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Comparison of the left and right caliber of the internal jugular vein (IJV), subclavian vein (ScV) and brachiocephalic vein (BcV). Except the ScV, the right side is significantly larger than the left side
Source publication
We measured the calibers of the left and right internal jugular veins (IJV) and sizes of the left and right transverse sinuses (TS) in 91 cadavers, compared them between the left and right sides, and also evaluated the drainage patterns of the superior sagittal sinus (SSS) and straight sinus (=rectal sinus, RS) in the torcular Herophili. In additio...
Context in source publication
Context 1
... mean caliber of the right IJV was significantly greater (P \ 0.01) at all sites (IJV-a, -b, -c, -max.) (Fig. 7). When the left and right IJV calibers were compared in each individual (IJV-c, differences C2 mm), the right IJV was larger in 81.3 %, and the left IJV was larger 11.0 %; the incidence differed markedly (Table 1). These incidences were relatively similar to those (R [ L, 67.4 %; R \ L, 12.1 %) reported by Goto and Koda (2000). The ...Similar publications
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Citations
... (23,24) Although non-contrast TOF-MRV can detect slow flow, but it can do so to a certain extent. The short interval radio-frequency pulses saturate spins flowing faster than this limit, resulting in signal loss, also known as "flow gap." a phenomenon that is further exacerbated by coplanar acquisition and mainly seen in hypoplastic dural sinuses, flow gaps were demonstrated in 31% of non-dominant TSs in a study performed by (25) The uneven venous drainage pattern of TSs is well-recognized and studies concerning of venous drainage patterns of cerebral hemispheres revealed that the flow was towards the right TS in the majority of cases (26). In this study, the measurement or observation of the side of direction of the four examined anatomical signs in addition to the method of measurement of cross-sectional area of each TS depended on a methodology described by Pettersson et al. (2018) (14). ...
Background: Differentiating flow gaps associated with hypoplastic transverse sinus from venous thrombosis is a diagnostic challenge in brain magnetic resonance imaging with venography.
Objectives: To assess the clinical benefit of anatomical signs to anticipate the side of the dominant transverse sinus.
Patients and Methods: A total of 100 patients underwent brain magnetic resonance imaging with venography at the radiology department /medical city and were retrospectively reviewed for the direction of superior sagittal sinus flow void, inclination of sulcus for the superior sagittal sinus, angulation of the posterior falx and direction of occipital lobe bending in axial non-contrast T1 weighted image, then compare these findings with a side of the dominant transverse sinus in magnetic resonance venography.
Results: Inclination of sulcus for superior sagittal sinus and superior sagittal sinus flow void direction toward the right side had high positive predictive values (95.5%) and (93.2 %) in proper matching with the right transverse sinus dominance, respectively. Right-sided angulation of the posterior flax and rightward direction of the occipital lobe had a positive predictive value of (90.9 %) in predicting transverse sinus dominance.
Conclusion: The side of dominant transverse sinus can be anticipated by reviewing anatomical signs in T1 weighted image, which may help to differentiate hypoplastic transverse sinus from venous thrombosis that aid in better interpretation of brain MRI- MRV examinations.
... Venous flow-related features vary among individuals depending on the configuration of the torcular. Asymmetric inflows to the TS can impact the shape and circulation patterns within other venous structures [32,34]. The caliber of the internal jugular veins (IJV) is thought to be influenced by the size of the intracranial veins and the degree of communication around the torcular Herophili [34]. ...
... Asymmetric inflows to the TS can impact the shape and circulation patterns within other venous structures [32,34]. The caliber of the internal jugular veins (IJV) is thought to be influenced by the size of the intracranial veins and the degree of communication around the torcular Herophili [34]. Conventional venograms provide relatively limited information on the dural sinus architecture [32]; consequently, thorough knowledge of this variable area is of high clinical and operative importance. ...
... The drainage pattern of the SSS is suggested to be determined at an early stage of the prenatal period [34]. A definitive configuration of the torcular develops at the end of the second trimester of gestation [5]. ...
Background
Classically, the torcular Herophili is described as the symmetric junction between the superior sagittal sinus (SSS), transverse sinuses (TSs), and straight sinus (SS). However, finding this pattern in practice is not standard. Anatomical variations are common, and different drainage patterns should be expected. Existing literature proposes highly detailed descriptions and classifications of this region. Still, a simplified and practical categorization is not available.
Methods
We present an anatomical finding of the torcular Herophili discovered on a cadaveric dissection. Then, we conducted a retrospective study examining the 100 most recent cranial magnetic resonance venographies (MRVs) from the Mayo Clinic, labeling them with a new proposed dural sinus classification system. Images were initially classified by two authors and further validated by a board-certified neurosurgeon and a board-certified neuroradiologist from our institution. To measure consistency in image identification, two additional international neurosurgeons were asked to classify a subset of the same MRV images, and their answers were compared.
Results
Of the MRV cohort, 33 patients were male and 67 were female. Their ages ranged from 18 to 86 years, with a mean of 47.35 years and a median of 49 years. Upon examination, 53 patients presented as confluent (53%), 9 as SSS divergent (9%), 25 as SS divergent (25%), 11 as circular (11%), and 2 as trifurcated (2%). The inter-rater reliability ranked very good; agreement between the two neurosurgeons was 83% (κ = 0.830, p < 0.0005).
Conclusion
The confluence of the venous sinuses is a highly variable anatomical area that is rarely evaluated with neuroimaging before surgery. The classic textbook configuration is not the rule. Using a simplified classification system may increase awareness and hopefully patient safety by preparing the physician for anatomical variations that they will encounter in a surgical or clinical scenario.
... The right and left IJVs are often asymmetrical due to asymmetries in the drainage of blood through the dural venous sinuses, favoring the right transverse sinus and IJV over the left [100]. Lim et al. found that the mean right IJV diameter was 14.1 mm compared to the mean left IJV diameter of 11.74 mm [70]. ...
The internal jugular veins (IJV) are the primary venous outflow channels of the head and neck. The IJV is of clinical interest since it is often used for central venous access. This literature aims at presenting an overview of the anatomical variations, morphometrics based on various imaging modalities, cadaveric and surgical findings, and the clinical anatomy of IJV cannulation. Additionally, the anatomical basis of complications, techniques to avoid complications, and cannulation in special instances are also included in the review. The review was performed by a detailed literature search and review of relevant articles. A total of 141 articles were included and organized into anatomical variations, morphometrics, and clinical anatomy of IJV cannulation. The IJV is next to important structures such as the arteries, nerve plexus, and pleura, which puts them at risk of injury during cannulation. Anatomical variations such as duplications, fenestrations, agenesis, tributaries, and valves, may lead to an increased failure rate and complications during the procedure, if unnoticed. The morphometrics of IJV, such as the cross-sectional area (CSA), diameter, and distance from the skin-to-cavo-atrial junction may assist in choosing the appropriate cannulation techniques and hence reduce the incidence of complications. Age, gender, and side-related differences explained variations in the IJV-common carotid artery relationship, CSA, and diameter. Accurate knowledge of anatomical variations in special considerations such as pediatrics and obesity may help prevent complications and facilitate successful cannulation.
... In a study made with skull specimens, they revealed that superior sagittal sinus groove continues with right transvers sinus in 41% of cases and continues with left transverse sinus in 10%.(16) Saiki et al found mean caliber of right internal jugular vein wider than the left side in their study on cadavers.(17). Significant correlation was found between sigmoid and jugular notch areas, in this series. ...
Purpose: To evaluate the association between the side of the spontaneous intracranial hemorrhage (sICH) and the jugular and sigmoid notch areas. Methods: A total of 265 patients (111 women and 154 men) with a mean age of 68.8±11.7 years (range between 50 to 90 years) and with sICH, were retrospectively enrolled. Control group harbored 45 patients (19 women and 26 men) with a mean age of 68.3±11.9 years (range between 50 to 90 years). Jugular and sigmoid notch areas were measured on axial plane CT images, for both the right and left side in the study and control groups. The association between ICH and sigmoid/jugular notch areas were assessed by student t test. The correlation between right/left sigmoid and right/left jugular notch areas were assessed by Pearson correlation. Results: There was a significant difference between right and left sigmoid/jugular notch areas in patients with right sided ICH (P
... In a study on 91 cadavers, which is consistent with the results of our research, the right IJV was found to be 81.3% larger, while the left IJV was larger in only 11.0 % [17]. In a study that performed computer tomography (CT) scans of 313 patients and examined the relationship between internal jugular vein shape and various chronic diseases, it was shown that the right IJV has a larger cross-sectional area than the left IJV [18]. ...
... Saiki et al. (63) demonstrated different drainage patterns between individuals. They noted that in 73.6% of 91 subjects the superior sagittal sinus drained principally (either perfectly or imperfectly: 100% or the vast majority) into the right TS (and hence the right IJV), whereas in 72.6% of subjects the smaller straight sinus drained equivalently into both the left and right TSs or favored the left TS (63). Thus, in the majority of people, the blood flow through the right IJV originates principally from the larger sagittal sinus and the blood flow through the left IJV originates from the smaller straight sinus. ...
Altered-gravity affects hemodynamics and blood flow in the neck. At least one incidence of jugular venous thrombosis has been reported in an astronaut on the International Space Station. This investigation explores the impact of changes in the direction of the gravitational vector on the characteristics of the neck arteries and veins. Twelve subjects underwent graded tilt from 45° head-up to 45° head-down in 15° increments in both supine and prone positions. At each angle, the cross-sectional area of the left and right common carotid arteries, A CCA , and internal jugular veins, A IJV , were measured using ultrasound. Internal jugular venous pressure, IJVP, was also measured using compression sonography. Gravitational dose-response curves were generated from experimental data. A CCA did not show any gravitational dependence. Conversely, both A IJV and IJVP increased in a non-linear fashion with head-down tilt. A IJV was significantly larger on the right side than the left side at all tilt angles. In addition, IJVP was significantly elevated in the prone position compared to the supine position, most likely due to raised intrathoracic pressure whilst prone. Dose-response curves were compared with existing experimental data from parabolic flight and spaceflight studies, showing good agreement on an acute timescale. The quantification of jugular hemodynamics as a function of changes in the gravitational vector presented herein provides a terrestrial model to reference spaceflight-induced changes, contributes to the assessment of the pathogenesis of spaceflight venous thromboembolism events, and informs the development of countermeasures.
... Among all measurements, the MAPD and CSA of the right IJV were the greatest followed by that of the left IJV. This finding was consistent with a previous study (16), which showed that the left IJV was slightly thinner and smaller in dimension than the right IJV. Regardless of the CC level or SBTC level, both the MAPD and CSA of the right IJV were greater than those of the left IJV, and the right IJV's CSA was more obvious. ...
Objective
Internal jugular vein puncture or cannulation is far more difficult in children compared with adults. Anthropometric measures of the internal jugular vein acquired by two-dimensional ultrasound are useful in the practice of puncture and catheterization. The aim of this study is to measure anthropometric parameters of bilateral internal jugular veins in children and to determine the best puncture site based on these parameters.
Materials
A total of 107 pediatric patients undergoing elective operation were included. Ultrasound-visible evaluation of bilateral internal jugular veins was used to obtain the depth from skin, maximum antero-posterior diameter, and cross-sectional area at the levels of the superior border of thyroid cartilage and cricoid cartilage. Statistical analysis was performed using these anthropometric data and demographic variables of all studied pediatric patients, such as age, height, and weight.
Results
A very weak correlation was noted between the depth, maximal antero-posterior diameter, and cross-sectional area of both internal jugular veins and the age, height, weight, and body surface index of all included children. All Pearson's R correlation coefficients were <0.45. The largest diameter and cross-sectional area were in the right internal jugular vein at the cricoid cartilage level ( p < 0.01) followed by the left internal jugular vein at this level ( p < 0.01). In addition, the internal jugular vein at the cricoid cartilage level was more superficial than that of the superior border of the thyroid cartilage ( p < 0.01).
Conclusion
The right internal jugular vein at the cricoid cartilage level is the best site for puncture. The most appropriate alternative site is the left internal jugular vein on the same level. Better correlation was not observed between the anthropometric parameters of the internal jugular vein and children's biological characteristics. This finding should be confirmed in a larger-scale demographical study in the future.
... These variations were noted to occur more on the left side. There is evidence to suggest that the right IJV is slightly larger and thicker in 7 dimension compared with the left. Additionally, it is common knowledge that the ease of access and relatively less intimate carotid artery makes the right IJV a popular venous access site. ...
The jugular veins of the neck are known to exhibit variations in its formation and course. Knowledge of the varying
drainage patterns of veins of the head and neck, in particular, jugular veins are not only important for anatomists but also
for the surgeons operating at this level and to clinicians performing catheterization. The present study has been done to detect any abnormalities of
internal jugular vein. 40 dissected cadavers with age ranging 45-60 years have been examined over a period of 5 years. One male cadaver showed a
variation in the course of IJVon the left side of the neck. It has been dissected clearly and photographs were taken. An abnormal vein has been seen
in the carotid sheath which is joining the IJV in the lower part of carotid triangle. The common carotid artery was seen in between them. A
communicating vein has also been detected connecting the IJV with the abnormal vein in the superior level of carotid sheath. The remaining
cadavers showed a normal pattern of IJV. The present study depicts one of the rare anomalies of IJV. The presence of such anomalous
communications may be important for surgeons and also radiologists performing angiographic and sonographic studies.
... As the values related to blood flow in patients were not obtained during the IJV ultrasound performed in this study due to technical limitations, only the canal diameter was evaluated. In evaluating the IJV canal diameter, we found that the percentage of canal diameter asymmetry was about 48%, and when analyzed with the side of the TS variant, the results suggested that the IJV canal diameter on the same side as the TS variant was significantly smaller, which is also consistent with the findings of previous studies (21). The IJV is the largest deep branch of the jugular vein, and is an important pathway for cerebrospinal fluid and cerebral venous return. ...
Background:
Hypoplasia of the transverse sinus (TS) is a common anatomical variation. The aim of this study was to investigate the effects of TS variation (i.e., TS hypoplasia) and no variation (i.e., TS symmetry) and their subgroups on the clinical outcomes of patients with atherosclerotic anterior circulation cerebral infarction (CI).
Methods:
A total of 75 patients were included in the study and were divided into the no TS variation group and the TS variation group. The TS variation group was further divided into the following subgroups: the TS variation with ipsilateral CI group and the TS variation with contralateral CI group. We retrospectively analyzed the correlations of the endpoint events of patients with large atherosclerotic anterior circulation infarction and TS no variant, and subgroups of TS variants.
Results:
We found that the diameter of the ipsilateral IJV in patients with TS variants were significantly smaller than those without TS variants, which was statistically significant (P<0.05). The differences in primary endpoint events, secondary endpoint events, and responsible vessel stenosis were not statistically significant when comparing the TS variant and no TS variant groups, and the TS variant subgroup (P>0.05). We found statistically significant differences in the National Institute of Health stroke scale (NIHSS) and Modified Rankin Scale (mRS) scores after 90 days of CI between the total anterior circulation infarct (TACI) TS variant group, the ipsilateral CI TS variant group, and the partial anterior circulation infarct (PACI) TS hypoplasia group and the ipsilateral CI TS variant group (P<0.05). There was a statistically significant difference (P<0.05) between the TS variant group with TACI, the TS variant group with ipsilateral CI, and the TS no variant group and the TS variant with contralateral CI group when comparing patients' mRS scores after 90 days of CI.
Conclusions:
The diameter of the internal jugular vein (IJV) ipsilateral to the TS variant was significantly smaller than that of the TS no variant. Patients with TACI in the TS variant group and one of its subgroups (the TS variant with ipsilateral CI group) had more severe clinical symptoms and a worse prognosis than patients in the same group with PACI.
... Diameters of TS and IJV are larger at the side into which SSS is dominantly drained. [18] Right TS and left TS dominance percentages were reported to be 33-59 and 8-36%, while reported codominance varied from 8 to 49%. [5,10,[19][20][21][22][23] Similar to many studies in the literature, TS diameters determined by 3D SPGR MRV were dominant on the right in 42.72% of the cases, on the left in 19.09% and codominant in 38.18% of the cases in the present study. ...
... It is important to note in dural venous sinuses diseases such as sinus thrombosis that each sinus has a certain tendency for drainage pattern, which is not the same in different patients. [18] Therefore, for the evaluation of venous system dimensions in various pathologies, average diameters of venous system in normal population should be known. Sayhan et al. [25] measured SSS diameters in six cadavers before lambdoid, coronal suture and confluence sinuum drainage areas and reported diameters of 13.1, 14.4 and 12.2 mm. ...
Background/Aims:In the present study, dural venous sinuses and
cerebral veins were examined using 3D SPGR MRV and 2D TOF MRV. These methods
were compared in terms of detectability of venous structures and their
diameters. Methods:A total of 110 patients(66 female and 44 male) who
had contrast-enhanced 3D SPGR MRV and 2D TOF MRV examinations using a 1.5 T MRI
machine in May 2008-June 2011 period were included in the present study.
Diameters of dural venous sinuses and veins were measured at three different
planes at a position 1cm distal to the site they drained into, and average
values were used. Both MRV methods were compared to reveal whether the
diameters calculated were different in age groups and between genders.Results:SSS, bilateral TS’s, right sigmoid sinus, Galen
vein and bilateral ICV’s all could be determined using 3D SPGR MRV. Not all
dural venous sinuses and veins other than right sigmoid sinus could be
visualized in all patients using 2D TOF MRV.There were significant differences
between the two examinations for SSS and ISS, bilateral TS and sigmoid sinuses,
SS, bilateral Labbe and ICV and Galen vein diameters(p<0.05) Diameters of
dural venous sinuses and cortical veins were generally measured larger by 3D
SPGR MRV compared to 2D TOF MRV.Conclusions:In conclusion,
differences could be observed between the two MRV examinations for
detectability and diameters of intracranial venous structures. Evaluation of
intracranial venous structures should not be carried out using only 2D TOF MRV.
