The Deep Middle Cerebral Vein. A, Anterosuperior view. The anterior portions of both cerebral hemispheres have been removed to expose the temporal horns, basal cisterns, deep MCVs, basal veins, and PCAs. The PCAs arise from the basilar artery in the interpeduncular cistern and pass around the brainstem. The anterior choroidal arteries course around the left and right unci to reach the temporal horns. The right deep MCV passes around the limen area to join the basal vein. The right basal vein passes above the PCA in the crural and ambient cisterns. The anterior segment of the basal vein ends where the peduncular vein joins the basal vein at the anterolateral portion of the cerebral peduncle. The inferior choroidal vein joins the basal vein at the posterior edge of the cerebral peduncle. On the left side, the anterior segment of the basal vein is hypoplastic and the deep MCV courses below the M1 segment and empties into the sphenoparietal sinus along the sphenoid ridge. The middle segment of the basal vein passes around the brainstem above the PCA and is joined by the inferior ventricular and choroidal veins. Both basal veins join the vein of Galen in the quadrigeminal cistern. B and C, Views of the deep MCV draining into a left basal vein. B, Lateral view of the anteroinferior portion of the left insula. The frontoparietal and temporal opercula have been retracted. The MCA bifurcation has been retracted anteriorly to expose the insular veins. The precentral insular vein joins the SSV. The central and posterior insular veins join at the limen insulae to form the deep MCV. The anterior insular vein courses near the anterior limiting sulcus and joins the deep MCV. C, Anteroinferior view of the anterior perforated substance of the left hemisphere shown in B. The prebifurcation M1 segment and the LSAs have been retracted to expose the formation of the anterior segment of the basal vein. The deep MCV passes medially across the limen insulae and anterior perforated substance and is joined by the inferior striate and olfactory veins. The anterior segment of the basal vein begins at the union of the deep MCV and the anterior cerebral vein below the anterior perforated substance. D, Inferior view of the left frontal lobe and anterior perforated substance in another hemisphere. The deep MCV is formed by the union of the insular veins and receives the inferior striate veins as it crosses the anterior perforated substance. The basal vein begins at the junction of the anterior cerebral vein, deep MCV, and olfactory vein. (Images courtesy of AL Rhoton, Jr.)