The inferior sagittal sinus runs in the inferior free margin of the falx cerebri, draining medial cerebral hemisphere tributaries and cingulate gyrus veins. It is much smaller than the superior sagittal sinus and ends by joining the great cerebral vein of Galen to form the straight sinus at the junction of the falx cerebri and tentorium cerebelli.
The inferior sagittal sinus is rarely the primary site of pathology but is involved in falcine meningioma surgery, where resection of the inferior falx requires ligation of this sinus. It is also involved in falcine dural arteriovenous fistulae. Its junction with the vein of Galen to form the straight sinus is a critical landmark during posterior interhemispheric and pineal region surgical approaches, where preservation of this drainage is essential.
Meningiomas of the inferior falx may involve the inferior sagittal sinus, requiring careful preoperative MR venography to assess sinus patency before surgical resection planning, as inadvertent sinus occlusion can cause bilateral medial cortical venous infarction.
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