Intraoperative Findings of Inferior Petrosal Vein During Microvascular Decompression for Hemifacial Spasm: A Single-Surgeon Experience

The microsurgical anatomy of the veins of the posterior fossa was defined in 25 cadavers. These veins are divided into four groups: superficial, deep, brain-stem, and bridging veins. The superficial veins are divided on the basis of which of the three cortical surfaces they drain: the tentorial surface, which faces the tentorium and is exposed in a supracerebellar approach, is drained by the superior hemispheric and vermian veins; the suboccipital surface, which is below and between the lateral and sigmoid sinuses and is exposed in a wide suboccipital craniectomy, is drained by the inferior hemispheric and inferior vermian veins; and the petrosal surface, which faces forward toward the posterior surface of the petrous bone and is retracted to expose the cerebellopontine angle, is drained by the anterior hemispheric veins. The deep veins course in the three fissures between the cerebellum and the brain stem, and on the three cerebellar peduncles. The major deep veins in the fissures between the cerebellum and brain stem are the veins of the cerebellomesencephalic, cerebellomedullary, and cerebellopontine fissures, and those on the cerebellar peduncles are the veins of the superior, middle, and inferior cerebellar peduncles. The veins of the brain stem are named on the basis of whether they drain the midbrain, pons, or medulla. The veins of the posterior fossa terminate as bridging veins, which collect into three groups: a galenic group which drains into the vein of Galen; a petrosal group which drains into the petrosal sinuses; and a tentorial group which drains into the tentorial sinuses near the torcula.