|
|
| (One intermediate revision by the same user not shown) |
| Line 1: |
Line 1: |
| The '''cerebrospinal venous system''' (CSVS) consists of the interconnected venous systems of the brain (the [[Cerebral circulation|cerebral venous system]]) and the spine (the [[Batson venous plexus|vertebral venous system]]).
| | '''Cerebrospinal venous system''' (CSVS) refers to the interconnected network of [[veins]] within the [[brain]] (the '''[[cerebral venous system]]''') and the [[spinal cord]] (the '''[[vertebral venous system]]'''). This anatomical and functional system plays a vital role in [[venous drainage]], [[metastasis]], [[intracranial pressure]] regulation, and even in [[drug delivery]] to the central nervous system. |
|
| |
|
| ==Introduction== | | == Introduction == |
| | The cerebrospinal venous system was first accurately described in 1819 by French anatomist '''[[Gilbert Breschet]]'''. Later, in 1940, the American anatomist '''[[Oscar Batson]]''' extensively studied the vertebral venous plexus, which has since been referred to as the '''[[Batson venous plexus]]'''. Batson’s work provided key insights into the anatomical continuity between the cerebral and vertebral venous networks and their physiological importance. |
|
| |
|
| The anatomic connections between the cerebral and vertebral venous systems was accurately depicted in 1819 by [[Gilbert Breschet]], a French physician later to become Professor of Anatomy at Faculté de médecine de Paris.<ref>Breschet, G., Recherches anatomiques physiologiques et pathologiques sur le systáeme veineux. 1829, Paris,: Rouen fráeres. 48 p.</ref> However, the significance and physiology of this venous complex remained obscure for more than a century, until the seminal work of Oscar Batson. Batson, a Professor of Anatomy at the University of Pennsylvania, in 1940 detailed the anatomy and physiology of the cerebrospinal venous system and its role in the spread of metastases.<ref name="Batson">Batson, O.V., The Function of the Vertebral Veins and their role in the spread of metastases. Annals of Surgery, 1940. 112: p. 138-149</ref> Batson’s work remains primarily known for its accurate depiction of the vertebral venous system as the route of [[metastasis]] of cancer from the prostate to the spine, and the vertebral venous system is often referred to as [[Batson venous plexus]] or Batson’s plexus. It is less commonly recognized that Batson’s detailed experiments also demonstrated the direct anatomic connection between the vertebral and cerebral venous system, an anatomical and physiological fact that was later confirmed by others.<ref>Anderson, R., Diodrast studies of the vertebral and cranial venous systems to show their probable role in cerebral metastases. J Neurosurg, 1951. 8(4): p. 411-22</ref><ref name="Epstein">Epstein, H.M., et al., The vertebral venous plexus as a major cerebral venous outflow tract. Anesthesiology, 1970. 32(4): p. 332-7</ref><ref name="Zouaoui">Zouaoui, A. and G. Hidden, The cervical vertebral venous plexus, a drainage route for the brain. Surg Radiol Anat, 1989. 11(1): p. 79-80</ref><ref name="SanMillan">San Millan Ruiz, D., et al., The craniocervical venous system in relation to cerebral venous drainage. AJNR Am J Neuroradiol, 2002. 23(9): p. 1500-8</ref> It was later recognized that the cerebrospinal venous system represents a main route for efflux of venous blood from the brain.<ref name="Epstein" /><ref name="Zouaoui" /><ref name="SanMillan" /> Modern imaging methodology, including [[Magnetic resonance imaging|MR scanning]], have detailed the [[anastomoses]] of the cerebral and spinal venous systems in the [[suboccipital triangle|suboccipital]] region.<ref>Takahashi, S., et al., Craniocervical junction venous anatomy around the suboccipital cavernous sinus: evaluation by MR imaging. Eur Radiol, 2005</ref><ref name="Arnautovic">Arnautovic, K.I., et al., The suboccipital cavernous sinus. J Neurosurg, 1997. 86(2): p. 252-62</ref> Batson, and others had recognized that blood flow in the cerebrospinal venous system was bi-directional, a unique feature that was enabled by a general lack of venous valves in these venous plexuses.<ref name="Batson_a">Batson, O.V., The vertebral vein system. Caldwell lecture, 1956. Am J Roentgenol Radium Ther Nucl Med, 1957. 78(2): p. 195-212</ref><ref>Herlihy, W.F., Revision of the venous system: the role of the vertebral veins. Med J Austr, 1947. 1(22): p. 661-72</ref><ref>Groen, R.J., et al., Morphology of the human internal vertebral venous plexus: a cadaver study after intravenous Araldite CY 221 injection. Anat Rec, 1997. 249(2): p. 285-94</ref> This bi-directional flow was thought to have physiologic significance with regard to the maintenance of pressure [[hemostasis]] within the cranium with changes in posture.<ref>Valdueza, J.M., et al., Postural dependency of the cerebral venous outflow. Lancet, 2000. 355(9199): p. 200-1</ref><ref>Gisolf, J., et al., Human cerebral venous outflow pathway depends on posture and central venous pressure. J Physiol, 2004. 560 (Pt 1): p. 317-27</ref> The terms “cerebrospinal venous system” and “CSVS” were coined in a 2006 review <ref>Tobinick, E., The cerebrospinal venous system: anatomy, physiology, and clinical implications. MedGenMed, 2006. 8(1): p. 53</ref> that has itself been cited in a number of subsequent articles and reviews.<ref>Pearce, J.M.S., The craniospinal venous system. Eur Neurol, 2006. 56(2): p. 136-8</ref><ref>Tubbs, R., et al., The basilar venous plexus. Clinical Anatomy, 2007. 20(7)</ref><ref name="DeWyngaert">De Wyngaert, R., I. Casteels, and P. Demaerel, Orbital and anterior visual pathway infection and inflammation. Neuroradiology, 2009. 51(6): p. 385-96</ref><ref>Jost, G., et al., Intradural spinal metastasis of renal cell cancer. Report of a case and review of 26 published cases. Acta Neurochir (Wien), 2009. 151(7): p. 815-21</ref><ref>Morimoto, A., et al., Assessment of cervical venous blood flow and the craniocervical venus valve using ultrasound sonography. Leg Med (Tokyo), 2009. 11(1): p. 10-7</ref><ref name="Nathoo">Nathoo, N., et al., History of the vertebral venous plexus and the significant contributions of Breschet and Batson. Neurosurgery, 2011. 69(5): p. 1007-14</ref><ref>Stringer, M.D., et al., The vertebral venous plexuses: the internal veins are muscular and external veins have valves. Clin Anat, 2012. 25(5): p. 609-18</ref>
| | Batson demonstrated that the cerebrospinal venous system is a key route for the hematogenous spread of [[prostate cancer]] and other tumors to the [[spine]] and [[central nervous system]]. He also established that the venous flow in this system is [[bidirectional]] due to the lack of [[venous valves]], a unique property with implications in [[posture]]-related pressure adjustments and venous blood flow regulation. |
|
| |
|
| ==The Continuity of the Venous Systems of the Brain and the Spine== | | == The Continuity of the Venous Systems of the Brain and Spine == |
| | Batson’s [[radiological]] and anatomical experiments revealed that the venous systems of the brain and spinal cord are continuous and interconnected. Injections of [[contrast agent]]s into the superficial veins of the body (e.g., breast) led to visualized filling of cerebral sinuses, including the [[superior sagittal sinus]], [[transverse sinus]], and associated [[dural venous sinuses]]. |
|
| |
|
| Beginning in 1937 Batson began a series of injection experiments investigating the anatomy and physiology of the cerebrospinal venous system.<ref name="Batson" /> His carefully documented results demonstrated the continuity of the venous systems of the brain and the spine, as injections of [[Radiocontrast agent|contrast dyes]] into venous systems feeding into the spinal venous plexus led to the appearance of contrast material in the cerebral veins (Figures 5 and 7, Batson 1940).<ref name="Batson" /><ref name="Batson_a" /> Batson noted "the extensive filling of the vertebral veins, the superior longitudinal sinus, transverse sinus as well as other dural and cerebral veins" following injection of radiopaque material into a superficial venule in the left breast (Batson 1940, Figure 5, page 143). Subsequent studies by multiple independent authors replicated Batson's findings of the continuity of the cerebral and vertebral venous systems, and the important physiological consequences of this continuity. For example, in 1996, Arnautovic et al., summarizing the results of their own work and that of others, stated: "In addition to confirming that the vertebral venous plexus is a direct continuation of the cranial venous sinuses, our study showed that it is also indirectly connected to these sinuses via the suboccipital cavernous sinus. The vertebral venous plexus is involved in regulating [[intracranial]] pressure, transmitting the influence of the respiratory and cardiac pressures to the intracranial compartment and equalizing the pressures within the venous system.<ref name="Arnautovic" />". The continuity of the cerebral and vertebral venous systems was therefore essential to an understanding of both normal physiology, as well as to an understanding of the distribution of tumor metastases, as Batson had so elegantly demonstrated.
| | This continuity allows for the transmission of [[respiratory]] and [[cardiac cycle]] pressure changes from the vertebral veins into the cranial cavity, influencing [[cerebral hemodynamics]] and [[intracranial pressure]]. Later studies confirmed the presence of [[anastomoses]] in the [[suboccipital triangle]], forming a connection between the cranial venous sinuses and the vertebral venous plexus. |
|
| |
|
| ==An Anatomical Route for Dissemination of Metastases and Infection== | | == Anatomical Route for Dissemination of Metastases and Infection == |
| | The CSVS plays an important role in the dissemination of both [[metastatic cancer]] and [[infectious diseases]] throughout the central nervous system. Because of its valveless architecture and direct access to deep structures, this system can transmit [[tumor emboli]], [[infectious agents]], or [[inflammatory mediators]] to distant parts of the central nervous system. Cancers like [[renal cell carcinoma]], [[glioblastoma]], and [[bladder carcinoma]] have all been associated with spinal or meningeal spread via the CSVS. |
|
| |
|
| It is now recognized that the cerebrospinal venous system represents not only a route for dissemination of metastases, but also a route for dissemination of infection throughout the cerebrospinal axis, in both directions.<ref name="DeWyngaert" /><ref>Sugimori, K., et al., Leptomeningeal carcinomatosis from urinary bladder adenocarcinoma: a clinicopathological case study. Neuropathology, 2005. 25(1): p. 89-94</ref><ref>Rajagopalan, V., et al., Bone marrow metastases from glioblastoma multiforme--A case report and review of the literature. J Neurooncol, 2005. 72(2): p. 157-61</ref>
| | == Batson's Legacy == |
| | Batson highlighted the previously unrecognized function of the vertebral veins as a systemic venous network. Despite early anatomical descriptions, the physiological role of the vertebral plexus was largely overlooked until his seminal work. The term \"cerebrospinal venous system\" itself was coined in 2006 and has since been widely adopted in [[neurosurgery]], [[neurology]], and [[radiology]]. |
|
| |
|
| ==Batson's Legacy==
| | Contemporary research recognizes the CSVS as a large-capacity, valveless, bidirectional venous network that regulates venous outflow, stabilizes [[cerebrovascular pressure]], and facilitates the transport of [[biological agents]] under pathological conditions. |
|
| |
|
| In 1957 Batson wrote, ""It seems incredible that a great functional complex of veins would escape recognition as a system until 1940 .... In the first four decades of the last [19th] century, our knowledge of the vertebral veins was developed and then almost forgotten.<ref name="Batson_a" />". During the past half century, our appreciation of Batson's findings and concepts has grown, expanding beyond his explanation for previously inexplicable routes of tumor metastasis. In 2011, researchers from the Department of Neurological Surgery at Ohio State Medical Center summarized the significance and current understanding of several aspects of the CSVS in their review article: "Today, the vertebral venous plexus is considered part of the cerebrospinal venous system, which is regarded as a unique, large-capacitance, valveless plexiform venous network in which flow is bidirectional that plays an important role in the regulation of intracranial pressure with changes in posture and in venous outflow from the brain, whereas in disease states, it provides a potential route for the spread of tumor, infection, or emboli.".<ref name="Nathoo" />
| | == Therapeutic Use == |
| | The CSVS is now being studied for its potential use in the delivery of [[biologic therapies]] to the [[brain]] and [[spinal cord]]. Because of its anatomical access and bidirectional flow properties, researchers are exploring novel [[drug delivery]] methods that use the vertebral venous system to bypass the [[blood-brain barrier]]. One example includes perispinal delivery of [[etanercept]] for conditions such as [[stroke]] and [[traumatic brain injury]], with suggested mechanisms involving CSVS-mediated uptake. |
|
| |
|
| ==Therapeutic Use== | | == Related Topics == |
| | * [[Cerebral venous sinus]] |
| | * [[Batson venous plexus]] |
| | * [[Cerebral circulation]] |
| | * [[Intracranial pressure]] |
| | * [[Venous drainage of the brain]] |
| | * [[Metastasis]] |
| | * [[Neuroanatomy]] |
| | * [[Spinal cord]] |
| | * [[Drug delivery to the CNS]] |
|
| |
|
| The cerebrospinal venous system may serve as a route for therapeutic delivery of large molecules to the brain<ref>Tobinick, E., Kim, N., Reyzin, G. et al., Selective TNF Inhibition for Chronic Stroke and Traumatic Brain Injury: An Observational Study Involving 629 Consecutive Patients Treated with Perispinal Etanercept, CNS Drugs, 2012, 26(12):1051-1070.</ref> and spinal cord,<ref>Esposito E, Cuzzocrea S. Anti-TNF therapy in the injured spinal cord. Trends Pharmacol Sci, 32(2), 107-115 (2011)</ref> as discussed: "... the drug enters the brain through the cerebrospinal venous system..."([[Sun Sentinel]], December 9, 2012, page 21A).<ref>Brochu, N., ''Stroke Patients Get a New Shot at Hope'', Sun Sentinel, December 9, 2012, front page, Fort Lauderdale, Florida</ref>
| | [[Category:Neurology]] |
| | | [[Category:Neuroanatomy]] |
| ==References==
| | [[Category:Cerebral circulation]] |
| {{reflist}}
| | [[Category:Venous system]] |
| | | [[Category:Anatomical systems]] |
| *
| |
| *
| |
| *
| |
| *
| |
| | |
| [[Category:Neurology|Cerebrospinal venous system]] | |
| {{dictionary-stub1}}
| |
| {{No image}}
| |
Cerebrospinal venous system (CSVS) refers to the interconnected network of veins within the brain (the cerebral venous system) and the spinal cord (the vertebral venous system). This anatomical and functional system plays a vital role in venous drainage, metastasis, intracranial pressure regulation, and even in drug delivery to the central nervous system.
Introduction[edit]
The cerebrospinal venous system was first accurately described in 1819 by French anatomist Gilbert Breschet. Later, in 1940, the American anatomist Oscar Batson extensively studied the vertebral venous plexus, which has since been referred to as the Batson venous plexus. Batson’s work provided key insights into the anatomical continuity between the cerebral and vertebral venous networks and their physiological importance.
Batson demonstrated that the cerebrospinal venous system is a key route for the hematogenous spread of prostate cancer and other tumors to the spine and central nervous system. He also established that the venous flow in this system is bidirectional due to the lack of venous valves, a unique property with implications in posture-related pressure adjustments and venous blood flow regulation.
The Continuity of the Venous Systems of the Brain and Spine[edit]
Batson’s radiological and anatomical experiments revealed that the venous systems of the brain and spinal cord are continuous and interconnected. Injections of contrast agents into the superficial veins of the body (e.g., breast) led to visualized filling of cerebral sinuses, including the superior sagittal sinus, transverse sinus, and associated dural venous sinuses.
This continuity allows for the transmission of respiratory and cardiac cycle pressure changes from the vertebral veins into the cranial cavity, influencing cerebral hemodynamics and intracranial pressure. Later studies confirmed the presence of anastomoses in the suboccipital triangle, forming a connection between the cranial venous sinuses and the vertebral venous plexus.
Anatomical Route for Dissemination of Metastases and Infection[edit]
The CSVS plays an important role in the dissemination of both metastatic cancer and infectious diseases throughout the central nervous system. Because of its valveless architecture and direct access to deep structures, this system can transmit tumor emboli, infectious agents, or inflammatory mediators to distant parts of the central nervous system. Cancers like renal cell carcinoma, glioblastoma, and bladder carcinoma have all been associated with spinal or meningeal spread via the CSVS.
Batson's Legacy[edit]
Batson highlighted the previously unrecognized function of the vertebral veins as a systemic venous network. Despite early anatomical descriptions, the physiological role of the vertebral plexus was largely overlooked until his seminal work. The term \"cerebrospinal venous system\" itself was coined in 2006 and has since been widely adopted in neurosurgery, neurology, and radiology.
Contemporary research recognizes the CSVS as a large-capacity, valveless, bidirectional venous network that regulates venous outflow, stabilizes cerebrovascular pressure, and facilitates the transport of biological agents under pathological conditions.
Therapeutic Use[edit]
The CSVS is now being studied for its potential use in the delivery of biologic therapies to the brain and spinal cord. Because of its anatomical access and bidirectional flow properties, researchers are exploring novel drug delivery methods that use the vertebral venous system to bypass the blood-brain barrier. One example includes perispinal delivery of etanercept for conditions such as stroke and traumatic brain injury, with suggested mechanisms involving CSVS-mediated uptake.
Related Topics[edit]
