Thrombosis of the deep cerebral venous system is a rare entity with a very poor prognosis. We report two patients with thrombosis of the internal cerebral veins and vein of Galen who responded to local urokinase. We review all 49 cases of deep cerebral venous thrombosis in the English literature. The mortality rate for patients treated with either IV heparin or local thrombolytics was 13% compared with 48% in untreated patients (p = 0.037). Based on this retrospective review of the literature and our two cases, we support the use of heparin or local thrombolytics in individual cases of deep cerebral venous thrombosis.