The spinal cord circulation is derived from segmental branches arising from the vertebral arteries, as well as multiple radicular arteries arising from segmental vessels in parallel, including the descending cervical, deep cervical, intercostal, lumbar, and sacral arteries. The venous drainage of the spinal cord is more symmetric and redundant when compared to the arterial system with both minimal anterior to posterior and right to left segmental variation.
Typically, the intrinsic cord venous drainage consists of paired radial draining veins, which drain into the anastomoses on the cord surface. Central veins in the anterior median fissure provide for venous return from the anterior horns and surrounding white matter and form the anterior median vein. The anterior median vein continues caudally along the filum terminale to the end of the thecal sac. The median veins drain to the “trans-dural” medullary (radicular) veins, which leave the intradural space at the root sleeve.
Peripheral and dorsolateral cord drainage is via the radial venous plexus, which extends to the coronal venous plexus on the cord surface, and then drains to the epidural venous plexus (of Batson), plexiform venous channels located at the anterior and posterior midline and antero- and posterolaterally along the line of attachments of the dorsal and ventral rootlets, a
continuous system from the sacrum to the skull base.
Connections with the azygos and hemiazygos venous systems include the vertebral and deep cervical veins (cervical); the intercostal-segmental veins (thoracic); segmental veins connected by the ascending lumbar vein (lumbar). Additionally, the basivertebral veins (intravertebral body), anterior plexus (vertebral body) and posterior plexus (posterior elements) components connect with the superior and inferior vena cava, azygos and hemiazygos systems, and the intracranial dural sinuses.
Intrinsic cord venous system
- Central and peripheral groups of radial veins drain into anastomoses on the cord surface
- Central group
- Provides return for anterior horns and surrounding white matter
- Drain into central veins in anterior median fissure
- Anterior median vein
- Peripheral dorsolateral group
- Drainage via radial venous plexus to the pial covering of the spinal cord
- Coronal venous plexus on cord surface
- Posterior median vein
- Drains to epidural venous plexus of Batson
- Anterior median vein
- Continues caudally along the filum terminale to end of dural sac
- Coronal, median veins drain to medullary veins
- “Trans-dural” medullary veins
- Drain the median veins
- Valveless with functional valve-like mechanism at dural margin
- Leave the intradural compartment at the root sleeve
- Site of spinal dural arteriovenous fistulas
- Epidural plexus
- Surrounds thecal sac
- Drains the medullary veins
- Continuous system from the sacrum to the skull base
- Plexiform venous channels (x6)
- Anterior and posterior midline (x2)
- Antero- and posterolaterally along the line of attachments of the dorsal and ventral rootlets (x4)
- Anastomotic connections to SVC, IVC, azygos/hemiazygos systems, intracranial dural sinuses
- Vertebral venous system
- Large valveless network of the vertebral column
- Extends from sacral hiatus to foramen magnum, ends in the clival plexus, suboccipital sinus
- Highly redundant collaterals, anastomoses
- Three major external complexes:
- Basivertebral veins
- External venous complexes
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