Deep Cervical Veins Research Articles

Posterior condylar canal dural arteriovenous fistula treated with transvenous embolization through the deep cervical vein

The posterior condylar vein is an emissary vein that connects the extracranial and intracranial venous systems through the posterior condylar canal (PCC). Dural arteriovenous fistulas (DAVF) of the PCC are rare, and only seven cases have been reported. Transvenous embolization (TVE) is the first-line treatment for PCC DAVF and is predominantly performed through the internal jugular vein. Herein, we report a case of PCC DAVF treated with TVE through the deep cervical vein. This is the first case report of a PCC DAVF treated with TVE through the deep cervical vein.

Post-Covid Cavernous Sinus Thrombosis with Peri-Orbital Cellulitis, Ophthalmoplegia, Deep Cervical Vein Thrombosis, Sinusitis in a 24-Year-Old Lady

A 24-year-old female presented with blurring of vision, chemosis, protrusion of eyeball, restriction of movements of right eye, numbness over the right side of the face with severe headache, stiffness of neck, and fever of 2 days duration. She gives a history of recent Covid-19 infection 3 weeks back. She was treated symptomatically and recovered fully. On examination, there was proptosis, chemosis, third, fourth, fifth, and sixth nerve palsy on the right side, and nuchal rigidity. She was started on broad spectrum antibiotics, analgesics, anticoagulant, and prophylactic antifungal thinking in line of post-Covid orbital cellulitis or mucormycosis. Her investigations revealed raised total leucocyte count and erythrocyte sedimentation rate with normal ultrasound abdomen and chest X-ray. Blood culture and culture of nasal swab and oral cavity for fungus were sterile. Contrast-enhanced magnetic resonance imaging brain, orbit, and sinus showed proptosis, myofascial edema, superior ophthalmic vein thrombosis, right cavernous sinus and deep cervical vein thrombosis, sphenoid and bilateral ethmoid sinusitis with narrow lumen of the internal jugular vein. She responded very well to the treatment. Her inflammatory parameters came down drastically and clinically, she started opening her eyes and ophthalmoplegia subsided within a week. By the 10th day she was asymptomatic. Repeat MRI showed reduction of proptosis, myofascial edema with partial recanalization of right superior ophthalmic vein, right cavernous sinus, and right deep cervical vein. She was discharged on injectable anticoagulant and antibiotics for another 10 days.

Alternative route to a hypoglossal canal dural arteriovenous fistula in case of failed jugular vein approach.

Hypoglossal canal dural arteriovenous fistulas (HC-DAVF) involve the anterior condylar vein (ACV) and anterior condylar confluence (ACC). They often present with tinnitus, bruit, and hypoglossal nerve palsy. The most common treatment in HC-DAVFs is transvenous embolization using coils and the most direct transvenous route is the trans-internal jugular vein access. When this approach is not feasible, a treatment attempt is possible through alternative routes. We report 2 patients with DAVFs involving the anterior condylar confluence. The first patient presented with pulsatile tinnitus and hypoglossal nerve palsy, and was treated by a standard transjugular approach. The second patient presented with pulse-synchronous bruit. Following an unsuccessful attempt of the transjugular approach, the fistulous point was reached via the deep cervical vein and complete occlusion was achieved by coil deployment. Both patients had complete regression of symptoms. Endovascular therapy is the elective treatment for HC-DAVFs and the transjugular approach is the most commonly used. The deep cervical vein (DCV) can be an alternative transvenous route when the transjugular approach fails.

Patterns and Rates of Supplementary Venous Drainage to the Internal Jugular Veins

Several studies have found supplemental venous drainage channels in addition to bilateral internal jugular veins for cerebral venous efflux. We performed this study to characterize the supplemental venous outflow patterns in a consecutive series of patients undergoing detailed cerebral angiography with venous phase imaging. The venographic phase of the arteriogram was reviewed to identify and classify supplemental cerebral venous drainage into anterior (cavernous venous sinus draining into pterygoid plexus and retromandibular vein) and posterior drainage pattern. The posterior drainage pattern was further divided into plexiform pattern (with sigmoid venous sinus draining into the paravertebral venous plexus), and solitary vein pattern (dominant single draining deep cervical vein) drainage. The posterior plexiform pattern was further divided into 2 groups: posterior plexiform with or without prominent solitary vein. Supplemental venous drainage was seen ipsilateral to internal jugular vein in 76 (43.7%) of 174 venous drainages (87 patients) analyzed. The patterns were anterior (n = 23, 13.2%), posterior plexiform without prominent solitary vein (n = 40, 23%), posterior plexiform with prominent solitary vein (n = 62, 35.6%), and posterior solitary vein alone (n = 3, 1.7%); occipital emissary veins and/or transosseous veins were seen in 1 supplemental venous drainage. Concurrent ipsilateral anterior and posterior supplemental drainage was seen in 6 of 174 venous drainages analyzed. We provide an assessment of patterns and rates of supplementary venous drainage to internal jugular veins to improve our understanding of anatomical and physiological aspects of cerebral venous drainage.

The Anatomical Correlation between the Internal Venous Vertebral System and the Cranial Venae Cavae in Rabbit

The aim of this study was to describe the possible variations in the connection between the internal venous vertebral system and the cranial vena cava in rabbit using corrosion technique. The study was carried out on 40 adult New Zealand white rabbits. The venous system was injected by using Batson's corrosion casting kit number 17. We found the connection between the internal venous vertebral system and the cranial vena cava by means of the vertebral veins and the right azygos vein. The vertebral vein was present as independent tributary in 36 cases (90%). In the rest of the cases, it was found as being double, being triple, or forming a common trunk with other veins. The azygos vein was present as independent tributary of the cranial vena cava in 39 cases (97.5%). We found also a common trunk formed by the junction of the deep cervical vein, the right vertebral vein, and the azygos vein in one case (2.5%). The azygos vein received 6, 7, 8, or 9 pairs of dorsal intercostal veins. Documenting the anatomical variations in the rabbit will aid in the planning of future experimental studies and determining the clinical relevance on such studies.

Basicranial Venous Anomalies Associated With Complex Nonsyndromic Craniosynostosis in a Child

We report the radiological findings of severe bilateral jugular foraminal stenosis along with anomalous basicranial venous drainage in a child with a history of complex nonsyndromic craniosynostosis. CT with 3D reconstructions and MR venography revealed that the lateral sinuses were draining transosseously through several markedly enlarged emissary veins. The main route of transverse and sigmoid sinus drainage was through large mastoid emissaries to the deep cervical veins. There was additional drainage of these mastoid emissaries into the vertebral and paravertebral plexuses as well as into venous collaterals which subsequently reconstituted the internal jugular veins. Basicranial venous anomalies are common among children with complex craniosynostosis, and although they may not resemble intracranial vascular outflow deficiencies, they can pose significant surgical risks. This case emphasizes the need for proper clinical assessment and documentation of anomalous basicranial venous anatomy to facilitate management of complex craniosynostosis patients.

Altered Cerebrovenous Drainage in Patients With Migraine as Assessed by Phase-Contrast Magnetic Resonance Imaging

We aimed to assess whether migraine is associated with changes in the distribution of the venous drainage through primary and secondary pathways by using phase-contrast magnetic resonance imaging (MRI). We examined 26 patients (37.3 ± 13.9 years) with recurring migraine headaches and 26 age- and gender-matched controls with no neurologic disease (37.3 ± 13.7 years) on a 3 Tesla MR scanner. A 2D time-of-flight MR-venography of the upper neck region was performed to visualize the venous vasculature. Cine-phase contrast scans with high-velocity encoding were employed to quantify arterial inflow and flow in the primary venous channels (right and left jugular veins), whereas scans with low-velocity encoding were employed to quantify flow in the secondary venous channels (epidural, vertebral, and deep cervical veins). Patients with migraine showed (i) a higher prevalence of dense secondary extracranial venous networks (15 vs. 2, P = 0.00002) and (ii) a significantly larger percentage of venous outflow through secondary channels (10.5% vs. 5.5%; of total cerebral blood flow, P = 0.02). This mainly included drainage through epidural, vertebral, and deep cervical veins. Migraine patients showed a significantly larger percentage of venous outflow through secondary channels. The mechanism of this alteration remains to be elucidated. Potential mechanisms include repeated release of vasoactive substances or growth factors.

Hemodynamic Alteration of the Cervical Venous Circulation in a Patient Suffering From Atlantoaxial Degenerative Osteoarthritis with Subluxation: A Case Report

A 52-year-old female patient was admitted to our hospital with severe occipitocervical pain. The radiographic examination revealed degenerative osteoarthritis and subluxation of the right atlantoaxial joint. Her pain was completely and immediately relieved after occipitocervical reduction and fusion. The marked dilatation of the extradural venous plexus around the vertebral artery and the enlarged deep cervical veins seen on the preoperative MR images had returned to normal dimensions on the postoperative MR images, and this explained the observed rapid pain relief. We report here on this case together with a review of the relevant literature.

ANATOMY OF THE MASTOID EMISSARY VEIN AND VENOUS SYSTEM OF THE POSTERIOR NECK REGION

The superficial venous system of the posterior neck (suboccipital venous plexus) is a potential source of complications from bleeding and air embolism. Because there is little information available about this in the literature, an anatomic study of the superficial posterior neck venous system and a morphometric analysis of the mastoid emissary vein (MEV) complex were undertaken. Both surgical and endovascular implications were considered. The posterior craniocervical regions of 15 silicon-injected human cadaveric specimens were dissected. The patterns and variances of venous anatomy were observed. Distances between fixed bony landmarks were measured with a caliper. The suboccipital venous plexus, which forms a complex venous network located between the posterior muscular layers of the neck, drains to the anterior vertebral vein and deep cervical vein. The MEV connects this plexus to the sigmoid sinus. Its average diameter was 2.15 mm, and it was located a mean of 21.14 mm from the asterion and a mean of 33.65 mm from the mastoid tip. However, the size of the MEV complex varied considerably. The suboccipital venous plexus in the posterior neck region may be very large. The size of the veins in the plexus varies, but the drainage pattern remains consistent. The plexus is a potential source of intense bleeding and air embolism during posterior fossa approaches. The risks are greatest for lateral surgical approaches, as a result of the anatomic position of the venous system. The described measurements can be used to approach the MEV in endovascular procedures that involve the sigmoid sinus.

Topographic Anatomy of the Vertebral Venous System in the Thoracic Inlet

Topographic Anatomy of the Vertebral Venous System in the Thoracic InletKenji Ibukuro1, Hozumi Fukuda, Koichi Mori and Yoshihiro InoueAudio Available | Share

Spontaneous Disappearance of Arteriovenous Fistula Between the Vertebral Artery and Deep Cervical Vein —Case Report—

A 58-year-old female was readmitted with pulsatile tinnitus in the right ear 8 months after subtemporo-occipital transtentorial clipping of a peripheral superior cerebellar artery aneurysm. On examination, she was normal except for pulsatile bruit over the right mastoid region. Angiography showed a fistulous communication between the muscular branches of the right vertebral artery and the deep cervical vein. The incision of the aneurysm surgery was supratentorial, so the only possible cause of the upper cervical arteriovenous (AV) fistula was fine gold acupuncture needles implanted for bronchial asthma 18 years before. The AV fistula disappeared spontaneously after 1 month, possibly because of thrombosis of the affected veins.

The vertebral and azygos venous systems, and some variations in systemic venous return.

The venous system of man, in accord with conventional anatomic description, is divided into two main groups: the pulmonary veins and the systemic veins. With the exception of the cardiac veins, the systemic venous drainage returns to the heart through two great vessels, the superior and the inferior vena cava. From the cranial cavity and the upper extremities the blood converges on the superior vena cava, and from the abdominal viscera and lower extremities on the inferior vena cava. Obstruction of either of these trunks is not incompatible with life in man (5, 36, 39). The development of a large by-pass mechanism, effectively establishing communication between the two vast caval drainage areas, is accomplished by collateral vessels, of which the vertebral veins and the azygos system form an important component (34, 37, 39, 40). In the dog, both venae cavae may be occluded for thirty minutes, with survival, if the azygos vein is patent (3). This is accompanied by a fivefold increase in azygos blood flow. How this is possible becomes apparent after consideration of the intercommunications of the vertebral veins (4, 37). At the base of the brain, they anastomose extensively with the venous trunks of the cranium; in the neck, with the deep cervical veins; in the thorax and abdomen, with the intercostal and lumbar veins; in the pelvis, with the large venous plexuses anterior to the sacrum. In turn, the sacral and lumbar veins communicate directly with the inferior vena caval system, the lumbar and intercostal veins with the azygos system, and the azygos system with the superior vena cava and its branches (26). In the early 1940's, Batson revived interest in the vertebral system of veins by demonstrating that a thin opaque medium injected into the dorsal vein of the penis of a cadaver would spread into the sacral canal, fill the veins in the wings of the bony pelvis, and finally move up the vertebral system as far as the cranial cavity. The mode of spread was similar to that of carcinoma of the prostate, and Batson suggested that in the great venous lakes formed by these plexuses, tumor emboli might well spread from origin to final site of deposition. He also showed that the vertebral veins filled, following injection in a live monkey, if the inferior vena cava were compressed (6–8). Shortly after Batson described the anatomy of the vertebral veins and expounded his theory of their role in metastases, Harris went to great lengths to prove that Batson's ideas were neither new nor original (24). As a matter of fact, the vertebral venous system was by no means unknown to anatomists prior to Batson's time, although Franklin in his Monograph on Veins, written in 1937, did not even mention the vertebral plexuses (20). Willis in 1664 (48) and Winslow in 1732 (49) characterized the structure of the spinal veins. Bock in 1823 described the rich plexuses within the bony canal, the posterior venous plexus, and the azygos system (9).

Post‐tonsillitic deep cervical abscess and internal jugular vein thrombophlebitis. A report of six cases

Post‐tonsillitic deep cervical abscess and internal jugular vein thrombophlebitis. A report of six cases