Superior petrosal vein

The superior petrosal vein, also known as Dandy’s vein is part of the venous drainage system in the posterior cranial fossa, draining the anterior aspect of the cerebellum and brainstem.

Gross anatomy

Each superior petrosal vein is usually formed by the convergence of multiple tributaries to form a single large vein that empties into the superior petrosal sinus.

History and etymology

The anatomical course of the superior petrosal vein was first described by Walter E Dandy (1886–1946), the American neurosurgeon, said to be one of the most outstanding of the 20th century . He highlighted the relation of the vein to the trigeminal nerve and cerebellum, and its significance during surgery for trigeminal neuralgia.

Clinical importance

The superior petrosal vein can be a hindrance for the retrosigmoid approach to the posterior fossa, limiting the extent of cerebellar retraction and blocking access to the upper cerebellopontine angle during surgery for trigeminal neuralgia, vestibular schwannomas, and meningiomas, obstructing the approach to the trigeminal nerve from the retrosigmoid corridor.

Preservation of this vein is a neurosurgical dilemma. A recent review has revealed that although the incidence of complications due to superior petrosal vein obliteration is low, preservation  should be attempted since the sequelae might be worse than the natural history of the existing pathology .

The superior petrosal vein has also been implied in trigeminal neuralgia due to "venous neurovascular conflict" .