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Cerebrospinal venous system
The cerebrospinal venous system (CSVS) consists of the interconnected venous systems of the brain (the cerebral venous system) and the spine (the vertebral venous system).
==Introduction==
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.〔Breschet, G., Recherches anatomiques physiologiques et pathologiques sur le systáeme veineux. 1829, Paris,: Rouen fráeres. 48 p.〕 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.〔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〕 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.〔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〕〔Epstein, H.M., et al., The vertebral venous plexus as a major cerebral venous outflow tract. Anesthesiology, 1970. 32(4): p. 332-7〕〔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〕〔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〕 It was later recognized that the cerebrospinal venous system represents a main route for efflux of venous blood from the brain.〔〔〔 Modern imaging methodology, including MR scanning, have detailed the anastomoses of the cerebral and spinal venous systems in the suboccipital region.〔Takahashi, S., et al., Craniocervical junction venous anatomy around the suboccipital cavernous sinus: evaluation by MR imaging. Eur Radiol, 2005〕〔Arnautovic, K.I., et al., The suboccipital cavernous sinus. J Neurosurg, 1997. 86(2): p. 252-62〕 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.〔Batson, O.V., The vertebral vein system. Caldwell lecture, 1956. Am J Roentgenol Radium Ther Nucl Med, 1957. 78(2): p. 195-212〕〔Herlihy, W.F., Revision of the venous system: the role of the vertebral veins. Med J Austr, 1947. 1(22): p. 661-72〕〔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〕 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.〔Valdueza, J.M., et al., Postural dependency of the cerebral venous outflow. Lancet, 2000. 355(9199): p. 200-1〕〔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〕 The terms “cerebrospinal venous system” and “CSVS” were coined in a 2006 review 〔Tobinick, E., The cerebrospinal venous system: anatomy, physiology, and clinical implications. MedGenMed, 2006. 8(1): p. 53〕 that has itself been cited in a number of subsequent articles and reviews.〔Pearce, J.M., The craniospinal venous system. Eur Neurol, 2006. 56(2): p. 136-8〕〔Tubbs, R., et al., The basilar venous plexus. Clinical Anatomy, 2007. 20(7)〕〔De Wyngaert, R., I. Casteels, and P. Demaerel, Orbital and anterior visual pathway infection and inflammation. Neuroradiology, 2009. 51(6): p. 385-96〕〔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〕〔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〕〔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〕〔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〕
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