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AJNR - American Journal of Neuroradiology

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American Journal of Neuroradiology 23:1500-1508, October 2002
© 2002 American Society of Neuroradiology

BRAIN

The Craniocervical Venous System in Relation to Cerebral Venous Drainage

Diego San Millán Ruíz^a,c, Philippe Gailloud^b,c, Daniel A. Rüfenacht^a,c, Jacqueline Delavelle^a, Frank Henry^a and Jean H.D. Fasel^c,d

^a the Department of Radiology, Geneva University Hospital, Geneva, Switzerland
^b the Division of Interventional Neuroradiology, Johns Hopkins Hospital, Baltimore, MD
^c the Groupe de Recherches en Anatomie Clinique, Department of Morphology, University of Geneva, Geneva, Switzerland
^d the Anatomy Division, Department of Morphology, University of Geneva, Geneva, Switzerland

Address reprint requests to Diego San Millán Ruíz, MD, Department of Radiology, Geneva University Hospital, 24, rue Micheli-du-Crest, 1211 Geneva 4, Switzerland

BACKGROUND AND PURPOSE: Passing from the supine to the upright position favors cerebral venous outflow into vertebral venous systems rather than into the internal jugular veins. We sought to determine venous connections between dural venous sinuses of the posterior cranial fossa and craniocervical vertebral venous systems.

METHODS: Corrosion casts of the cranial and cervical venous system were obtained from 12 fresh human cadavers, and anatomic confirmation was made by dissection of three previously injected fresh human specimens. MR venography was performed to provide radiologic correlation.

RESULTS: The lateral, posterior, and anterior condylar veins and the mastoid and occipital emissary veins were found to represent the venous connections between the dural venous sinuses of the posterior cranial fossa and the vertebral venous systems. This study revealed the nearly constant presence of the anterior condylar confluent (ACC) located on the external orifice of the canal of the hypoglossal nerve. The ACC offered multiple connections with the dural venous sinuses of the posterior cranial fossa, the internal jugular vein, and the vertebral venous system. All these structures were shown by MR venography.

CONCLUSION: The lateral, posterior, and anterior condylar veins and the mastoid and occipital emissary veins connect the dural venous sinuses of the posterior cranial fossa with the vertebral venous systems. These connections are clinically relevant, because encephalic drainage occurs preferentially through the vertebral venous system in the upright position. The ACC is a constant anatomic structure that may play an important role in the redirection of cerebral blood in the craniocervical region.

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