<aside>
The cerebral venous circulation refers to the system of veins and dural venous sinuses responsible for draining deoxygenated blood and cerebrospinal fluid (CSF) from the brain, meninges, and skull into the internal jugular veins (IJVs).
</aside>
It consists of superficial and deep venous systems, both of which ultimately drain into the dural venous sinuses.
Diagram showing the main components of the cerebral venous system. Blue vessels represent the deep venous system.
Schematic of cranial and upper cervical venous systems, emphasizing hemodynamic balance, interconnectedness or isolation of available drainage pathways, and specific venous pathologies. AFV, anterior frontal vein; AG, arachnoid granulation; AV, angular vein; BV, basal vein, with its three functional segments (telencephalic=purple; mesencephalic=red; galenic=green). CoV, cortical vein; CS, cavernous sinus; D, diverticulum; DV, diploic vein; DVC, dural venous channel; EV, emissary vein; GCV, Galen; GRS, granulation-related stenosis; IH, intracranial hypertension-related stenosis; IOV, inferior ophthalmic vein; iPS, inferior petrosal sinus; IPV, inferior petroclival vein; L, venous lake; LCS, laterocavernous sinus; LPMV, lateral (anastomotic) pontomesencephalic vein; MHV, medial hemispheric vein; MV, medullary veins; OS, occipital sinus; PVP, pterygopalatine venous plexus; SiS, sigmoid sinus; SOV, superior ophthalmic vein; SOVP, suboccipital venous plexus; SPS, superior petrosal sinus; SS, straight sinus; SSS, superior sagittal sinus; SSV, superficial sylvian (superficial middle cerebral) veins; TOV, temporo-occipital veins; TrV, Trolard vein; TS, transverse sinus; TV, transmedullary (transcerebral) veins; vp(L), venous pouch (Lake). Inserts A-C: A, normal anatomy; B, superficially-draining developmental venous anomaly (DVA); C, deep-draining DVA.
Shapiro M, Raz E, Nossek E, et al. Cerebral venous anatomy: implications for the neurointerventionalist. Journal of NeuroInterventional Surgery. 2022;15(5):452-460. doi:10.1136/neurintsurg-2022-018917
Flowchart showing the intracranial venous system
Mahal, S., Yadav, T., Panda, S. et al. Multimodality imaging in cerebral venous thrombosis: a synopsis for emergency radiologist. Jpn J Radiol 42, 437–449 (2024). https://doi.org/10.1007/s11604-023-01522-y
(A) Developing cranial venous system in a fetus at 23mm crown–rump length, stage 6 (40–44d), as viewed from above. The anterior dural plexus, from which the sagittal and straight sinus are derived, drains predominantly to the right side in all. Medial situated plexus-formed venous channels will join the bifurcated limbs and then fuse into the posterior portion of the superior sagittal sinus. (1) Primitive transverse sinus; (2) sagittal plexus, which will join the anterior portion of the superior sagittal sinus in adults; (3) primitive straight sinus; (4) tentorial sinus; (5) primitive marginal sinus, which will join the posterior portion of the superior sagittal sinus in adults. IJV, internal jugular vein; L, left; P, pineal body; R, right. Reproduced from Padget.6 Development of the transverse and occipital sinus. (B), (a) Three-month-old fetus: the transverse sinus is small in calibre. The occipital sinus has not developed. (b) Five-month-old fetus: the transverse sinus balloons from its lateral end in the fourth month and gradually extends medially to reach the confluence, becoming relatively even in calibre in the fifth month. The sigmoid sinus and superior jugular bulb are underdeveloped, whereas the occipital sinus channels appear well developed and connect to the medial part of the transverse sinus with either the marginal sinus or the distal end of the sigmoid sinus (i.e. the superior jugular bulb). (c) Six-month-old fetus: despite attenuation of the ballooning, the enlarged configuration of the occipital sinus is sustained until birth. The occipital sinus has regressed into a single channel along the cerebellar falx. (d) After the birth: (d-1–3) represent the various development of the occipital sinus: short and rudimentary (d-1), medium-sized (d-2), and large (d-3). The large transverse sinus may be associated with contralateral aplastic or hypoplastic transverse sinus and/or sigmoid sinus. Em, emissary veins; MS, marginal sinus; OS, occipital sinus; SigS, sigmoid sinus; SSS, superior sagittal sinus; TS, transverse sinus. Reproduced from T Okudera, YP Huang, T Ohta , et al. Development of posterior fossa dural sinuses, emissary veins, and jugular bulb: morphological and radiologic study, AJNR Am J Neuroradiol, 15(10), 1871–83, 1994, © by American Society of Neuroradiology.9
Unlike systemic veins, cerebral veins:
These features predispose the intracranial venous system to retrograde spread of infection (e.g., from face or scalp).
The venous system is divided into: