The great cerebral vein (vein of Galen) is a short, unpaired midline vein formed by the union of the two internal cerebral veins at the posterior end of the corpus callosum below the splenium. It courses posteriorly in the cisterna ambiens and joins the inferior sagittal sinus to form the straight sinus. It drains the deep white matter, basal ganglia, thalami, and lateral ventricle walls via the internal cerebral veins and the basal veins of Rosenthal.
| Origin | Union of the two internal cerebral veins beneath the splenium of the corpus callosum |
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| Course | A short midline vein that curves backward and upward around the splenium to join the inferior sagittal sinus, forming the straight sinus |
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Vein of Galen malformations are congenital high-flow shunts between cerebral arteries and the embryonic precursor of the vein (the median prosencephalic vein), and are the commonest intracranial vascular malformation to present in newborns. They cause high-output cardiac failure, hydrocephalus and macrocephaly, can be detected on prenatal ultrasound, and are treated by staged endovascular embolisation of the feeding arteries. The vein is compressed by pineal region tumours and must be preserved in pineal and posterior third ventricle surgery, including supracerebellar infratentorial and posterior interhemispheric approaches.
A congenital arteriovenous malformation involving the median prosencephalic vein presents in neonates with high-output cardiac failure and cardiomegaly from massive cerebral arteriovenous shunting, managed by staged endovascular embolisation of arterial feeders to progressively reduce shunt flow.
Thrombosis of the vein of Galen as part of deep cerebral venous sinus thrombosis produces bilateral thalamic infarction with profound alteration of consciousness, requiring urgent anticoagulation even in the presence of haemorrhagic transformation.
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