Accessory Vertebral Vein: A Branch of the Vertebral Vein
The accessory vertebral vein is a lower continuation of the vertebral vein and vertebral venous plexus that passes through the foramen of the transverse process of the 7th cervical vertebra and empties into the brachiocephalic vein. It is a paired vessel found on either side of the neck.
The function of the accessory vertebral vein is to drain the venous blood from the lower part of the cervical spine and some of the prevertebral muscles. It also communicates with the external venous plexuses at the intervertebral level of C7.
The accessory vertebral vein is one of the tributaries of the vertebral vein, which arises from a venous plexus that surrounds the vertebral artery and travels as far as the brachiocephalic veins. The vertebral vein drains the venous blood from the cervical spine, suboccipital and prevertebral muscles, and receives other tributaries such as the occipital vein, anterior vertebral vein, and suboccipital venous plexus.
The accessory vertebral vein, along with the vertebral vein and venous plexus, is part of the cerebrospinal venous system (CSVS), which is a large-capacity, valveless venous network that connects the veins, venous sinuses, and venous plexuses of the brain and the spine. The CSVS plays important roles in the regulation of intracranial pressure with changes in posture, and in venous outflow from the brain.
However, the CSVS also provides a direct vascular route for the spread of tumor, infection, or emboli among its different components in either direction. For example, an accessory iliac vein, which is a variation of the iliocaval drainage system that communicates with the CSVS, can facilitate the metastasis of pelvic tumors to the spine or vice versa. Moreover, the presence of accessory foramen transversarium, which can transmit the accessory vertebral vein and other structures, may affect their course and result in diverse clinical presentations ranging from headache to vertebrobasilar insufficiency. Therefore, it is important to be aware of these anatomical variations and their potential implications for diagnosis and treatment.
Treatment Options for Vertebrobasilar Insufficiency
The treatment options for vertebrobasilar insufficiency depend on the severity of the symptoms, the extent of the arterial blockage, and the risk of stroke. The main goals of treatment are to improve blood flow, protect nerve cells, and reduce dizziness. Some of the common treatment options are:
Lifestyle changes: These include stopping smoking, cutting back on alcohol, exercising more, following a low-cholesterol diet, and controlling diabetes . These measures can help prevent further plaque buildup and lower the risk of stroke.
Medication: These include drugs to improve blood flow, such as aspirin, Plavixâ¢, vinpocetine, and pentoxifylline; drugs to protect nerve cells, such as memantine, choline alfoscerate, cerebrolyine, gamma-aminobutyric acid, pyracetam, and cortexin; and drugs to reduce dizziness, such as cinnarizine and beta-histidine. These drugs can help relieve symptoms and prevent complications.
Surgery: These include procedures to remove plaque, bypass or stent blocked arteries, or relieve pressure on the vertebral arteries . Surgery is usually reserved for cases with severe symptoms or high risk of stroke. Minimally invasive techniques are preferred over open surgery.
The choice of treatment depends on the individual case and the preference of the patient and the healthcare provider. The best way to prevent vertebrobasilar insufficiency is to maintain a healthy lifestyle and avoid risk factors for atherosclerosis.