The anatomy of collateral venous flow from the brain and its value in aetiological interpretation of intracranial pathology
The anatomy of collateral venous flow from the brain and its value in aetiological interpretation of intracranial pathology
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DOI：
10.1007/s002340050321
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发表时间：
1996-10-01
期刊：
影响因子：
2.8
通讯作者：
Andeweg, J
中科院分区：
文献类型：
--
作者：
Andeweg, J
一个多世纪以来，关于大脑侧静脉流出的现有数据没有得到足够的重视，因为现有的理论没有赋予它们实际的重要性。关于动脉供血和脑脊液循环的观点被认为更相关。但现有数据提供了脑静脉流出的示意图模型，它确实具有重要的病理生理后果。通过颈内静脉的主要流出物可以通过颅底的交通被大椎丛完全取代。颅顶的信使静脉很小，数量很少。从深静脉系统流出经盖伦大静脉可被脉络膜、丘脑和纹状静脉向基底静脉吻合取代。所谓的脑内静脉吻合通过半瓣膜体向凸部方向是不存在或可以忽略不计的。相反，存在一个静脉分水岭，将室旁白质与皮层下白质层分开。在大多数婴儿中，海绵窦尚未连接到脑静脉。一旦这样的交通形成，重要的侧支通路通过基底静脉和尾静脉经由海绵窦到达翼状神经丛。主静脉和副静脉流出同时受阻将导致静脉压升高，最终导致脑血流量不足。这将导致颅内压升高，以及由于脑室周围萎缩导致的脑室增大。CBF双室模型的慢期与深静脉系统室旁白质区重合。在新生儿中发现CBF仍然很低，在两个隔室中CBF以不同的速率增加，在儿童时期达到最大值。在脑积水中，测量慢深室的CBF，而不是快速皮质室的CBF，将是最有信息的。
For more than a century, available data concerning collateral venous outflow from the brain have received insufficient attention, as existing theories did not assign practical importance to them. Ideas concerning arterial blood supply and circulation of cerebrospinal fluid were considered more relevant. But available data afford a schematic model of cerebral venous outflow that does have important pathophysiological consequences. Principal outflow through the internal jugular veins can be substituted completely by the large vertebral plexuses, through communications at the cranial base. Emissary veins of the skull vault are small and few in number. Outflow from the deep venous system through the great vein of Galen can be substituted by choroidal, thalamic and striate anastomoses toward the basal vein. So-called intracerebral venous anastomoses through the centrum semiovale towards the convexity are nonexistent or negligible. Instead, a venous watershed exists separating paraventricular white matter from a layer of subcortical white matter. In most infants, the cavernous sinus is not yet connected to the cerebral veins. Once such communications have been formed, important collateral pathways exist through basal and Sylvian veins via the cavernous sinus to the pterygoid plexuses. Simultaneous hindrance of principal and collateral venous outflow will lead to elevated venous pressure and eventual insufficiency of cerebral blood flow (CBF). This will cause increased intracranial pressure, and ventricular enlargement due to periventricular atrophy. The slow phase of the two-compartment model of CBF coincides with the paraventricular white matter area of the deep venous system. In the neonate CBF was found to be still very low and in the two compartments CBF increases at a different rate to a maximum in childhood. In hydrocephalus, measurement of CBF in the slow deep compartment, rather than the fast cortical one, will be most informative.