The cortical bridging veins are thin-walled venous channels draining the cortical surface of the cerebral hemispheres into the dural venous sinuses — primarily the superior sagittal sinus. They traverse the subdural space over a variable distance (2-4 cm) from the cortical surface to the sinus, running through the subarachnoid and subdural space without protective support. Their thin walls and long subdural course make them the most vulnerable cerebral veins to shearing forces.
Bridging vein rupture is the primary mechanism of subdural haematoma (SDH) in head trauma: the rotational acceleration-deceleration of the brain tears the bridging veins as they stretch between the cortex and the fixed sinus wall. In elderly patients with brain atrophy (increased bridging vein length from brain shrinkage), even trivial trauma tears bridging veins producing chronic SDH. In non-accidental head injury (shaken baby syndrome), the high angular acceleration from shaking tears bridging veins producing bilateral acute-on-chronic SDH. Vein of Labbé (large bridging vein from temporal lobe to transverse sinus) sacrifice during temporal craniotomy causes venous infarction.
Rotational head acceleration tears the bridging veins as they span the subdural space between the cortical surface and the fixed superior sagittal sinus, producing acute SDH that expands over hours with brain compression; elderly patients with cerebral atrophy have longer unsupported bridging veins making them vulnerable to SDH from minor falls.
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