title: How does the blood leave the brain? A systematic ultrasound analysis of cerebral venous drainage patterns.
abstract: The internal jugular veins are considered to be the main pathways of cerebral blood drainage. However, angiographic and anatomical studies show a wide anatomical variability and varying degrees of jugular and non-jugular venous drainage. The study systematically analyses the types and prevalence of human cerebral venous outflow patterns by ultrasound and MRI. Fifty healthy volunteers (21 females; 29 males; mean age 27+/-7 years) were studied by color-coded duplex sonography. Venous blood volume flow was measured in both internal jugular and vertebral veins in the supine position. Furthermore, the global arterial cerebral blood volume flow was calculated as the sum of volume flows in both internal carotid and vertebral arteries. Three types of venous drainage patterns were defined: a total jugular volume flow of more than 2/3 (type 1), between 1/3 and 2/3 (type 2) and less than 1/3 (type 3) of the global arterial blood flow. 2D TOF MR-venography was performed exemplarily in one subject with type-1 and in two subjects with type-3 drainage. Type-1 drainage was present in 36 subjects (72%), type 2 in 11 subjects (22%) and type 3 in 3 subjects (6%). In the majority of subjects in our study population, the internal jugular veins were indeed the main drainage vessels in the supine body position. However, a predominantly non-jugular drainage pattern was found in approximately 6% of subjects.
authors.affiliation: Department of Neurology, University Hospital Charité, Schumannstr. 20/21, 10117, Berlin, Germany. florian.doepp@charite.de
authors.forename: Florian
authors.initials: F
authors.lastname: Doepp
authors.forename: Stephan J
authors.initials: SJ
authors.lastname: Schreiber
authors.forename: Thomas
authors.initials: T
authors.lastname: von Münster
authors.forename: Jörg
authors.initials: J
authors.lastname: Rademacher
authors.forename: Randolf
authors.initials: R
authors.lastname: Klingebiel
authors.forename: José M
authors.initials: JM
authors.lastname: Valdueza
mesh_terms: D000328:Adult; D002550:Cerebral Veins / Q000033:anatomy & histology / Q000000981:diagnostic imaging*; D002560:Cerebrovascular Circulation; D005260:Female; D006801:Humans; D007601:Jugular Veins / Q000033:anatomy & histology / Q000000981:diagnostic imaging*; D008297:Male; D011187:Posture; D017585:Ultrasonography, Doppler, Transcranial