22 Neuroanatomy: Draw It to Know It
Cisterns, Sinuses, & Veins (Advanced)
Here, we will draw the subarachnoid cisterns, dural
venous sinuses, and cerebral veins. Begin with the cis-
terns. Draw a few key anatomic landmarks; fi rst, the
brainstem: label the midbrain, pons, and medulla; then,
the thalamus; next, the splenium of the corpus callosum;
and lastly, the sella turcica. First, above the sella turcica,
label the suprasellar cistern. Th e optic chiasm lies within
this cistern and, thus, it is also referred to as the chias-
matic cistern. Next, in front of the midbrain, in between
the cerebral peduncles, label the interpeduncular cistern;
then, along the lateral midbrain, label the ambient cis-
tern; and fi nally, behind the midbrain, label the quadri-
geminal cistern, which is also called the cistern of the
great vein because it contains the great cerebral vein (aka
vein of Galen).
Next, label the cistern of the velum interpositum in
between the thalamus and the splenium of the corpus
callosum. Note that this small cistern actually lies
between the tela choroidea that lines the inferior surface
of the fornix and splenium of the corpus callosum and
the superior surface of the third ventricle and thalamus.
Within the velum interpositum lie the internal cerebral
veins (drawn later). Now, in front of the pons, label the
prepontine cistern and lateral to it, label the pontocere-
bellar cistern. Next, in front of the medulla, label the
premedullary cistern and, lateral to it, label the lateral
cerebellomedullary cistern. Th en, underneath the cere-
bellum, label the posterior cerebellomedullary cistern
(aka cisterna magna); this is the cerebrospinal extraction
site during cisternal puncture.^14 – 16
Collectively, the subarachnoid cisterns at the base of
the brain are referred to as the basal cisterns. Obliter-
ation of the basal cisterns on radiographic imaging
suggests brainstem swelling or compression, which is
life-threatening — see Figures 2-3 and 2-4.
Next, let’s draw the dural venous sinuses. First show
that the superior sagittal sinus runs along the superfi cial
midline surface of the cerebrum. Th en, indicate that at
the occiput, lies the confl uence of sinuses (torcular
Herophili). Next, show that the confl uence of sinuses
merges with the bilateral transverse sinuses, which
wrap horizontally along the tentorium cerebelli.
Note that oft en the right transverse sinus is larger than
the left. Now, show that the confl uence of sinuses
also receives the straight sinus, which as we will later
indicate, drains the deep cerebral veins. Note that an
occipital sinus also exists, which drains inferiorly from
the confl uence of sinuses; we leave it out of our diagram
for simplicity.
Next, draw the inferior sagittal sinus; it runs inferior
to the superior sagittal sinus along the same midline
course, just above the corpus callosum, and it empties
into the straight sinus. Now, indicate that each transverse
sinus empties into a sigmoid sinus, which forms an
S-shaped curve along the intracranial surface of the mas-
toid portion of the temporal bone. Th en, show that at
the jugular bulb, each sigmoid sinus empties into its
respective internal jugular vein.
Now, let’s introduce a few key deep cerebral veins.
First, show that the vein of Galen (aka the great cerebral
vein) lies posterior to the splenium of the corpus callo-
sum and drains directly into the straight sinus. Th en,
indicate that each of the bilateral basal veins of Rosenthal
passes around the midbrain to drain into the vein of
Galen, and that each of the bilateral internal cerebral
veins passes through the cistern of the velum interposi-
tum to drain into the vein of Galen, as well.
Finally, show a representative superfi cial cerebral
vein — the superior cerebral vein, which drains into the
superior sagittal sinus. Th e superfi cial cerebral veins
divide into superior, middle, and inferior groups of veins,
which drain the superfi cial cerebrum.^4 – 8 , 17