Andeweg J
Neuroradiology. 1999 Apr;41(4):233-41. doi: 10.1007/s002340050739.
The deep venous system is best defined as the entire territory served by the great vein of Galen and the basal veins. This comprises not only the choroid plexuses and the deep grey matter of the thalamus and striatum, but also the periventricular white matter and corpus callosum, hippocampus and the cortical areas of the limbic lobe including the cingulate and parahippocampal gyri, the visual cortex, the diencephalon and rostral brain stem, and part of the cerebellum. The superficial venous system comprises the remaining neocortex (with the cortex of the entire convexity) together with a layer of subcortical white matter, separated from the periventricular white matter by a venous watershed. Outflow towards the great vein of Galen and straight sinus can be substituted by collateral channels towards the basal vein. The basal vein in turn is connected not only to the great vein of Galen, but also to the superior petrosal sinus (via the lateral mesencephalic vein), and in the adult configuration to the cavernous sinus and pterygoid plexus (via the deep and superficial sylvian veins). Evidence from pathological anatomy indicates that the venous watershed exists not only in the white matter of the hemispheres, but between the entire territories of the deep and superficial venous systems. Because of their anastomotic interconnections, only simultaneous obstruction of veins of Galen and basal veins wil effectively obstruct deep venous outflow. This can occur in the tentorial incisura, from swelling or displacement of the midbrain due to brain oedema, haematoma or tumour. Complete obstruction of great vein of Galen and basal veins leads to rapid death. In patients who survive incomplete obstruction, various combinations of damage to parts of the deep venous territory exist. This is possible because very many tributaries of the deep system unite below and sometimes above the tentorial incisura. The hallmarks these varying deep venous obstructions have in common are sparing of the subcortical white matter of the convexity, and cortical involvement limited to the limbic lobe and visual cortex. Obstruction of cerebral venous outflow explains many pathological phenomena. Treatment must aim at relieving this obstacle to blood flow.
深静脉系统最好被定义为大脑大静脉和基底静脉所服务的整个区域。这不仅包括脉络丛、丘脑和纹状体的深部灰质，还包括脑室周围白质和胼胝体、海马以及边缘叶的皮质区域，包括扣带回和海马旁回、视觉皮质、间脑和脑桥前部，以及部分小脑。浅静脉系统包括其余的新皮质（整个脑凸面的皮质）以及一层皮质下白质，它通过静脉分水岭与脑室周围白质分隔开来。流向大脑大静脉和直窦的血流可以通过向基底静脉的侧支通道来替代。基底静脉不仅与大脑大静脉相连，还与岩上窦（通过中脑外侧静脉）相连，在成人结构中还与海绵窦和翼静脉丛（通过深、浅大脑外侧静脉）相连。病理解剖学证据表明，静脉分水岭不仅存在于半球的白质中，也存在于深静脉系统和浅静脉系统的整个区域之间。由于它们的吻合连接，只有大脑大静脉和基底静脉同时阻塞才会有效地阻碍深静脉流出。这种情况可发生在小脑幕切迹处，由于脑水肿、血肿或肿瘤导致中脑肿胀或移位。大脑大静脉和基底静脉的完全阻塞会导致迅速死亡。在不完全阻塞后存活的患者中，存在深静脉区域各部分受损的各种组合。这是可能的，因为深静脉系统的许多分支在小脑幕切迹下方甚至有时在上方汇合。这些不同的深静脉阻塞的共同特征是脑凸面的皮质下白质不受影响，皮质受累仅限于边缘叶和视觉皮质。脑静脉流出受阻解释了许多病理现象。治疗必须旨在解除这种血流障碍。
