Anatomy and Frequency of Large Pontomesencephalic Veins on 3D CT Angiograms of the Circle of Willis

Mehmet Teksam; Sean Casey; Alexander McKinney; Eduard Michel; Charles L. Truwit

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Fig 1.
34-year-old man who presented to the emergency department with headache.
A, Nonenhanced CT scan of the head demonstrates a focal hyperattenuation (arrow) suggestive of subarachnoid hemorrhage in the interpeduncular cistern.
B, CT angiographic source image demonstrates a large anterior PMV (arrow) in the interpeduncular fossa posterior to basilar artery (arrowhead).
C–E, Sagittal slab MIP image (C) and 3D volume-rendered craniocaudal (D) and posteroanterior (E) views demonstrate the large anterior PMV (white arrowhead) posterior to the basilar artery (black arrowhead) and the interpeduncular veins (black arrows). A indicates anterior; P, posterior; S, superior; I, inferior.
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Fig 2.
68-year-old woman with basilar tip aneurysm.
A and B, Sagittal slab MIP (A) and 3D volume-rendered (Towne’s view) (B) images demonstrate an anterior PMV (large white arrow in A) posterior to the basilar artery (large black arrow in A). Note that the interpeduncular veins (small white arrows), which connect the anterior PMV with the basal vein of Rosenthal, are draping over the basilar tip aneurysm (small black arrows). A indicates anterior; P, posterior; S, superior; I, inferior.
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Fig 3.
56-year-old woman evaluated with CT angiography for aneurysm of the supraclinoid segment of the internal carotid artery.
A, Three-dimensional volume-rendered image (posteroanterior view) demonstrates a transverse pontine vein (large black arrows) that appears to be arising from the basilar artery (thin black arrow). This vein could potentially be confused with the anterior inferior cerebellar artery. The actual anterior inferior cerebellar artery is located more inferiorly (black arrowhead). Note that the interpeduncular vein (white arrow), which drains into the basal vein of Rosenthal (white arrowhead), appears to be coming out of the basilar artery.
B and C, Three-dimensional volume-rendered images in anteroposterior (B) and posteroanterior (C) views better demonstrate the anterior PMV (white arrowhead) behind the basilar artery (black arrowhead). Note that the hypoplastic P1 segment of the right posterior cerebral artery (green arrow in C) and right interpeduncular vein (large white arrow) draining into the basal vein of Rosenthal (small white arrows in B) are now clearly separated. R indicates right; L, left; S, Superior; I, inferior.
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Fig 4.
A and B, Anteroposterior (A) and lateral (B) anatomic diagrams demonstrate the anatomy of the PMVs in relation to the vertebrobasilar system. 1 indicates interpeduncular vein; 2, basal vein of Rosenthal; 3, posterior cerebral artery; 4, superior cerebellar artery; 5, anterior PMV; 6, petrosal vein; 7, anterior inferior cerebellar artery; 8, vertebral artery; 9, anterior medullary vein; 10, posterior inferior cerebellar artery; 11, basilar artery; 12, transverse pontine vein; 13, lateral mesencephalic vein; 14, internal cerebral vein; 15, inferior sagittal sinus; 16, vein of Galen; 17, sraight sinus; 18, superior sagittal sinus.