A, The superior petrosal veins drain the anterior and lateral surfaces of the brainstem, the petrosal surface, and some of the lateral part of the tentorial and suboccipital surfaces. The veins of the middle cerebellar peduncle ascend on the middle cerebellar peduncles and join the veins of the cerebellopontine fissure and the transverse pontine veins to form superior petrosal veins that empty into the superior petrosal sinuses. B, Lateral view of a large superior petrosal vein formed by the union of the transverse pontine, pontotrigeminal, and anterior hemispheric veins and the vein of the cerebellopontine fissure. A large branch of the superior cerebellar artery and the trigeminal nerve are enmeshed in the tributaries of this superior petrosal vein. Care is required to avoid occluding the superior cerebellar artery when occluding a multipronged petrosal vein. C, Retrosigmoid view. The right cerebellopontine angle is drained by a superior petrosal vein formed by the pontotrigeminal and transverse pontine veins and the vein of the cerebellopontine fissure. D, The tributaries of this superior petrosal vein include the transverse pontine, pontotrigeminal, and anterior hemispheric veins and the vein of the cerebellopontine fissure. E, Superior petrosal vein with multiple tributaries. The vestibulocochlear nerve has been depressed to expose the facial nerve. F, The segment of the superior petrosal sinus, which crosses above the trigeminal nerve and receives the superior petrosal veins, has been removed. The posterior trigeminal nerve passes forward below the tentorial edge and the superior petrosal sinus to enter Meckel’s cave. The superior petrosal sinus extends medially through the upper edge of the porus of Meckel’s cave and above the trigeminal nerve to join the cavernous sinus. Some superior petrosal veins may join the sinus on the medial side of the trigeminal nerve. (Images courtesy of AL Rhoton, Jr.)