Anatomy Sem2 PDF

Veins of the head, neck and thorax. 2. Veins of the head and neck 2. Veins of the thorax Lecturer: PhD, professor T.Hacina Blood from the head and neck flows into the superior vena cava system. The superior vena cava (vena cava superior) is a thick short trunk, the length of...

Veins of the head, neck and thorax. 2. Veins of the head and neck 2. Veins of the thorax Lecturer: PhD, professor T.Hacina Blood from the head and neck flows into the superior vena cava system. The superior vena cava (vena cava superior) is a thick short trunk, the length of which is 5 -6 cm, diameter 2 -2.5 cm, has no valves. It is formed when the right and left brachiocephalic veins merge behind the junction of the cartilage of the first right rib and the sternum. Then the vein descends down and opens into the right atrium. The superior vena cava collects blood from the head, neck, upper limbs, from the walls and organs of the chest cavity,  VEINS OF THE HEAD AND NECK Anatomical features of the cerebral veins: They form anastomoses with the diploic and extracranial veins They have multiple ways of drainage Their walls are devoid of muscles The cerebral veins have no valves In order to maintain patency, some of them open into the venous sinuses against the direction of blood flow in the sinus, The pachimeningeal sinuses do not collapse and cause hemivacuum. All these specific features maintain constant blood pressure and pressure of the cerebrospinal fluid. There are two groups of the veins of the brain: superficial and deep.  Venous drainage from the scalp The veins of the scalp accompany the arteries and thus have similar names, e.g. supratrochlear and supraorbital veins, which unite at the medial angle of the eye, and form the angular vein, which further continues as the facial vein. The superficial temporal vein descends in front of the tragus, enters the parotid gland, and then joins the maxillary vein to form the retromandibular vein. The anterior part of it unites with the facial vein to form the common facial vein, which drains into internal jugular vein, and ultimately to the subclavian vein. The occipital vein terminates to the suboccipital plexus. There are other veins, like the emissary vein and frontal diploic vein, which also contribute to the venous drainage.  Veins of the brain (Venae encephali) They are subdivided into superficial and deep The outflow of blood through these veins is carried out into the venous sinuses. As a result of anastomosis of the superficial veins of the brain, a venous network is formed on its surface, in which collateral blood flow in different directions is possible. An important role is played by the superior anastomotic vein (v. Anastomotica superior), which connects the superior sagittal and cavernous sinuses and parietal veins with the temporal veins (2), and the inferior anastomotic (v. Anastomotica inferior), which connects the transverse venous sinus with the cavernous or sphenoid- parietal temporal and parietal veins with the occipital (8).  Superficial veins of the brain Veins Region Termination of drainage The superior Superolateral surface of The superior sagittal sinus cerebral vv. the hemisphere /6-12/ The The area round the The cavernous sinus or superficial posterior branch of the The sphenoparietal sinus middle lateral groove cerebral v. The deep Surface of the insula The basal vein middle cerebral v. The inferior The orbit The superior cerebral vv. cerebral vv. The temporal lobe The superior sagittal sinus The cavernous or neighbouring sinuses The anterior The corpus callosum The basal vein cerebral vv. The anterior part of the medial surface of the hemisphere  Some of veins open into the venous sinuses against the Multiple ways of the venous drainage of the direction of blood flow in the sinus brain  Due to the special function of the brain (it is an organ with high energy needs, which works continuously, providing body integrity), multidirectional blood flow paths are formed on the head, which ensure high reliability. Inside the skull there are specially arranged, non- decaying venous collectors - venous sinuses of the dura mater, as well as multilateral and multitiered connections of various outflow paths. In the region of the head are distinguished: ▪ Diploic veins – these are veins of the skull bones, ▪ Sinuses of the dura mater, ▪ Emissary veins – venous anastomoses connecting extra- and intracranial veins, ▪ Cerebral venous bed and ways of its outflow — cerebral veins, ▪ Veins of the orbit and the eyeball, ▪ Venous bed of the face, carrying blood into the facial, retromandibular and, partially, into the internal jugular veins; ▪ Venous bed of the skull vault with an outflow to the vertebral, retromandibular, facial and ophthalmic veins. Veins of the region of the neck are classified into two groups: superficial and deep, carrying blood into the internal and external jugular veins, and brachiocephalic veins.  Vv. diploicae - are located in the spongy substance of the bones of the cranial vault. Through the vv.emissariae they flow into the superficial veins of the head and anastomose with the sinuses of the dura mater, providing a link between the internal and external jugular veins. Valves in the diploic veins are absent, therefore, blood flow through them is possible in two directions. They go from top to bottom to the base of the skull, where they connect through openings in the bones of the skull or with the saphenous veins of the cranial vault, or with the venous sinuses of the dura mater. Frontal v. (2) Anterior temporal v. (1) Posterior temporal v. (4) Occipital v. (5)  Sinus sagittalis superior -it begins at the apex of the falx cerebri above the crista gali. Course: it passes backwards along the upper convex border of the falx cerebri grooving the inner aspect of the skull cap (forming the superior sagittal sulcus). Sinus sagittalis inferior — it lies in the posterior 2/3 of the lower free border of the falx cerebri. Termination: it ends at the free margin of the tentorium uniting with the great cerebral vein to form the straight sinus.. Sinus rectus it connects the posterior ends of the superior and inferior sagittal sinuses Sinus transversus — It runs laterally along the transverse sulcus (in the attached margin of the tentorium). Sinus occipitalis It is a small sinus which runs in the attached border of the falx cerebelli. Sinus cavernosus— it lies on the side of the body of sphenoid in the middle cranial fossa. Sinus intercavernosis — is located around the Turkish saddle, forming a closed venous ring with the cavernous sinuses Sinus sphenoparietalis — runs along the free border of the lesser wing of the sphenoid. Sinus petrosus superior — runs along the upper border of the petrous temporal bone in the attached margin of the tentorium and ends joining the lateral end of the transverse sinus. Sinus petrosus inferior runs in the petrooccipital sulcus to reach the jugular foramen, it connects the cavernous and sigmoid sinuses.  Sinuses of dura mater: 1 – cavernous and intercavernous sinuses; 2 - superficial cerebral veins flowing into the superior sagittal sinus; 3 - superior sagittal sinus; 4 - inferior sagittal sinus; 5 - superior and inferior petrosal sinuses on the right; 6 - the right sigmoid sinus; 7 – greater cerebral vein (of Galen); 9 - the right transverse sinus; 10 - straight sinus; 12 – confluence of sinuses; 13 - left transverse sinus; 14 - occipital sinus; 15 - marginal sinus; 16 – superior petrosal sinus on the left; 17 - spheno-parietal sinus; 18 - superior ophthalmic vein; 19 - internal jugular vein  Veins of the orbit Orbital veins; lateral view. (The lateral wall of the orbit is removed): 1 - supratrochlear vein; 2 - angular vein; 3 - vorticose veins; 4 - facial vein; 5 - deep facial vein; 6 – retromandibular vein; 7 - maxillary vein; 8 - pterygoid venous plexus; 9 – inferior ophthalmic vein; 10 - cavernous plexus; 11 - superior ophthalmic vein 12 - supraorbital vein https://medbe.ru/materials/litsevoy-skelet-i-cherep/diploicheskie-i- emissarnye-veny-veny-glaza-litsa-cherepa-i-shei/  Emissary veins: 1 - deep cervical vein; 2 - vertebral artery; 3 - the atlanto-occipital sinus through which the vertebral artery passes; 4 - condylary emissary vein; 5 - anastomosis of the atlanto-occipital sinus with the occipital vein; 6 - mastoid emissary vein; 7 - sigmoid sinus; 8 - an occipital emissary vein; 9 - transverse sinus; 10 – confluence of sinuses; 11 - superior sagittal sinus; 12 - parietal emissary vein; 13 - superficial temporal vein; 14, 16 - occipital vein; 15 - posterior auricular vein; 17 - occipital sinus; 18 - internal jugular vein; 19 - vertebral vein  Emissary veins, vv. emissariae connect the sinuses of the dura mater and the diploic veins with the superficial veins of the head. 1. Parietal emissary vein, v. emissaria parietalis (1). It connects the superior sagittal sinus and superficial temporal vein and passes through the parietal opening. 2. Mastoid emissary vein, v. emissaria mastoidea (2). Through the mastoid opening connects the sigmoid sinus with the occipital vein. 3. Condylar emissary vein, v. emissaria condylaris (4). Through the condylar canal, the sigmoid sinus connects to the external vertebral venous plexus. 4. Occipital emissary vein, v. emissaria occipitalis (3)- is a small vein which passes through the condylar canal. It rovides a venous communication between the dural venous sinuses and veins of the scalp or veins inferior to the skull base (cranial-cerebral anastomosis). Venous plexuses of the head 1. Plexus pterygoideus, (33) It is located between the pterygoid muscles in the pterygo-palatine fossa and on the surface of the auditory tube. It collects blood from the mucous membrane of the nasal cavity, dura mater, temporal muscle, teeth of the lower jaw and masseter muscle. 2.Plexus venosus canalis hypoglossi. (5) It connects the venous plexus around the foramen magnum and the internal jugular vein. 3.Plexus venosus foraminis ovalis (30). It connects the cavernous sinus and pterygoid plexus. 4. Plexus venosus caroticus internus. It is connecting the cavernous sinus and internal jugular vein. 5. Vv. portales hypophysialis. It is an outflow of blood from the capillary network of the infundibulum and adenohypophysis into the cavernous sinus.  System of deep veins of the brain ▪ Are located within the brain ▪ They are represented by groups of venous trunks collecting blood from: - Septum pellucidum - Basal nuclei - Thalamus - Brain stem - Cerebellum  Deep veins of the brain These veins do not typically follow the arterial supply and there is significant variation in anatomy between different subjects. Another notable feature of these veins is that they lack muscular walls and valves. ▪ Through deep veins, blood flows from the basal nuclei, the walls of the lateral ventricles and their vascular plexuses and the diencephalon. ▪ Topographically, the deep cerebral veins are divided into the superior and inferior groups.  Superior group of deep veins of the brain 1. V. thalamostriata superior and its tributaries 2. Vv. internae cerebri and their tributaries - Each of them them is formed near the interventricular septum due to the merger of the thalamostriate and choroidal (villous) veins. - The internal cerebral veins of both hemispheres go backward parallel to each other, between the layers of the vascular tissue of the third ventricle of the brain, and connect near the splenium of the corpus callosum, forming a short thick branch - the Galen’s vein. - Before opening into the vein of Galen, a corresponding basal vein flows into each of them. 3. Vv. of the lateral ventricle  Veins of the inferior group 1) Vv. basales and their tributaries (27): - venae trunci encephali; - v. pontomesencephalica; - vv. pontis - vv. medullae oblongatae. When combined, the basal veins form greater cerebral vein (v. Magna cerebri) (37), which flows into the straight sinus. The basal vein of Rosenthal originates on the medial surface of the temporal lobe and runs posteriorly and medially. It passes lateral to the midbrain to drain into the vein of Galen. It is closely related to the posterior cerebral artery (PCA). Venous drainage from the cerebellum Vv. cerebelli superiores et inferiores - Their tributaries from the vermis (superior and inferior veins of the vermis) and hemispherae are very variable (topographically and anatomi- cally): inferior medial vv and inferior lateral vv, superior medial and superior lateral vv. - They merge with the veins of the peduncles of the brain, the roof of the midbrain and the pons into the veins of the flocculus that flow into the superior petrosal sinus. - The cerebellar veins can independently open: the superior ones - into the straight sinus and the great cerebral vein, - the inferior ones - into the transverse and inferior petrosal sinuses. Veins of the posterior cerebral fossa, left side: 1 – pulvinar of left thalamus; 2 — pulvinar of rightt thalamus; 3 — internal cerebral veins; 4 – splenium of callosal body; 5 — great cerebral vein; 6 — posterior vein of corpus callosum; 7 — inferior sagittal sinus; 8 — straight sinus; 9 — falx cerebri; 10 — наtentyorium cerebelli; 11 — confluence of sinuses; 12 — transverse sinus; 13 — superior sagittal sinus; 14 — superior vein of vermis; 15 — inferior vein of vermis; 16 — occipital sinus; 17, 19 — inferior veins of cerebellum; 18 — superior vein of cerebellum; 20 — vein of cerebello-medullary sistern; 21 —posterior spinal vein; 22 — the fourth ventricle; 23 — anterior spinal vein; 24 — cerebellar peduncles; 25 — vein of fourth ventricle; 26 — vein of medulla oblongata; 27 — lateral pontine vein; 28 — petrosal vein; 29 — ponto-mesencephalic vein; 30 — anterior cerebral vein; 31 — deep middle cerebral vein; 32 — lateral middle cerebral vein; 33 — peduncular vein; 34 — basal vein. A venous anastomotic network /circle Trolard/ at the base of the brain closely resembles the vicinal arterial circle of Willis. This venous polygon is composed of the: - anterior cerebral and - communicating veins, - the basal vein of Rosenthal , - the posterior communicating, - lateral mesencephalic veins. This venous circle might cause bleeding with such procedures as an endoscopic third ventriculostomy. This information regarding venous circle may be useful to neuroradiologists or neurosurgeons operating at the base of the brain.  Venous circle /Trolard’s/ of the brain For reference, note the olfactory tracts and midbrain cross section. Note the veinous ring encircling the mamillary bodies and floor of the third ventricle. The anterior cerebral veins are seen leaving the longitudinal fissure. Note the anterior communicating vein between the two anterior cerebral veins and deep Sylvian vein /upper arrow/. An anastomotic vein /lower arrow/ is seen linking the basal vein of Rosenthal just posterior to the mammillary bodies. There are three pairs of the jugular veins in the region of the neck, carring blood from the head and neck to the system of SVC. 1. Vena jugularis interna 2. Vena jugularis externa 3. Vena jugularis anterior  Internal jugular vein It is formed by the union of inferior petrosal and sigmoid dural venous sinuses in or just distal to the jugular foramen (forming the jugular bulb). It descends in the carotid sheath with the internal carotid artery. The vagus nerve (CN X) lies between the two. After receiving tributaries from the face and neck (listed below) it continues to descend before descending into the thorax, usually posterior to the space between the two heads of the sternocleidomastoid muscle, before uniting with the subclavian vein to form the brachiocephalic vein.  Tributaries of the internal jugular vein Blood from the head and neck is collected mainly in the internal jugular vein. The tributaries of the internal jugular vein can be divided into two large groups: extracranial and intracranial. Intracranial tributaries 1) Diploic veins originate from the spongy substance of the bones of the cranial vault, they flow into the cerebral sinuses and, through the emissary veins, connect to the veins of the external integument of the head. 2) Emissary veins are located in small bony canals, through them blood flows from the sinuses outwards. 3) The upper and lower ophthalmic veins, 4) Veins of the labyrinth emerging from the internal auditory meatus and flowing into the inferior petrosal sinus, 5) Sinuses of dura mater. Extracranial tributaries 1) Pharyngeal veins из глоточного сплетения, 2) Lingual vein, 3) Superior thyroid vein, 4) Facial vein 5) Retromandibular vein. Tributaries of the retromandibular vein 1. v. temporalis superficialis 2. v. maxillaris 3. plexus pterygoideus 4. v. facialis (sometimes) External jugular vein It is formed by the union of the occipital vein and the posterior auricular vein. The external jugular vein originates at the lrevel of the the angle of the mandible, descends to the clavicle, penetrating the deep cervical fascia and draining into the subclavian vein. The main tributaries of the external jugular vein are: anterior jugular vein, posterior external jugular vein, transverse cervical vein, and suprascapular vein. The external jugular vein collects blood from the scalp, face, neck, and the superficial muscles of the back.  Anterior jugular vein It begins near the level of hyoid bone by the confluence of several superficial veins from the submandibular region. It descends between the median line and the anterior border of the sternocleidomastoideus muscle, and, at the lower part of the neck, passes beneath that muscle to open into the termination of the external jugular vein, or, in some instances, into the subclavian vein. It varies considerably in size, bearing usually an inverse proportion to the external jugular; most frequently there are two anterior jugulars, a right and left; but sometimes only one. Its tributaries are some laryngeal veins, and occasionally a small thyroid vein. Just above the sternum the two anterior jugular veins communicate by a transverse trunk, the venous jugular arch, which receives tributaries from the inferior thyroid veins; each also communicates with the internal jugular. There are no valves in this vein.  Superficial veins of the face The facial vein is a large vessel of the face and is much less tortuous than the artery of the same name. It lies posterior to the facial artery and begins from the lateral side of the nose. Its tributaries are: - v. angularis - v. supraorbitalis - w. palpebrales superioris et inferioris - vv. nasales externae - vv. labiales superior et inferiores - v. palatina externa - v. submentalis - v. profunda faciei The deep facial vein originates from the pterygoid venous plexus and is of considerable size.  Deep veins of the face Vena retromandibularis It is formed by fusion of the superficial and middle temporal veins collecting blood from the temporal and parietal regions. It is located in front of the auricle, pierces the parotid gland, passes behind the mandibular branch together with the ECA. Its tributaries: 1. V. temporalis superficialis 2. V. maxillaris 3. Plexus pterygoideus 4. V. facialis /sometimes/ 5. Anterior auricular v. 6. Parotid vv. 7. Transverse vein of the face – collects blood from the lateral regions of the face.  Veins of the thorax The axillary and internal thoracic veins are responsible for venous drainage, while nervous supply is carried out by branches from the intercostal nerves. Veins of the Thorax Brachiocephalic veins, also called innominate veins, are large veins at the upper thorax and represent united trunks of the internal jugular veins and subclavian veins. There are no valves in these veins.  The right brachiocephalic vein is approximately 2.5 cm long, following an almost vertical direction in front of the right brachiocephalic trunk, and joining the left brachiocephalic vein, thereby forming the superior vena cava. The tributaries are the - right vertebral, - internal thoracic, - inferior thyroid, and - occasionally the first right intercostal veins. The left brachiocephalic vein is 6 cm long, following an oblique path to the right direction to join the right brachiocephalic vein to form the superior vena cava. The tributaries are: - the left vertebral, - internal thoracic, - inferior thyroid, - superior intercostal, - thymic vein, and - pericardiophrenic veins. Variations of the brachiocephalic veins include entering the right atrium separately and the configuration of a left vena cava. The internal thoracic veins are venae comitans to the internal thoracic arteries, ending in the corresponding brachiocephalic veins. Tributaries are the intercostal veins and pericardiophrenic veins. The inferior thyroid veins originate in the glandular venous plexus, having connections with the middle and superior thyroid veins. The left superior intercostal vein drains the second and third left posterior intercostal veins, directly to the left brachiocephalic vein. The superior vena cava is the main vein for venous drainage for the superior aspect of the body. It is around 7 cm in length and is formed by the confluence of the brachiocephalic veins. It has no valves and ends in the right atrium. Tributaries are the azygos vein and small veins from the mediastinum. The pericardiophrenic veins are the main venous drainage channel for the diaphragm and the pericardium. These veins are in contact with the pericardium and pleura. The thymic veins are small in adults, unless there is some enlargement of the thymus gland.  Azygos system The azygos vein is formed by the confluence of the ascending lumbar veins, subcostal veins, and lumbar azygos. It ascends in the posterior mediastinum up to the level of the fourth vertebra, where it arches anteriorly above the right pulmonary hilum, ending in the superior vena cava. Tributaries are the posterior intercostal veins, the hemiazygos, the accessory hemiazygos veins, and the esophageal, mediastinal, and pericardial veins. - When present, the trunk formed by the subcostal and ascending lumbar veins is a major tributary of the azygos vein. - The azygos vein starts laterally to the vertebral bodies but turns anterior to the thoracic spine as it approaches the vena cava.  The right bronchial veins also drain to the azygos vein, near the hilum. Blood from the head and neck flows into the superior vena cava system. The superior vena cava (vena cava superior) is a thick short trunk, the length of which is 5 -6 cm, diameter 2 -2.5 cm, has no valves. It is formed when the right and left brachiocephalic veins merge behind the junction of the cartilage of the first right rib and the sternum. Then the vein descends down and opens into the right atrium. The superior vena cava collects blood from the head, neck, upper limbs, from the walls and organs of the chest cavity,  VEINS OF THE HEAD AND NECK Anatomical features of the cerebral veins: They form anastomoses with the diploic and extracranial veins They have multiple ways of drainage Their walls are devoid of muscles The cerebral veins have no valves In order to maintain patency, some of them open into the venous sinuses against the direction of blood flow in the sinus, The pachimeningeal sinuses do not collapse and cause hemivacuum. All these specific features maintain constant blood pressure and pressure of the cerebrospinal fluid. There are two groups of the veins of the brain: superficial and deep. Venous drainage from the scalp The veins of the scalp accompany the arteries and thus have similar names, e.g. supratrochlear and supraorbital veins, which unite at the medial angle of the eye, and form the angular vein, which further continues as the facial vein. The superficial temporal vein descends in front of the tragus, enters the parotid gland, and then joins the maxillary vein to form the retromandibular vein. The anterior part of it unites with the facial vein to form the common facial vein, which drains into jugular vein, and ultimately to the subclavian vein. The occipital vein terminates to the suboccipital plexus. There are other veins, like the emissary vein and frontal diploic vein, which also contribute to the venous drainage.  Veins of the brain (Venae encephali) They are subdivided into superficial and deep The outflow of blood through these veins is carried out into the venous sinuses. As a result of anastomosis of the superficial veins of the brain, a venous network is formed on its surface, in which collateral blood flow in different directions is possible. An important role is played by the superior anastomotic vein (v. Anastomotica superior), which connects the superior sagittal and cavernous sinuses and parietal veins with the temporal veins (2), and the inferior anastomotic (v. Anastomotica inferior), which connects the transverse venous sinus with the cavernous or sphenoid- parietal temporal and parietal veins with the occipital (8).  Superficial veins of the brain Veins Region of drainage Termination The superior Superolateral surface of the The superior sagittal sinus cerebral vv. hemisphere /6-12/ The The area round the The cavernous sinus or superficial posterior branch of the The sphenoparietal sinus lateral groove middle cerebral v. The deep Surface of the insula The basal vein middle cerebral v. The inferior The orbit The superior cerebral vv. cerebral vv. The temporal lobe The superior sagittal sinus The cavernous or neighbouring sinuses The anterior The corpus callosum The basal vein cerebral vv. The anterior part of the medial surface of the hemisphere  Some of veins open into the venous sinuses against the Multiple ways of the venous drainage of the direction of blood flow in the sinus brain  Due to the special function of the brain (it is an organ with high energy needs, which works continuously, providing body integrity), multidirectional blood flow paths are formed on the head, which ensure high reliability. Inside the skull there are specially arranged, non- decaying venous collectors - venous sinuses of the dura mater, as well as multilateral and multi-tiered connections of various outflow paths. In the region of the head are distinguished: ▪ Diploic veins – these are veins of the skull bones, ▪ Sinuses of the dura mater, ▪ Emissary veins – venous anastomoses connecting extra- and intracranial veins, ▪ Cerebral venous bed and ways of its outflow — cerebral veins, ▪ Veins of the orbit and the eyeball, ▪ Venous bed of the face, carrying blood into the facial, retromandibular and, partially, into the internal jugular veins; ▪ Venous bed of the skull vault with an outflow to the vertebral, retromandibular, facial and ophthalmic veins. Veins of the region of the neck are classified into two groups: superficial and deep, carrying blood into the internal and external jugular veins, and brachiocephalic veins.  Vv. diploicae - are located in the spongy substance of the bones of the cranial vault. Through the vv.emissariae they flow into the superficial veins of the head and anastomose with the sinuses of the dura mater, providing a link between the internal and external jugular veins. Valves in the diploic veins are absent, therefore, blood flow through them is possible in two directions. They go from top to bottom to the base of the skull, where they connect through openings in the bones of the skull or with the saphenous veins of the cranial vault, or with the venous sinuses of the dura mater. Frontal v. (2) Anterior temporal v. (1) Posterior temporal v. (4) Occipital v. (5)  Sinus sagittalis superior -it begins at the apex of the falx cerebri above the crista galli. Course: it passes backwards along the upper convex border of the falx cerebri grooving the inner aspect of the skull cap (forming the superior sagittal sulcus). Sinus sagittalis inferior — it lies in the posterior 2/3 of the lower free border of the falx cerebri. Termination: it ends at the free margin of the tentorium uniting with the great cerebral vein to form the straight sinus.. Sinus rectus it connects the posterior ends of the superior and inferior sagittal sinuses Sinus transversus — It runs laterally along the transverse sulcus (in the attached margin of the tentorium). Sinus occipitalis It is a small sinus which runs in the attached border of the falx cerebelli. Sinus cavernosus— it lies on the side of the body of sphenoid in the middle cranial fossa. Sinus intercavernosis — располагаются вокруг турецкого седла, образуя с пещеристыми синусами замкнутое венозное кольцо. Sinus sphenoparietalis — runs along the free border of the lesser wing of the sphenoid. Sinus petrosus superior — runs along the upper border of the petrous temporal bone in the attached margin of the tentorium and ends joining the lateral end of the transverse sinus. Sinus petrosus inferior runs in the petrooccipital sulcus to reach the jugular foramen, it connects the cavernous and sigmoid sinuses.  Sinuses of dura mater: 1 – cavernous and intercavernous sinuses; 2 - superficial cerebral veins flowing into the superior sagittal sinus; 3 - superior sagittal sinus; 4 - inferior sagittal sinus; 5 - superior and inferior petrosal sinuses on the right; 6 - the right sigmoid sinus; 7 – greater cerebral vein (of Galen); 9 - the right transverse sinus; 10 - straight sinus; 12 – confluence of sinuses; 13 - left transverse sinus; 14 - occipital sinus; 15 - marginal sinus; 16 – superior petrosal sinus on the left; 17 - spheno-parietal sinus; 18 - superior ophthalmic vein; 19 - internal jugular vein  Emissary veins: 1 - deep cervical vein; 2 - vertebral artery; 3 - the atlanto-occipital sinus through which the vertebral artery passes; 4 - condylary emissary vein; 5 - anastomosis of the atlanto-occipital sinus with the occipital vein; 6 - mastoid emissary vein; 7 - sigmoid sinus; 8 - an occipital emissary vein; 9 - transverse sinus; 10 – confluence of sinuses; 11 - superior sagittal sinus; 12 - parietal emissary vein; 13 - superficial temporal vein; 14, 16 - occipital vein; 15 - posterior auricular vein; 17 - occipital sinus; 18 - internal jugular vein; 19 - vertebral vein  Emissary veins, vv. emissariae connect the sinuses of the dura mater and the diploic veins with the superficial veins of the head. 1. Parietal emissary vein, v. emissaria parietalis (1). It connects the superior sagittal sinus and superficial temporal vein and passes through the parietal opening. 2. Mastoid emissary vein, v. emissaria mastoidea (2). Through the mastoid opening connects the sigmoid sinus with the occipital vein. 3. Condylar emissary vein, v. emissaria condylaris (4). Through the condylar canal, the sigmoid sinus connects to the external vertebral venous plexus. 4. Occipital emissary vein, v. emissaria occipitalis (3). Connects the sinus drain with the occipital vein.  Venous plexuses of the head 1. Plexus pterygoideus, (33) It is located between the pterygoid muscles in the pterygo- palatine fossa and on the surface of the auditory tube. It collects blood from the mucous membrane of the nasal cavity, dura mater, temporal muscle, teeth of the lower jaw and masseter muscle. 2.Plexus venosus canalis hypoglossi. (5) It connects the venous plexus around the foramen magnum and the internal jugular vein. 3.Plexus venosus foraminis ovalis. It connects the cavernous sinus and pterygoid plexus. 4. Plexus venosus caroticus internus. It is connecting with the cavernous sinus and internal jugular vein. 5. Vv. portales hypophysialis. It is an outflow of blood from the capillary network of the infundibulum and adenohypophysis into the cavernous sinus.  System of deep veins of the brain ▪ Are located within the brain ▪ They are represented by groups of venous trunks collecting blood from: - Septum pellucidum - Basal nuclei - Thalamus - Brain stem - Cerebellum  Deep veins of the brain These veins do not typically follow the arterial supply and there is significant variation in anatomy between different subjects. Another notable feature of these veins is that they lack muscular walls and valves. ▪ Through deep veins, blood flows from the basal nuclei, the walls of the lateral ventricles and their vascular plexuses and the diencephalon. ▪ Topographically, the deep cerebral veins are divided into the superior and inferior groups.  Superior group of deep veins of the brain 1. V. thalamostriata superior and its tributaries 2. Vv. internae cerebri and their tributaries - Each of them them is formed near the interventricular septum due to the merger of the thalamostriate and choroidal (villous) veins. - The internal cerebral veins of both hemispheres go backward parallel to each other, between the layers of the vascular tissue of the third ventricle of the brain, and connect near the splenium of the corpus callosum, forming a short thick branch - the Galen’s vein. - Before opening into the vein of Galen, a corresponding basal vein flows into each of them. 3. Vv. of the lateral ventricle  Veins of the inferior group 1) Vv. basales and their tributaries (27): - venae trunci encephali; - v. pontomesencephalica; - vv. pontis - vv. medullae oblongatae. When combined, the basal veins form greater cerebral vein (v. Magna cerebri) (37), which flows into the straight sinus. The basal vein of Rosenthal originates on the medial surface of the temporal lobe and runs posteriorly and medially. It passes lateral to the midbrain to drain into the vein of Galen. It is closely related to the posterior cerebral artery (PCA). Venous drainage from the cerebellum Vv. cerebelli superiores et inferiores - Their tributaries from the vermis (superior and inferior veins of the vermis) and hemispherae are very variable (topographically and anatomi- cally): inferior medial vv and inferior lateral vv, superior medial and superior lateral vv. - They merge with the veins of the peduncles of the brain, the roof of the midbrain and the pons into the veins of the flocculus that flow into the superior petrosal sinus. - The cerebellar veins can independently open: the superior ones - into the straight sinus and the great cerebral vein, - the inferior ones - into the transverse and inferior petrosal sinuses.  Veins of the posterior cerebral fossa, left side: 1 – pulvinar of left thalamus; 2 — pulvinar of rightt thalamus; 3 — internal cerebral veins; 4 – splenium of callosal body; 5 — great cerebral vein; 6 — posterior vein of corpus callosum; 7 — inferior sagittal sinus; 8 — straight sinus; 9 — falx cerebri; 10 — наtentyorium cerebelli; 11 — confluence of sinuses; 12 — transverse sinus; 13 — superior sagittal sinus; 14 — superior vein of vermis; 15 — inferior vein of vermis; 16 — occipital sinus; 17, 19 — inferior veins of cerebellum; 18 — superior vein of cerebellum; 20 — vein of cerebello-medullary sistern; 21 —posterior spinal vein; 22 — the fourth ventricle; 23 — anterior spinal vein; 24 — cerebellar peduncles; 25 — vein of fourth ventricle; 26 — vein of medulla oblongata; 27 — lateral pontine vein; 28 — petrosal vein; 29 — ponto-mesencephalic vein; 30 — anterior cerebral vein; 31 — deep middle cerebral vein; 32 — lateral middle cerebral vein; 33 — peduncular vein; 34 — basal vein. A venous anastomotic network /circle Trolard/ at the base of the brain closely resembles the vicinal arterial circle of Willis. This venous polygon is composed of the: - anterior cerebral and - communicating veins, - the basal vein of Rosenthal , - the posterior communicating, - lateral mesencephalic veins. This venous circle might cause bleeding with such procedures as an endoscopic third ventriculostomy. This information regarding venous circle may be useful to neuroradiologists or neurosurgeons operating at the base of the brain.  Venous circle /Trolard’s/ of the brain For reference, note the olfactory tracts and midbrain cross section. Note the veinous ring encircling the mamillary bodies and floor of the third ventricle. The anterior cerebral veins are seen leaving the longitudinal fissure. Note the anterior communicating vein between the two anterior cerebral veins and deep Sylvian vein /upper arrow/. An anastomotic vein /lower arrow/ is seen linking the basal vein of Rosenthal just posterior to the mamillary bodies. There are three pairs of the jugular veins in the region of the neck, carring blood from the head and neck to the system of SVC. 1. Vena jugularis interna 2. Vena jugularis externa 3. Vena jugularis anterior  Internal jugular vein It is formed by the union of inferior petrosal and sigmoid dural venous sinuses in or just distal to the jugular foramen (forming the jugular bulb). It descends in the carotid sheath with the internal carotid artery. The vagus nerve (CN X) lies between the two. After receiving tributaries from the face and neck (listed below) it continues to descend before descending into the thorax, usually posterior to the space between the two heads of the sternocleidomastoid muscle, before uniting with the subclavian vein to form the brachiocephalic vein.  Tributaries of the internal jugular vein Blood from the head and neck is collected mainly in the internal jugular vein. The tributaries of the internal jugular vein can be divided into two large groups: extracranial and intracranial. Intracranial tributaries 1) Diploic veins originate from the spongy substance of the bones of the cranial vault, they flow into the cerebral sinuses and, through the emissary veins, connect to the veins of the external integument of the head. 2) Emissary veins are located in small bony canals, through them blood flows from the sinuses outwards. 3) The upper and lower ophthalmic veins, 4) Veins of the labyrinth emerging from the internal auditory meatus and flowing into the inferior petrosal sinus, 5) Sinuses of dura mater. Extracranial tributaries 1) Pharyngeal veins из глоточного сплетения, 2) Lingual vein, 3) Superior thyroid vein, 4) Facial vein 5) Retromandibular vein. Tributaries of the retromandibular vein 1. v. temporalis superficialis 2. v. maxillaris 3. plexus pterygoideus 4. v. facialis (sometimes) External jugular vein It is formed by the union of the occipital vein and the posterior auricular vein. The external jugular vein originates at the lrevel of the the angle of the mandible, descends to the clavicle, penetrating the deep cervical fascia and draining into the subclavian vein. The main tributaries of the external jugular vein are: anterior jugular vein, posterior external jugular vein, transverse cervical vein, and suprascapular vein. The external jugular vein collects blood from the scalp, face, neck, and the superficial muscles of the back.  Anterior jugular vein It begins near the level of hyoid bone by the confluence of several superficial veins from the submandibular region. It descends between the median line and the anterior border of the sternocleidomastoideus muscle, and, at the lower part of the neck, passes beneath that muscle to open into the termination of the external jugular vein, or, in some instances, into the subclavian vein. It varies considerably in size, bearing usually an inverse proportion to the external jugular; most frequently there are two anterior jugulars, a right and left; but sometimes only one. Its tributaries are some laryngeal veins, and occasionally a small thyroid vein. Just above the sternum the two anterior jugular veins communicate by a transverse trunk, the venous jugular arch, which receives tributaries from the inferior thyroid veins; each also communicates with the internal jugular. There are no valves in this vein.  Superficial veins of the face The facial vein is a large vessel of the face and is much less tortuous than the artery of the same name. It lies posterior to the facial artery and begins from the lateral side of the nose. Its tributaries are: - v. angularis - v. supraorbitalis - w. palpebrales superioris et inferioris - vv. nasales externae - vv. labiales superior et inferiores - v. palatina externa - v. submentalis - v. profunda faciei The deep facial vein originates from the pterygoid venous plexus and is of considerable size.  Deep veins of the face Vena retromandibularis It is formed by fusion of the superficial and middle temporal veins collecting blood from the temporal and parietal regions. It is located in front of the auricle, pierces the parotid gland, passes behind the mandibular branch together with the ECA. Its tributaries: 1. V. temporalis superficialis 2. V. maxillaris 3. Plexus pterygoideus 4. V. facialis /sometimes/ 5. Anterior auricular v. 6. Parotid vv. 7. Transverse vein of the face – collects blood from the lateral regions of the face. Непарная вена, v. azygos, направляется вверх по правой переднебоковой поверхности грудного отдела позвоночного столба и на уровне тела III грудного позвонка поворачивает вперед. Образовав дугу, обращенную выпуклостью кверху, v. azygos перебрасывается через правый бронх и сразу же впадает в верхнюю полую вену. Непарная вена у места впадения в v. cava superior имеет два клапана. В непарную вену вливаются пищеводные вены, vv. esophageae; бронхиальные вены, vv. bronchiales; задние межреберные вены, vv. intercostales posteriores, полунепарная вена, v. hemiazygos. Полунепарная вена, v. hemiazygos, вступив в грудную полость, направляется вверх по левой боковой поверхности позвоночного столба. На уровне Х-ХII грудных позвонков полунепарная вена заворачивает вправо, ложится на переднюю поверхность позвоночного столба позади аорты и пищевода. Полунепарная вена пересекает переднюю поверхность позвоночного столба поперек и на уровне VIII грудного позвонка вливается в непарную вену. Полунепарная вена короче и несколько тоньше, чем непарная вена, и принимает пищеводные вены, vv. esophageae; медиастинальные вены, vv. mediastinales; задние межреберные вены, vv. intercostales posteriores и добавочную полунепарную вену, v. hemiazygos accessoria. Добавочная полунепарная вена, v. hemiazygos accessoria, образуется из 3- 4 верхних задних межреберных вен левой стороны и следует сверху вниз по левой боковой поверхности позвоночного столба, впадая в v. hemiazygos или непосредственно в v. azygos. Рисунок 1 – схема портокавальных и кавакавальных анастомозов 1 — v. cava superior; 2 — v. brachiocephalica sinistra; 3 — v. hemiazygos accessoria; 4 — v. hemiazygos; 5 — plexus venosus esophageus; 6 — v. cava inferior; 7 — v. gastrica dextra; 8 — v. lienalis; 9 — v. mesenterica inferior; 10 — vv. lumbales; 11 — v. iliaca communis; 12 — v. rectalis superior; 13 — v. iliaca interna; 14 — v. rectalis media; 15 — plexus venosus rectalis; 16 — v. epigastrica inferior; 17 — v. epigastrica superficialis; 18 — v. lumbalis ascendens; 19 — vv. paraumbiliales; 20 — v. portae; 21 — v. epigastrica superior; 22 — v. thoracoepigastrica; 23 — v. azygos; 24 — v. axillaris; 25 — vv. intercostales posteriores; 26 — v. thoracica interna; 27 — v. subclavia; 28 — plexus venosus vertebralis  Лимфатический дренаж грудной клетки Различаем 2 группы лимфатических узлов: 1) Пристеночные 2) Висцеральные - Предперикардиальные - Окологрудные - Плечеголовные - Окологрудинные - Латеральные перикардиальные - Околотрахеальные - Межреберные - Трахеобронхиальные - Верхние диафрагмальные - Бронхолегочные - Внутрилегочные - Юкстапищеводные - Превертебральные Лимфа от стенок и органов правой половины грудной клетки направляется в правый средостенный ствол, который впадает в правый лимфатический проток – в правый венозный угол. От левой стороны образуется левый средостенный ствол, впадающий в грудной лимфатический проток.