Confluence of sinuses | |
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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.
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]
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]
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]
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]
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]
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]
Veins are blood vessels in the circulatory system of humans and most other animals that carry blood towards 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.
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.
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.
Intracranial hemorrhage (ICH), also known as intracranial bleed, is bleeding within the skull. Subtypes are intracerebral bleeds, subarachnoid bleeds, epidural bleeds, and subdural bleeds.
In anatomy, the epidural space is the potential space between the dura mater and vertebrae (spine).
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, first identified in dogs by the anatomist Guillaume Dupuytren. A single layer of endothelium lines these veins 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. It has been suggested that the venous patterns they form resemble fingerprints in their individuality.
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. They may also connect to diploic veins within the skull.
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.
The dural venous sinuses are venous sinuses (channels) found between the endosteal and meningeal layers of dura mater in the brain. They receive blood from the cerebral veins, and cerebrospinal fluid (CSF) from the subarachnoid space via arachnoid granulations. They mainly empty into the internal jugular vein. Cranial venous sinuses communicate with veins outside the skull through emissary veins. These communications help to keep the pressure of blood in the sinuses constant. The major dural venous sinuses included the superior sagittal sinus, inferior sagittal sinus, transverse sinus, straight sinus, sigmoid sinus and cavernous sinus. These sinuses play a crucial role in cerebral venous drainage. A dural venous sinus, in human anatomy, is any of the channels of a branching complex sinus network that lies between layers of the dura mater, the outermost covering of the brain, and functions to collect oxygen-depleted blood. Unlike veins, these sinuses possess no muscular coat.
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.
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.
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.
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.".
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.
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.".
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.
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 empty delta sign is a radiologic sign seen on brain imaging which is associated with cerebral venous sinus thrombosis. It is usually seen on magnetic resonance imaging (MRI) or computed tomography (CT) scans with contrast. It is seen as dural wall enhancement in the absence of intra-sinus enhancement. This is due to the presence of a blood clot in the dural venous sinuses. The dural venous sinuses drain blood from the brain to the internal jugular veins, which in turn drains blood to the heart. It has been proposed that the empty delta sign occurs in dural venous thromboses due to contrast material filling the dural venous collateral circulation immediately surrounding the dura whilst being unable to fill the intra-dural sinus space due to the presence of a blood clot. The superior sagittal sinus is most commonly affected, but the radiologic sign may also be seen in the transverse sinuses.
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.