Venous drainage from the brain. Veins of the brain

- this is a large vessel that passes from the visual tubercles through a cavity filled with cerebrospinal fluid, and located between the arachnoid and soft shells head and spinal cord. The subarachnoid space was called the cistern of the vein of Galen.

Aneurysm of the vein of Galen includes various disorders circulatory system brain, expressed in the form of interweaving of abnormal vessels and the formation of glomeruli from them different shapes and size, as well as protrusion of the walls of the vein of Galen.

Types of aneurysms that may occur

Abnormal vessels are characterized by thinning of the walls of different diameters. They cannot be attributed to either veins or arteries, since they have a special composition of tissue layers. The walls of abnormal vessels are composed of collagen and hyaline fibers. Violations in the development of the brain is called vascular malformations. These pathologies are congenital, they occur on different stages prenatal development fetus.

Vascular malformations are characterized by the absence of capillaries, and therefore, blood flows directly from the arteries into the venous system. The anomaly leads to the fact that the blood supply to the tissues is disturbed, since a considerable amount of blood goes into.

Insufficient blood flow to the brain causes disturbances in metabolic processes in tissues and the occurrence of the pathology of the vein of Galen.

Aneurysm is the most dangerous defect among brain pathologies. It causes a change in the structure of the vessel tissue, due to which its elasticity is lost. This leads to possible rupture veins and cerebral hemorrhage.

The consequence of the pathology is a violation of the circulatory process and a possible fatal outcome. Deformations of blood vessels in aneurysms are no less dangerous. Blood fills the neoplasms, their size increases. The bulges put pressure on the nerves and tissues of the organ.

Aneurysm of the vein of Galen is a rare malformation. Among total number cases of congenital disorders of the circulatory system in newborns, a third refers to this anomaly. It is characterized by a high mortality rate in newborns. In 90%, the disease ends in death. High level mortality up to 78% persists during embolization. In boys, this anomaly occurs 2 times more often.

Causes of pathology

The unequivocal cause of the formation of aneurysms in the fetus has not been determined. Factors that influence their formation have been identified:

Consequences of a break

An aneurysm rupture causes subarachnoid hemorrhage into the cavity between the arachnoid and pia mater, or intracerebral hematoma.

Due to rupture and hemorrhage of blood vessels, necrosis of brain tissue occurs

This leads to blood entering the tissues and ventricles of the brain. Spasm is necessarily caused when there is a repeated narrowing of the lumen blood vessels. The accumulation of fluid causes dropsy of the brain or hydrocephalus. Tissue necrosis occurs, and some of its sections cease to function.

A person gets partial paralysis, he experiences nausea and a sharp headache possible vomiting, convulsions, prolapse upper eyelid, visual impairment.

The gap leads to the following complications.

as a result of subarachnoid hemorrhage, throbbing pains develop, which are difficult to respond to the action of painkillers;
memory is broken brain activity, the ability to perceive information is reduced;
irritability, anxiety, depression become a constant phenomenon;
defecation and urination cause difficulty;
the swallowing process is difficult, and therefore, food can get into the trachea or bronchi, dehydration develops;
delayed response and emotional instability- from aggression to shyness;
speech impairment is possible: it is difficult for a person to speak, he does not understand well, he cannot read and write;
violations occur motor function, paralysis is possible, coordination is disturbed.

Treatment Methods

Timely help and treatment can increase the chance of recovery from an aneurysm. Most often, the most effective tool is a surgical intervention that reduces the risk of rupture and prevents death. It is more likely in cases of giant aneurysms and neglected cases when help was not provided on time.

Death is possible due to the characteristics of the organism or aggravating diseases that are not associated with the operation.

In case of pathology, the following types surgical intervention.

Cupping. This is an intracranial operation, as a result of which the aneurysm is excluded from the bloodstream and the patency of neighboring and supporting vessels is preserved. During the operation, blood is removed from the subarachnoid space and an outflow of a blood clot (hematoma) is performed. In neurosurgery, cupping is considered one of the most difficult operations.
Strengthening the walls of the vessel. The operation aims to obtain the formation of a capsule at the site of the rupture from connective tissue, which is caused by wrapping the problem area with surgical gauze. Postoperative period characterized by a significant risk of bleeding.
Removal of an artery with an aneurysm (trapping). The operation consists in applying clips on both sides of the rupture and stopping the blood flow in it. Such actions are possible only with normal blood flow in neighboring vessels and normal blood supply to the brain.
Endovascular operations. The essence of the operation is to stop the patency of the aneurysm. The damaged section of the vein is blocked using microcoils. The method provides minimal intervention in the body and minimal trauma, opening the skull is not required. Its use is possible with the guarantee of the patency of adjacent vessels.

After surgery, complications may occur. Their cause is usually cerebral hypoxia and spasms. Their probability is especially high if the operation was performed during the period of hemorrhage. During surgery, damage to the walls of the aneurysm is possible.

Surgical treatment is carried out in combination with conservative. It involves constant medical supervision. task conservative treatment is to provide access to the blood supply to the areas of the brain affected by the aneurysm. The following drugs are commonly used:

painkillers and antiemetics that help alleviate the condition;
stabilizing pressure, the increase of which contributes to tissue rupture and hemorrhage;
anticonvulsants;
calcium channel blockers, which reduce the possibility of cerebral spasm and maintain the stability of the circulatory system.

The combination of conservative and operational ways treatment, since with an aneurysm of the vein of Galen it is necessary surgery, it reduces the risk of rupture and may prevent death.

Forecasts

High mortality in the neonatal period, and before reaching one year of age with an aneurysm of the vein of Galen, they try to reduce by embolization, when arteriovenous malformation is excluded from the bloodstream. Some operations are successful, but they reduce the proportion of deaths in newborns to only 78%.

In this regard, doctors insist on the importance prenatal diagnosis. In the second trimester of pregnancy, pathology, as a rule, is not detected. In the medical literature, it is noted that aneurysm is accompanied by, which researchers record in 66.7% of cases, vasodilatation of the neck, which is noted in 25.6% of cases, ventriculomegaly, which is determined in 30.9% of cases, non-immune dropsy that accompanies the pathology in 16, 2% of cases.

Cardiomegaly occurs in the fetus due to an increase in cardiac output in an aneurysm of the vein of Galen. Dropsy is a consequence of decompensation of cardiac activity. This occurs with arteriovenous malformations, when regular blood flow into the venous system causes the flow a large number blood to the heart and makes it work hard. The heart increases in size, adapts, building muscle mass. Ventriculomegaly occurs due to the expansion of the vessel and compression of the brain.

Currently, there are 300 clinical cases of such fetal pathology described in studies. 50 of them were able to diagnose in the prenatal period, in the third trimester. An aneurysm is identified by performing ultrasound examination fetus by the method of Color Doppler mapping (CDC).

The diagnosis confirms the turbulent nature of blood flow - arterial and venous, it is observed in the median hypoechoic formation. The final diagnosis is established after childbirth using MRI.

An aneurysm of the vein of Galen is a disease that is characterized by abnormalities in the development of the vein of Galen (a vessel located in the human brain). Also, such vessels can be intertwined or have processes that come out of the vein. The disease can progress in the embryonic period, so it is associated with congenital ailments. Vessel weaves usually have strange sheaths that ordinary person thick, and in people with pathology - thin. Doctors very rarely encounter such a disease as an aneurysm of the vein of Galen.

These weaves are not supplied with blood, it goes into the veins, so the blood circulation becomes different from healthy. It is because of the low blood supply that various disorders of the brain and the appearance of the pathology of the vein of Galen occur. It is very important to remember that an aneurysm is very dangerous, because at any moment the vessels can burst and hemorrhage can form. Therefore, it is necessary to immediately consult a doctor in order not to bring the disease to a fatal outcome.

Of course, doctors still cannot find all the causes of this disease, but there are some factors that affect the development:

if a person has congenital damage to the vessels of the brain due to the fact that they are tortuous, bent, then this can be the cause (especially hereditary predisposition);
if a person has high pressure, then it presses on the already damaged areas of the vessels, which leads to their rupture;
if a person had some kind of injury associated with damage to blood vessels or the brain, as well as various cardio - vascular diseases or a tumor, such as a brain tumor or a tumor that interferes with circulation, this can lead to aneurysms.

It is possible to identify the disease from birth only in fifty percent of patients. Since blood circulation is disturbed, sometimes there is high pressure, then there is a big load on the heart, which leads to heart failure. As already mentioned, the disease is formed in the baby even in the womb of the mother, so the signs of insufficiency are visible on the face.

From an early age, a child may show:

fatigue - when the mother gives the baby a breast, and the newborn gets tired when feeding;
edema, swollen places in certain parts body;
pulmonary edema.

In addition, an aneurysm of the vein of Galen can cause hydrocephalus, which is characterized by an increase in the size of the child's head, as well as pronounced veins on the scalp. In this case, symptoms such as vomiting, blurred vision, protrusion will be observed. eyeball and others. Also, due to the fact that the pressure is increased, there may be convulsions in the newborn, as well as hemorrhage.

If the mother of a newborn has noticed deviations in the behavior of her child, changes in appearance, then you should immediately consult a doctor to rule out or confirm this serious disease.

Tracking changes in the child's body is possible when examining the mother for later dates pregnancy when the fetus is fully formed. Ultrasound is often done in such a diagnosis, in which mothers are informed about the health status of their unborn child. Also, doctors sometimes do dopplerography, because it is effective in identifying such ailments.

In general, if the mother of the newborn has not been examined for the appearance of such abnormalities or they have not been identified, then it is difficult to judge pathologies when the child has already appeared.

This is due to the fact that:

the disease is extremely rare, therefore, its signs are not fully understood by everyone, and sometimes they are not known at all;
symptoms do not always appear, which delays the treatment and diagnosis of the disease.

Also, magnetic resonance imaging or CT scan, which fix changes in the vessels and detect their interweaving. For their further study, a contrast x-ray is used, which also examines the nearest vessels in order to understand the scheme of surgical intervention.

To solve problems, it is very important to have the right doctors who will explain the situation and help parents cope with this difficult matter, and it is also necessary to have diagnostic equipment that only qualified specialists have available.

Due to the fact that treatment is sometimes delayed, a person may experience a brain hemorrhage. As a result, blood enters all brain tissues, which leads to their necrosis and complete dysfunction, along with this, hydrocephalus can be detected.

Due to the gap may occur:

headaches, often pulsating in the brain, which are not helped by any drugs;
lost in space;
uncomfortable being in society or stress in life;
poor management of their actions.

Nowadays, the percentage of lives saved from this disease increases due to the development of medicine and modern technologies. Most best method treatment, according to doctors, surgical intervention, which saves even the largest aneurysms.

During surgery, there is a risk of damaging the aneurysm. This is what is postoperative complications. In addition, surgical intervention goes hand in hand with traditional treatment, are issued various drugs, for example, to anesthetize the operated site or to save a person from vomiting.

Of course, despite the progress in science and medicine, doctors can not save all newborns, mortality is still very high. To save children, they are trying to identify the disease at the stage of the embryo, but this is not always possible, so now it is actively developing Technical equipment for the study of this disease.

Vienna Galena (defects and anomalies).

Vienna Galena is a large cerebral vessel passing above and behind the visual tubercles in the subarachnoid space, known as the cistern of the vein of Hapen. It connects to the inferior sagittal sinus, which runs along the lower edge of the crescent of the brain, with which they form a straight sinus. The term "aneurysm of the vein of Gapen" refers to various vascular malformations from multiple communications between the system of the great cerebral vein and the cerebral vessels of the system of carotid and vertebrobasilar arteries to the actual aneurysm of the vein of Gapin.

Vascular malformations of the brain-this group congenital diseases associated with impaired development of cerebral vessels at various stages of their embryogenesis. Arteriovenous malformations are various shapes and the size of the "tangles" formed as a result of the disorderly interweaving of pathological vessels. These vessels have different diameters, their walls are thinned and differ in their structure from both arteries and veins; devoid of layers characteristic of arteries and veins, represented by hyaline and collagen fibers. Most often, arteriovenous malformations are located supratentorially (cerebral hemispheres, the region of the great cerebral vein), less often - in the posterior cranial fossa.

The afferent vessels are branches main vessels brain, they can be greatly expanded and twisted. The draining veins are also dilated and lengthened due to the development pathological loops. characteristic feature The structure of vascular malformations is the absence of a capillary network in them, which leads to direct shunting of blood from the arterial pool to the system of superficial and deep veins. In this regard, part of the blood rushes along the path of least resistance, i.e. through arteriovenous malformations and does not take part in the blood supply to the brain tissue. Arteriovenous malformations divert to themselves a significant part of the blood entering the hemisphere, which leads to its anemia and disruption of tissue metabolism.

Although aneurysm of the vein of Galen is very rare, this anomaly accounts for 1/3 of all cases of arteriovenous malformations of the neonatal period and early childhood. In boys, it occurs 2 times more often.

At birth at half of the children clinical symptoms absent. The remaining 50% of newborns have signs of heart failure, which is an unfavorable prognostic sign. Hydrocephalus is rarely diagnosed at birth, but in some cases it develops over time. In more late age intracranial hemorrhages and disorders may occur cerebral circulation leading to ischemia.

Unfavorable - in more than 90% of cases, death occurs in the neonatal period and infancy. Great hopes are placed on embolization of arteriovenous malformation (occlusion of both arterial and venous parts). Despite some successful clinical cases surgical treatment, predominantly by embolization, mortality remains high at 78%, so the prenatal diagnosis of an aneurysm of the vein of Galen is important practical value.

Since 1937, when the first Jr. Jaeger et al. described an aneurysm of the vein of Galen, more than 300 descriptions of clinical observations of this pathology have been published, of which only about 50 cases were diagnosed in the prenatal period, usually in the middle of the third trimester. At ultrasound examination Fetal aneurysm of the vein of Galen is visualized as a median hypoechoic formation located above the cerebellar tenon. CDI greatly simplifies the prenatal diagnosis of an aneurysm of the vein of Galen.

Main diagnostic criterion aneurysms is the turbulent arterial and venous nature of the blood flow, found in the median hypoechoic formation. To clarify the diagnosis after childbirth, MRI should be used, which makes it possible to clarify the structure of the vascular bed and identify venous drainages. Differential Diagnosis it is necessary to carry out with a median arachnoid cyst, porencephaly and an interhemispheric cyst, which can form with agenesis of the corpus callosum.

For the first time about prenatal ultrasound diagnostics aneurysm of the vein of Galen in 1983 reported J. Hirsch et al. and K. Mao, J. Adams. A. Reiter et al. first in 1986 for differential diagnosis aneurysms used Doppler echography, and T. Hata et al. - CDC in 1988

The table summarizes international experience with prenatal diagnosis and perinatal outcomes of 42 cases. aneurysm of the vein of Galen. At the same time, only those observations were selected in which Doppler sonography was necessarily used and full clinical information was presented.

As can be seen from the data in the table, in most cases, prenatal diagnosis of an aneurysm of the vein of Galen was only installed in III trimester pregnancy. In many of the presented observations, no aneurysm was found in the study of the structures of the fetal brain in the second trimester of pregnancy.

According to the summary data of the literature, among the combined changes detected in fetuses with an aneurysm of the vein of Galen, cardiomegaly was noted in 28 (66.7%) cases, vasodilation of the neck - in 11 (25.6%) cases, ventriculomegaly - in 13 (30.9%) cases, non-immune dropsy - in 7 (16.2%) cases.

Frequently occurring cardiomegaly in fetuses with an aneurysm of the vein of Galen is a consequence of an increase in cardiac output, and in cases of cardiac decompensation, dropsy develops. In arteriovenous malformations, there is a constant discharge arterial blood into the venous system (shunt phenomenon), most of blood flows towards the heart, as a result of which the heart has to work with increased load. Adaptation processes take place in the heart muscle, expressed in an increase in its muscle mass. At the same time, there is an increase in all parts of the heart. Gradually, heart failure develops. The speed and degree of development of cardiac decompensation depend primarily on the volume of arteriovenous blood flow.

Importance has a caliber of altered vessels and a duration of existence aneurysms. In addition, hemodynamic disturbances are gradually formed, associated with a difficult outflow of venous blood distal to the anastomosis and an increase in venous pressure in the area of the affected vessels. They lead to varicose veins, insufficiency of venous valves, stagnant-trophic disorders. The origin of ventriculomegaly is associated with compression of the cerebral aqueduct by an enlarged vessel or with an increase in intracranial venous pressure.

Prognosis for aneurysm of the vein of Galen in most cases unfavorable, especially in cases of combination with cardiomegaly, ventriculomegaly and non-immune dropsy. In studies conducted by N. Hoffman et al. in the late 1970s and early 1980s, 8 out of 9 neonatal deaths with a Galen vein aneurysm at Toronto Children's Hospital were reported. The surviving child had severe neurological disorders. According to I. Johnston et al., obtained in the mid-80s. in the analysis of 80 case histories of newborns with an aneurysm of the vein of Galen, deaths were recorded in 91.4% of cases. IN last years due to timely embolization, perinatal losses decreased. Our summary analysis of 42 published cases of prenatal diagnosis of this anomaly showed that perinatal loss or death in infancy was noted in 29 (69%) cases. Modern development Ultrasound technology allows the physician to accurately, although not always timely, make a prenatal diagnosis of an aneurysm of the vein of Galen.

Topic title " Inner base skulls. Blood supply to the brain. Venous drainage from the brain.

Cerebral veins usually do not accompany arteries. Superficial veins brain located on the surface of the cerebral convolutions, deep - in the depths of the brain. Deep veins, merging, form a large vein of the brain, v. cerebri magna, or vein of Galen, - a short trunk that flows into the direct sinus of the dura mater. Other cerebral veins also fall into one or another sinus.

Sinuses of the dura mater. Sagittal sinuses

Sinuses of the dura mater collecting venous blood from the veins of the brain, are formed at the points of attachment of the dura mater to the bones of the skull due to the splitting of its sheets. Through the sinuses, blood flows from the cranial cavity into the internal jugular vein(Fig. 5.11). Sinuses do not have valves.

Superior sagittal sinus of the dura mater, sinus sagittalis superior, is located in the upper edge of the falx cerebri, attached to the cranial sulcus of the same name, and extends from crista galli to protuberantia occipitalis interna. In the anterior sections of this sinus there are anastomoses with the veins of the nasal cavity. Through parietal emissary veins, it is connected with diploic veins and superficial veins of the cranial vault. The posterior end of the sinus flows into the sinus drain Herophilus, confluens sinuum.

inferior sagittal sinus, sinus sagittalis inferior, is located in the lower edge of the falx cerebri and goes into a straight sinus.

We also recommend a video of the anatomy and topography of the sinuses of the dura mater

Other video tutorials on this topic are: "".

Vienna Galena (vena magna cerebri) is one of the main venous collectors of the brain, which collects blood from its internal structures(basal nuclei, visual tubercles, transparent septum, choroid plexus lateral ventricles of the brain) and flows into the direct sinus. By modern ideas, arteriovenous malformations (AVM) of the vein of Galen is a congenital malformation of the cerebral vessels associated with a delay in the reverse development of arteriovenous communications that exist in the embryonic period of development, with the obligatory presence of an aneurysmally dilated vein of Galen. Despite the fact that AVMs of the vein of Galen are very rare (1% of all intracranial vascular malformations), this anomaly is diagnosed in one third of cases of AVMs in the neonatal and early childhood period. In boys, it occurs 2 times more often.

This malformation is characterized by hypoplasia of the muscle and elastic fibers of the middle layer. big vein brain, in connection with which even slight increase venous pressure can lead to diffuse or limited varicose veins that gradually progress. There are diffuse and saccular dilatations of the vein of Galen. According to the classification of A. Berenstein and P. Lasjaunias (1992), based on angiostructural differences, there are two types of AVMs of the vein of Galen:

vasculature

A significant increase in the size of the vein of Galen causes mechanical pressure on the surrounding structures of the brain, causing their atrophy, dislocation, and disruption. venous outflow and liquorodynamics and, ultimately, progressive hydrocephalus of the ventricular system of the brain. The manifestation of the disease occurs in the early childhood(extremely rare - in adults) and can be represented by hypertensive-hydrocephalic syndrome (developing as a result of occlusion of the water pipe), intracranial hemorrhage, epileptic seizures, psychomotor retardation, focal neurological symptoms, heart failure (AVM of the vein of Galen is often combined with malformations of the heart and vascular system: insufficiency of the tricuspid valve, non-closure of the foramen ovale, coarctation of the aorta). Most authors distinguish 3 types clinical manifestation AVM of the vein of Galen:

■ Type 1 - severe, often leading to death - cardiovascular and pulmonary insufficiency, hepatomegaly, non-communicating hydrocephalus, intracranial pulsatile noises;
■ Type 2 - a local arterial phenomenon with a classic "steal" syndrome and underdevelopment of brain structures with severe focal disorders;
■ Type 3 - local venous manifestations in the form of impaired venous outflow, increased venous pressure and CSF circulation disorders with the development of communicating hydrocephalus.

Prenatal diagnosis of AVMs of the vein of Galen using ultrasonography (ultrasound) and MRI of the fetus makes it possible to establish a diagnosis in the third trimester of pregnancy. Based on these data, it is possible to assess the size of the AVM, the presence of hydrocephalus and concomitant heart failure in the fetus, as well as adequately plan delivery and further treatment child (in children, angiography is also used: superselective angiography, vertebral angiography, etc.). At the present stage of development of vascular neurosurgery, the method of choice in the treatment of AVMs of the vein of Galen is endovascular exclusion of the AVM: the endovascular method is the main, highly effective and low-traumatic method of treatment, with low level disability and mortality. The presence of progressive hydrocephalus with corresponding symptoms is an indication for CSF shunting before endovascular treatment. The method of choice is the imposition of a ventriculo-peritoneal shunt. In view of the rare occurrence of pathology, complex angioarchitectonics, and peculiarities of perioperative management of patients, endovascular interventions should be performed in large federal centers of the country that have the appropriate equipment and sufficient experience in intravascular neurovascular interventions.

The goal of endovascular treatment is to minimize or stop the flow of arterial blood into the venous system of the brain. At the same time, even incomplete shutdown of blood flow in the AVM in the vast majority of cases leads to regression or stabilization. clinical symptoms. Optimal age patients for endovascular interventions - 3 - 5 months. However, with increasing symptoms of cardiovascular insufficiency, intervention should be carried out in more early dates. Expectant management in asymptomatic AVMs of the vein of Galen is unreasonable, since successful endovascular treatment in the first year of life, before the appearance of irreversible neurological disorders, allows you to achieve good clinical results. Endovascular treatment of AVMs of the vein of Galen in older children and adults is associated with a high risk of intracranial hemorrhage due to the possibility of developing hyperperfusion changes in cerebral hemodynamics due to the duration of AVM functioning.

For occlusion of afferent vessels in AVMs of the vein of Galen of the mural type, it is preferable to use microcoils. It is not recommended to use the balloon-catheter technique due to the high risk of hemorrhagic complications due to the detachment of the afferent vessel or its branches at the moment of catheter traction during balloon separation. In AVMs of the Galen veins of the choroidal type, adhesive compositions are most effective, the introduction of which, as a rule, requires several stages. At the same time, adhesive compositions can be used in patients of all age groups, non-adhesive compositions should be used with caution in children under 1 year of age. Intravascular manipulations on the afferent vessels of the AVM of the vein of Galen should be extremely careful in view of the high risk of their perforation, especially with severe tortuosity. In the event of the development of such complications, it is necessary to occlude the area of the damaged vessel, stop further surgical procedures and start conservative measures aimed at preventing angiospasm, cerebral edema, maintaining normal indicators vital functions of the body.