Topics

Topic

design image
Vertebral vein

The vertebral vein is a major venous channel of the neck that accompanies the vertebral artery through the transverse foramina of the cervical vertebrae. It begins in the suboccipital venous plexus, exits the transverse foramen at C6, and descends anterior to the vertebral artery. It terminates by draining into the brachiocephalic vein near the root of the neck.

The vertebral vein forms important communications with the vertebral venous plexuses (internal and external), deep cervical vein, occipital vein, and posterior intercostal veins. These connections create a valveless venous network that provides collateral drainage between the intracranial dural venous sinuses and the systemic venous system.

Clinically, the vertebral vein is significant in spinal venous drainage, collateral circulation during jugular vein obstruction, and potential venous spread of infection or metastases via Batson’s plexus.

Synonyms

  • Vena vertebralis

  • Cervical vertebral vein

  • Venous counterpart of vertebral artery

Function

  • Drains blood from the cervical spinal cord, vertebrae, meninges, and posterior cranial fossa

  • Provides collateral venous pathways between intracranial and systemic venous systems

  • Contributes to venous return of the neck and upper thoracic region

  • Serves as a key structure in spinal venous circulation and interventional venography

Tributaries

  • Suboccipital venous plexus

  • Internal vertebral venous plexus

  • External vertebral venous plexus

  • Deep cervical vein

  • Posterior intercostal veins (via collateral channels)

MRI Appearance

T1-weighted images:

  • Appears as a signal void (black lumen) alongside vertebral artery in transverse foramina

  • Surrounded by high-signal fat, aiding delineation

T2-weighted images:

  • Lumen shows signal void from venous flow

  • Thrombosed segments appear intermediate to high signal depending on clot age

STIR:

  • Suppresses fat to improve visualization of vertebral vein within foraminal and paravertebral fat

  • Highlights perivascular edema or inflammatory changes

T1 Post-Gadolinium (Gd-enhanced MRI):

  • Vertebral vein enhances homogeneously

  • Useful for mapping venous plexus connections, detecting thrombosis, varices, or abnormal venous shunts

MRA / MR Venography (contrast-enhanced):

  • Depicts vertebral venous system and plexus communications

  • Useful for cerebrospinal venous mapping, preoperative planning, and pathology evaluation

CT Appearance

Non-contrast CT:

  • Difficult to identify due to small caliber unless thrombosed or dilated

  • Seen as soft-tissue density channels in transverse foramina and paravertebral region

CT Post-Contrast (CT Venography):

  • Opacifies vertebral vein clearly, showing its course through cervical transverse foramina into brachiocephalic vein

  • Demonstrates tributary connections with vertebral venous plexuses

  • Essential in detecting venous thrombosis, collateral pathways, or abnormal dilation

  • 3D reconstructions assist in surgical and interventional planning

MRI images

vertebral vein anatomy axial MRI image -img-00000-00000

MRI images

vertebral vein anatomy axial MRI image -img-00000-00000_00001

CT image

vertebral vein anatomy axial CT image -img-00000-00000