Anterior pontomesencephalic vein
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The anterior pontomesencephalic vein (APMV) is a longitudinal vein running along the anterior surface of the pons and mesencephalon and in the interpeduncular fossa. Uncommonly it can become large and can potentially lead to confusion on imaging. In a midline position, it is called the median anterior or anteromedian pontomesencephalic vein. In a more lateral position, it is called the lateral anterior pontomesencephalic vein.
The anterior pontomesencephalic vein runs anterior to the pons and mesencephalon and adheres to the anterior surface of those structures 1. It drains blood from the small pontine and mesencephalic veins into the basal veins of Rosenthal via the peduncular veins 1-3. It might be directly continuous with the anterior medullary vein or connect to it via one or both transverse pontine veins 1,2. Furthermore, it might connect to the superior petrosal vein/petrosal sinus, cavernous or marginal sinus via bridging veins 2,3.
The anterior pontomesencephalic vein is visible in up to 4% of CT angiograms and about half of the cases, it can become large enough to be confused with an arterial structure 1. If large it can also cause hyperattenuation in the interpeduncular cistern on non-contrast CT 1.
The mesencephalic veins might become obstructed as a result of transtentorial herniation or surgical procedures with subsequent hemorrhage 3.
- 1. Teksam M, Casey S, McKinney A, Michel E, Truwit C. Anatomy and Frequency of Large Pontomesencephalic Veins on 3D CT Angiograms of the Circle of Willis. AJNR Am J Neuroradiol. 2003;24(8):1598-601. PMC7974009
- 2. Kiyosue H, Tanoue S, Sagara Y et al. The Anterior Medullary-Anterior Pontomesencephalic Venous System and Its Bridging Veins Communicating to the Dural Sinuses: Normal Anatomy and Drainage Routes from Dural Arteriovenous Fistulas. Neuroradiology. 2008;50(12):1013-23. doi:10.1007/s00234-008-0433-3
- 3. Matsushima T, Rhoton A, de Oliveira E, Peace D. Microsurgical Anatomy of the Veins of the Posterior Fossa. J Neurosurg. 1983;59(1):63-105. doi:10.3171/jns.1983.59.1.0063