the latter its termination. Its orifice is guarded by a pair of valves (Gray 1918).

Anterior Condylar Confluent (Confluens Condyloideum Anterius, Trolard 1868)

The anterior condylar confluent (ACC) (Fig. 3.12) was initially observed by Trolard (1868), but was to a large extent ignored in the literature. San Millan Ruiz et al. (2002) recently “rediscovered” this short, venous structure located extracranially in front of the aperture of the hypoglossal canal at the level of the skull base. It provides a communication between the cerebral venous system and the internal and external vertebral venous plexus via six main channels: the anterior condylar vein, the lateral condylar vein, the IJV, the IPS, the venous plexus of Rektorzik, and the prevertebral plexus. Knott (1882) saw a venous plexus surrounding the hypoglossal nerve as it passes through the inner part of the anterior condyloid foramen, (the circellus venosus hypoglossi after Luschka) and found two veins proceeding from this plexus, one of which communicates with the vertebral plexus, the other with the IPS. He did not observe a consistent confluent. Katsuta et al. (1997), however, described in their study on microsurgical anatomy of the jugular foramen (see therein) a confluens that connects the anterior condylar vein, the posterior condylar vein, the IPS, the inferior petroclival and the vertebral venous plexus vein with the JB. This channel likely corresponds to the ACC illustrated by San Millan Ruiz et al. (2002).

Detailed knowledge of the complex and variant anatomy in this region is important, not only to understand of basic physiology of the venous circulation in the cranio-cervical region but also to perform petrosal sinus sampling. It certainly facilitates transvenous catheterizations for transvenous occlusion of a DCSF. The ACC may form anastomoses with the IPS at a variable distance from its termination into the IJV. In some cases the direct communication between IPS and IJV may be small or non-existent and the route through the ACC is the alternative. See more details in Chap. 7.

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