Anatomy of Cerebral Veins and Dural Sinuses

Introduction

Venous infarction of brain comprises only 1% of all strokes . Many predisposing conditions such as dehydration, coagulopathies, pregnancy, trauma, surgical interventions, inherited collagen disorders, and autoimmune vascular diseases may result in cerebral vein thrombosis. Fortunately not all of veins lead to severe complications. However, in case of clinical manifestations developed, diagnosis must be done immediately in order to investigate and treat possible reasons. This chapter aims to present anatomical configuration of cerebral venous system regarding possible significant origin of “stroke.”

Dural Venous Sinuses

The dural sinuses are large endothelial-lined trabeculated channels that collect cerebral blood from the superficial, deep, and posterior fossa and drain into the internal jugular vein at the level of the jugular bulb ( Fig. 5.1 ) . These sinuses, which lie between the superficial (periosteal) and deep (meningeal) layers of the dura mater, also excrete cerebrospinal fluid (CSF) via arachnoid granulations (i.e., Pacchionian granulations) that emerge from the subarachnoid space . These arachnoid granulations (villi) are commonly found around the superior sagittal and transverse sinuses . Furthermore, cavernous sinuses (CS), which are paired dural venous sinuses, contain cranial nerves, arteries, and veins.

Figure 5.1, Magnetic resonance venography of brain with lateral (A), oblique (B), and anteroposterior (C) views. Superior sagittal, straight, and occipital sinuses join at the point of torcular herophili. Then they drain into transverse, sigmoid sinuses and internal jugular vein orderly. Superficial middle cerebral vein makes anastomosis to superior sagittal sinus via vein of Trolard, to transverse sinus via vein of Labbé, and to cavernous sinus via sphenoparietal sinus. Intercavernous plexus and clival plexus also make connection between two cavernous sinuses.

Superior Sagittal Sinus

The superior sagittal sinus (SSS), which is the longest dural sinus, lies along the superior edge of the falx cerebri, which is attached to the crista galli at the interhemispheric space just underneath the cranial vault. The SSS originates from the anterior part of the frontal lobe at the foramen caecum and drains into the torcular herophili . Contact with the SSS leads to the development of an impression on the frontal and parietal bone.

The SSS enlarges posteriorly due to tributaries from cortical veins and arachnoid granulations. Concurrently, emissary veins carry diploic blood into the SSS. Thus, the posterior portion of the SSS is more visible in the venous phase of digital subtraction angiography (DSA) and magnetic resonance venography (MRV). The radiological appearance of the SSS is curvilinear with an enlarged line in the sagittal view and a reverse triangular shape in the coronal view. A rudimentary view of the anterior one-third portion of the SSS has been well characterized .

Inferior Sagittal Sinus

The inferior sagittal sinus (ISS) originates from the inferior edge of the anterior one-third portion of the falx cerebri and lies within the interhemispheric spaces. This relatively small sinus collects anterior pericallosal veins . The ISS has a curvilinear shape like the SSS. The ISS joins with the great cerebral vein (i.e., vein of Galen) at the level of the falcotentorial junction, which both drain into the straight sinus .

Straight Sinus

The straight sinus (SS) originates from the falcotentorial junction via the union of the great cerebral vein and the ISS. The SS receives veins from the falx cerebri, tentorium cerebelli, and adjacent brain parenchyma. The SS drains into the torcular herophili together with the SSS . As a variation, the SS may also drain into the transverse sinus; this variation tends to occur more frequently on the left side .

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