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Hosapatna M, Kunder K, Bhat NP, Shetty A, Sanyal S, Prabhath S, Sumalatha S. Falx cerebelli and its associated occipital venous sinus: an anatomical study. Surg Radiol Anat 2024; 46:1561-1569. [PMID: 38977460 PMCID: PMC11405493 DOI: 10.1007/s00276-024-03416-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 06/12/2024] [Indexed: 07/10/2024]
Abstract
PURPOSE This study presents the morphological variation of falx cerebelli, which helps to identify the possible variations in the presence of the occipital sinus in the posterior margin of the fold whose damage during midline incision of posterior cranial fossa surgeries may lead to internal hemorrhage. METHOD The study was conducted on 48 cranial cavities exploring the falx cerebelli. Variations in the number of folds, its proximal and distal attachments, and the drainage pattern of the occipital sinus were evaluated by histological processing of the upper 1/3rd section of the falx fold. RESULTS The variation in the number of folds recorded are single folds in 87.5%, double folded in 8.3%, and multiple folds (five and seven folded) in 4.2% of the cases. The variation in the proximal and distal attachments in single falx folds showed three combinations: Ramified triangular in 66.7%, both ramified type in 12.5%, and both triangular type in 8.3% of the cases. Double and multiple folds showed ramified and triangular types of variation in their attachments. Histological findings showed the presence of occipital venous sinuses in most of the single falx fold. Two aberrant venous sinuses were seen in a double and five-folded falx cerebelli. CONCLUSIONS This study records the variations in the morphology of falx cerebelli. The histological data of this study sheds light on the drainage pattern of venous sinuses in the area whose negligence during midline incisions of brain surgeries may increase the possibility of hemorrhage.
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Affiliation(s)
- Mamatha Hosapatna
- Department of Anatomy, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Kushi Kunder
- Department of Anatomy, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Nandini Prashanth Bhat
- Department of Anatomy, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India.
| | - Ashwija Shetty
- Department of Anatomy, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Sanjoy Sanyal
- Department of Anatomy, Department Chair of Anatomical Sciences, Richmond Gabriel University College of Medicine, Kingstown, West Indies, VC0282, Saint Vincent And The Grenadines
| | - Sushma Prabhath
- Department of Anatomy, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Suhani Sumalatha
- Department of Anatomy, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India.
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Erol G, Çavuşoğlu N, Sevgi UT, Fidan S, Canbolat Ç, Doğruel Y, Luzzi S, Cohen Gadol AA, Güngor A. Occipital Sinus-Sparing Linear Paramedian Dural Incision: A Technical Note and Case Series for Median Suboccipital Approach. World Neurosurg 2024; 184:e121-e128. [PMID: 38244681 DOI: 10.1016/j.wneu.2024.01.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 01/11/2024] [Accepted: 01/12/2024] [Indexed: 01/22/2024]
Abstract
BACKGROUND Durotomies, traditionally used during the midline suboccipital approach, involve sacrificing the occipital sinus (OS) with consequent shrinking of the dura, risk of venous complications, difficulty performing watertight closure, and a higher rate of postoperative cerebrospinal fluid (CSF) leaks. The present technical note describes the OS-sparing linear paramedian dural incision, which leads to a decrease in the risk of complications during the median suboccipital approach in our case series. METHODS The OS-sparing linear incision technique involves a dural incision placed 1 cm lateral to the OS. The angle of view of the microscope is frequently changed to overcome the narrowed exposure of the linear durotomy. Copious irrigation with saline prevents drying of the dura. A running watertight closure of the dura is performed. The overall results of 5 cases are reviewed. RESULTS The cases were 3 tumors and 2 cavernomas. The OS was preserved in all 5, and no duraplasty was needed. The average dura closure time was 16.8 minutes. No CSF leak occurred, and no wound complications were observed. A gross total resection of the lesion was achieved in all the patients. The mean follow-up was 10.2 months, and there were no late complications related to the dura closure. CONCLUSIONS In comparison to the types of durotomies conventionally used for the midline suboccipital approach, the OS-sparing linear paramedian dural incision entails lower risks of bleeding, venous complications, CSF leaks, and infections by avoiding duraplasty. Validation of this technical note on a larger patient cohort is needed.
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Affiliation(s)
- Gökberk Erol
- Department of Neurosurgery, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Neslihan Çavuşoğlu
- Department of Neurosurgery, Bakırköy Mazhar Osman Research and Training Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul, Turkey
| | - Umut Tan Sevgi
- Department of Neurosurgery, Tepecik Research and Training Hospital, Izmir, Turkey
| | - Semih Fidan
- Department of Neurosurgery, Bakırköy Mazhar Osman Research and Training Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul, Turkey
| | - Çağrı Canbolat
- Department of Neurosurgery, Liv Hospital Vad istanbul, Istanbul, Turkey
| | - Yücel Doğruel
- The Neurosurgical Atlas, Carmel, Indiana, USA; Department of Neurosurgery, Tunceli State Hospital, Tunceli, Turkey
| | - Sabino Luzzi
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy; Neurosurgery Unit, Department of Surgical Sciences, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Aaron A Cohen Gadol
- The Neurosurgical Atlas, Carmel, Indiana, USA; Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Abuzer Güngor
- Department of Neurosurgery, Liv Hospital Vad istanbul, Istanbul, Turkey; Faculty of Medicine, Department of Neurosurgery, Istinye University, Istanbul, Turkey.
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Zhou Z, Zhao F, Yu J. The effect of the occipital sinus on the torcular Herophili and neighboring structures. Heliyon 2024; 10:e25547. [PMID: 38375300 PMCID: PMC10875375 DOI: 10.1016/j.heliyon.2024.e25547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 12/23/2023] [Accepted: 01/29/2024] [Indexed: 02/21/2024] Open
Abstract
Objective The occipital sinus (OS) has many variations. It is unknown whether OS can change the angioarchitecture of torcular Herophili. Therefore, we performed magnetic resonance venography (MRV) in a cohort of Han Chinese individuals to determine whether OS can change the angioarchitecture of torcular Herophili. Methods Participants were divided into a normal OS group and a hyperplastic OS group. Parameters of the OS and torcular Herophili and its neighboring structures were recorded. Statistical analysis was used to determine the effects of OS on torcular Herophili and neighboring structures. Results One hundred forty-five healthy participants were enrolled. One hundred patients were in the normal OS group, and 45 were in the hyperplastic OS group. In the normal OS group, the diameters at the transverse sinus (TS) origin were 5.8 ± 2.3 mm on the left side and 7.5 ± 2.2 mm on the right side. In the hyperplastic OS group, the diameters at the TS origin were 6.0 ± 2.1 mm on the left side and 7.0 ± 2.7 mm on the right side. Fenestration was observed in 33% of the torculars in the normal OS group and 6.7% of the torculars in the hyperplastic group. An unpaired t-test revealed a significant difference between bilateral TSs in the normal OS group (P < 0.05) but no difference in the hyperplastic OS group. The chi-square test revealed a significant difference in torcular Herophili fenestration between the normal and hyperplastic OS groups (P < 0.05). Conclusions Hyperplastic OS makes bilateral TSs equal in diameter and weakens the predominance of the right TS. A hyperplastic OS reduces the occurrence of torcular Herophili fenestration.
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Affiliation(s)
- Zibo Zhou
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, 130021, China
| | - Fasheng Zhao
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, 130021, China
| | - Jinlu Yu
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, 130021, China
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Tochigi S, Isoshima A, Ohashi H, Kawamura D, Karagiozov K, Hatano K, Ohashi S, Nagashima H, Murayama Y, Abe T. Preoperative assessment of dominant occipital sinus in patients with Chiari malformation type I: anatomical variations and implications for preventing potentially life-threatening surgical complications. J Neurosurg 2023; 138:540-549. [PMID: 35901697 DOI: 10.3171/2022.5.jns212973] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 05/16/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The surgical treatment of Chiari malformation type I (CM-I) frequently involves dural incision at the posterior cranial fossa. In cases of persistent patent occipital sinus (OS), the sinus is usually obliterated and divided. However, there are some patients whose OS is prominent and requires crucial modification of the operative planning to avoid potentially life-threatening massive hemorrhage and disturbance of cerebral venous circulation. In the present study, the anatomical variations of the dominant OS in patients with CM-I were analyzed and the authors attempted to develop treatment recommendations for patients with CM-I with dominant OS. METHODS The study included 213 patients with CM-I who underwent MR venography (MRV) prior to surgical treatment. OS dominance was assessed using 2D time-of-flight MRV or 3D phase-contrast MRV. Particular attention was paid to the pattern of venous outflow channels. The characteristics of the patients with dominant OS and the surgical outcomes were retrospectively reviewed. RESULTS Dominant OS was identified in 7 patients (3.3%). The age in those with dominant OS was significantly younger than in those without (p = 0.0202). The incidence of concurrent scoliosis in the patients with dominant OS was significantly higher than in those without (p = 0.0366). All the dominant OSs were found to be of the oblique type. Unilateral oblique OS (OOS) with normal ipsilateral transverse sinus (TS) and hypoplastic contralateral TS was found in 2 patients (0.9%). The authors found 1 patient each (0.5%) who had unilateral OOS with hypoplastic ipsilateral TS and normal contralateral TS, unilateral OOS with bilateral hypoplastic TSs, and bilateral OOSs with bilateral normal TSs. Bilateral OOSs with bilateral hypoplastic TSs were found in 2 patients (0.9%). All these patients had syringomyelia. Instead of performing Y-shaped dural incision and duraplasty, surgical procedures were modified depending on the types of the OOSs to preserve their venous drainage routes. Although massive bleeding from the dominant OS during dural incision occurred in 1 patient, none suffered neurological deterioration. The syrinx volume decreased in all but 1 of the patients postoperatively. CONCLUSIONS Assessment of the venous drainage pattern using MRV is indispensable for safe surgical treatment in patients with CM-I. The surgical procedure should be modified based on the type of dominant OS to minimize the surgical risks.
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Affiliation(s)
- Satoru Tochigi
- 1Department of Neurosurgery, The Jikei University Kashiwa Hospital, Kashiwa, Chiba
| | - Akira Isoshima
- 2Department of Neurosurgery, Omori Red Cross Hospital, Tokyo
| | - Hiroki Ohashi
- 3Department of Neurosurgery, The Jikei University School of Medicine, Tokyo
| | - Daichi Kawamura
- 3Department of Neurosurgery, The Jikei University School of Medicine, Tokyo
| | | | - Keisuke Hatano
- 3Department of Neurosurgery, The Jikei University School of Medicine, Tokyo
| | - So Ohashi
- 4Department of Neurosurgery, Kawasaki Saiwai Hospital, Kawasaki, Kanagawa
| | - Hiroyasu Nagashima
- 5Department of Neurosurgery, The Jikei University Katsushika Medical Center, Tokyo; and
| | - Yuichi Murayama
- 3Department of Neurosurgery, The Jikei University School of Medicine, Tokyo
| | - Toshiaki Abe
- 3Department of Neurosurgery, The Jikei University School of Medicine, Tokyo.,6Department of Neurosurgery, Mishima Central Hospital, Mishima, Shizuoka, Japan
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Cortese J, Eliezer M, Guédon A, Houdart E. Pulsatile Tinnitus Due to Stenosis of the Marginal Sinus: Diagnosis and Endovascular Treatment. AJNR Am J Neuroradiol 2021; 42:2194-2198. [PMID: 34711551 DOI: 10.3174/ajnr.a7325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 08/18/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND PURPOSE Venous pulsatile tinnitus is a disabling condition mainly caused by a stenosis of the lateral sinus. Here, we aimed to report a novel cause of venous pulsatile tinnitus, stenosis of the marginal sinus. MATERIALS AND METHODS We retrospectively analyzed patients with isolated venous pulsatile tinnitus for which the suspected cause was a stenosis of the marginal sinus, treated or not, between January 2017 and December 2020. Patient charts and imaging were systematically reviewed. All patients underwent noncontrast temporal bone CT and MR imaging. RESULTS Eight patients (7 women; median age, 36 years) were included. Six patients (75%) were overweight, and 1 patient had idiopathic intracranial hypertension. All patients presented with a typical venous pulsatile tinnitus. The stenosis of the marginal sinus was detected using oblique reconstructions on postcontrast 3D MR imaging. There was no other pathologic finding except ipsilateral stenosis of the lateral sinus in 3 patients. Four patients underwent endovascular therapy with placement of a stent in the marginal sinus, leading to complete resolution of the pulsatile tinnitus for all of them. No complication occurred. Of note, the symptoms of intracranial hypertension also regressed after stent placement in that patient. CONCLUSIONS Marginal sinus stenosis is a novel cause of venous pulsatile tinnitus, which can be easily detected on MR imaging. Marginal sinus stent placement is safe and efficient. We hypothesized that the marginal sinus stenosis pathophysiology is similar to that of lateral sinus stenosis, which is a common and well-known cause of venous pulsatile tinnitus, explaining the similar clinical presentation and endovascular management.
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Affiliation(s)
- J Cortese
- From the Department of Interventional and Diagnostic Neuroradiology, Lariboisière University Hospital, University de Paris, Paris, France
| | - M Eliezer
- From the Department of Interventional and Diagnostic Neuroradiology, Lariboisière University Hospital, University de Paris, Paris, France
| | - A Guédon
- From the Department of Interventional and Diagnostic Neuroradiology, Lariboisière University Hospital, University de Paris, Paris, France
| | - E Houdart
- From the Department of Interventional and Diagnostic Neuroradiology, Lariboisière University Hospital, University de Paris, Paris, France
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Bridging veins of the cerebellum: a magnetic resonance imaging study. Surg Radiol Anat 2021; 43:437-444. [PMID: 33423146 DOI: 10.1007/s00276-020-02664-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 12/19/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE To date, no study has yet explored the bridging veins (BVs) of the cerebellum using neuroimaging modalities. Therefore, this study aimed to characterize them using magnetic resonance imaging (MRI). METHODS A total of 90 patients with intact cerebellar hemispheres and intracranial dural sinuses underwent thin-sliced, contrast-enhanced MRI. RESULTS The BVs were classified into six routes based on the draining pattern into the dural sinuses. The superior vermian vein emptying into the straight sinus was delineated in 100% of the patients. The inferior vermian vein emptying into the confluence of the sinuses was identified in 66.7% of the patients. The inferior hemispheric and cerebellar cortical veins emptying into the transverse sinus were identified in 54.4% and 26.7% of the patients, respectively. The inferior vermian and cerebellar cortical veins emptying into the straight sinus were identified in 77.8% and 12.2% of the patients, respectively. The cerebellar cortical vein emptying into the tentorial sinus was identified in 83.3% of the patients; it was delineated on 54 sides with an average number per right hemisphere of 1.9 and 63 sides with an average number per left hemisphere of 2. The pontine-trigeminal and anterior hemispheric veins emptying into the superior petrosal sinus were identified in 42.2% of the patients. CONCLUSIONS The BVs of the cerebellum can be classified into six distinct routes. Radiological classification may be useful for understanding the drainage pattern of the cerebellum.
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Tyagi G, Singh GJ, Beniwal M, Srinivas D. Management of a Persistent Oblique Occipital Sinus with Staged Ligation in a Case of Medulloblastoma: A Case Report. Pediatr Neurosurg 2021; 56:460-464. [PMID: 34265776 DOI: 10.1159/000517214] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 05/13/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION A patent persistent occipital sinus (OS) can be seen in 10% of adults. The presence of such a dominant draining OS can present as a challenge for posterior fossa surgeries. Occlusion or division of the sinus can cause venous hypertension, causing a cerebellar bulge or increased intra-op bleeding. CASE REPORT A 3-and-a-half-year-old female child presented with a vermian medulloblastoma with hydrocephalus. MR venography (MRV) revealed a large patent OS draining from the torcula to the right sigmoid sinus. She underwent a left Frazier's point VP shunt followed by a midline suboccipital craniotomy for the lesion. The OS was divided during a "Y"-shaped durotomy. Following the sinus ligation, there was a significant cerebellar bulge and excessive bleeding from the lesion. We released cisternal CSF and punctured the tumor cysts to allow the brain bulge to settle. Hemostasis was secured, and surgery was deferred, an augmented duroplasty was done, and bone flap was removed to allow for intracranial pressure decompression. The patient was electively ventilated for 24 h and weaned off gradually. A repeat MRV at 7 days showed the reorganization of the venous outflow at the torcula. Reexploration with tumor resection was done on post-op day 10. The patient recovered well from the surgery and was referred for adjuvant therapy. CONCLUSION Surgeons should carefully analyze venous anatomy before posterior fossa surgeries. The persistent dominant OS, when present, should be taken care of while planning the durotomy. A hypoplastic but persistent transverse sinus allowed us to ligate and divide the OS. By doing a staged division of the sinus, reorganization of the venous outflow from the torcula can be allowed to occur, and the lesion can be resected.
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Affiliation(s)
- Gaurav Tyagi
- National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Gyani Jail Singh
- National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Manish Beniwal
- National Institute of Mental Health and Neurosciences, Bangalore, India
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Broussolle T, Berhouma M. On the importance of a thorough analysis of pre-operative imaging: Variations of posterior fossa venous sinus anatomy. Neurochirurgie 2020; 67:518-519. [PMID: 33340511 DOI: 10.1016/j.neuchi.2020.11.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 11/29/2020] [Indexed: 11/26/2022]
Affiliation(s)
- T Broussolle
- Department of Neurosurgical Oncology and Vascular Neurosurgery, Pierre Wertheimer Neurological and Neurosurgical Hospital, Hospices Civils de Lyon, 58, avenue des Frères-Lumière, 69008 Lyon, France.
| | - M Berhouma
- Department of Neurosurgical Oncology and Vascular Neurosurgery, Pierre Wertheimer Neurological and Neurosurgical Hospital, Hospices Civils de Lyon, 58, avenue des Frères-Lumière, 69008 Lyon, France; Creatis Lab - CNRS UMR 5220, INSERM U1206, Lyon 1 University, INSA Lyon, Lyon, France
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Çavdar S, Solmaz B, Taniş Ö, Guler OU, Dalçık H, Aydoğmuş E, Altunkaya L, Kara E, Aslıyüksek H. Anatomic variations of the human falx cerebelli and its association with occipital venous sinuses. Br J Neurosurg 2020; 35:306-312. [PMID: 32781846 DOI: 10.1080/02688697.2020.1793907] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE Human falx cerebelli is an important anatomical structure in regard to its relations with venous structures during infratentorial approach to reach cerebellar tumors, vascular malformations, traumatic hemorrhage and Chiari malformations. The present study aim to describe the different types of variations of the falx cerebelli, its morphological features and its association with occipital venous sinuses. METHOD In this study 49 dura mater was obtained from the Institution of Forensic Medicine. The length, width and the depth of the falx cerebelli were measured using a digital compass. The data obtained were statistically analyzed in relation to age and gender. The relations of the falx cerebelli with the occipital sinus was documented. Histological sections from the falx cerebelli were stained with Hematoxylin Eosin to evaluate the fine structure. RESULTS Among the 49 falx cerebelli examined 36 (73.5%) were classified as normal. The average length, width and depth of the normal falx cerebelli was 3.7, 1.0 and 0.4 cm respectively. Of the 49 falx cerebelli in 1 (2%) case it was absent, in 5 cases (10.2%) duplicate, in 5 cases (10.2%) triplicate, in 1 (2%) case quadruplets and in 1 case (2%) it was five-folded. The proximal and the distal attachments of the falx cerebelli showed 3 types of variations; both attachments triangular, the proximal attachments triangular and the distal ramified and distal attachments triangular and the proximal attachments ramified. The drainage of the occipital sinus of falx cerebelli with variations were evaluated. The increased number of falx cerebelli highly corresponded with the increased number of occipital sinus. CONCLUSIONS The dural-venous variation in the posterior cranial fossa can be problematic in various diagnostic and operative procedures of this region. Neurosurgeons should be aware of such variations, as these could be potential sources of haemorrhage during the midline suboccipital and infratentorial approaches.
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Affiliation(s)
- Safiye Çavdar
- Department of Anatomy, Koç University, School of Medicine, Istanbul, Turkey
| | - Bilgehan Solmaz
- Department of Neurosurgery, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Özgül Taniş
- Department of Anatomy, Koç University, School of Medicine, Istanbul, Turkey
| | - Orhan Ulas Guler
- Department of Anatomy, Koç University, School of Medicine, Istanbul, Turkey
| | - Hakkı Dalçık
- Department of Histology Embryology, Aydın University, School of Medicine, Istanbul, Turkey
| | - Evren Aydoğmuş
- Department of Neurosurgery, Dr. Lutfi Kirdar Kartal Education and Research Hospital, Istanbul, Turkey
| | - Leyla Altunkaya
- Department of Anatomy, Koç University, School of Medicine, Istanbul, Turkey
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Omoto K, Takeshima Y, Nishimura F, Nakagawa I, Motoyama Y, Park YS, Nakase H. Additional Assessment of Developed Occipital Sinus Using Intraoperative Indocyanine Green Videoangiography for a Safe Foramen Magnum Decompression—Technical Case Report. Oper Neurosurg (Hagerstown) 2020; 19:E533-E537. [DOI: 10.1093/ons/opaa125] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 03/17/2020] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND AND IMPORTANCE
Although foramen magnum decompression (FMD) with expansive duraplasty is a popular procedure for treating chiari malformation (CM), the common Y-shaped dural incision can lead to a life-threatening cerebral venous circulation disturbance in patients with a developed occipital sinus. Here, we describe the effectiveness of intraoperative indocyanine green video angiography (ICG-VA) for a CM type 1 (CM1) patient with a highly developed unilateral occipital sinus.
CLINICAL PRESENTATION
A 40-yr-old woman presented with sensory disturbance on the left side of the body. Magnetic resonance imaging (MRI) revealed cerebellar tonsil herniation into the foramen magnum with cervical syringomyelia, and computed tomography additionally revealed skull anomalies: fontanel closure insufficiencies, cranial dysraphism, thin cranial bone, and dentition abnormalities. We diagnosed as symptomatic CM1 with syringomyelia associated with cleidocranial dysplasia, which is a dominantly inherited autosomal bone disease. Cerebral angiography revealed a developed right occipital sinus and hypoplasia of the bilateral transverse sinus. We performed FMD, paying special attention to the developed occipital sinus using ICG-VA to ensure a safe duraplasty. The angiography clearly highlighted a right-sided occipital sinus with a high contrast ratio, and no left-sided occipital sinus was visible. After a dural incision in a unilateral curvilinear fashion was safely completed, expansive duraplasty was performed. The sensory disorders experienced by the patient disappeared postoperatively. Postoperative MRI revealed elevation of the cerebellar tonsil and decreasing of the syringomyelia.
CONCLUSION
Additional assessment using intraoperative ICG-VA provides useful information for a safe FMD, particularly in patients with complicated cerebral venous circulation anomalies.
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Affiliation(s)
- Koji Omoto
- Department of Neurosurgery, Nara Medical University, Kashihara, Japan
| | | | | | - Ichiro Nakagawa
- Department of Neurosurgery, Nara Medical University, Kashihara, Japan
| | - Yasushi Motoyama
- Department of Neurosurgery, Nara Medical University, Kashihara, Japan
| | - Young-Su Park
- Department of Neurosurgery, Nara Medical University, Kashihara, Japan
| | - Hiroyuki Nakase
- Department of Neurosurgery, Nara Medical University, Kashihara, Japan
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The oblique occipital sinus - implications in posterior fossa approaches. J Clin Neurosci 2020; 76:202-204. [PMID: 32317189 DOI: 10.1016/j.jocn.2020.04.055] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 04/06/2020] [Accepted: 04/12/2020] [Indexed: 11/22/2022]
Abstract
The retrosigmoid craniotomy is the standard approach to resect pathologies in the cerebellopontine angle (CPA). Following the craniotomy, the dura mater is opened in the inferolateral direction and the basal cistern arachnoid is dissected in order to release pressure by the outflow of cerebrospinal fluid (CSF) from the foramen magnum, so that the CPA compartment can be approached with minimal retraction of the cerebellum. We report two patients, both with vestibular schwannoma, in whom preoperative magnetic resonance imaging (MRI) revealed unusual large oblique occipital sinus (OOS) draining laterally into the sigmoid sinus - jugular bulb junction. The sinuses were preserved intact while dura mater was opened for CSF release. Careful preoperative imaging is essential prior to posterior fossa lesions approaches in order to evaluate the persistency of an OOS, especially in a retrosigmoid approach. Inadvertent OOS damage might result in, not only significant bleeding during dural opening, but also air embolism or venous hypertension, if the contralateral sigmoid sinus is small or absent.
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Eisová S, Píšová H, Velemínský P, Bruner E. Normal craniovascular variation in two modern European adult populations. J Anat 2019; 235:765-782. [PMID: 31236921 PMCID: PMC6742892 DOI: 10.1111/joa.13019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2019] [Indexed: 01/06/2023] Open
Abstract
The vascular networks running into the meningeal layers, between the brain and braincase, leave imprints on the endocranial surface. These traces are visible in osteological specimens and skeletal collections, providing indirect evidence of vascular patterns in those cases in which bone remains are the only source of anatomical information, such as in forensic science, bioarchaeology and paleontology. The main vascular elements are associated with the middle meningeal artery, the venous sinuses of the dura mater, and the emissary veins. Most of these vascular systems have been hypothesized to be involved in endocranial thermal regulation. Although these traits deal with macroanatomical features, much information on their variation is still lacking. In this survey, we analyze a set of craniovascular imprints in two European dry skull samples with different neurocranial proportions: a brachycephalic Czech sample (n = 103) and a mesocephalic Italian sample (n = 152). We analyzed variation and distribution, correlation with cranial metrics, and sex differences in the dominance of the branches of the middle meningeal artery, the patterns of confluence of the sinuses, and the size of the emissary foramina. The descriptive statistics provide a reference to compare specimens and samples from different case studies. When compared with the Italian skulls, the Czech skulls display a greater dominance of the anterior branch of the middle meningeal artery and more asymmetric right-dominance of the confluence of the venous sinuses. There is no sex difference in the middle meningeal vessels, but males show a greater prevalence of the occipito-marginal draining system. Differences in the middle meningeal vessels or venous sinuses are apparently not influenced by cranial dimensions or proportions. The mastoid foramina are larger in larger and more brachycephalic skulls, which increases the emissary potential flow in the Czech sample and males, when compared with the Italian samples and females, respectively. The number of mastoid foramina increases in wider skulls. This anatomic information is necessary to develop further morphological and functional inferences on the relationships between neurocranial bones and vessels at the genetic, ontogenetic, and phylogenetic levels.
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Affiliation(s)
- Stanislava Eisová
- Department of Anthropology and Human GeneticsCharles UniversityPragueCzech Republic
- Department of AnthropologyNational MuseumPragueCzech Republic
| | - Hana Píšová
- Department of Anthropology and Human GeneticsCharles UniversityPragueCzech Republic
| | - Petr Velemínský
- Department of AnthropologyNational MuseumPragueCzech Republic
| | - Emiliano Bruner
- Centro Nacional de Investigación sobre la Evolución HumanaBurgosSpain
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Champagne PO, Cayouette F, Lortie A, Decarie JC, Weil AG. Intracranial hypertension following sacrifice of occipital and marginal sinuses during posterior fossa decompression for Chiari I malformation: case report. J Neurosurg Pediatr 2018; 22:659-662. [PMID: 30239281 DOI: 10.3171/2018.7.peds18237] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Accepted: 07/10/2018] [Indexed: 11/06/2022]
Abstract
The occipital and marginal sinuses, when present, must be sacrificed in order to open the dura in most posterior fossa surgeries in the pediatric population, including posterior fossa decompression for Type I Chiari malformation (CM-I) with duraplasty. Apart from the immediate risk of hemorrhage, the voluntary occlusion of this structure is almost universally well tolerated. The authors report a case of intracranial hypertension following the sacrifice of occipital and marginal sinuses following posterior fossa decompression with duraplasty for CM-I. The specific draining pattern variant of the occipital and marginal sinuses leading to this complication as well as avoidance and management strategies of this condition are discussed.
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Affiliation(s)
| | | | | | - Jean-Claude Decarie
- 3Radiology, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montreal, Quebec, Canada
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Pettersson DR, McLouth JD, Addicott B, Pollock JM, Barajas RF. The Gibraltar Sign: An Anatomic Landmark for Predicting Transverse Sinus Dominance Laterality on Conventional MRI. J Neuroimaging 2017; 28:99-105. [PMID: 28722200 DOI: 10.1111/jon.12457] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 06/15/2017] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND AND PURPOSE Physiologic asymmetry of transverse sinus (TS) caliber is common and can lead to misinterpretation of magnetic resonance venography (MRV) studies of the brain. This retrospective study assesses the ability of multiple anatomic features on axial noncontrast T1-weighted images (T1WIs) of the brain to predict congenital TS dominance. METHODS One hundred consecutively acquired combined MRI-MRV studies of the brain were reviewed. On noncontrast axial T1WI, each reviewer measured (1) inclination of the groove for the superior sagittal sinus (SSS), (2) angulation of the posterior falx, (3) laterality of the SSS flow void, and (4) laterality of the inferior-most occipital lobe. TS cross-sectional area was measured on noncontrast sagittal 2-dimensional time-of-flight MRV images and served as the reference standard. RESULTS The bony groove for the SSS sloped down to the right in 65 of 100 patients and correctly predicted right TS dominance in 63 of 65 cases (97% positive predictive value [PPV]). The groove sloped down to the left in 24 of 100 patients and correctly predicted left TS dominance in 22 of 24 cases (92% PPV). Laterality of the SSS flow void, laterality of the inferior-most occipital lobe, and angulation of the posterior falx had 91% PPV, 82% PPV, and 74% PPV for predicting TS dominance, respectively. CONCLUSIONS Multiple anatomic features seen on conventional axial T1WI can be used to predict the laterality of congenital TS dominance and can help inform the interpretation of MRV studies of the brain.
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Affiliation(s)
- David R Pettersson
- Department of Radiology, Oregon Health & Science University, Portland, OR
| | - Joel D McLouth
- School of Medicine, Oregon Health & Science University, Portland, OR
| | - Benjamin Addicott
- Department of Radiology, Oregon Health & Science University, Portland, OR
| | - Jeffrey M Pollock
- Department of Radiology, Oregon Health & Science University, Portland, OR
| | - Ramon F Barajas
- Department of Radiology, Oregon Health & Science University, Portland, OR
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Tubbs RS, Demerdash A, Loukas M, Curé J, Oskouian RJ, Ansari S, Cohen-Gadol AA. Intracranial Connections of the Vertebral Venous Plexus: Anatomical Study with Application to Neurosurgical and Endovascular Procedures at the Craniocervical Junction. Oper Neurosurg (Hagerstown) 2017; 14:51-57. [DOI: 10.1093/ons/opx080] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 03/15/2017] [Indexed: 01/30/2023] Open
Abstract
Abstract
BACKGROUND
Descriptions of intracranial extensions of vertebral venous plexuses are lacking.
OBJECTIVE
To identify vertebral venous plexuses at the craniocervical junction in cadavers and describe them.
METHODS
The authors dissected 15 ink-injected, formalin-fixed, adult cadaveric heads and measured cranial extensions of the spinal venous plexuses.
RESULTS
All specimens had vertebral venous plexuses at the craniocervical junction composed of multiple interwoven vessels concentrated anteriorly (anterior vertebral plexuses), posteriorly (posterior vertebral venous plexuses), and laterally (lateral vertebral venous plexuses). Veins making up the plexus tended to be largest for the anterior internal vertebral venous plexus. On 33%, a previously unnamed lateral internal vertebral venous plexus was identified that connected to the lateral marginal sinus. The anterior external vertebral venous plexus connected to the basilar venous plexus via transclival emissary veins in 13%; remaining veins connected either intracranially via small perforating branches through the anterior atlanto-occipital membrane (33%) or had no direct gross connections inside the cranium (53%). The anterior internal vertebral plexus, which traveled between layers of the posterior longitudinal ligament, connected to the anterior half of the marginal sinus in 33% and anterolateral parts of the marginal sinus in 20%. The posterior internal venous plexus connected to the posterior aspect of the marginal sinus on 80% and into the occipital sinus in 13.3%. The posterior external venous plexus connected to veins of the hypoglossal canal in 20% and into the posterior aspect of the marginal sinus in 13.3%.
CONCLUSION
Knowledge of these connections is useful to neurosurgeons and interventional radiologists.
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Affiliation(s)
| | - Amin Demerdash
- Pediatric Neurosurgery, Children's of Alabama, Birmingham, Al-abama
| | - Marios Loukas
- Department of Anatomical Sci-ences, St. George's University, Grand Anse, Grenada
| | - Joel Curé
- Department of Neuro-radiology, University of Alabama, Birm-ingham, Alabama
| | | | - Shaheryar Ansari
- Goodman Campbell Brain and Spine, Indiana University Department of Neurological Surgery, Indianapolis, Indiana
| | - Aaron A Cohen-Gadol
- Goodman Campbell Brain and Spine, Indiana University Department of Neurological Surgery, Indianapolis, Indiana
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Kizmazoglu C, Lee JH, Sade B. Dominant Occipital Sinus Complicating Surgery of a Fourth Ventricular Mass. World Neurosurg 2017; 97:753.e17-753.e19. [DOI: 10.1016/j.wneu.2016.10.048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 10/05/2016] [Accepted: 10/07/2016] [Indexed: 11/26/2022]
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Shin HS, Choi DS, Baek HJ, Choi HC, Choi HY, Park MJ, Kim JE, Han JY, Park S. The oblique occipital sinus: anatomical study using bone subtraction 3D CT venography. Surg Radiol Anat 2016; 39:619-628. [DOI: 10.1007/s00276-016-1767-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 10/24/2016] [Indexed: 10/20/2022]
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Lasjaunias P, Magufis G, Goulao A, Piske R, Suthipongchai S, Rodesch R, Alvarez H. Anatomoclinical Aspects of Dural Arteriovenous Shunts in Children. Interv Neuroradiol 2016; 2:179-91. [DOI: 10.1177/159101999600200303] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/1996] [Accepted: 07/25/1996] [Indexed: 11/17/2022] Open
Abstract
We review 29 children (presenting between 1985–1996) with dural arteriovenous shunts. By analysing the anatomical features from axial and angiographic imaging and examining the clinical history and pathophysiological characteristics, we hypothesize that different diseases can be distinguished and divided into three groups: dural sinus malformation (DSM), infantile type of dural arteriovenous shunts (IDAVS) and adult type of dural arteriovenous shunts (ADAVS). It was helpful to classify these diseases when assessing the treatment options and long-term prognosis. Our group of 29 children comprised 19 DSM, 7 IDAVS, 3 ADAVS. A slight male preponderance was noted in the DSM group. The range of symptoms encountered included mild cardiac failure and coagulopathies, macro-crania, developmental delay, mental retardation, seizures and focal neurological deficits (in the neonates and early infancy age group) with or without haemorrhagic venous infarctions secondary to venous outlet restriction. We found all types of lesion in the neonatal age group, but in general the different types of lesion correspond to the paediatric subgroups with DSM occurring in the neonatal age group, IDAVS in infancy and ADAVS in children. DSMs are revealed in the first few months of live and the prognosis is good if the torcular is not involved. Two types can be seen: 1) DSM involving the posterior sinus with or without the confluens sinusum, with giant dural lakes and slow flow mural AV shunting. Spontaneous thrombosis may further restrict cerebral venous drainage and subsequently lead to intraparenchymatous haemorrhagic infarction. 2) DSM involving the jugular bulb with otherwise normal sinuses but associated with a high flow sigmoïd sinus AVF. The prognosis is excellent with embolisation treament. IDAVS are high flow and low pressure. The sinuses are large and patent with no lakes. Clinical onset is seen in the first few years of life and the shunts are initially well tolerated. Progressive symptoms (symptoms of raised ICP and venous ischaemia) develop at a later age and initially respond to partial embolisation. The long term prognosis is poor with neurological deterioration in early adulthood. ADAVS present in all age groups and almost all of them are located in the cavernous venous plexus. Post embolisation outcome is excellent.
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Affiliation(s)
| | | | - A. Goulao
- Neuroradiologie, Hospital Garcia de Orta; Almada, Portugal
| | - R. Piske
- Med Imagem, Hospital Beneficencia Portuguesa, Paraiso; Sao Paulo SP Brazil
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Morphologic Analysis of Occipital Sinuses for Occipital Screw Fixation Using Digital Subtraction Angiography. World Neurosurg 2016; 91:279-84. [PMID: 27108024 DOI: 10.1016/j.wneu.2016.04.038] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 04/12/2016] [Accepted: 04/12/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND Numerous methods to achieve occipitocervical stabilization have been described, including the use of occipital plate/screw constructs. Bicortical screws may increase the pullout strength, but intracranial injuries to venous sinuses have been reported. This study was performed to analyze the variations in occipital sinuses to prevent sinus injury caused by the bicortical screw. METHODS Occipital sinuses of 1720 patients were examined using digital subtraction angiography. The data collected included patient age and sex, occipital sinus type, distance between occipital sinus and midline, depth from inion to occipital sinus, and distance between occipital sinus and midline occiput at different levels. RESULTS The mean age of patients was 57 years ± 13. There were 807 (46.9%) men and 913 (53.1%) women. The most common occipital sinus type was single occipital sinus off-midline (type B2). The least common occipital sinus type was absent occipital sinuses (type A; 8.7% of patients). There was no significant difference between age and occipital sinus type (P = 0.310). Also, the difference between sexes was not significant in regard to occipital sinus type in general. However, in subgroup analysis of type B1 and B2, there was a significant difference between sexes (P < 0.01). The mean depth from bone to occipital sinus was 19.913 mm ± 7.437. CONCLUSIONS The occipital sinus shows several variations, and many morphologic differences can be seen. Preoperative detailed examination by magnetic resonance venography or vertebral angiography may be required for cases in which bicortical occipital screw fixation is necessary to avoid occipital sinus-related complications.
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20
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Occipital Sinus Thrombosis: An Exceptional Case Report. J Stroke Cerebrovasc Dis 2016; 25:e71-3. [PMID: 27036927 DOI: 10.1016/j.jstrokecerebrovasdis.2016.02.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 02/04/2016] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Variations of the dural venous sinuses may result in inaccurate imaging interpretation or complications during surgical approaches. One variation of the dural venous sinuses reported infrequently in the literature is the occipital sinus. We report an exceptional case of occipital sinus thrombosis. CASE REPORT A 48-year-old right-handed man with a 5-month history of hypertension and chronic renal failure presented with cephalalgia, vomiting, and blurred vision evolving over 48 hours. Neurological examination revealed papillary edema stage 1 with no others abnormalities. An initial brain computed tomography (CT) scan performed was normal. The opening pressure of cerebrospinal fluid (CSF) was 35 cmH2O with normal level of protein and no hypercellularity in CSF analysis. The evolution was marked by the occurrence of generalized tonic-clonic seizure. A second CT scan performed showed a hyperdensity of the occipital sinus. Magnetic resonance imaging and magnetic resonance venography studies confirmed the diagnosis with highlighting the thrombosis of the occipital sinus in association to an ectasia of the torcular. The patient received adequate anticoagulation for 6 months in association to antiepileptic drugs with a good evolution. DISCUSSION According to our review, such a thrombosis must be a rare condition, because our literature search has shown a lack of any report describing this condition. Herein, we review the anatomy of the occipital sinus and we illustrate the characteristics of this unusual thrombosis with multiple imaging modalities. CONCLUSION Understanding of the cerebral venous anatomy and recognition of venous variations essentially help when dealing with a pathology, which presents along with a particular venous variation, no matter how rare this combination is.
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Gaumont-Darcissac M, Viart L, Foulon P, Le Gars D, Havet E, Peltier J. [The occipital sinus: a radioanatomic study]. Morphologie 2015; 99:18-22. [PMID: 25660165 DOI: 10.1016/j.morpho.2015.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Revised: 12/18/2014] [Accepted: 01/05/2015] [Indexed: 06/04/2023]
Abstract
INTRODUCTION The aim of this study was to assess the presence of an occipital sinus in both children and adults, and to detail its main associated anatomical characteristics. METHODS One hundred of patients' MRI (3D T1 EG) between 0 and 86 years old were studied, in sagittal and axial sections, with the software DxMM. Occipital sinus length, perimeter, and cerebellar falx length measurements were performed with the software's tools. RESULTS Forty-three percent of patients had an occipital sinus (average perimeter was 3.02 mm, average length was 19.85 mm), and 23.26% of these patients had a cerebellar falx, 30.23% of these patients had one vein or more draining into the occipital sinus. Sixty-two percent of children had an occipital sinus (average perimeter was 2.87 mm, average length was 21.63 mm), and 29.03% of them had a cerebellar falx. Twenty-four percent of adults had an occipital sinus (average perimeter was 3.4mm, average length was 15.28 mm), and 8.33% of them had a cerebellar falx. CONCLUSION This work highlights a link between the age and the occipital sinus existence. The perimeter of this sinus seems to be superior for adults, but its length seems to be superior for children. A cerebellar falx with the occipital sinus was found more frequently for children.
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Affiliation(s)
- M Gaumont-Darcissac
- Laboratoire d'anatomie et d'organogenèse, faculté de médecine, 3, rue des Louvels, 80036 Amiens cedex 1, France.
| | - L Viart
- Laboratoire d'anatomie et d'organogenèse, faculté de médecine, 3, rue des Louvels, 80036 Amiens cedex 1, France
| | - P Foulon
- Laboratoire d'anatomie et d'organogenèse, faculté de médecine, 3, rue des Louvels, 80036 Amiens cedex 1, France
| | - D Le Gars
- Laboratoire d'anatomie et d'organogenèse, faculté de médecine, 3, rue des Louvels, 80036 Amiens cedex 1, France
| | - E Havet
- Laboratoire d'anatomie et d'organogenèse, faculté de médecine, 3, rue des Louvels, 80036 Amiens cedex 1, France
| | - J Peltier
- Laboratoire d'anatomie et d'organogenèse, faculté de médecine, 3, rue des Louvels, 80036 Amiens cedex 1, France
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Non-standard intracranial connections and alternative pathways between dural venous sinuses and cerebral veins in the rat. Anat Sci Int 2014; 90:172-9. [PMID: 24817648 DOI: 10.1007/s12565-014-0241-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Accepted: 04/21/2014] [Indexed: 10/25/2022]
Abstract
The aim of this study was to describe the uncommon intracranial venous connections and vein structures that may play a role in the redirection of cerebral blood drainage. The study was carried out on 35 adult Wistar rats. Corrosion casts were prepared from the cerebral venous system and Spofacryl® was used as a casting medium. The highest prevalence of non-standard connections and variations was noted in the region of sinus petrosus dorsalis (SPD) (31.2 %) and v. cerebri magna (VCM) (28.5 %). SPD established a non-standard anastomosis with sinus petrosus ventralis in 8.6 % of cases, with sinus interperiopticus in 2.8 % of cases, with sinus sigmoideus in 5.7 % of cases and with confluens sinuum (CS) in 2.8 % of cases, where higher prevalence was observed on the left side of the brain. In 11.4 % of cases VCM formed a secondary connection between CS and sinus rectus leading to the formation of the loop. In a similar manner, VCM entered the sinus transversus in 8.6 % of cases, while in 5.7 % of cases VCM merged with SPD and formed an unusual connection among dorsal and ventral systems of sinuses. Several sinuses were observed as inconsistent, including sinus occipitalis (14.3 %), sinus intercavernosus rostralis (22.8 %) and sinus interbasilaris (14.3 %). The hypoplastic posterior and anterior anastomotic vein did not reach one another in 20 % of observed cases. Anatomical information concerning different drainage pathways are important in preoperative planning and can provide necessary understanding in experimental studies, including cerebral vein occlusion, venous infarction, or experimentally induced cerebral venous obstruction.
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Raets MMA, Sol JJ, Govaert P, Lequin MH, Reiss IKM, Kroon AA, Appel IM, Dudink J. Serial Cranial US for Detection of Cerebral Sinovenous Thrombosis in Preterm Infants. Radiology 2013. [DOI: 10.1148/radiology.13130401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Raets MMA, Sol JJ, Govaert P, Lequin MH, Reiss IKM, Kroon AA, Appel IM, Dudink J. Serial cranial US for detection of cerebral sinovenous thrombosis in preterm infants. Radiology 2013; 269:879-86. [PMID: 23985276 DOI: 10.1148/radiol.13130401] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To report the incidence of cerebral sinovenous thrombosis (CSVT) in a prospective cohort of preterm infants with a gestational age of less than 29 weeks. MATERIALS AND METHODS The local medical ethics review board approved this study, and written parental consent was obtained. Preterm infants with a gestational age of less than 29 weeks who were admitted to the neonatal intensive care unit were prospectively studied with cranial ultrasonography (US). The scanning protocol included visualization with color Doppler imaging of the superior sagittal sinus and transverse sinuses through the anterior (8.5-MHz probe) and mastoid (13-MHz probe) fontanelles. When feasible, magnetic resonance imaging was performed to confirm cranial US-diagnosed CSVT. The differences between preterm infants with and those without CSVT were analyzed by using Mann-Whitney tests for continuous variables and Fisher exact tests for categorical data. RESULTS Cranial US was used to document CSVT in 11 of 249 preterm infants with a gestational age of less than 29 weeks. Transverse sinuses were most frequently affected (in all 11 patients with CSVT). All infants with CSVT were asymptomatic. Postnatal age at diagnosis ranged from 5 to 34 days. The mean gestational age was significantly lower in infants with CSVT (25.9 weeks vs 26.8 weeks, P = .038). Of the risk factors studied, only duration of mechanical ventilation was associated with CSVT; it was significantly longer in the CSVT group. CONCLUSION Systematic serial cranial US of infants with a gestational age of less than 29 weeks showed a remarkably high incidence of CSVT of 4.4%. Cranial US including color Doppler imaging with scans obtained through the mastoid fontanelle can depict CSVT at an early stage. Treatment of this possibly important condition needs attention.
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Affiliation(s)
- Marlou M A Raets
- From the Departments of Neonatology (M.M.A.R., J.J.S., P.G., I.K.M.R., A.A.K., J.D.), Pediatric Radiology (M.H.L., J.D.), and Hematology (I.M.A.), Erasmus MC-Sophia Children's Hospital Rotterdam, Dr Molewaterplein 60, 3015 GJ Rotterdam, the Netherlands; and Department of Pediatrics, Koningin Paola Children's Hospital, Antwerp, Belgium (P.G.)
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Torcular Herophili classification and evaluation of dural venous sinus variations using digital subtraction angiography and magnetic resonance venographies. Surg Radiol Anat 2013; 36:527-36. [DOI: 10.1007/s00276-013-1223-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Accepted: 10/14/2013] [Indexed: 10/26/2022]
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Kelly LP, Saindane AM, Bruce BB, Ridha MA, Riggeal BD, Newman NJ, Biousse V. Does bilateral transverse cerebral venous sinus stenosis exist in patients without increased intracranial pressure? Clin Neurol Neurosurg 2012; 115:1215-9. [PMID: 23219404 DOI: 10.1016/j.clineuro.2012.11.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2012] [Revised: 11/02/2012] [Accepted: 11/09/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Transverse cerebral venous sinus stenosis (TSS) is common among patients with idiopathic intracranial hypertension. TSS likely also exists among individuals with normal intracranial pressure (ICP) but the prevalence is unclear. The goal of this study was to identify patients with incidental TSS and normal ICP and describe their characteristics. METHODS Among 240 adult patients who underwent brain magnetic resonance imaging (MRI) with magnetic resonance venography (MRV) with contrast at our institution between September 2009 and September 2011, 44 had isolated TSS without further substantial imaging abnormality. Medical records were reviewed for symptoms of increased ICP, papilledema, cerebrospinal fluid (CSF) constituents and opening pressure (OP), and reason for brain imaging. Of these, 37 were excluded for confirmed or possible idiopathic intracranial hypertension. Of the remainder, 5 had CSF-OP≤25 cmH2O without papilledema, and 2 did not have measured ICP, but had no papilledema or symptoms of increased ICP. Imaging was re-interpreted to assess for signs suggestive of elevated ICP and to characterize the TSS further. RESULTS All patients were women (mean age: 41, mean BMI: 37.1). CSF contents were normal, but OPs were at the upper limit of normal (22-25 cmH2O). Indications for MRI/MRV included query pituitary abnormality (1), migraine (4), and anomalous-appearing optic nerves (2). All had bilateral TSS. Six had short TSS and an empty sella; 1 had long TSS and no empty sella; 1 had flattening of the posterior sclera; 2 had prominence of peri-optic nerve CSF. CONCLUSION Asymptomatic bilateral TSS exists in patients with ICP≤25 cmH2O, but is likely uncommon. CSF-OP was at the upper limit of normal in our patients, who also had other radiologic signs suggestive (but not specific) of chronically-raised ICP. Findings of bilateral TSS on imaging should prompt funduscopic examination for papilledema.
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Affiliation(s)
- Linda P Kelly
- Department of Ophthalmology, Emory University, Atlanta, GA 30322, USA
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Crescent posterior fossa durotomy for occipito-marginal venous sinus preservation: a pilot study. Acta Neurochir (Wien) 2012; 154:2115-21. [PMID: 22855072 DOI: 10.1007/s00701-012-1457-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Accepted: 07/17/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE The standard approach of midline suboccipital craniectomy entails sacrifice of the Occipito-marginal sinus. We have attempted to preserve this venous channel by using a durotomy technique which preserves this system. In a pilot study initiative, two groups of patients using this technique versus the standard approach, were compared in terms of per and post operative benefits, morbidity and complications. The literature with reference to the anatomy and venous flow dynamics of the occipital and marginal sinuses and their significance has been reviewed. Similarly, literature regarding dural closure technique with reference to postoperative complications has also been reviewed. METHODS In this novel approach, the dura is opened as a crescent to avoid damage to the occipital sinus. This technique was compared with the standard midline dural opening technique by random usage of both techniques in 24 patients. RESULTS The 'crescent' approach has been found to reduce the need for duroplasty, with comfortable primary closure and to reduce the risk of postoperative pseudomeningocele. CONCLUSIONS This is a novel dural opening technique which attempts to preserve the normal venous flow physiology. In essence it helps in increased primary dural closures and reduction of Pseudomeningiocele/CSF leak as well as blood loss and venous hypertension.
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Kathuria S, Chen J, Gregg L, Parmar HA, Gandhi D. Congenital Arterial and Venous Anomalies of the Brain and Skull Base. Neuroimaging Clin N Am 2011; 21:545-62, vii. [DOI: 10.1016/j.nic.2011.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Peña-Melián A, Rosas A, García-Tabernero A, Bastir M, De La Rasilla M. Paleoneurology of two new neandertal occipitals from El Sidrón (asturias, Spain) in the context of homo endocranial evolution. Anat Rec (Hoboken) 2011; 294:1370-81. [PMID: 21714107 DOI: 10.1002/ar.21427] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2010] [Accepted: 04/21/2011] [Indexed: 11/10/2022]
Abstract
The endocranial surface description and comparative analyses of two new neandertal occipital fragments (labelled SD-1149 and SD-370a) from the El Sidrón site (Asturias, Spain) reveal new aspects of neandertal brain morphological asymmetries. The dural sinus drainage pattern, as observed on the sagittal-transverse system, as well as the cerebral occipito-petalias, point out a slightly differential configuration of the neandertal brain when compared to other Homo species, especially H. sapiens. The neandertal dural sinus drainage pattern is organized in a more asymmetric mode, in such a way that the superior sagittal sinus (SSS) drains either to the right or to the left transverse sinuses, but in no case in a confluent mode (i.e. simultaneous continuation of SSS with both right (RTS) and left (LTS) transverse sinuses). Besides, the superior sagittal sinus shows an accentuated deviation from of the mid-sagittal plane in its way to the RTS in 35% of neandertals. This condition, which increases the asymmetry of the system, is almost nonexistent neither in the analyzed Homo fossil species sample nor in that of anatomically modern humans. Regarding the cerebral occipito-petalias, neandertals manifest one of the lowest percentages of left petalia of the Homo sample (including modern H. sapiens). As left occipito-petalia is the predominant pattern in hominins, it seems as if neandertals would have developed a different pattern of brain hemispheres asymmetry. Finally, the relief and position of the the cerebral sulci and gyri impressions observed in the El Sidrón occipital specimens look similar to those observed in modern H. sapiens.
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Affiliation(s)
- Angel Peña-Melián
- Departamento de Anatomía y Embriología Humana I, Facultad de Medicina, Universidad Complutense de Madrid, Spain
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Tubbs RS, Bosmia AN, Shoja MM, Loukas M, Curé JK, Cohen-Gadol AA. The oblique occipital sinus: a review of anatomy and imaging characteristics. Surg Radiol Anat 2011; 33:747-9. [DOI: 10.1007/s00276-011-0831-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2011] [Accepted: 05/16/2011] [Indexed: 10/18/2022]
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Anatomical evaluation of the dural sinuses in the region of the torcular herophili using three dimensional CT venography. Acad Radiol 2010; 17:1103-11. [PMID: 20619699 DOI: 10.1016/j.acra.2010.04.020] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2010] [Revised: 04/22/2010] [Accepted: 04/22/2010] [Indexed: 11/21/2022]
Abstract
RATIONALE AND OBJECTIVES The torcular herophili, or "confluence of the sinuses," shows various configurations with other venous sinuses, as revealed by angiography. The aims of this study were to evaluate anatomic variations of this confluence and to assess their clinical relevance using three-dimensional (3D) computed tomographic (CT) venography. MATERIALS AND METHODS The torcular herophili and its relevant venous sinuses were analyzed using 3D CT venography in 120 adults, consisting of 76 patients who were proven to have aneurysms and 44 patients who were proven to have no vascular malformations or aneurysms after the examinations. Three-dimensional CT venography was performed following the arterial phase of 3D CT angiography without any additional injection of contrast material. Three-dimensional volume-rendered venous images were reconstructed on a workstation and reviewed. RESULTS The superior sagittal sinus (SSS) drained into the transverse sinus (TS) in four patterns: the SSS reached the centrally located confluence, where it divided into the bilateral TS (20.0%); the SSS was prematurely duplicated into the right and left limbs and drained into the same side TS (26.7%); the SSS drained exclusively into the right TS (44.2%); or the SSS drained exclusively into the left TS (9.2%). The draining pattern of the straight sinus was also classified into four types. The right TS was larger than the left TS. The right TS were higher compared to the left TS. Persistent occipital sinuses were recognized in 57.5% of the subjects. Finally, persistent falcial sinuses were seen in 2.5% of the subjects. A septum in the SSS and complicated venous channels in the confluence were each seen in only one case. CONCLUSION Three-dimensional CT venography is useful as a noninvasive method to evaluate the confluence and its relevant dural sinuses and can provide useful information for surgical intervention.
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Hamnett NTJ, Ogungbo B, Nahser H, Javadpour M. Anomalous cerebral venous sinus drainage. Br J Neurosurg 2010; 24:497-8. [DOI: 10.3109/02688697.2010.489657] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Balak N, Ersoy G, Uslu Ü, Tanriöver N, Tapul L, Çetin G, Işik N, Elmaci I. Microsurgical and histomorphometric study of the occipital sinus: Quantitative measurements using a novel approach of stereology. Clin Anat 2010; 23:386-93. [DOI: 10.1002/ca.20947] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Abstract
The outermost centimeter of the head contains multiple layers ranging from the skin to the meninges. The venous drainage of this region is complex and with wide anatomical variation. With advances in imaging techniques, delineation of this venous system has become better appreciated. Understanding the anatomy of the superficial venous system is fundamental in being able to differentiate pathology from normal variants and structures. This review aims to characterize the basic venous architecture of the first centimeter. In addition, it hopes to give an introduction to and examples of the methods employed to image it.
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Affiliation(s)
- Neel Patel
- Department of Radiology, John Radcliffe Hospital, Oxford, United Kingdom.
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Kopuz C, Aydin ME, Kale A, Demir MT, Corumlu U, Kaya AH. The termination of superior sagittal sinus and drainage patterns of the lateral, occipital at confluens sinuum in newborns: clinical and embryological implications. Surg Radiol Anat 2010; 32:827-33. [PMID: 20182724 DOI: 10.1007/s00276-010-0628-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2009] [Accepted: 01/22/2010] [Indexed: 11/28/2022]
Abstract
Drainage patterns of dural venous sinuses at confluens sinuum are variable and clinically significant. It has been generally investigated in adults; however, we thought that neonatal cadaver study might be more informative in views of embryological and clinical. A total of 33 skull bases of neonatal cadavers were resected to identify termination patterns of lateral sinus (LS), superior sagittal sinus (SSS) and occipital sinus (OS) at the confluens sinuum. Termination patterns of these sinuses were classified into six types: the SSS showed continuity with right transverse sinus (TS) (with OSs) (30.3%) (Type I); or multiple OSs (21.2%) (Type II). The SSS continued with left TS (with OSs) (12.1% (Type III); or with multiple OSs (6.1%) (Type IV). The SSS shows continuity with both TS (9.1%) (Type V). SSS symmetrically bifurcated, the confluens sinuum has a large OS (21.2%) (Type VI). Understanding of the cerebral venous drainage and large variation of the posterior fossa dural sinuses is crucially important for planning surgical intervention to some tumors in the neck which may require ligation of the internal jugular vein.
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Affiliation(s)
- Cem Kopuz
- Department of Anatomy, Faculty of Medicine, Ondokuz Mayis University, Körfez Mah. Atatürk Bulvari No:112, Kurupelit, Samsun, Turkey.
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La Montanara P, Crisi G. MRA Evidence of Superior Sagittal Sinus — Torcular Herophili Divisions in a New Type of Occipital Sinus. Neuroradiol J 2009; 22:378-80. [DOI: 10.1177/197140090902200402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2009] [Accepted: 08/07/2009] [Indexed: 11/15/2022] Open
Abstract
We describe a new type of occipital sinus: absence (or hypoplasy) of the right transverse sinus, patent right sigmoid sinus and a well formed left occipital sinus draining into the left marginal sinus. The lateral and occipital sinus variations were classified into five groups by Kalbag. This classification was modified in 1980 by Dora and Zileli. We speculate on the possible MRA evidence of “divisions” of the superior sagittal sinus (SSS), as reported by Shao et Al (2009) who examined the lumen of the SSS and torcular Herophili with the aid of an endoscope.
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Affiliation(s)
- P. La Montanara
- Department of Radiology, University of Parma, Ospedale Civile Maggiore; Parma, Italy
| | - G. Crisi
- Institute of Radiology, Parma University Hospital; Parma, Italy
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Connor SEJ, Siddiqui MA, Stewart VR, O'Flynn EAM. The relationship of transverse sinus stenosis to bony groove dimensions provides an insight into the aetiology of idiopathic intracranial hypertension. Neuroradiology 2008; 50:999-1004. [PMID: 18622602 DOI: 10.1007/s00234-008-0431-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2008] [Accepted: 06/25/2008] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Transverse sinus tapered narrowings are frequently identified in patients with idiopathic intracranial hypertension (IIH); however, it remains unclear whether they are primary stenoses or whether they occur secondary to raised cerebrospinal fluid pressure. Computed tomographic venography demonstrates both the morphology of the venous system and the adjacent bony grooves so it may provide an insight into the aetiology of these transverse sinus stenoses. MATERIALS AND METHODS Tapered transverse sinus narrowings (>50%) were studied in 19 patients without IIH and 14 patients with IIH. Computed tomography vascular studies were reviewed and the dimensions of the venous sinuses and bony grooves at the sites of maximum and minimum transverse sinus area dimensions were recorded. RESULTS There was demonstrated to be a strong correlation of bony groove height with venous sinus height at the largest portions of the transverse sinus in both IIH patients and non-IIH subjects as well as at the transverse sinus narrowing in non-IIH subjects. There was a discordant relationship between bony groove height and venous sinus height at the site of transverse sinus stenoses in IIH patients. In 5/23 IIH transverse sinus stenoses, the bony groove height was proportionate to that seen in non-IIH subjects. There were a further 8/23 cases where the small or absent sinus was associated with an absent bony groove. CONCLUSION Transverse sinus tapered narrowings in subjects without IIH and in the majority of patients with IIH were associated with proportionately small or absent grooves, and these are postulated to be primary or fixed. Some patients with IIH demonstrate tapered transverse sinus stenoses with disproportionately large bony grooves, suggesting a secondary or acquired narrowing. This implies a varied aetiology for the transverse sinus stenoses of IIH.
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Affiliation(s)
- S E J Connor
- Neuroradiology Department, Ruskin Wing, King's College Hospital, Denmark Hill, London, UK.
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Rosas A, Peña-Melián A, García-Tabernero A, Bastir M, De La Rasilla M, Fortea J. Endocranial Occipito-Temporal Anatomy of SD-1219 from the Neandertal El Sidrón Site (Asturias, Spain). Anat Rec (Hoboken) 2008; 291:502-12. [DOI: 10.1002/ar.20684] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Kobayashi K, Suzuki M, Ueda F, Matsui O. Anatomical study of the occipital sinus using contrast-enhanced magnetic resonance venography. Neuroradiology 2006; 48:373-9. [PMID: 16758154 DOI: 10.1007/s00234-006-0087-y] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2004] [Accepted: 04/30/2005] [Indexed: 11/29/2022]
Abstract
The frequency and anatomical features of the occipital sinus (OS) were analyzed in this study by contrast-enhanced magnetic resonance venography (MRV) with enhanced fast gradient echo three-dimensional (EFGRE3D) and we discuss the clinical usefulness of this method. The study included 555 patients who underwent contrast-enhanced MRV with EFGRE3D, and maximum intensity projection (MIP), multiplanar reformation (MPR) and multiprojection volume reconstruction (MPVR) images were obtained for the regions of interest. The frequency, size and communication of the OS with other vessels were assessed. The OS was identified in 209 of the 555 patients (37.7%). There were no statistically significant sex-related differences. The OS was observed less frequently in subjects younger than 50 years. Cranially and/or caudally, some OS were separated and communicated with multiple vessels. In five patients, the straight sinus (StS) communicated directly with the OS and not with the other sinuses; in two patients, the StS communicated with veins other than the OS only via small anastomotic veins. Many morphological differences in the OS can be seen. In addition, some OS function as the main drainage route of the intracranial veins instead of the transverse sinus or sigmoid sinus. In addition to MIP, detailed examination by MPR and MPVR is required for the preoperative evaluation of posterior cranial fossa lesions.
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Affiliation(s)
- Keiko Kobayashi
- Department of Radiology, Kanazawa University School of Medicine, Kanazawa, Ishikawa, Japan.
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Abstract
Object
Descriptions of the marginal venous sinus are lacking in the extant medical literature. The aim of this study was to characterize the anatomy of this intracranial venous sinus.
Methods
The authors examined the marginal sinuses in 15 adult cadavers following the injection of latex into the intracranial venous system. The maximal vertical height of the sinuses, which ranged from 7 to 15 mm (mean 10 mm), was located at the lateral aspect of the foramen magnum at or near the region at which the spinal accessory nerve crossed en route to the jugular foramen. In all specimens the sinus tapered as it traveled both anteriorly and posteriorly. Ninety-three percent of the specimens demonstrated significant drainage into the veins of the hypoglossal canal. The hypoglossal nerve rootlets pierced the sinus and its tributaries in 11 (73%) of 15 specimens. The marginal sinus communicated with the basilar venous plexus in 12 (80%) of 15 specimens and with the occipital sinus in all specimens (100%). There was venous communication with the sigmoid sinus in all specimens. The vertebral artery coursed through the marginal sinus as it pierced the posterior atlantooccipital membrane in all left sides and in 87% of the right sides.
Conclusions
These quantitative data will be useful to the neurosurgeon who operates in the region of the marginal sinus.
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Affiliation(s)
- R Shane Tubbs
- Department of Cell Biology and Division of Neurosurgery, University of Alabama at Birmingham, USA.
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Singh M, Nagashima M, Inoue Y. Anatomical variations of occipital bone impressions for dural venous sinuses around the torcular Herophili, with special reference to the consideration of clinical significance. Surg Radiol Anat 2004; 26:480-7. [PMID: 15290106 DOI: 10.1007/s00276-004-0269-4] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Venous blood flow through the cerebral dural sinus is variable and clinically significant. It has been investigated by cadaver dissection or radiology; however, we thought that osteology might be informative. A total of 160 dried skulls were macroscopically examined for impressions on the inner surface of the occipital bone in order to interpret the sinus flow around the torcular Herophili. The continuity between the grooves for the superior sagittal sinus (SSS) and the transverse sinuses was categorized into four types. Confluence type was noted in 56 specimens (35%), in which SSS drained into a common pool of venous sinuses. Bifurcation type was noted in 22 cases (14%), in which SSS was divided to drain into the bilateral transverse sinuses. Right dominant type was the most frequent one with 66 cases (41%), in which SSS drained only into the right transverse sinus. Left dominant type was the least frequent one with 16 cases (10%), in which SSS drained to the left, in a mirror image to the right dominant type. Clinical significance is discussed with our preliminary trial for the optimization of the inner skull surface and venous flow using computed tomography and magnetic resonance imaging, and demonstration of cerebrovascular disease.
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Affiliation(s)
- M Singh
- Department of Anatomy, Institute of Medical Sciences, Bananas Hindu University, 221-005 Vanarasi, India
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Sekhar LN, Tzortzidis FN, Bejjani GK, Schessel DA. Saphenous vein graft bypass of the sigmoid sinus and jugular bulb during the removal of glomus jugulare tumors. Report of two cases. J Neurosurg 1997; 86:1036-41. [PMID: 9171186 DOI: 10.3171/jns.1997.86.6.1036] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Glomus jugulare tumors always invade the jugular bulb and sigmoid sinus, making it difficult to resect these tumors totally without sacrificing the involved sinus. Although the sinus can be sacrificed safely in most patients, a few patients will have serious consequences. Reconstruction of the jugular bulb using a saphenous vein graft may enable tumor resection in these patients without complications. The authors describe two cases of saphenous vein grafting used to bypass the sigmoid sinus. The first case is that of a 61-year-old man with a glomus jugulare tumor that invaded the dominant sigmoid sinus, which was poorly collateralized. Temporary occlusion of the sinus during surgery caused a 15-mm Hg increase in intrasinus pressure, without brain swelling or changes in evoked potentials. A saphenous vein graft was used to bypass the sigmoid sinus and jugular bulb and to allow for total tumor removal. The patient had a good outcome. The second case is that of a 41-year-old man with a left glomus jugulare tumor and another smaller tumor on the opposite, dominant sinus. The left glomus jugulare tumor was resected via a two-stage procedure. A saphenous vein graft was used to reconstruct the left sigmoid sinus because of the presence of contralateral disease, with the potential for bilateral sigmoid sinus occlusion. An evaluation of the venous collateral circulation during jugular foramen surgery and the prevention of complications are also discussed.
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Affiliation(s)
- L N Sekhar
- Department of Neurological Surgery, George Washington University Medical Center, Washington, DC 20037, USA
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Lasjaunias P, Manelfe C, Chiu M. Angiographic architecture of intracranial vascular malformations and fistulas--pretherapeutic aspects. Neurosurg Rev 1986; 9:253-63. [PMID: 3614684 DOI: 10.1007/bf01743632] [Citation(s) in RCA: 68] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
The authors describe the angio-architecture of intracranial vascular malformations. Several patterns can be identified thanks to the intracranial superselective angiograms that can now be performed. Schematically, the following features can be seen: direct arterial supply, indirect arterial supply, flow-related arterial ectasia (aneurysm), dysplastic aneurysm, direct arteriovenous fistula, intralesional arterial ectasia (aneurysm), intralesional venous ectasia (aneurysm), venous ectasia. Each of these elementary arrangements are illustrated and their clinical significance outlined whenever possible. Finally, the dural AVM drainage into the cortical venous system serves as an almost experimental model for the appreciation of the role played by the venous congestive phenomenon in brain AVM symptoms.
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Lasjaunias P, Chiu M, ter Brugge K, Tolia A, Hurth M, Bernstein M. Neurological manifestations of intracranial dural arteriovenous malformations. J Neurosurg 1986; 64:724-30. [PMID: 3701421 DOI: 10.3171/jns.1986.64.5.0724] [Citation(s) in RCA: 403] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The authors describe their experience with four cases of dural arteriovenous malformation (AVM) which led them to analyze the clinical aspects of these lesions in an attempt to understand their pathophysiology. An additional 191 previously reported cases of dural AVM's were reviewed with special attention to the mechanism of intradural, central, and peripheral nervous system manifestations. Apart from the peripheral cranial nerve symptoms, which are most likely due to arterial steal, the central nervous system (CNS) symptoms appear to be related to passive venous hypertension and/or congestion. Generalized CNS symptoms can be related to cerebrospinal fluid malabsorption due either to increased pressure in the superior sagittal sinus, to venous sinus thrombosis, or to meningeal reaction resulting from minimal subarachnoid hemorrhages. These phenomena are not related to the anatomical type of venous drainage. On the other hand, focal CNS symptoms are specifically indicative of cortical venous drainage. Seizures, transient ischemic attacks, motor weakness, and brain-stem and cerebellar symptoms can be encountered depending on the territory of the draining vein or veins. Therefore, the localizing value of focal CNS symptomatology relates to the venous territory and not to the nidus or to the arterial supply characteristics of dural AVM's. Furthermore, the venous patterns of various dural AVM's at the base of the skull are expressed by differences in their clinical presentation. Dural AVM's of the floor of the anterior cranial fossa and of the tentorium are almost always drained by the cortical veins and, therefore, have a high risk of intradural bleeding. The remarkable similarities in the manifestations of dural and brain AVM's and the differences in the manifestations of dural and spinal dural AMV's are pointed out. High-quality angiograms and a multidisciplinary approach to the study of dural AVM's will provide the best understanding of their symptoms and, therefore, the most appropriate treatment strategy.
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Sainte-Rose C, LaCombe J, Pierre-Kahn A, Renier D, Hirsch JF. Intracranial venous sinus hypertension: cause or consequence of hydrocephalus in infants? J Neurosurg 1984; 60:727-36. [PMID: 6707742 DOI: 10.3171/jns.1984.60.4.0727] [Citation(s) in RCA: 166] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
From a previous study of achondroplasia as well as from the observation of patients with hydrocephalus associated with craniostenosis, the authors have concluded that an increased superior sagittal sinus venous pressure (SSVP) could be the cause of the enlarged ventricles. However, other workers have demonstrated that an increased SSVP could be the consequence of increased intracranial pressure (ICP). Therefore, the authors undertook a study to determine if there was a physiological test that could distinguish between rare instances of increased SSVP caused by structural and irreversible narrowing of the sinus and those caused by increased ICP. In 20 hydrocephalic infants and children, pressure was simultaneously measured in the lateral ventricle, the superior sagittal sinus, and the jugular vein. Stable baseline pressures were recorded, as well as the variations observed after the withdrawal of an amount of cerebrospinal fluid (CSF) sufficient to lower ICP to zero. Similar recordings were taken after reinjection of an equal quantity of CSF. In all of the patients, SSVP was increased, but not as much as the ICP. In the cases of hydrocephalus without any associated cranial malformation, and therefore without any likely anatomical interruption of the sinus, CSF withdrawal induced a simultaneous decrease of ICP and SSVP. However, whereas ICP could be lowered to zero, SSVP never fell below the jugular venous pressure, which remained stable (around 5 mm Hg) throughout the recording session. Results were different when sinography demonstrated an anatomical interruption of the sinus, as in cases of hydrocephalus associated with achondroplasia or craniostenosis. In these cases, although ICP was normally lowered by CSF withdrawal, SSVP remained nearly unchanged, usually greater than the jugular venous pressure. The present study demonstrated that SSVP recording during ICP variations induced by CSF withdrawal permits differentiation between a reversible collapse of the sigmoid sinus due to increased ICP and a fixed obstructive lesion of the sinuses. Based upon this test and the results of sinography, the authors inserted a venous bypass between the lateral sinus and a jugular vein in three patients.
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