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Basal Vein of Rosenthal

vena basalis Rosenthali

The basal vein of Rosenthal is a large deep cerebral vein arising near the anterior perforated substance by the union of the anterior cerebral and deep middle cerebral veins. It encircles the midbrain in the ambient cistern, draining the insular cortex, the temporal lobe base, and the midbrain, before joining its counterpart at the great cerebral vein of Galen. It is the largest tributary of the vein of Galen.

Region: Head & Skull

Clinical Relevance

Clinical Notes

The basal vein of Rosenthal is the primary drainage of the insular cortex and temporal lobe base, and its occlusion in deep CVT produces temporal lobe and insular ischaemia. It is a surgical landmark in the ambient cistern during approaches to the pineal region, posterior thalamus, and upper brainstem, where it lies immediately lateral to the surgical corridor and must be preserved. Arteriovenous malformations draining into the basal vein produce arterialized venous hypertension visible on DSA as early venous drainage into the Galenic system.

Pathology

Common Injuries & Conditions

Basal Vein Injury in Posterior Fossa Surgery

The basal vein of Rosenthal encircling the midbrain in the ambient cistern is encountered during infratentorial supracerebellar and occipital transtentorial approaches to the pineal region; its injury produces haemorrhagic infarction of the ipsilateral temporal lobe and insula, requiring meticulous dissection technique in this corridor.