History of the Vertebral Venous Plexus and the Significant Contributions of Breschet and Batson

Abstract

Before the 18th century, the vertebral venous plexus (VVP) received scant mention, had no clinical relevance, and was largely ignored by anatomists, most likely because of its location and nondistensible nature. Gilbert Breschet in 1819 provided the first detailed anatomic description of the VVP, describing it as a large plexiform valveless network of vertebral veins consisting of 3 interconnecting divisions and spanning the entire spinal column with connections to the cranial dural sinuses distributed in a longitudinal pattern, running parallel to and communicating with the venae cavae, and having multiple interconnections. More than a century passed before any work of significance on the VVP was noted. In 1940, Oscar V. Batson reported the true functionality of the VVP by proving the continuity of the prostatic venous plexus with the VVP and proposed this route as the most plausible explanation for the distribution of prostate metastatic disease. With his seminal work, Batson reclassified the human venous system to consist of the caval, pulmonary, portal, and vertebral divisions. Further advances in imaging technology confirmed Batson's results. Today, the VVP is considered part of the cerebrospinal venous system, which is regarded as a unique, large-capacitance, valveless plexiform venous network in which flow is bidirectional that plays an important role in the regulation of intracranial pressure with changes in posture and in venous outflow from the brain, whereas in disease states, it provides a potential route for the spread of tumor, infection, or emboli.

Tumor Necrosis Factor-Induced Cerebral Insulin Resistance in Alzheimer's Disease Links Numerous Treatment Rationales

“…The earliest of these is a novel approach termed the perispinal route (Tobinick et al, 2006(Tobinick et al, , 2010(Tobinick et al, , 2012. Its logic depends on 1) a short period of head-down tilting to gain a gravitational advantage, 2) an awareness of anatomy of Batson's plexus [a valveless venous system that surrounds the spinal column in continuum with the choroid plexus (Nathoo et al, 2011)], and 3) knowledge of the effect of acute hypertension on choroid plexus permeability [a 30-fold increase in albumin in CSF within 10 min of pharmacologically induced acute local hypertension (Murphy and Johanson, 1985)]. Not surprisingly, therefore, the gravitational effect on this valveless blood column of a 5-min head-down tilt of head and trunk has been reported, in anesthetized rabbits, to increase dramatically the passage of albumin and globulin, molecules of etanercept size, from plasma to the cerebrospinal fluid (Wen et al, 1994).…”

Metastasis of lung cancer through Batson’s plexus: very rare but possible

“…Although veins leaving the vertebral bodies were noted as early as 1519 by Vesalius (founder of modern anatomy), 1 Breschet (1819) and Batson (1940) provided a more complete description of the vertebral venous plexus (commonly known as Batson's plexus). 1,6 This system extends from the sacrum to the cranium and forms a large capacitance venous system which communicates freely with the other venous systems through segmental vessels.…”

“…1,6 This system extends from the sacrum to the cranium and forms a large capacitance venous system which communicates freely with the other venous systems through segmental vessels. This venous system is more correctly known as the cerebrospinal venous system since it consists of the cranial venous system (ophthalmic veins, cavernous sinus, dural veins, and intracranial veins) and the vertebral venous plexus.…”

“…It has an important role in the regulation of intracranial pressure with posture. 1 The VVS communicates with the veins of the thoracoabdominal wall, veins of the back, azygous, cavae, veins of the pelvis, prostate, and sacral venous plexus. The CSVS provides a venous channel connecting the cerebral, abdominal, and pelvic cavities.…”

“…One important channel for metastases involves the vertebral venous plexus, now named Batson's plexus. 1 This valveless paravertebral network of veins can provide a channel for the spread of cancers of the colon, rectum, and prostate. [2][3][4][5] However, dissemination of lung cancer through this channel is considered extremely rare, probably because the entire pulmonary venous drainage and more than 85 % of the bronchial circulation go to the left side of the heart through the pulmonary veins and do not have access to the cere-brospinal venous system (CSVS).…”