor. Gray’s anatomy the anatomical basis of clinical practice, e-book, 2016, Elsevier Health Sciences; 2015. p. 280–290.Google Scholar
  6. 6.
    Fujii S, Kanasaki Y, Matsusue E, Kakite S, Kminou T, Okudera T, et al. Demonstration of deep cerebral venous anatomy on phase-sensitive MR imaging. AJNR Am J Neuroradiol. 2008;18(4):216–23.  https://doi.org/10.1007/s00062-008-8027-3.CrossRefGoogle Scholar
  7. 7.
    Hassler O. Deep cerebral venous system in man. A microangiographic study on its areas of drainage and its anastomoses with the superficial cerebral veins. Neurology. 1966;16(5):505–11.CrossRefPubMedGoogle Scholar
  8. 8.
    Okudera T, Huang YP, Fukusumi A, Nakamura Y, Hatazawa J, Uemura K. Micro-angiographical studies of the medullary venous system of the cerebral hemisphere. Neuropathology. 1999;19(1):93–111.  https://doi.org/10.1046/j.1440-1789.1999.00215.x.CrossRefPubMedGoogle Scholar
  9. 9.
    Suzuki Y, Ikeda H, Shimadu M, Ikeda Y, Matsumoto K. Variations of the basal vein: identification using three-dimensional CT angiography. AJNR Am J Neuroradiol. 2001;22(4):670–6.PubMedGoogle Scholar
  10. 10.
    Bradac GB. Cerebral Veins. In: Bradac GB, editor. Cerebral angiography normal anatomy and vascular pathology. 2nd ed. London: Springer; 2014. p. 109–34.CrossRefGoogle Scholar
  11. 11.
    Fukusumi A. Normal anatomy of intracranial veins: demonstration with MR angiography, 3D–CT angiography and microangiographic injection study. In: Takahashi S, editor. Neurovascular imaging MRI & microangiography. London: Springer-Verlag; 2010. p. 274–6.Google Scholar
  12. 12.
    Huang YP. Deep cerebral veins. In: Salamon G, Huang YP, editors. Radiologic anatomy of the brain. Berlin, Heidelberg: Springer-Verlag; 1976. p. 210–61.Google Scholar
  13. 13.
    Huang YP. Basal cerebral vein. In: Salamon G, Huang YP, editors. Radiologic anatomy of the brain. Berlin, Heidelberg: Springer-Verlag; 1976. p. 127–72.Google Scholar
  14. 14.
    Yasargil MG, Krisht AF, Ture U, Al-Mefty O, Yasargil DCH. Microsurgery of insular gliomas part II: opening of the sylvian fissure. Contemp Neurosurg. 2002;24(12):1–5.CrossRefGoogle Scholar
  15. 15.
    Lang J Floor and contents of the middle cranial fossa. In Lang J editor (translated by Wilson RR, Winstanley DP). Clinical anatomy of the head neurocranium, orbit, craniocervical regions. Berlin, Heidelberg: Springer-Verlag; 1983. p. 282–283.Google Scholar
  16. 16.
    Ture U, Yasargil DC, Al-Mefty O, Yasargil MG. Topographic anatomy of the insular region. J Neurosurg. 1999;90(4):720–33.  https://doi.org/10.3171/jns.1999.90.4.0720.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Afif A, Mertens P. Description of sulcal organization of the insular cortex. Surg Radiol Anat. 2010;32(5):491–8.  https://doi.org/10.1007/s00276-009-0598-4.CrossRefPubMedGoogle Scholar
  18. 18.
    Wen HT, Rhoton AL Jr, de Oliveira E, LHM C, Figueiredo EG, Teixeira MJ. Microsurgical anatomy of the temporal lobe: part 2-Sylvian fissure region and its clinical application. Neurosurgery. 2009;65(6):1–35.  https://doi.org/10.1227/01.Neu.0000336314.20759.85.CrossRefPubMedGoogle Scholar
  19. 19.
    Yasargil MG. Organization of the cerebral microcirculation. In: Yasargil MG, editor. Microneurosurgery in 4 volumes: III A-AVM of the brain, history, embryology, pathological considerations, hemodynamics, diagnostic studies, microsurgical anatomy. Stuttgart: Georg Thieme Verlag; 1987. p. 284–337.Google Scholar
  20. 20.
    Nowinski WL. Proposition of a new classification of the cerebral veins based on their termination. Surg Radiol Anat. 2012;34(2):107–14.  https://doi.org/10.1007/s00276-011-0852-4.CrossRefPubMedGoogle Scholar
  21. 21.
    Yasargil MG, Krisht AF, Ture U, Al-Mefty O, DCH Y. Microsurgery of insular gliomas part IV: surgical treatment and outcome. Contemp Neurosurg. 2002;24(14):1–5.CrossRefGoogle Scholar
  22. 22.
    Kazumata K, Kamiyama H, Ishikawa T, Takizawa K, Maeda T, Makino K, et al. Operative anatomy and classification of the sylvian veins for the distal transsylvian approach. Neurol Med Chir (Tokyo). 2003;43(9):427–33. discussion 34.CrossRefGoogle Scholar
  23. 23.
    Galligioni F, Bernardi R, Pellone M, Iraci G. The superficial sylvian vein in normal and pathologic cerebral angiography. Am J Roentgenol Radium Ther Nucl Med. 1969;107(3):565–78.CrossRefPubMedGoogle Scholar
  24. 24.
    Frigeri T, Paglioli E, de Oliveira E, Rhoton AL Jr. Microsurgical anatomy of the central lobe. J Neurosurg. 2015;122(3):483–98.  https://doi.org/10.3171/2014.11.JNS14315.CrossRefPubMedGoogle Scholar
  25. 25.
    Straus D, Byrne RW, Sani S, Serici A, Moftakhar R. Microsurgical anatomy of the transsylvian translimen insula approach to the mediobasal temporal lobe: Technical considerations and case illustration. Surg Neurol Int. 2013;4:159.  https://doi.org/10.4103/2152-7806.123285.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Kubota H, Sanada Y, Nagatsuka K, Yoshioka H, Iwakura M, Kato A. Safe and accurate sylvian dissection with the use of indocyanine green videoangiography. Surg Neurol Int. 2016;7(Suppl 14):S427–9.  https://doi.org/10.4103/2152-7806.183526.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Lasjaunias P, Berenstein A, terBrugge KG, Raybaud C. Intracranial venous system. In: Lasjaunias P, Berenstein A, ter Brugge KG, editors. Surgical neuroangiography volume 1 clinical vascular anatomy and variations. 2nd ed. Berlin: Springer-Verlag; 2001. p. 631–713.CrossRefGoogle Scholar
  28. 28.
    Kaminogo M, Hayashi H, Ishimaru H, Morikawa M, Kitagawa N, Matsuo Y, et al. Depicting cerebral veins by three-dimensional CT angiography before surgical clipping of aneurysms. AJNR Am J Neuroradiol. 2001;23(1):85–91.Google Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Servet Celik
    • 1
  • Okan Bilge
    • 1
  • Mehmet Turgut
    • 2
  • Canan Yurttaş
    • 1
  1. 1.Department of AnatomyEge University School of MedicineIzmirTurkey
  2. 2.Department of NeurosurgeryAdnan Menderes University School of MedicineAydınTurkey

Personalised recommendations