Craniocervical junction venous anatomy around the suboccipital cavernous sinus: evaluation by MR imaging

The present study evaluated the venous anatomy of the craniocervical junction, focusing on the suboccipital cavernous sinus (SCS), a vertebral venous plexus surrounding the horizontal portion of the vertebral artery at the skull base. MR imaging was reviewed to clarify the venous anatomy of the SCS in 33 patients. Multiplanar reconstruction MR images were obtained using contrast-enhanced three-dimensional fast spoiled gradient-recalled acquisition in the steady state (3-D fast SPGR) with fat suppression. Connections with the SCS were evaluated for the following venous structures: anterior condylar vein (ACV); posterior condylar vein (PCV); lateral condylar vein (LCV); vertebral artery venous plexus (VAVP); and anterior internal vertebral venous plexus (AVVP). The SCS connected with the ACV superomedially, with the VAVP inferolaterally, and with the AVVP medially. The LCV connected with the external orifice of the ACV and superoanterior aspect of the SCS. The PCV connected with the posteromedial aspect of the jugular bulb and superoposterior aspect of the SCS. The findings of craniocervical junction venography performed in eight patients corresponded with those on MR imaging, other than with regard to the PCV. Contrast-enhanced 3-D fast SPGR allows visualization of the detailed anatomy of these venous structures, and this technique facilitates interventions and description of pathologies occurring in this area.