The confluence of sinuses (

Latin Latin (, or , ) is a classical language belonging to the Italic branch of the Indo-European languages. Latin was originally a dialect spoken in the lower Tiber area (then known as Latium) around present-day Rome, but through the power of the ...

: confluens sinuum), torcular Herophili, or torcula is the connecting point of the

superior sagittal sinus The superior sagittal sinus (also known as the superior longitudinal sinus), within the human head, is an unpaired area along the attached margin of the falx cerebri. It allows blood to drain from the lateral aspects of anterior cerebral hemispher ...

straight sinus The straight sinus, also known as tentorial sinus or the , is an area within the skull beneath the brain. It receives blood from the inferior sagittal sinus and the great cerebral vein, and drains into the confluence of sinuses. Structure The s ...

, and

occipital sinus The occipital sinus is the smallest of the dural venous sinuses. It is usually unpaired, and is sometimes altogether absent. It is situated in the attached margin of the falx cerebelli. It commences near the foramen magnum, and ends by draining int ...

. It is below the

internal occipital protuberance Along the internal surface of the occipital bone, at the point of intersection of the four divisions of the cruciform eminence, is the internal occipital protuberance. Running transversely on either side is a groove for the transverse sinus. Addit ...

of the

skull The skull is a bone protective cavity for the brain. The skull is composed of four types of bone i.e., cranial bones, facial bones, ear ossicles and hyoid bone. However two parts are more prominent: the cranium and the mandible. In humans, the ...

. It drains

venous blood Venous blood is deoxygenated blood which travels from the peripheral blood vessels, through the venous system into the right atrium of the heart. Deoxygenated blood is then pumped by the right ventricle to the lungs via the pulmonary artery whic ...

from the

brain A brain is an organ that serves as the center of the nervous system in all vertebrate and most invertebrate animals. It is located in the head, usually close to the sensory organs for senses such as vision. It is the most complex organ in a v ...

into the

transverse sinuses The transverse sinuses (left and right lateral sinuses), within the human head, are two areas beneath the brain which allow blood to drain from the back of the head. They run laterally in a groove along the interior surface of the occipital bone. ...

. It may be affected by arteriovenous fistulas, a

thrombus A thrombus (plural thrombi), colloquially called a blood clot, is the final product of the blood coagulation step in hemostasis. There are two components to a thrombus: aggregated platelets and red blood cells that form a plug, and a mesh of c ...

major trauma Major trauma is any injury that has the potential to cause prolonged disability or death. There are many causes of major trauma, blunt and penetrating, including falls, motor vehicle collisions, stabbing wounds, and gunshot wounds. Dependin ...

, or surgical damage, and may be imaged with many

radiology Radiology ( ) is the medical discipline that uses medical imaging to diagnose diseases and guide their treatment, within the bodies of humans and other animals. It began with radiography (which is why its name has a root referring to radiat ...

techniques.

Structure

The confluence of sinuses is found deep to the

of the

occipital bone The occipital bone () is a neurocranium, cranial dermal bone and the main bone of the occiput (back and lower part of the skull). It is trapezoidal in shape and curved on itself like a shallow dish. The occipital bone overlies the occipital lobe ...

of the

. This puts it inferior to the

occipital lobes The occipital lobe is one of the four major lobes of the cerebral cortex in the brain of mammals. The name derives from its position at the back of the head, from the Latin ''ob'', "behind", and ''caput'', "head". The occipital lobe is the v ...

of the

, and posterosuperior to the

cerebellum The cerebellum (Latin for "little brain") is a major feature of the hindbrain of all vertebrates. Although usually smaller than the cerebrum, in some animals such as the mormyrid fishes it may be as large as or even larger. In humans, the cerebel ...

. It connects the ends of the

, the

, and the

. Blood from it can drain into the left and right

. It is lined with

endothelium The endothelium is a single layer of squamous endothelial cells that line the interior surface of blood vessels and lymphatic vessels. The endothelium forms an interface between circulating blood or lymph in the lumen and the rest of the vessel ...

, with some

smooth muscle Smooth muscle is an involuntary non-striated muscle, so-called because it has no sarcomeres and therefore no striations (''bands'' or ''stripes''). It is divided into two subgroups, single-unit and multiunit smooth muscle. Within single-unit mus ...

Variation

The confluence of sinuses shows significant variation. Most commonly, there is a continuous connection between all of the sinuses. A very common variant is the

only draining into the right

transverse sinus The transverse sinuses (left and right lateral sinuses), within the human head, are two areas beneath the brain which allow blood to drain from the back of the head. They run laterally in a groove along the interior surface of the occipital bone. ...

- more rarely, it may also only drain into the left transverse sinus. Another variation involves a continuous connection, but where most blood from the superior sagittal sinus drains into the right transverse sinus, and most blood from the

drains into the left transverse sinus. Other less common variations also exist.

Development

The confluence of sinuses develops from the anterior plexus and the middle plexus. These fuse so that the anterior plexus becomes a remnant.

Function

The confluence of sinuses is important in drainage of

from the

. It drains most of the blood from the brain.

Clinical significance

The confluence of sinuses may be affected by arteriovenous fistulas. This is treated with surgery to embolise of the fistula. It may also be affected by a

. This can be treated with

anticoagulants Anticoagulants, commonly known as blood thinners, are chemical substances that prevent or reduce coagulation of blood, prolonging the clotting time. Some of them occur naturally in blood-eating animals such as leeches and mosquitoes, where the ...

. It may be injured by a variety of

. It may also be damaged during surgery, such as that to remove a

meningioma Meningioma, also known as meningeal tumor, is typically a slow-growing tumor that forms from the meninges, the membranous layers surrounding the brain and spinal cord. Symptoms depend on the location and occur as a result of the tumor pressing o ...

. The confluence of sinuses can be imaged with

Angiography Angiography or arteriography is a medical imaging technique used to visualize the inside, or lumen, of blood vessels and organs of the body, with particular interest in the arteries, veins, and the heart chambers. Modern angiography is performe ...

, CT scan,

magnetic resonance imaging Magnetic resonance imaging (MRI) is a medical imaging technique used in radiology to form pictures of the anatomy and the physiological processes of the body. MRI scanners use strong magnetic fields, magnetic field gradients, and radio wave ...

medical ultrasound Medical ultrasound includes diagnostic techniques (mainly imaging techniques) using ultrasound, as well as therapeutic applications of ultrasound. In diagnosis, it is used to create an image of internal body structures such as tendons, muscles ...

, or

interventional radiology Interventional radiology (IR) is a medical specialty that performs various minimally-invasive procedures using medical imaging guidance, such as x-ray fluoroscopy, computed tomography, magnetic resonance imaging, or ultrasound. IR performs bo ...

may be used.

History

The confluence of sinuses may also be known as the confluens sinuum (from

), or the torcular Herophili (or more simply the torcula). The last term is older, and describes the veins as a gutter or canal. This is named after

Herophilos Herophilos (; grc-gre, Ἡρόφιλος; 335–280 BC), sometimes Latinised Herophilus, was a Greek physician regarded as one of the earliest anatomists. Born in Chalcedon, he spent the majority of his life in Alexandria. He was the first sci ...

, the

Greek Greek may refer to: Greece Anything of, from, or related to Greece, a country in Southern Europe: *Greeks, an ethnic group. *Greek language, a branch of the Indo-European language family. **Proto-Greek language, the assumed last common ancestor ...

anatomist Anatomy () is the branch of biology concerned with the study of the structure of organisms and their parts. Anatomy is a branch of natural science that deals with the structural organization of living things. It is an old science, having its ...

who first used

cadavers A cadaver or corpse is a dead human body that is used by medical students, physicians and other scientists to study anatomy, identify disease sites, determine causes of death, and provide tissue to repair a defect in a living human being. Stude ...

for the systematic study of

anatomy Anatomy () is the branch of biology concerned with the study of the structure of organisms and their parts. Anatomy is a branch of natural science that deals with the structural organization of living things. It is an old science, having its ...

. This term more precisely refers to the concavity in the bone, which is the location of the confluence of sinuses.Tubbs, R.S. Neuroanatomy, 2002:1, 14

Additional images

File:Confluence of sinuses.jpg, Confluence of sinuses

References

External links

* * http://neuroangio.org/venous-brain-anatomy/venous-sinuses/ {{Authority control Veins of the head and neck