Confluence of sinuses

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Confluence of sinuses
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Dural veins. (Labeled with "confluens sinuum")
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Sagittal section of the skull, showing the sinuses of the dura. (Labeled with "torcula herophili".)
Details
Source superior sagittal sinus, straight sinus, occipital sinus
Drains to transverse sinuses
Identifiers
Latin confluens sinuum, torcula herophili
TA98 A12.3.05.103
TA2 4852
FMA 50784
Anatomical terminology

The confluence of sinuses (Latin: confluens sinuum), torcular Herophili, or torcula is the connecting point of the superior sagittal sinus, straight sinus, and occipital sinus. It is below the internal occipital protuberance of the skull. It drains venous blood from the brain into the transverse sinuses. It may be affected by arteriovenous fistulas, a thrombus, major trauma, or surgical damage, and may be imaged with many radiology techniques.

Contents

Structure

The confluence of sinuses is found deep to the internal occipital protuberance of the occipital bone of the skull. [1] This puts it inferior to the occipital lobes of the brain, and posterosuperior to the cerebellum. [1] It connects the ends of the superior sagittal sinus, the straight sinus, and the occipital sinus. [1] Blood from it can drain into the left and right transverse sinuses. [1] It is lined with endothelium, with some smooth muscle. [1]

Variation

The confluence of sinuses shows significant variation. [1] Most commonly, there is a continuous connection between all of the sinuses. [1] [2] A very common variant is the superior sagittal sinus only draining into the right transverse sinus - more rarely, it may also only drain into the left transverse sinus. [1] [2] Another variation involves a continuous connection, but where most blood from the superior sagittal sinus drains into the right transverse sinus, and most blood from the occipital sinus drains into the left transverse sinus. [1] Other less common variations also exist. [1]

Development

The confluence of sinuses develops from the anterior plexus and the middle plexus. [1] These fuse so that the anterior plexus becomes a remnant. [1]

Function

The confluence of sinuses is important in drainage of venous blood from the brain. [1] It drains most of the blood from the brain. [3]

Clinical significance

The confluence of sinuses may be affected by arteriovenous fistulas. [1] This is treated with surgery to embolise of the fistula. [1] It may also be affected by a thrombus. [1] This can be treated with anticoagulants. [1] It may be injured by a variety of major trauma. [3] It may also be damaged during surgery, such as that to remove a meningioma. [3]

The confluence of sinuses can be imaged with radiology. [1] Angiography, CT scan, magnetic resonance imaging, medical ultrasound, or interventional radiology may be used. [1]

History

The confluence of sinuses may also be known as the confluens sinuum (from Latin), or the torcular Herophili (or more simply the torcula). The last term is older, and describes the veins as a gutter or canal. This is named after Herophilos, the Greek anatomist who first used cadavers for the systematic study of anatomy. This term more precisely refers to the concavity in the bone, which is the location of the confluence of sinuses. [4]

Additional images

Related Research Articles

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Veins are blood vessels in the circulatory system of humans and most other animals that carry blood toward the heart. Most veins carry deoxygenated blood from the tissues back to the heart; exceptions are those of the pulmonary and fetal circulations which carry oxygenated blood to the heart. In the systemic circulation, arteries carry oxygenated blood away from the heart, and veins return deoxygenated blood to the heart, in the deep veins.

<span class="mw-page-title-main">Great cerebral vein</span>

The great cerebral vein is one of the large blood vessels in the skull draining the cerebrum of the brain. It is also known as the vein of Galen, named for its discoverer, the Greek physician Galen.

<span class="mw-page-title-main">Cerebral circulation</span> Brain blood supply

Cerebral circulation is the movement of blood through a network of cerebral arteries and veins supplying the brain. The rate of cerebral blood flow in an adult human is typically 750 milliliters per minute, or about 15% of cardiac output. Arteries deliver oxygenated blood, glucose and other nutrients to the brain. Veins carry "used or spent" blood back to the heart, to remove carbon dioxide, lactic acid, and other metabolic products. The neurovascular unit regulates cerebral blood flow so that activated neurons can be supplied with energy in the right amount and at the right time. Because the brain would quickly suffer damage from any stoppage in blood supply, the cerebral circulatory system has safeguards including autoregulation of the blood vessels. The failure of these safeguards may result in a stroke. The volume of blood in circulation is called the cerebral blood flow. Sudden intense accelerations change the gravitational forces perceived by bodies and can severely impair cerebral circulation and normal functions to the point of becoming serious life-threatening conditions.

<span class="mw-page-title-main">Intracranial hemorrhage</span> Hemorrhage, or bleeding, within the skull

Intracranial hemorrhage (ICH), also known as intracranial bleed, is bleeding within the skull. Subtypes are intracerebral bleeds, subarachnoid bleeds, epidural bleeds, and subdural bleeds.

<span class="mw-page-title-main">Epidural space</span> Space between the dura mater and vertebrae

In anatomy, the epidural space is the potential space between the dura mater and vertebrae (spine).

<span class="mw-page-title-main">Diploic veins</span> Large valveless veins in the skull

The diploic veins are large, thin-walled valveless veins that channel in the diploë between the inner and outer layers of the cortical bone in the skull. They are lined by a single layer of endothelium supported by elastic tissue. They develop fully by the age of two years. The diploic veins drain this area into the dural venous sinuses. The four major trunks of the diploic veins found on each side of the head are frontal, anterior temporal, posterior temporal, and occipital diploic veins. They tend to be symmetrical, with the same pattern of large veins on each side of the skull.

The emissary veins connect the extracranial venous system with the intracranial venous sinuses. They connect the veins outside the cranium to the venous sinuses inside the cranium. They drain from the scalp, through the skull, into the larger meningeal veins and dural venous sinuses.

<span class="mw-page-title-main">Falx cerebri</span> Anatomical structure of the brain

The falx cerebri is a large, crescent-shaped fold of dura mater that descends vertically into the longitudinal fissure between the cerebral hemispheres of the human brain, separating the two hemispheres and supporting dural sinuses that provide venous and CSF drainage to the brain. It is attached to the crista galli anteriorly, and blends with the tentorium cerebelli posteriorly.

<span class="mw-page-title-main">Cavernous sinus</span> Sinus in the human head

The cavernous sinus within the human head is one of the dural venous sinuses creating a cavity called the lateral sellar compartment bordered by the temporal bone of the skull and the sphenoid bone, lateral to the sella turcica.

<span class="mw-page-title-main">Straight sinus</span> Venous sinus draining the brain

The straight sinus, also known as tentorial sinus or the sinus rectus, is an area within the skull beneath the brain. It receives blood from the inferior sagittal sinus and the great cerebral vein, and drains into the confluence of sinuses.

<span class="mw-page-title-main">Occipital sinus</span> Organ In the brain

The occipital sinus is the smallest of the dural venous sinuses. It is usually unpaired, and is sometimes altogether absent. It is situated in the attached margin of the falx cerebelli. It commences near the foramen magnum, and ends by draining into the confluence of sinuses.

<span class="mw-page-title-main">Superior sagittal sinus</span> Anatomical structure of the brain

The superior sagittal sinus, within the human head, is an unpaired area along the attached margin of the falx cerebri. It allows blood to drain from the lateral aspects of anterior cerebral hemispheres to the confluence of sinuses. Cerebrospinal fluid drains through arachnoid granulations into the superior sagittal sinus and is returned to venous circulation.

<span class="mw-page-title-main">Inferior sagittal sinus</span> Anatomical structure of the brain

The inferior sagittal sinus, within the human head, is an area beneath the brain which allows blood to drain outwards posteriorly from the center of the head. It drains to the straight sinus, which connects to the transverse sinuses. See diagram : labeled in the brain as "SIN. SAGITTALIS INF.".

<span class="mw-page-title-main">Dural arteriovenous fistula</span> Medical condition

A dural arteriovenous fistula (DAVF) or malformation is an abnormal direct connection (fistula) between a meningeal artery and a meningeal vein or dural venous sinus.

<span class="mw-page-title-main">Transverse sinuses</span>

The transverse sinuses, within the human head, are two areas beneath the brain which allow blood to drain from the back of the head. They run laterally in a groove along the interior surface of the occipital bone. They drain from the confluence of sinuses to the sigmoid sinuses, which ultimately connect to the internal jugular vein. See diagram : labeled under the brain as "SIN. TRANS.".

<span class="mw-page-title-main">Inferior ophthalmic vein</span> Vein of the orbit around the eye

The inferior ophthalmic vein is a vein of the orbit that - together with the superior ophthalmic vein - represents the principal drainage system of the orbit. It begins from a venous network in the front of the orbit, then passes backwards through the lower orbit. It drains several structures of the orbit. It may end by splitting into two branches, one draining into the pterygoid venous plexus and the other ultimately into the cavernous sinus.

<span class="mw-page-title-main">Occipital vein</span> Vein of the scalp

The occipital vein is a vein of the scalp. It originates from a plexus around the external occipital protuberance and superior nuchal line to the back part of the vertex of the skull. It usually drains into the internal jugular vein, but may also drain into the posterior auricular vein. It drains part of the scalp.

<span class="mw-page-title-main">Cerebellar veins</span> Veins that drain the cerebellum

The cerebellar veins are veins which drain the cerebellum. They consist of the superior cerebellar veins and the inferior cerebellar veins. The superior cerebellar veins drain to the straight sinus and the internal cerebral veins. The inferior cerebellar veins drain to the transverse sinus, the superior petrosal sinus, and the occipital sinus.

The cerebrospinal venous system (CSVS) consists of the interconnected venous systems of the brain and the spine.

The marginal sinus is a dural venous sinus surrounding the margin of the foramen magnum inside the skull, accommodated by the groove for marginal sinus. It usually drains into either the sigmoid sinus, or the jugular bulb. It communicates with the basilar venous plexus anteriorly, and the occipital sinus posteriorly ; it may form extracranial communications with the internal vertebral venous plexuses, or deep cervical veins.

References

  1. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 Granger, Andre; Tubbs, R. Shane (2020). "7 - The Torcular Herophili (Confluence of Sinuses)". Anatomy, Imaging and Surgery of the Intracranial Dural Venous Sinuses. Elsevier. pp. 71–85. doi:10.1016/B978-0-323-65377-0.00007-6. ISBN   978-0-323-65377-0. S2CID   198402766.
  2. 1 2 Joseph, Shamfa C.; Rizk, Elias; Tubbs, R. Shane (2020). "25 - Variations of the Intracranial Dural Venous Sinuses". Anatomy, Imaging and Surgery of the Intracranial Dural Venous Sinuses. Elsevier. pp. 205–220. doi:10.1016/B978-0-323-65377-0.00025-8. ISBN   978-0-323-65377-0. S2CID   198283297.
  3. 1 2 3 Mortazavi, Martin M.; Surya, Sajid S.; Hami, Farzad; Sadati, Mohsen; Jazi, Ghazaleh Ahmadi; Tubbs, R. Shane (2020). "27 - Surgical Nuances in Management of Intracranial Venous Sinus Injuries". Anatomy, Imaging and Surgery of the Intracranial Dural Venous Sinuses. Elsevier. pp. 231–236. doi:10.1016/B978-0-323-65377-0.00027-1. ISBN   978-0-323-65377-0. S2CID   198282914.
  4. Tubbs, R.S. Neuroanatomy, 2002:1, 14