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Falcine venous plexus within the falx cerebri: anatomical and scanning electron microscopic findings and clinical significance

  • Experimental research - Neurosurgical Anatomy
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Abstract

Background

Only limited attention has been paid to the anatomy and clinical importance of the falcine venous plexus. The aim of this study was to evaluate the falcine venous plexus anatomically using scanning electron microscopy (SEM), and to provide guidance for neurosurgical approaches.

Methods

Latex or ink was injected into the superior and inferior sagittal sinus. The falcine venous plexus lying within the connective tissue of the falx cerebri was observed by dividing the falx into thirds (anterior, middle and posterior). Further, the SEM appearance of the falcine venous plexus was evaluated.

Results

The anterior third of the falx cerebri consisted of small diameter falcine venous vessels. These vessels were localized close to either the superior or inferior sagittal sinus, and none extended as far as mid-falx cerebri levels in any of the 16 cases. They communicated with either superior or inferior sagittal sinuses, but not with both of these sinuses. In the middle third of the falx cerebri, the majority of the vessels of the falcine venous plexus had larger diameter compared to those of the anterior third. These vessels extended the length of the falx cerebri levels. They communicated with both superior and inferior sagittal sinuses. In the posterior third of the falx cerebri, the vessels of the falcine venous plexuses had the largest diameter and were located at the junction of the inferior sagittal sinus and the straight sinus. They were localized at the lower two-thirds of the falx cerebri. In all cases, the dense venous networks communicated with the inferior sagittal sinus but not with the superior sagittal sinus. The falcine venous plexus observed in the posterior third of the falx cerebri was denser than in the anterior and middle portions.

The SEM revealed small vessels whose diameter ranged between 42 and 138 μm. The vessels of the falcine venous plexus in the anterior third had a mean diameter of 0.42 ± 0.1 mm, in the middle third a mean diameter of 0.87 ± 0.17 mm, and in the posterior third, 1.38 ± 0.21 mm.

Conclusion

The falcine venous plexus is a network of venous channels that exists within the connective tissue of the falx; the sizes and patterns of communication of these structures showed regional differences. Neurosurgeons should be aware of the regional differences when making an incision or puncturing the falx during a surgical approach.

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Acknowledgments

The authors thank Dr. Uğur Ünal from Koç University for his technical support with scanning electron microscopy.

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Dr. Lutfi Kirdar Kartal Education and Research Hospital, Istanbul, Turkey

    Necati Tatarlı

  2. Institute of Neurological Sciences, Marmara University, Istanbul, Turkey

    Necati Tatarlı, Hüsniye Hacıoğlu Bay, Aşkın Şeker & Türker Kılıç

  3. Department of Neurosurgery, Sakarya University School of Medicine, Sakarya, Turkey

    Davut Ceylan

  4. Department of Neurosurgery, Haseki Education and Research Hospital, Istanbul, Turkey

    Hüseyin Canaz

  5. Department of Neurosurgery, Medipol University School of Medicine, Istanbul, Turkey

    Mehmet Tokmak

  6. Department of Anatomy, Marmara University School of Medicine, Istanbul, Turkey

    Hüsniye Hacıoğlu Bay

  7. Department of Neurosurgery, Marmara University School of Medicine, Istanbul, Turkey

    Aşkın Şeker & Türker Kılıç

  8. Department of Neurosurgery, Koç University School of Medicine, Istanbul, Turkey

    Evren Keleş

  9. Department of Anatomy, Koç University School of Medicine, Sarıyer, 34450, Istanbul, Turkey

    Safiye Çavdar

Authors
  1. Necati Tatarlı
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  2. Davut Ceylan
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  3. Hüseyin Canaz
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  4. Mehmet Tokmak
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  5. Hüsniye Hacıoğlu Bay
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  6. Aşkın Şeker
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  7. Evren Keleş
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  8. Türker Kılıç
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  9. Safiye Çavdar
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Corresponding author

Correspondence to Safiye Çavdar.

Additional information

Comment

The study by Tatarlı and Colleagues describing the macroscopic and microscopic anatomy of the venous system forming a "falcine venous plexus" is particularly relevant to neurosurgical practice. Actually, this falcine venous plexus could play an important role as a collateral venous outflow pathway when the superior sagittal sinus is occluded by a parasagittal meningioma.

When dealing with meningiomas occluding the middle or posterior third of the superior sagittal sinus, resection of the sinus en bloc with the tumor is commonly considered a safe procedure. Nevertheless, several cases of patients who deteriorated and died following en bloc resection of a completely occluded sinus with the tumor have been described. This circumstance could be reasonably explained on the grounds of lack of development of adequate collateralization of the venous outflow anterior to the site of occlusion. The implication is that in those cases without adequate collateralization of the venous outflow anterior to the site of occlusion, a complete en bloc resection of the tumor with the sinus could interrupt anastomotic pathways that run through the tumor, the capsule of the tumor, or even the walls of the sinus and along the falx [1]. The present study clearly demonstrates the existence of a venous plexus coursing along the falx that otherwise could be only supposed.

The resection of a parasagittal meningioma together with the occluded sinus should be therefore performed only if there is evidence that an adequate venous outflow from the sinus anterior to the area of occlusion has been developed. This can occur by drainage through the most distal patent veins prior to the occlusion into alternative routes like the transverse sinus through the vein of Labbé or the spheno-parietal sinus through sylvian veins [2].

References

1. Heros RC (2006) Meningiomas involving the sinus. J Neurosurg 105:511-513; discussion 513

2. Tomasello F, Conti A, Cardali S, Angileri FF (2013) Venous preservation-guided resection: a changing paradigm in parasagittal meningioma surgery. J Neurosurg 119(1):74-81

Alfredo Conti

Francesco Tomasello

Messina, Italy

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Tatarlı, N., Ceylan, D., Canaz, H. et al. Falcine venous plexus within the falx cerebri: anatomical and scanning electron microscopic findings and clinical significance. Acta Neurochir 155, 2183–2189 (2013). https://doi.org/10.1007/s00701-013-1863-1

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  • DOI: https://doi.org/10.1007/s00701-013-1863-1

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