New vascular system in reptiles: anatomy and postural hemodynamics of the vertebral venous plexus in snakes

On the spinal venous sinus of Alligator mississippiensis

The epidural space of the American alligator (Alligator mississippiensis) is largely filled by a continuous venous sinus. This venous sinus extends throughout the trunk and tail of the alligator, and is continuous with the dural sinuses surrounding the brain. Segmental spinal veins (sl) link the spinal venous sinus (vs) to the somatic and visceral venous drainage. Some of these sl, like the caudal head vein along the occipital plate of the skull, are enlarged, suggesting more functional linkage. No evidence of venous valves or external venous sphincters was found associated with the vs; the relative scarcity of smooth muscle in the venous wall of the sinus suggests limited physiological regulation. The proatlas (pr), which develops between the occipital plate and C1 in crocodylians, is shaped like a neural arch and is fused to the dorsal surface of the vs. The present study suggests that the pr may function to propel venous blood around the brain and spinal cord. The vs effectively encloses the spinal dura, creating a tube-within-a-tube system with the (smaller volume) spinal cerebrospinal fluid (CSF). Changes in venous blood pressure, as are likely during locomotion, would impact dural compliance and CSF pressure waves propagating along the spinal cord.

Neural canal ridges: A novel osteological correlate of postcranial neuroanatomy in dinosaurs

In this article, we document the widespread presence of bony ridges in the neural canals of non-avian dinosaurs, including a wide diversity of sauropods, two theropods, a thyreophoran, and a hadrosaur. These structures are present only in the caudal vertebrae. They are anteroposteriorly elongate, found on the lateral walls of the canal, and vary in size and position both taxonomically and serially. Similar bony projections into the neural canal have been identified in extant teleosts, dipnoans, and urodelans, in which they are recognized as bony spinal cord supports. In most non-mammals, the dura mater that surrounds the spinal cord is fused to the periosteum of the neural canal, and the denticulate ligaments that support the spinal cord can pass through the dura and periosteum to anchor directly to bone. The function of these structures in dinosaurs remains uncertain, but in sauropods they might have stabilized the spinal cord during bilateral movement of the tail and use of the tail as a weapon. Of broader significance, this study emphasizes that important new discoveries at the gross anatomical level can continue to be made in part by closely examining previously overlooked features of known specimens.

Is there only one species of Hepatozoon infecting Brazilian caimans? Integrative taxonomy unveiling the parasite's diversity

Hepatozoon spp. are the most common haemoparasites reported from reptiles around the world, however, only six species have been described infecting crocodilians. In Brazil, Hepatozoon caimani Carini, 1909 is currently the only recognized species from the caiman hosts. This study provides new data on the diversity of species of Hepatozoon infecting Caiman crocodilus (Linnaeus) using molecular data and phylogenetic analysis, with additional support of morphological data of developmental stages from host blood and tissue. Forty-four individuals were collected and screened for haemogregarines, and blood and tissue samples were analysed by light microscopy with 31 (70.45%) infected. Hepatozoon spp. blood developmental stages included immature and mature gamonts with or without cytoplasmic vacuoles and free gamonts. Additionally, merogonic developmental stages were found in the liver and spleen of infected hosts. Based on the morphological and molecular data, this study identified two possible different species of Hepatozoon, being one of them the H. caimani with intragenotypic divergence.

Hemogregarine Diversity Infecting Brazilian Turtles with a Description of Six New Species of Haemogregarina (Apicomplexa: Adeleorina: Haemogregarinidae)

(1) Background: Hemoparasites of the genus Haemogregarina (Haemogregarinidae) are commonly reported in freshwater turtles. However, in Brazil, only three species have currently been characterised using molecular methods. This study aimed to bring new insights on the diversity of species of Haemogregarina infecting Brazilian freshwater turtles from Mato Grosso and Goiás states using molecular and morphological tools. (2) Methods: In total, 2 mL of blood was collected, with between two to five blood smears prepared, fixed with absolute methanol, and stained with a 10% Giemsa solution. Blood was stored at −20 °C for molecular analysis targeting the 18S rRNA gene. Fragments of the organs (liver, spleen, heart, and kidney) were separated and stained with hematoxylin-eosin. (3) Results: A total of 40 turtles were screened and hemogregarines were observed in 34 (85%) individuals (3 Podocnemis expansa and 31 Podocnemis unifilis). Haemogregarina embaubali and six new species of Haemogregarina were observed and formally described as follows: H. unifila n. sp., H. rubra n. sp., H. goianensis n. sp., H. araguaiensis n. sp., H. tigrina n. sp., and H. brasiliana n. sp. (4) Conclusions: This study contributes to the diversity and knowledge of Brazilian fresh-water turtle blood parasites, using integrative approaches for diagnosing and characterizing hemoparasites, with the identification of six undescribed species.

Diversity of Haemogregarine Parasites Infecting Brazilian Anurans, with a Description of New Species of Dactylosoma (Apicomplexa: Adeleorina: Dactylosomatidae)

PURPOSE

Brazilian anurans are considered the most diverse and species rich around the world. Although in recent years there has been a strong focus on research related to this group of animals, their parasites have not received the same attention. Thus, this study aimed to provide morphological and molecular data on haemogregarines biodiversity infecting Brazilian anurans.

METHODS

During 2020, 116 anurans were collected from four Brazilian States and their blood and fragment of organs were screened for haemogregarine parasites.

RESULTS

From the total, seven (6.03%) animals were found infected with species of Hepatozoon and Dactylosoma. Based on the morphological and molecular analysis, four anurans were found infected with Hepatozoon latrensis. The phylogenetic analysis has shown the isolates from this study grouping with the Brazilian anuran Hepatozoon clade, also with gene similarity ranging from 99.70 to 100% to H. latrensis isolates available on GenBank. Furthermore, three specimens (Trachycephalus typhonius, Leptodactylus latrans, and Rhinella diptycha) were infected with the same species of Dactylosoma (100% genetic similarity), with a genetic similarity of 98.56% to Dactylosoma piperis the only other species described in Brazil. In support of the molecular data, different morphological characters were observed in the blood smears as compared to D. piperis, suggesting that the species of Dactylosoma from the present study infecting three different species of Brazilian anurans is an undescribed species.

CONCLUSION

Thus, this study increases the knowledge of Brazilian anuran blood parasites and demonstrates the importance of using integrative approaches for the diagnosis of haemoparasites.

Diversity of haemogregarine parasites infecting Brazilian snakes from the Midwest and Southeast regions with a description of two new species of Hepatozoon (Apicomplexa: Adeleorina: Hepatozoidae)

Although Brazil is a hotspot for snake species, there is a lack of information on the biodiversity of haemoparasites infecting these hosts. Thus, the present study aimed to bring new insights about the diversity of species of Hepatozoon (Apicomplexa: Adeleorina: Hepatozoidae) infecting Brazilian snakes from the Midwest and Southeast regions. The snakes were captured from 2018 to 2020 from the states of Mato Grosso, Mato Grosso do Sul, Goiás, and São Paulo. Three to five blood smears were made and the remaining blood sample was stored for further molecular analysis. Moreover, histopathological slides of the organs were stained with haematoxylin-eosin. Regarding molecular diagnosis, PCR was performed targeting different regions of the 18S rDNA of apicomplexan parasites. From the 13 free-living snakes screened, ten (76.92%) were found infected with Hepatozoon spp. Based on morphological and morphometric tools, five different morphotypes of species of Hepatozoon gamonts were detected. Molecular data and phylogenetic analysis support the morphological data, identifying five species of Hepatozoon from snakes, of which three species belong to previously described species, Hepatozoon cevapii, Hepatozoon cuestensis, and Hepatozoon quagliattus, with gene similarity of 100% (based on the 18S rRNA genetic marker). The present study identifies and describes two new species of Hepatozoon, Hepatozoon annulatum sp. nov. infecting the snake Leptodeira annulata and Hepatozoon trigeminum sp. nov. infecting the snake Oxyrhopus trigeminus. Thus, based on morphological and molecular data this study brings new insights on haemogregarine diversity infecting Brazilian snakes from the Midwest and Southeast regions.

Description of a New Species Hepatozoon quagliattus sp. nov. (Apicomplexa: Adeleorina: Hepatozoidae), infecting the Sleep Snake, Dipsas mikanii (Squamata: Colubridae: Dipsadinae) from Goiás State, Brazil

PURPOSE

Species of Hepatozoon Miller, 1908 (Hepatozoidae) are blood protozoans with a cosmopolitan distribution and are reported to parasitize a range of vertebrate hosts including mammals, birds, reptiles, and amphibians. The present study aimed to describe a new species of Hepatozoon (Apicomplexa: Adeleorina: Hepatozoidae) found infecting the sleep snake Dipsas mikanii (Schlegel, 1837) (Squamata: Colubridae: Dipsadinae).

METHODS

The snake was collected in 2017 at the municipality of Britânia, Goiás State, Brazil. Blood smears were made in order to find blood gametocytes and PCR was performed targeting the 18S rRNA gene.

RESULTS

Microscopy screening of blood smears revealed the presence of intraerythrocytic gamont stages of Hepatozoon sp. in the peripheral blood with a parasitemia of 0.25%. Furthermore, meronts and monozoic cysts were observed in histological sections of the liver from the infected individual. The interspecific divergence of 18S rRNA sequences fragments isolated from D. mikanii had differences (2.39-11.3%) as compared to other sequences of species of Hepatozoon from snakes.

CONCLUSIONS

Based on morphological and molecular data, a new species of Hepatozoon infecting D. mikanii from Brazil is described.

Morphometrical Study of the Lumbar Segment of the Internal Vertebral Venous Plexus in Dogs: A Contrast CT-Based Study

Simple Summary

The internal vertebral venous plexus (IVVP) is a valveless venous network running inside the vertebral canal. The objective of this study was to morphometrically describe the IVVP, dural sac, epidural space and vertebral canal of the lumbar segment in dogs with enhanced computerized tomography. Six clinically healthy adult dogs were used for the study. Dorsal reconstructed computed tomography (CT) images showed a continuous rhomboidal morphological pattern for the IVVP. The dural sac was observed as an isodense structure with a rounded shape throughout the vertebral canal. The average percentage area occupied by the IVVP between L1 and L7 vertebrae ranged between 6.3% and 8.9% of the area of the vertebral canal, and the dural sac ranged between 13.8% and 72.2% of the vertebral canal. The epidural space accounted between 27.08% and 86.2% of the lumbar vertebral canal. CT venography is a safe technique that allows adequate visualization and evaluation of the lumbar IVVP and adjacent structures in dogs.

Abstract

The internal vertebral venous plexus (IVVP) is a thin-walled, valveless venous network that is located inside the vertebral canal, communicating with the cerebral venous sinuses. The objective of this study was to perform a morphometric analysis of the IVVP, dural sac, epidural space and vertebral canal between the L1 and L7 vertebrae with contrast-enhanced computed tomography (CT). Six clinically healthy adult dogs weighing between 12 kg to 28 kg were used in the study. The CT venographic protocol consisted of a manual injection of 880 mgI/kg of contrast agent (587 mgI/kg in a bolus and 293 mgI/mL by continuous infusion). In all CT images, the dimensions of the IVVP, dural sac, and vertebral canal were collected. Dorsal reconstruction CT images showed a continuous rhomboidal morphological pattern for the IVVP. The dural sac was observed as a rounded isodense structure throughout the vertebral canal. The average area of the IVVP ranged from 0.61 to 0.74 mm² between L1 and L7 vertebrae (6.3–8.9% of the vertebral canal), and the area of the dural sac was between 1.22 and 7.42 mm² (13.8–72.2% of the vertebral canal). The area of the epidural space between L1 and L7 ranged from 2.85 to 7.78 mm² (27.8–86.2% of the vertebral canal). This CT venography protocol is a safe method that allows adequate visualization and morphometric evaluation of the IVVP and adjacent structures.

New insights on the diversity of Brazilian anuran blood parasites: With the description of three new species of Hepatozoon (Apicomplexa: Hepatozoidae) from Leptodactylidae anurans

The Amphibia are considered the most threatened vertebrate class globally, yet in Brazil they are also one of the more diverse and species rich groups. Although, in recent years there has been strong focus on amphibian related research, their parasites have not received the same attention. In Brazil, only a single species of Hepatozoon, namely H. leptodactyli (Lesage, 1908) Pessoa, 1970, has been described from anuran hosts. The present study aimed to describe three new species of Hepatozoon parasitising Leptodactylus labyrinthicus and Leptodactylus latrans from Mato Grosso State, Brazil. From 66 anurans screened for haemogregarines, four belonging to the Leptodactylidae were found positive for species of Hepatozoon. Based on the morphological analysis of peripheral blood gamonts and spleen and liver tissue meronts, three different morphotypes of Hepatozoon spp. were identified. Morphotype 1 (M1) and morphotype 2 (M2) in L. labyrinthicus and morphotype 3 (M3) in L. latrans. Molecular data based on partial 18S rDNA sequences revealed an interspecific divergence, between the species ranging from 0.43% to 1.16%. Phylogenetic analysis recovered isolates from the present study monophyletic with other isolates from Brazilian reptile and anuran hosts, sister to a clade comprising species isolated from African, North American and European reptile and anuran host species. Thus, using morphological and molecular analysis three new species infecting Brazilian Leptodactylidae anurans were identified and described. This study increases the knowledge of Brazilian anurans blood parasites and demonstrates the importance of using integrative approaches for diagnosis of hemoparasites.

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Diversity and phylogenetic relationship of haemogregarines from Brazilian anurans.

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Description of a three new species of Hepatozoon from Brazilian anurans.

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First report of species of Hepatozoon descriptions using both morphological and molecular approaches from Brazilian anurans.

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Merogonic data of Hepatozoon spp. infection on Brazilian anurans.

Noncavernous arteriovenous shunts mimicking carotid cavernous fistulae

PURPOSE

The classic symptoms and signs of carotid cavernous sinus fistula or cavernous sinus dural arteriovenous fistula (AVF) consist of eye redness, exophthalmos, and gaze abnormality. The angiography findings typically consist of arteriovenous shunt at cavernous sinus with ophthalmic venous drainage with or without cortical venous reflux. In rare circumstances, the shunts are localized outside the cavernous sinus, but mimic symptoms and radiography of the cavernous shunt. We would like to present the other locations of the arteriovenous shunt, which mimic the clinical presentation of carotid cavernous fistulae, and analyze venous drainages.

METHODS

We retrospectively examined the records of 350 patients who were given provisional diagnoses of carotid cavernous sinus fistulae or cavernous sinus dural AVF in the division of Interventional Neuroradiology, Ramathibodi Hospital, Bangkok between 2008 and 2014. Any patient with cavernous arteriovenous shunt was excluded.

RESULTS

Of those 350 patients, 10 patients (2.85%) were identified as having noncavernous sinus AVF. The angiographic diagnoses consisted of three anterior condylar (hypoglossal) dural AVF, two traumatic middle meningeal AVF, one lesser sphenoid wing dural AVF, one vertebro-vertebral fistula (VVF), one intraorbital AVF, one direct dural artery to cortical vein dural AVF, and one transverse-sigmoid dural AVF. Six cases (60%) were found to have venous efferent obstruction.

CONCLUSION

Arteriovenous shunts mimicking the cavernous AVF are rare, with a prevalence of only 2.85% in this series. The clinical presentation mainly depends on venous outflow. The venous outlet of the arteriovenous shunts is influenced by venous afferent-efferent patterns according to the venous anatomy of the central nervous system and the skull base, as well as by architectural disturbance, specifically, obstruction of the venous outflow.

Crack/Fold Hybrid Structure-Based Fluidic Networks Inspired by the Epidermis of Desert Lizards

A bioinspired fluidic system with cracks and folds was introduced to emulate the structures and functions of desert lizards' integuments, which show marked ability of water management. Because there was a structural analogy between scales and interscalar channels of lizard's skin and cracks and folds of a bilayer elastic material, we can mimic lizard's skin by controlling the stress distribution on patterned elastomers. Our system showed not only capillary-driven water retention within confined fluidic network, but also stretching-driven biaxial water transport. Observed features of our system may enhance understanding of water management in relation to morphogenetic aspects of lizards.

Cerebral venous overdrainage: an under-recognized complication of cerebrospinal fluid diversion

Understanding the altered physiology following cerebrospinal fluid (CSF) diversion in the setting of adult hydrocephalus is important for optimizing patient care and avoiding complications. There is mounting evidence that the cerebral venous system plays a major role in intracranial pressure (ICP) dynamics especially when one takes into account the effects of postural changes, atmospheric pressure, and gravity on the craniospinal axis as a whole. An evolved mechanism acting at the cortical bridging veins, known as the “Starling resistor,” prevents overdrainage of cranial venous blood with upright positioning. This protective mechanism can become nonfunctional after CSF diversion, which can result in posture-related cerebral venous overdrainage through the cranial venous outflow tracts, leading to pathological states. This review article summarizes the relevant anatomical and physiological bases of the relationship between the craniospinal venous and CSF compartments and surveys complications that may be explained by the cerebral venous overdrainage phenomenon. It is hoped that this article adds a new dimension to our therapeutic methods, stimulates further research into this field, and ultimately improves our care of these patients.

Microscopic agglutination test on captive rattlesnakes : Data on serovars and titers

The microscopic agglutination test (MAT) is considered the “golden standard” leptospirosis serodiagnostic test, but there is little information about it as it pertains to snakes. To fill this information gap, we provide data on serovars and titers of fifty-six Crotalus durissus collilineatus sera samples that tested positive by MAT (10.1016/j.actatropica.2016.02.006 (Rodrigues et al., 2016) [5]). These data are presented in a table, along with a description of the methodology used for sample collection and serologic testing.

Anti-Leptospira spp. antibodies in Crotalus durissus collilineatus kept in captivity and its zoonotic relevance

Leptospirosis is a worldwide spread zoonosis that can affect all groups of vertebrates, including reptiles. Because it has been little studied in snakes, this study focused on determining the occurrence of anti-Leptospira spp. antibodies in 64 Crotalus durissus collilineatus kept in captivity and on identifying the most common serovars in these animals, using the microscopic agglutination test. Of these, almost 90% were positive and there were reactions to the 22 serovars used in the study. The most common serovar in these snakes was Javanica, Andamana and Patoc. Most frequent titers were 25 and 50, although high titers (such as 1600) were also recorded, despite the absence of clinical symptoms. The possibility should be considered of captive snakes serving as a serious source of leptospiral infection in humans, which is why it is essential to study, prevent and control the disease in breeding centers and serpentariums.

Transvenous embolization of an intraosseous dural arteriovenous fistula of the anterior condylar vein with anomalous venous drainage causing ocular manifestations

We report a patient with a rare dural arteriovenous fistula of the anterior condylar vein, who presented with unusual clinical symptoms due to the anomalous venous drainage. The patient had progressive ocular signs, a dilated venous pouch at the skull base and, on angiography, retrograde venous drainage into the superior ophthalmic vein. Transvenous embolization of the venous pouch produced complete amelioration of the ocular symptoms. Such treatment may be curative for dural arteriovenous fistulas of the anterior condylar vein.

A morphological study of the vertebral venous plexus and its connections in the Cape dune mole-rat, Bathyergus suillus (Bathyergidae)

Bathyergus suillus are subterranean rodents found in the Western Cape of South Africa, where they inhabit sandy, humid burrows. Vertebral venous plexuses around the vertebral column have been implicated in aiding the maintenance of a constant central nervous system temperature via its connections with muscles and interscapular brown adipose tissue. The morphology of the vertebral venous plexuses and its connections in B.suillus were investigated. Frozen (n = 10) animals were defrosted; the venous system injected with latex and the vertebral venous plexuses, azygos- and intercostal veins dissected along the dorsal and ventral aspects of the vertebral column. Specimens (n = 4) were used for histological serial cross sections of the thoracic vertebrae. Veins drained from the interscapular brown adipose tissue to the external vertebral venous plexus, via a dorsal vein at the spinous process of T2 which might represent the "vein of Sulzer" described in rats. The intercostal veins cranial to the level of T8 drained directly into the ventral external vertebral venous plexus instead of into the azygos vein as seen in rats. The azygos vein was situated ventrally on the thoracic vertebral bodies in the median plane as opposed to most rodents that have a left sided azygos vein. The internal vertebral venous plexus consisted of two ventrolateraly placed longitudinal veins in the spinal epidural space. Veins from the forelimbs entered the internal vertebral venous plexus directly at the levels of C7 and T1 and have not been described in other rodents. Serial histological sections, revealed no regulatory valves in vessels leading toward the internal vertebral venous plexus, allowing blood to presumably move in both directions within the vertebral venous plexus. The vertebral venous plexus of B. suillus shows similarities to that of the rat but the vessels from the forelimbs draining directly into to the internal vertebral venous plexus and the position of the azygos vein and the intercostal veins draining into the external vertebral venous plexus are notable exceptions.

An allometric analysis of the giraffe cardiovascular system

There has been co-evolution of a long neck and high blood pressure in giraffes. How the cardiovascular system (CVS) has adapted to produce a high blood pressure, and how it compares with other similar sized mammals largely is unknown. We have measured body mass and heart structure in 56 giraffes of both genders ranging in body mass from 18 kg to 1500 kg, and developed allometric equations that relate changes in heart dimensions to growth and to cardiovascular function. Predictions made from these equations match measurements made in giraffes. We have found that heart mass increases as body mass increases but it has a relative mass of 0.51+/-0.7% of body mass which is the same as that in other mammals. The left ventricular and interventricular walls are hypertrophied and their thicknesses are linearly related to neck length. Systemic blood pressure increases as body mass and neck length increase and is twice that of mammals of the same body mass. Cardiac output is the same as, but peripheral resistance double that predicted for similar sized mammals. We have concluded that increasing hydrostatic pressure of the column of blood during neck elongation results in cardiac hypertrophy and concurrent hypertrophy of arteriole walls raising peripheral resistance, with an increase in blood pressure following.

A phase-contrast MRI study of physiologic cerebral venous flow

Although crucial in regulating intracranial hydrodynamics, the cerebral venous system has been rarely studied because of its structural complexity and individual variations. The purpose of our study was to evaluate the organization of cerebral venous system in healthy adults. Phase-contrast magnetic resonance imaging (PC-MRI) was performed in 18 healthy volunteers, in the supine position. Venous, arterial, and cerebrospinal fluid (CSF) flows were calculated. We found heterogeneous individual venous flows and variable side dominance in paired veins and sinuses. In some participants, the accessory epidural drainage preponderated over the habitually dominant jugular outflow. The PC-MRI enabled measurements of venous flows in superior sagittal (SSS), SRS (straight), and TS (transverse) sinuses with excellent detection rates. Pulsatility index for both intracranial (SSS) and cervical (mainly jugular) levels showed a significant increase in pulsatile blood flow in jugular veins as compared with that in SSS. Mean cervical and cerebral arterial blood flows were 714+/-124 and 649+/-178 mL/min, respectively. Cerebrospinal fluid aqueductal and cervical stroke volumes were 41+/-22 and 460+/-149 microL, respectively. Our results emphasize the variability of venous drainage for side dominance and jugular/epidural organization. The pulsatility of venous outflow and the role it plays in the regulation of intracranial pressure require further investigation.

Reptile cardiology

Cardiovascular disease in reptiles generally is considered an uncommon finding in captive animals, but no large-scale, cross-sectional studies have been performed to determine its prevalence. It is possible that cardiovascular disease is more common than is generally accepted and that the current belief results from limited clinical and diagnostic experience. This article offers guidance drawn from the author's clinical experience and the available literature. It is important that veterinarians pursue a thorough history, physical examination, and diagnostic work-up when managing cardiovascular disease in a reptile case. Veterinarians working with these cases should document their findings and share them with their colleagues to build an evidence-based foundation for reptile medicine.

Patterns of the Cranial Venous System from the Comparative Anatomy inVertebrates. Part III. The Ventricular System and Comparative Anatomy of the Venous Outlet of Spinal Cord and Its Homology with the Five Brain Vesicles

SUMMARY

Ontogenetically, the ventricular venous systemmay develop in order to drain the gray matter(cells of the mantle layer of the neural tube) which migrates dorsally. On primitive brain vesicles of submammals especially fish, amphibianand reptile, the ventricular venous system is the major venous collector located on the middorsal surface, in between the meningeal layers comparable to the subarachnoid space in mammals. The ventricular venous system functions as a major drainage system for the brain vesicles in these submammals but its role decreases when the other two venous systems develop. Concerning the route of venous exit from the brain vesicles, we found that it resembles the spinal cord but could not be found all the way along the brain vesicles.

Morphology of the human internal vertebral venous plexus: a cadaver study after latex injection in the 21-25-week fetus

The morphology of the anterior and posterior internal vertebral venous plexus (IVVP) in human fetuses between 21-25 weeks of gestational age is described. The results are compared to the findings of a previous morphological study of the IVVP in the aged. The morphological pattern of the anterior IVVP in the fetus is very similar with the anterior IVVP in the aged human. In contrast, the posterior IVVP in the fetus lacks the prominent transverse bridging veins that are present in the aged lower thoracic and the lumbar posterior IVVP. The background of these morphological differences is unclear. Maybe the thoracolumbar part of the posterior IVVP is subject to "developmental delay," or the observed differences in the aged may result from functional and age-related factors that trigger this part of the vertebral venous system during (erect) life. The observed age related morphological differences of the posterior IVVP support the concept of the venous origin of the spontaneous spinal epidural hematoma (SSEH).

Human cerebral venous outflow pathway depends on posture and central venous pressure

Internal jugular veins are the major cerebral venous outflow pathway in supine humans. In upright humans the positioning of these veins above heart level causes them to collapse. An alternative cerebral outflow pathway is the vertebral venous plexus. We set out to determine the effect of posture and central venous pressure (CVP) on the distribution of cerebral outflow over the internal jugular veins and the vertebral plexus, using a mathematical model. Input to the model was a data set of beat-to-beat cerebral blood flow velocity and CVP measurements in 10 healthy subjects, during baseline rest and a Valsalva manoeuvre in the supine and standing position. The model, consisting of 2 jugular veins, each a chain of 10 units containing nonlinear resistances and capacitors, and a vertebral plexus containing a resistance, showed blood flow mainly through the internal jugular veins in the supine position, but mainly through the vertebral plexus in the upright position. A Valsalva manoeuvre while standing completely re-opened the jugular veins. Results of ultrasound imaging of the right internal jugular vein cross-sectional area at the level of the laryngeal prominence in six healthy subjects, before and during a Valsalva manoeuvre in both body positions, correlate highly with model simulation of the jugular cross-sectional area (R(2) = 0.97). The results suggest that the cerebral venous flow distribution depends on posture and CVP: in supine humans the internal jugular veins are the primary pathway. The internal jugular veins are collapsed in the standing position and blood is shunted to an alternative venous pathway, but a marked increase in CVP while standing completely re-opens the jugular veins.

Anatomy of the crocodilian spinal vein

The crocodilian spinal vein is remarkably robust yet historically overlooked. Using corrosion casting, we describe the anatomy of this vessel and its connections with the caval and hepatic venous systems in representatives from four crocodilian genera. The spinal vein arises from an enlarged occipital sinus over the medulla and extends the entire length of the vertebral column. Unlike in squamate reptiles, the spinal vein is single (nonplexiform), voluminous, and situated dorsal to the spinal cord, and plexi lateral to the cord span between emerging intercostal veins. The connections with the other venous systems are otherwise similar to those in other tetrapods. The overall anatomy of this vessel and its abundant connections with the other venous systems indicate it likely plays a primary role in returning blood to the heart from all parts of the body. Preliminary studies of function suggest that this vessel could also play an adaptive role during basking and diving.

Anatomical and pathological considerations in percutaneous vertebroplasty and kyphoplasty: a reappraisal of the vertebral venous system

OBJECTIVES

To focus attention of the clinician on the anatomy and (patho)physiology of the vertebral venous system, so as to offer a tool to better understand and anticipate (potential) complications that are related to the application of percutaneous vertebroplasty and kyphoplasty.

BACKGROUND

Percutaneous vertebroplasty and kyphoplasty are newly developed, minimally invasive techniques for the relief of pain and for the strengthening of bone in vertebral body lesions. With the clinical implementation of these techniques, a number of serious neurologic and cardiopulmonary complications have been reported in the international medical literature. Most complications appear to be related to the extrusion of bone cement into the vertebral venous system.

METHODS

The literature about complications of percutaneous vertebroplasty and kyphoplasty is reviewed, and the anatomic and (patho)physiologic characteristics of the vertebral venous system are reported. Based on what is currently known from the anatomy and physiology of the vertebral venous system, the procedures of percutaneous vertebroplasty and kyphoplasty are analyzed, and suggestions are made to improve the safety of these techniques.

CONCLUSIONS

Thorough knowledge of the anatomic and (patho)physiologic characteristics of the vertebral venous system is mandatory for all physicians that participate in percutaneous vertebroplasty and kyphoplasty. To reduce the risk of cement extrusion into the vertebral venous system during injection, vertebral venous pressure should be increased during surgery. This can be achieved by operating the patient in the prone position and by raising intrathoracic venous pressure with the aid of the anesthesiologist during intravertebral instrumentation and cement injection. Intensive theoretical and practical training, critical patient selection, and careful monitoring of the procedures, also taking into account patient positioning and intrathoracic and intra-abdominal pressures, will help to facilitate low morbidity outcomes in these very promising minimally invasive techniques.

Computed tomographic anatomy of the canine cervical vertebral venous system

Computed tomographic (CT) venography of the cervical vertebral canal was performed in six, clinically normal, adult mixed-breed dogs from 14 to 23 kg. After dogs were euthanized and saline perfused, a gelatin and iothalamate mixture was injected into the right external jugular vein. Contiguous, 4-mm-thick CT images were obtained with dogs in sternal recumbency. Dogs were kept in the same position as for the CT scan and frozen to approximately -8 degrees C. All post-contrast CT images were analyzed using similar bone window and level settings. Additional multiplanar reformatted dorsal images were obtained in all dogs. The frozen cadavers were sectioned through the cervical region extending from the occiput to T1 at approximately 8-mm intervals. The frozen sections were then compared with the CT images. The CT appearance of the normal cervical vertebral venous system was described and illustrated. Components such as the internal vertebral venous plexus, interarcuate veins, intervertebral veins, and vertebral veins were clearly identified on the CT images.