Anatomy of Spinal Venous Drainage for the Neurointerventionalist: From Puncture Site to Intervertebral Foramen.

L.E Savastano,H.J Cloft,T Huynh,W Brinjikji,S Oushy,J Cutsforth-Gregory,N Borg,G Lanzino

doi:10.3174/ajnr.a7409

L.E Savastano, H.J Cloft + Show 6 more

Open Access

https://doi.org/10.3174/ajnr.a7409

Copy DOI

Abstract

CSF-venous fistula is a relatively novel entity that is increasingly being recognized as a cause for spontaneous intracranial hypotension. Recently, our group published the first series of transvenous embolization of CSF-venous fistulas in this journal. Having now performed the procedure in 60 patients, we have garnered increasing familiarity with the anatomy and how to navigate our way through the venous system to any intervertebral foramen in the cervical, thoracic, and lumbar spine. The first part of this review summarizes the organization of spinal venous drainage as described in classic anatomy and interventional radiology texts, the same works that we studied when attempting our first cases. In the second part, we draw mostly on our own experience to provide a practical roadmap from the puncture site to the foramen. On the basis of these 2 parts, we hope this article will serve to collate the relevant anatomic knowledge and give confidence to colleagues who wish to embark on transvenous spinal procedures.

Highlights

Recalling that the azygos vein courses over the right main exists as a uniform single channel, but higher up, its configura- bronchus to drain into the posterior aspect of the superior vena cava (SVC), when the tion consists of a rich, confluent, and valveless paravertebral guide catheter reaches the level of the right main bronchus in the plexus (Figs 4 and 9)
In cases in which a stump is not seen at the desired level, directing a curved microwire to the right of the azygos vein at the level of the target intervertebral foramen usually results in the wire finding the segmental vein
Once the microcatheter tip is close to the intervertebral foramen, microcatheter venography is performed to show the intercostal vein and foraminal venous plexus

Summary

Introduction

The internal and external vertebral plexuses are functionally and anatomically connected through each intervertebral foramen via the foraminal veins (Fig 5), which form a plexus surrounding each nerve root. The hemiazygos vein drains the ascending lumbar vein, left subcostal, and 9th-to-11th intercostal veins, usually coursing around the anterior aspect of the T9 vertebral body to drain into the azygos vein (Fig 8).

Results

Conclusion