Rusu Mugurel Constantin, Tudose Răzvan Costin, Vrapciu Alexandra Diana
Division of Anatomy, Department 1, Faculty of Dentistry, "Carol Davila" University of Medicine and Pharmacy, 8 Eroilor Sanitari Blvd, 050474, Bucharest, Romania.
Research Department, "Dr. Carol Davila" Central Military Emergency Hospital, 010825, Bucharest, Romania.
Surg Radiol Anat. 2025 Jun 19;47(1):162. doi: 10.1007/s00276-025-03676-y.
The superficial middle cerebral vein (SMCV) typically drains into the cavernous sinus, which, in turn, connects to the pterygoid venous plexus via a sphenoidal emissary vein. The latter may course through the foramen ovale. The pterygoid plexus drains in most cases into the retromandibular and facial veins. A peculiar SMCV drainage pathway to the internal jugular vein (IJV) via a parapharyngeal vein was found here.
The anatomic variant reported here was identified by carefully reviewing the archived CT angiogram in a 68-year-old male case.
A double SMCV was found on the right side. The resulting common SMCV trunk passed laterally to the foramen rotundum to empty into the cavernous sinus. A sphenoidal emissary vein joined it, which continued inferiorly through the foramen ovale to the pterygoid plexus. This plexus was connected to a reservoir on the inner side of the lateral pterygoid plate from which a fenestrated parapharyngeal vein left. It had two primary fenestrations, and the proximal one had a fenestrated arm. It reached inferiorly and turned around the external carotid artery. At that level, it received two tributaries: first, the superior thyroid vein and then, the facial vein. The resulting facial-parapharyngeal trunk ended in the IJV. These veins and the carotid arteries, deep to them, were hidden beneath the submandibular gland. The right maxillary vein and the anterior branch of the retromandibular vein were absent.
The parapharyngeal vein may be a direct drainage pathway for the SMCV and the pterygoid plexus. It should therefore be acknowledged and spared during various surgical approaches.
大脑中浅静脉（SMCV）通常引流至海绵窦，海绵窦又通过蝶导静脉与翼静脉丛相连。后者可能经卵圆孔走行。翼静脉丛在大多数情况下引流至下颌后静脉和面静脉。在此发现了一种通过咽旁静脉将SMCV引流至颈内静脉（IJV）的特殊途径。
通过仔细回顾一名68岁男性病例的存档CT血管造影来确定此处报告的解剖变异。
右侧发现双大脑中浅静脉。形成的大脑中浅静脉总干向外侧经圆孔汇入海绵窦。一条蝶导静脉与之汇合，该导静脉继续向下经卵圆孔至翼静脉丛。该静脉丛与翼外板内侧的一个血池相连，一条有小孔的咽旁静脉从血池发出。它有两个主要小孔，近端的一个有一条有小孔的分支。它向下走行并绕过颈外动脉。在该水平，它接收两条属支：首先是甲状腺上静脉，然后是面静脉。形成的面-咽旁干汇入颈内静脉。这些静脉以及位于其深面的颈动脉隐藏在下颌下腺下方。右侧上颌静脉和下颌后静脉前支缺如。
咽旁静脉可能是大脑中浅静脉和翼静脉丛的直接引流途径。因此，在各种手术入路中应予以识别并避免损伤。
