ONS Advance Access: Intracranial Connections of the Vertebral Venous Plexus: Anatomical Study with Application to Neurosurgical and Endovascular Procedures at the Craniocervical Junction

Traditionally, the vertebral venous plexus has been described as consisting of 4 parts, an anterior external (outside the spinal canal) and internal (inside the spinal canal, epidural) component and a posterior external and internal (epidural) component.1 However, only vague statements regarding the cranial confluence of the vertebral venous system are found in the literature. For example, Groen et al2 stated that the vertebral venous plexus finds “a cranial terminus in the dural sinuses,” and Falk3 mentioned that distally, the marginal sinus drains freely into the vertebral venous plexus. Even studies dedicated to evaluating the spinal venous plexus2 and sinuses near the foramen magnum48 have not commented on the specific anatomy of the intracranial connections.

Because some investigators9 have found that the vertebral venous plexus is the main intracranial venous outflow in the upright position and is a secondary pathway of intracranial egress during Valsalva maneuvers or with compromised internal jugular veins, a study aimed at better quantitating this anatomy seemed reasonable. Moreover, recently, the vertebral venous plexus has been used for transvenous embolization of dural arteriovenous fistulas involving the marginal sinus.10

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