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Benson JC, Hamilton-Cave M, Carr CM, Lane JI. Prevalence of intra-osseous veins and venous lakes in the posterior skull base on 3T MRI. Neuroradiol J 2023; 36:702-706. [PMID: 37382936 PMCID: PMC10649541 DOI: 10.1177/19714009231187350] [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] [Indexed: 06/30/2023] Open
Abstract
BACKGROUND Intra-osseous vessels are normal anatomic structures in the calvarium and skull base. On imaging, these structures-particularly venous lakes-can mimic pathologic abnormalities. This study sought to assess the prevalence of veins and lakes in the skull base on MRI. MATERIALS AND METHODS A retrospective review was completed of consecutive patients that underwent contrast-enhanced MRI imaging of the internal auditory canals. The clivus, jugular tubercles, and basio-occiput were assessed for the presence of both intra-osseous veins (serpentine and/or branching vessels) and venous lakes (well-circumscribed round or oval enhancing structures). Vessels in the adjacent synchondroses major foramina were excluded. Three board-certified neuroradiologists performed independent blinded reviews, with discrepancies agreed upon by consensus. RESULTS 96 patients were included in this cohort (58.3% female). Mean age was 58.4 years (range = 19-85). At least one intra-osseous vessel was identified in 71 (74.0%) patients. 67 (70.0%) had at least one skull base vein, and 14 (14.6%) had at least one venous lake. Both vessel subtypes were observed in 8.3% of patients. Vessels were more commonly observed in women, though this did not reach statistical threshold (p = 0.56). Age was not associated with the presence of vessels (0.59) or vessel location (p values ranged from 0.44-0.84). CONCLUSIONS Intra-osseous skull base veins and venous lakes are relatively common findings on MRI. Both vascular structures should be considered normal anatomy, and care should be taken to not confuse these for pathologic entities.
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Affiliation(s)
- John C Benson
- Department of Radiology, Mayo Clinic, Rochester, MN USA
| | | | - Carrie M Carr
- Department of Radiology, Mayo Clinic, Rochester, MN USA
| | - John I Lane
- Department of Radiology, Mayo Clinic, Rochester, MN USA
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Tucci M, Chaiyamoon A, Suwannakhan A, Cardona JJ, Comert A, Iwanaga J, Dumont AS, Tubbs RS. A Novel Direct Pathway of Dural Venous Outflow from the Basilar Venous Plexus via the Diploic Space of the Clivus. World Neurosurg 2023; 175:e1182-e1185. [PMID: 37121502 DOI: 10.1016/j.wneu.2023.04.093] [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: 03/29/2023] [Accepted: 04/21/2023] [Indexed: 05/02/2023]
Abstract
BACKGROUND The internal jugular vein (IJV) is the pre-eminent outflow of the dural venous sinuses (DVS) in the supine position, while the vertebral venous plexus (VVP) dominates venous outflow in the upright position. Emissary veins can also be an accessory pathway for this venous egress. To our knowledge, alternative dural venous sinus directly drainage via the diploic space has not been previously reported in the literature. METHODS Ten fresh frozen adult cadavers underwent exposure of the basilar venous plexus. The entire plexus, still adhered to the underlying clivus, was removed with its underlying bone and submitted for histological examination following decalcification (Masson Trichrome, 5 μm slices). RESULTS All specimens were found to have direct communication between the basilar venous plexus and underlying diploic space of the clivus i.e., no intermediate clival emissary vein. These were concentrated near the midline and were more numerous over the clivus near the junction of the occipital and sphenoid bones. The endothelium of the venous sinus was continuous at the opening into the diploic space and these openings ranged in size from 500 to 750 μm (mean 650 μm). CONCLUSIONS An improved understanding of the cerebral venous drainage can assist clinicians and surgeons in recognizing normal, pathologic, and variant anatomy in this region. Based on our study, direct venous sinus (DVS) to diploic space drainage offers an additional pathway for venous egress from the intracranium. Therefore, removal of the dura over the clivus during various skull base procedures might be associated with increased venous bleeding from the basilar venous plexus on its deep surface where it interfaces with the clivus.
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Affiliation(s)
- Marissa Tucci
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Arada Chaiyamoon
- Department of Anatomy, Faculty of Medicine, Khon Kaen, Thailand.
| | - Athikhun Suwannakhan
- Department of Anatomy, Faculty of Science, Mahidol University, Bangkok, Thailand; In Silico and Clinical Anatomy Research Group (iSCAN), Bangkok, Thailand
| | - Juan J Cardona
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Ayhan Comert
- Department of Anatomy, School of Medicine, Ankara University, Ankara, Turkey
| | - Joe Iwanaga
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, LA, USA; Department of Neurology, Tulane University School of Medicine, New Orleans, LA, USA; Department of Structural & Cellular Biology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Aaron S Dumont
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - R Shane Tubbs
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, LA, USA; Department of Neurology, Tulane University School of Medicine, New Orleans, LA, USA; Department of Structural & Cellular Biology, Tulane University School of Medicine, New Orleans, LA, USA; Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA; Department of Anatomical Sciences, St. George's University, St. George's, Grenada; Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, LA, USA; University of Queensland, Brisbane, Australia
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Ventral Clival Branch of the Ascending Pharyngeal Artery as a Transosseous Feeder of an Arteriovenous Fistula Surrounding the Clival Lesions. Clin Neuroradiol 2022; 33:467-474. [DOI: 10.1007/s00062-022-01232-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 10/13/2022] [Indexed: 12/12/2022]
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Evaluating diploic vein blood flow using time-resolved whole-head computed tomography angiography and determining the positional relationship between typical craniotomy approaches and diploic veins in patients with meningioma. Acta Neurochir (Wien) 2022; 164:2999-3010. [PMID: 36006508 DOI: 10.1007/s00701-022-05349-w] [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: 07/22/2022] [Accepted: 08/18/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Diploic veins may act as collateral venous pathways in cases of meningioma with venous sinus invasion. Diploic vein blood flow should be preoperatively evaluated to consider preserving the veins. In this study, we evaluated the use of time-resolved whole-head computed tomography angiography (4D-CTA)-which is less patient-intensive than digital subtraction angiography (DSA)-for assessing diploic vein blood flow and the positional relationship between typical craniotomy approaches and diploic veins. METHODS We retrospectively examined 231 patients who underwent surgery for intracranial meningioma. We performed contrast-enhanced magnetic resonance imaging (MRI) to evaluate diploic vein pathways and compared the visualization rates of diploic vein blood flow assessed using 4D-CTA and DSA. Subsequently, we evaluated the rates of the diploic veins transected during craniotomy by comparing the pre- and postoperative contrast-enhanced MRI. RESULTS The diagnostic performance of 4D-CTA was assessed in 45 patients. Of the 320 diploic veins identified in these patients, blood flow in 70 (21.9%) diploic veins was identified by 4D-CTA and DSA, and both results were consistent. To assess the transection rates of the diploic veins, 150 patients were included. A trend towards a high transection rate of the diploic vein in the basal interhemispheric, frontotemporal, orbitozygomatic, combined transpetrosal, and convexity craniotomy approaches was observed. CONCLUSIONS In patients with meningiomas, both 4D-CTA and DSA are useful in evaluating diploic vein blood flow. In meningiomas with venous sinus invasion, determining the extent of craniotomy after understanding the pathways and blood flow of diploic veins is recommended.
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Extracranial prevertebral venous network of the craniocervical junction: CT-digital subtraction venography analysis. Neuroradiology 2022; 64:2227-2233. [PMID: 35596067 DOI: 10.1007/s00234-022-02980-3] [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: 02/16/2022] [Accepted: 05/12/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Although the craniocervical junction has a complex anatomical structure associated with clinical diseases, its ventral venous network has not been well studied. This study aimed to clarify the extracranial ventral venous structure at the craniocervical junction. METHODS Head computed tomography digital subtraction venography (CT-DSV) images of 273 patients (age 6 months to 93 years) taken at our department were retrospectively analyzed. We analyzed the frequency and anatomical features of the venous channels, as well as their upstream and downstream connections with the surrounding channels at the ventral craniocervical junction, from the level of the hypoglossal canal to the second cervical vertebra. RESULTS In 54% of the cases, the vein descended from the anterior condylar confluence, running medially along the basioccipital and fusing with its counterpart in the midline at the level of the atlanto-occipital membrane. Furthermore, 24% of this vein was connected caudally to the anterior external vertebral venous plexus. We also identified venous channels, either as a sole vein or venous plexus, on the tip of the odontoid process (10%), which has not been well described previously. The vein around the odontoid process was connected to several veins, including the aforementioned vein anterior to the condyle and the anterior internal vertebral venous plexus. CONCLUSIONS CT-DSV analysis revealed a detailed venous architecture ventral to the craniocervical junction. Venous structures identified in this study may be involved in diseases in this area.
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Imai R, Mizutani K, Akiyama T, Horiguchi T, Takatsume Y, Toda M. Imaging of the venous plexus of Rektorzik using CT-digital subtraction venography: a retrospective study. Neuroradiology 2022; 64:1961-1968. [PMID: 35449478 DOI: 10.1007/s00234-022-02962-5] [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: 02/10/2022] [Accepted: 04/13/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE The venous plexus of Rektorzik (VPR), first described by Rektorzik in 1858, is a venous plexus around the internal carotid artery in the carotid canal. However, the VPR has never been investigated using the recently developed imaging modalities. In this study, we analyzed the VPR using computed tomography-digital subtraction venography (CT-DSV). METHODS This study included 253 patients who had undergone head CT-DSV. The presence or absence of the right and left VPRs and their connecting veins were visually examined by two researchers. RESULTS The VPR was observed in 60 patients (24%), 39 of which showed VPR only on the right side, 10 only on the left side, and 11 on both sides. VPR was significantly more common on the right side (p = 0.0002) and was observed more frequently around the horizontal segment of the internal carotid artery than around the vertical segment. The most common veins identified as distal and proximal VPR connections were the cavernous sinus (63/71, 89%) and the anterior condylar confluence (27/71, 38%), respectively. The mean age was significantly lower in patients with the VPR than in those without (53 vs. 57 years, p = 0.02). CONCLUSION The VPR was significantly more frequent on the right side and in younger patients but was not a radiographically constant structure. In most cases, the VPR connected the cavernous sinus and anterior condylar confluence. Preoperative evaluation of VPR may lead to refined surgical procedures.
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Affiliation(s)
- Ryotaro Imai
- Department of Neurosurgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Katsuhiro Mizutani
- Department of Neurosurgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan.
| | - Takenori Akiyama
- Department of Neurosurgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Takashi Horiguchi
- Department of Neurosurgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Yoshifumi Takatsume
- Department of Anatomy, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Masahiro Toda
- Department of Neurosurgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan
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Couldwell MW, Jackson N, Wysiadecki G, Keen J, Iwanaga J, Delashaw J, Dumont AS, Tubbs RS. Transosseous Veins of the Temporal Bone: Connection Between Middle and Posterior Cranial Fossa Venous Structures. World Neurosurg 2021; 155:e824-e829. [PMID: 34520867 DOI: 10.1016/j.wneu.2021.09.024] [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: 08/03/2021] [Revised: 09/04/2021] [Accepted: 09/06/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND The veins and dural venous sinuses of the skull base are important to understand in terms of imaging findings, diagnoses, and surgery. However, to date and to the best of our knowledge, the transosseous veins of the petrous part of the temporal bone have not been studied. METHODS Ten latex-injected adult cadaveric specimens (20 sides) were dissected to identify the intraosseous and transosseous veins. The petrous part of the temporal bone was drilled away, and the petrous part of the internal carotid artery and the veins of the middle and posterior cranial fossa adjacent to the petrous part of the temporal bone were exposed. RESULTS Transosseous veins traveling through the petrous part of the temporal bone were identified on all 20 sides. In general, these were most concentrated near the anterior and posterior parts of the petrous part of the temporal bone. Most traveled more or less vertically from the petrous ridge and related superior petrosal sinus internally through the petrous part of the temporal bone toward the inferior petrosal sinus or horizontally, uniting the veins of the floor of the middle cranial fossa with the veins of the posterior cranial fossa. These transosseous veins connected the veins in the middle cranial fossa with the veins of the posterior cranial fossa. Most (70%) of these transosseous veins were also found to have small connections to the internal carotid venous plexus. CONCLUSIONS To the best of our knowledge, previous studies have not reported on transosseous veins of the temporal bone or described their anatomy of connecting the veins of the middle and posterior cranial fossae.
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Affiliation(s)
- Mitchell W Couldwell
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Neal Jackson
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA; Department of Otolaryngology, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Grzegorz Wysiadecki
- Department of Normal and Clinical Anatomy, Medical University of Lodz, Lodz, Poland; Department of Anatomy and Histology, Medical University of Lodz, Lodz, Poland
| | - Joseph Keen
- Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, Louisiana, USA
| | - Joe Iwanaga
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA; Department of Neurology, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA.
| | - Johnny Delashaw
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Aaron S Dumont
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - R Shane Tubbs
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA; Department of Neurology, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA; Department of Structural and Cellular Biology, Tulane University School of Medicine, New Orleans, Louisiana, USA; Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA; Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, Louisiana, USA; Department of Anatomical Sciences, St. George's University, Grenada, West Indies; University of Queensland, Brisbane, Queensland, Australia
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8
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Yamashiro K, Muto J, Wakako A, Murayama K, Kojima D, Omi T, Adachi K, Hasegawa M, Hirose Y. Diploic veins as collateral venous pathways in patients with dural venous sinus invasion by meningiomas. Acta Neurochir (Wien) 2021; 163:1687-1696. [PMID: 33629122 DOI: 10.1007/s00701-021-04777-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 02/17/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Although it is known that diploic veins frequently communicate with the dural venous sinuses, the role of diploic veins in patients with venous sinus invasion from meningiomas remains unknown. METHODS We retrospectively examined the medical records of 159 patients who underwent their first craniotomies for intracranial meningiomas. Contrast-enhanced magnetic resonance imaging was used to evaluate diploic vein routes, and digital subtraction angiography (DSA) was used to evaluate diploic vein blood flow. When high blood flow was visualized concurrently with the venous sinuses, the veins were classified as of the "early type." Diploic vein routes were classified into five routes. RESULTS DSA was performed in 110 patients, with 14 showing superior sagittal sinus (SSS) invasion (SSS group) and 23 showing non-SSS venous sinus invasion (non-SSS group). The proportion of early type diploic veins was significantly higher in the SSS group (27.1%) than in other patients (patients without venous sinus invasion, 2.1%; non-SSS, 4.3%) (p < 0.01). In patients not in the SSS group, diploic veins were sacrificed during craniotomy in 76 patients, including four patients with veins of the early type. No patients demonstrated new neurological deficits postoperatively. In the SSS group, diploic veins were sacrificed in all patients, and early type diploic veins were cut in five patients. Two of these five patients showed postoperative neurological deficits. CONCLUSIONS In the SSS group, diploic veins may function as collateral venous pathways, and attention is recommended for their interruption. In patients without SSS invasion, diploic veins, even of the early type, can be sacrificed.
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Eponyms in Vascular Neurosurgery: Comprehensive Review of 18 Veins. World Neurosurg 2021; 151:190-200. [PMID: 34033951 DOI: 10.1016/j.wneu.2021.05.053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 05/13/2021] [Accepted: 05/14/2021] [Indexed: 11/20/2022]
Abstract
This review is the first comprehensive anatomic report of all venous eponyms used in vascular neurosurgery and provides the historical context of their authors as well as the surgical relevance of every structure. A PubMed literature review identified 13 individuals for whom 18 eponymous venous structures of the brain were named. These structures are the Batson plexus, veins of Breschet, Breschet sinus, vein of Dandy, vein of Galen, prosencephalic vein of Markowski, torcular Herophili, vein of Labbé, venous plexus of Rektorzik, vein of Rolando, basal vein of Rosenthal, sylvian veins, lateral lakes of Trolard, vein of Trolard, hypoglossal plexus of Trolard, petro-occipital vein of Trolard, venous circle of Trolard, and the vein of Vesalius. Eponyms provide a valuable shorthand that encompasses anatomic nuances, variabilities, and surgical relevance. In addition, they elucidate the historical context in which these structures were described and are an academic honor to our predecessors.
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Hirata K, Kato N, Yamazaki T, Yasuda S, Shiigai M, Matsumaru Y. Arteriovenous fistula of the clival diploic vein associated with arteriovenous fistula of the posterior condylar canal. Interv Neuroradiol 2021; 27:672-676. [PMID: 33715499 DOI: 10.1177/15910199211002427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We herein report a rare case of a patient with a clival diploic vein arteriovenous fistula (AVF) associated with a posterior condylar canal AVF and discuss the radiological features of clival diploic vein AVF during decision-making on treatment strategies. A 69-year-old male patient with one-year history of pulsatile tinnitus was evaluated with magnetic resonance angiography, which revealed a dilated venous structure. Digital subtraction angiography revealed AVFs located in the clivus and posterior condylar canal. The clival diploic vein AVF was fed by the right internal maxillary artery and the petrous branch of middle meningeal artery and shed to the posterior condylar canal only through an intraosseous vein in the jugular tubercle. Although a catheter could not be navigated into the venous pouch in the clivus, the AVFs were successfully obliterated by transvenous embolization of the venous pouch in the posterior condylar canal.
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Affiliation(s)
- Koji Hirata
- Department of Neurosurgery, National Hospital Organization Mito Medical Center, Ibaraki, Japan.,Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Noriyuki Kato
- Department of Neurosurgery, National Hospital Organization Mito Medical Center, Ibaraki, Japan
| | - Tomosato Yamazaki
- Department of Neurosurgery, National Hospital Organization Mito Medical Center, Ibaraki, Japan
| | - Susumu Yasuda
- Department of Neurosurgery, National Hospital Organization Mito Medical Center, Ibaraki, Japan
| | - Masanari Shiigai
- Department of Diagnostic Radiology, Tsukuba Medical Center Hospital, Ibaraki, Japan
| | - Yuji Matsumaru
- Department of Neurosurgery, Division of Stroke Prevention and Treatment, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
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Tokairin K, Osanai T, Fujima N, Ishizaka K, Motegi H, Ishi Y, Kameda H, Sugiyama T, Kazumata K, Nakayama N. Use of magnetic resonance venography for inferior petrosal sinus sampling. J Vasc Access 2021; 23:422-429. [PMID: 33626978 DOI: 10.1177/1129729821997263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Inferior petrosal sinus (IPS) sampling (IPSS) is a transvenous interventional procedure performed to diagnose Cushing's disease. The reported IPSS failure rate is approximately 10% because IPS catheter delivery is conducted blindly and is challenging because of IPS anatomical variations. This study aimed to evaluate the usefulness of preprocedural magnetic resonance venography (MRV) for assessing IPS access routes before IPSS. METHODS Nineteen consecutive patients who underwent IPSS at a single university hospital in Japan were retrospectively studied. A preprocedural MRV protocol optimized to visualize the IPS before IPSS was established and utilized in the eight most recent cases. An IPSS procedure was considered successful when bilateral IPS catheterization was accomplished. Patient demographics, IPSS success rate, and radiation dose required during IPSS were compared between two groups: MRV group (N = 8) and no-MRV group (N = 11) before IPSS. RESULTS There were no significant differences in age, sex, and IPSS success rates between the groups. The average radiation dose was 663.6 ± 246.8 (SD) mGy and 981.7 ± 389.5 (SD) mGy in the MRV group and no-MRV group, respectively. Thus, there was a significant reduction in radiation exposure in the MRV group (p = 0.044). Catheterization of the left IPS was unsuccessful in only one patient in the MRV group owing to IPS hypoplasty, as found on the MRV. CONCLUSIONS Hypoplastic IPSs occur in patients and can complicate IPSS. Preprocedural MRV assessment is useful for understanding venous anatomy and preventing unnecessary intravenous catheter manipulation during IPSS, which involves blind manipulation around the IPS.
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Affiliation(s)
- Kikutaro Tokairin
- Department of Neurosurgery, Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Toshiya Osanai
- Department of Neurosurgery, Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Noriyuki Fujima
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Sapporo, Hokkaido, Japan
| | - Kinya Ishizaka
- Department of Radiological Technology, Hokkaido University Hospital, Sapporo, Hokkaido, Japan
| | - Hiroaki Motegi
- Department of Neurosurgery, Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Yukitomo Ishi
- Department of Neurosurgery, Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Hiraku Kameda
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Taku Sugiyama
- Department of Neurosurgery, Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Ken Kazumata
- Department of Neurosurgery, Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Naoki Nakayama
- Department of Neurosurgery, Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
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Caglar YS, Erdogan K, Kilinc CM, Mammadkhanli O, Ozgural O, Eroglu U. Retroclival epidural hematoma: A rare location of epidural hematoma, case report, and review of literature. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2020; 11:342-346. [PMID: 33824566 PMCID: PMC8019111 DOI: 10.4103/jcvjs.jcvjs_97_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 08/20/2020] [Indexed: 11/10/2022] Open
Abstract
Retroclival epidural hematoma in adults is uncommon. Although most cases are associated with craniocervical trauma, other mechanisms have been reported, such as coagulopathy, vascular lesions, and pituitary apoplexy. We report two adults diagnosed with retroclival epidural hematoma. One patient was an 89-year-old male with leukemia and thrombocytopenia who sustained a fall and developed a traumatic retroclival epidural hematoma with brainstem compression; surgery could not be performed due to his clinical condition and he died 5 days later. The other patient was a 78-year-old female with atrial fibrillation who developed a spontaneous retroclival epidural hematoma as a result of warfarin use; she was treated conservatively with anticoagulant reversal and methylprednisolone and was subsequently discharged without neurological deficit. Retroclival hematomas are primarily treated conservatively due to the difficulty of surgical approach. The bleeding mechanism and dural and venous anatomy of this region tend to limit hematoma expansion.
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Affiliation(s)
- Yusuf Sukru Caglar
- Department of Neurosurgery, Ibn-i Sina Hospital, Ankara University, Ankara, Turkey
| | - Koral Erdogan
- Department of Neurosurgery, Ibn-i Sina Hospital, Ankara University, Ankara, Turkey
| | - Cemil Mustafa Kilinc
- Department of Neurosurgery, Ibn-i Sina Hospital, Ankara University, Ankara, Turkey
| | | | - Onur Ozgural
- Department of Neurosurgery, Ibn-i Sina Hospital, Ankara University, Ankara, Turkey
| | - Umit Eroglu
- Department of Neurosurgery, Ibn-i Sina Hospital, Ankara University, Ankara, Turkey
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13
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Hiramatsu M, Sugiu K, Haruma J, Hishikawa T, Takahashi Y, Murai S, Nishi K, Yamaoka Y, Date I. Osseous arteriovenous fistulas in the dorsum sellae, clivus, and condyle. Neuroradiology 2020; 63:133-140. [PMID: 32761279 DOI: 10.1007/s00234-020-02506-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 07/28/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE Arteriovenous fistulas (AVFs) located in the cavernous sinus (CS), clivus, and condyle can be osseous shunts in nature. Here, we reviewed the angioarchitecture, clinical characteristics, and treatment results of AVFs in these lesions. METHODS Twenty-five patients with 27 lesions who underwent rotational angiography in our department between May 2013 and December 2019 were reviewed. We examined 20 CS AVFs, 2 clival AVFs, and 5 condylar AVFs. We divided the anatomical shunted pouches into five locations: the dorsum sellae (posteromedial of the CS), posterolateral wall of the CS, lateral wall of the CS, clivus, and condyle. We divided the AVFs into three categories: intraosseous, transitional, and nonosseous shunts. We analyzed the characteristics and treatment results. RESULTS A total of 33 shunted pouches or points were identified in 27 lesions. The dorsum sellae (n = 16) was the most frequent location. Fourteen AVFs (88%) in the dorsum sellae were osseous (intraosseous or transitional) shunts. All AVFs in the clivus or condyle were also osseous shunts. Eleven lesions (92%) of intraosseous and all lesions of transitional shunts exhibited bilateral external carotid artery involvement as feeders. Ten lesions (83%) of intraosseous shunts were treated with selective transvenous embolization of the shunted pouch with or without additional partial embolization of the sinus. Eleven (92%) intraosseous shunts were completely occluded, and symptom resolution was achieved in all intraosseous shunts. CONCLUSION Most of the CS AVFs with shunted pouches in the dorsum sellae and all of the AVFs in the clivus and condyle share similar characteristics.
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Affiliation(s)
- Masafumi Hiramatsu
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan.
| | - Kenji Sugiu
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Jun Haruma
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Tomohito Hishikawa
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Yu Takahashi
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Satoshi Murai
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Kazuhiko Nishi
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Yoko Yamaoka
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Isao Date
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
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Hiramatsu M, Sugiu K, Haruma J, Hishikawa T, Takahashi Y, Murai S, Nishi K, Yamaoka Y, Date I. Dural Arteriovenous Fistulas in the Parasellar Region Other Than the Cavernous Sinus. JOURNAL OF NEUROENDOVASCULAR THERAPY 2020; 14:593-604. [PMID: 37502140 PMCID: PMC10370661 DOI: 10.5797/jnet.ra.2020-0042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 04/08/2020] [Indexed: 07/29/2023]
Abstract
Besides cavernous sinus (CS) dural arteriovenous fistulas (AVFs), AVF may develop around the parasellar region. They can cause various symptoms, and some of them may show similar symptoms to those of CS dural AVF. Therefore, these AVFs may be misdiagnosed as CS dural AVFs. In this review, we divided parasellar AVFs into four groups based on their locations related to the CS: anterior group (orbit), anterolateral group (sphenoid wing), posteroinferior group (inferior petrosal sinus and clivus), and posterior group (superior petrosal sinus and petrosal vein). Although parasellar AVFs share common points, there are many differences between the four groups. We herein discuss commonalities and differences in parasellar AVFs based on a review of the literature and our experience.
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Affiliation(s)
- Masafumi Hiramatsu
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Okayama, Japan
| | - Kenji Sugiu
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Okayama, Japan
| | - Jun Haruma
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Okayama, Japan
| | - Tomohito Hishikawa
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Okayama, Japan
| | - Yu Takahashi
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Okayama, Japan
| | - Satoshi Murai
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Okayama, Japan
| | - Kazuhiko Nishi
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Okayama, Japan
| | - Yoko Yamaoka
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Okayama, Japan
| | - Isao Date
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Okayama, Japan
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Murase M, Mizutani K, Kawata K, Fujiwara H, Jinzaki M, Toda M, Yoshida K. Analysis of the superficial middle cerebral vein in sphenoid ridge meningioma using contrast-enhanced dynamic computed tomography angiography. Clin Neurol Neurosurg 2020; 191:105683. [PMID: 31982694 DOI: 10.1016/j.clineuro.2020.105683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 01/01/2020] [Accepted: 01/16/2020] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The superficial middle cerebral vein (SMCV) is of clinical importance because of its contribution to the venous drainage of the superficial part of the cerebrum. Sphenoid ridge meningioma (SRM) grows adjacent to the SMCV and its drainage routes, and is thought to occasionally influence the hemodynamics of the SMCV, although this has seldom been suggested in the literature. We investigated the effect of SRM on the SMCV via blood flow analysis using multi-detector computed tomography. PATIENTS AND METHODS Overall, 22 patients with SRM who preoperatively underwent contrast-enhanced dynamic computed tomography at our institution were included in this study. We serially measured the Hounsfield units at each point of the SMCV and its adjacent veins on the side on which the tumor was located. We then obtained a time-density curve for each point via gamma distribution fitting. We determined the time-to-peak at each point by calculating the derivative of the time-density curve function and deduced the direction of blood passing through each vein by comparing the time-to-peak values between several points. RESULTS In total, 26 SMCVs were measured in 19 out of 22 cases. Of the 26 SMCVs, 16 were patent in the medial portion and contributed to normal venous drainage: 4 of them emptied into the cavernous sinus (CS), and 12 of them into the para-cavernous sinus (ParaCS). Out of the 10 that had their medial portions occluded because of the effects of the tumor, 6 SMCVs mainly drained into the vein of Labbé and/or the vein of Trolard retrogradely. However, in 2 of these, the small medial portions of the SMCVs near the occluded portion were maintained anterogradely by the collateral venous structures. In 4 SMCVs, the blood flow through the collateral veins remained anterograde; this was considered to contribute to normal venous drainage. CONCLUSION The SRM is likely to cause occlusion or stenosis in the SMCV and influence its hemodynamics. In cases in which the connection between the SMCV and the CS or the ParaCS has been lost, the SMCV may still be involved in normal venous drainage via the collateral veins in some of those cases. Thus, the contribution of these veins to normal venous drainage in the brain should be analyzed preoperatively in careful detail.
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Affiliation(s)
- Makoto Murase
- Department of Neurosurgery, Keio University School of Medicine, Japan
| | - Katsuhiro Mizutani
- Department of Neurosurgery, Keio University School of Medicine, Japan; Department of Interventional Neuroradiology, Hospital Foch, Suresnes, France
| | - Kento Kawata
- Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | - Hirokazu Fujiwara
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Masahiro Jinzaki
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Masahiro Toda
- Department of Neurosurgery, Keio University School of Medicine, Japan.
| | - Kazunari Yoshida
- Department of Neurosurgery, Keio University School of Medicine, Japan
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Tsutsumi S, Ono H, Ishii H, Yasumoto Y. Diploic veins of the cranial base: an anatomical study using magnetic resonance imaging. Surg Radiol Anat 2019; 41:1029-1036. [PMID: 31286202 DOI: 10.1007/s00276-019-02283-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 07/01/2019] [Indexed: 12/20/2022]
Abstract
PURPOSE The anatomy and distribution of the diploic veins (DVs) of the cranial base have not been fully documented. The aim of this study was to characterize these veins using contrast magnetic resonance imaging (MRI). METHODS In total, 95 patients underwent thin-sliced, contrast MRI. Coronal and sagittal images were used for the analysis. The cranial base was divided into the anterior, middle, and posterior bases. Then, each base was further subdivided into three equal parts in the anteroposterior and lateromedial directions. The anteroposterior parts were evaluated on coronal images, while the lateromedial parts were evaluated on sagittal images. RESULTS The DVs were identified over the entire cranial base. However, they were more frequent in the posterior-third of the lateral-third region of the anterior, middle-third of the lateral and middle-third regions of the middle, and middle-third region of the posterior cranial base, and sparse in the posterior and medial-third regions of the middle cranial base. The DVs showed marked morphological variability. For instance, the DVs of the pterional area were generally well defined, as pivotal channels connecting the lateral parts of the anterior and middle cranial base, but were highly varied in appearance. CONCLUSIONS The DVs of the cranial base are distinct structures characterized by morphological variability and topographical predilection. Contrast MRI is useful for delineating these veins.
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Affiliation(s)
- Satoshi Tsutsumi
- Department of Neurological Surgery, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu, Chiba, 279-0021, Japan.
| | - Hideo Ono
- Division of Radiological Technology, Medical Satellite Yaesu Clinic, Tokyo, Japan
| | - Hisato Ishii
- Department of Neurological Surgery, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu, Chiba, 279-0021, Japan
| | - Yukimasa Yasumoto
- Department of Neurological Surgery, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu, Chiba, 279-0021, Japan
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Skull Base Venous Anatomy Associated with Endoscopic Skull Base Neurosurgery: A Literature Review. World Neurosurg 2018; 120:405-414. [DOI: 10.1016/j.wneu.2018.09.067] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 09/07/2018] [Accepted: 09/11/2018] [Indexed: 11/21/2022]
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Gridding Microsurgical Anatomy of Far Lateral Approach in the Three-Dimensional Model. J Craniofac Surg 2018; 30:87-90. [PMID: 30394967 DOI: 10.1097/scs.0000000000004849] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE The far lateral craniotomy involves osteotomy of various portions of occipital condyle. Intracranial operation exposing clivus encounters complicated neurovascular anatomy. The aim of the present study was to make refinement for the anatomy of far lateral approach by gridding route in the 3-dimensional model. METHODS Computed tomography and magnetic resonance imaging data were used to construct 3-dimensional model containing osseous and neurovascular structures of skull base. Then, far lateral approach was simulated by triangular prism and divided into gridding surgical route. The relationship of surgical route and osseous and neurovascular structures was observed. Measurement of volume was performed to evaluate surgical exposure. RESULTS Observation of 3-dimensional model showed bony drilling of far lateral approach started with the occipital condyle and passed through the lateral edge of foramen magnum. The cerebellum and medulla oblongata were exempted from the surgical route exposing clivus. The anatomy variances of operative space, osseous, and neurovascular structures in the gridding route were displayed clearly and compared objectively. CONCLUSION The gridding operative spaces for the far lateral approach are useful to disclose the detailed discrepancy in the different surgical region. The volumetric measurement provides quantified information to facilitate a better understanding of the anatomy variance.
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Transclival Venous Circulation: Anatomic Study. World Neurosurg 2018; 121:e136-e139. [PMID: 30236809 DOI: 10.1016/j.wneu.2018.09.038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 09/05/2018] [Accepted: 09/07/2018] [Indexed: 11/21/2022]
Abstract
INTRODUCTION The clivus is a small, central area of the basal cranium with limited surgical access and high morbidity associated with pathologies of its surrounding structures. Therefore thorough knowledge and understanding of the anatomy in this region are crucial for the success of treatments and interpretation of imaging. As to our knowledge, there is no extant cadaveric examination of the transclival veins, so the present study was performed. METHODS Fifteen lightly embalmed adult heads underwent blue latex injection of the left and right internal jugular veins. Special attention was given to the presence or absence of transclival vessels. When transclival veins were identified, their intracranial source, point of penetration of the clivus and anterior connections were documented. RESULTS Ten (66.7%) specimens were found to have transclival veins. These connected the basilar venous plexus to the retropharyngeal venous plexus on all specimens. Eight of the 10 specimens had multiple transclival veins, and 2 had only 1 vessel. The majority of the transclival veins were found penetrating the clivus at its lower one third. However, 2 specimens also had transclival veins that pierced the clivus at its upper one third. CONCLUSIONS An improved understanding of the skull base and its venous drainage can assist clinicians and surgeons in better understanding normal, pathologic, and variant anatomy in this region.
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Mizutani K, Akiyama T, Minami Y, Toda M, Fujiwara H, Jinzaki M, Yoshida K. Intraosseous venous structures adjacent to the jugular tubercle associated with an anterior condylar dural arteriovenous fistula. Neuroradiology 2018; 60:487-496. [PMID: 29411060 DOI: 10.1007/s00234-018-1990-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 01/26/2018] [Indexed: 11/25/2022]
Abstract
PURPOSE Although involvement of the osseous component with an anterior condylar dural arteriovenous fistula (AC-DAVF) has been frequently described, osseous venous structures in which AC-DAVFs develop have not been fully elucidated. We investigated osseous venous structures adjacent to the hypoglossal canal in normal controls and patients with AC-DAVFs. METHODS The study included 50 individuals with unruptured aneurysms as normal controls and seven patients with AC-DAVFs. Osseous venous structures adjacent to the hypoglossal canal in normal controls were analyzed using computed tomography (CT) digital subtraction venography. In patients with AC-DAVFs, the fistulous pouches, draining veins, and surrounding venous structures were examined using cone beam CT. RESULTS In 46.0% of laterals in normal controls, osseous venous structures were visualized within the jugular tubercle superomedially to the hypoglossal canal. We named these structures the jugular tubercle venous complex (JTVC). The JTVC was always continuous with the anterior condylar vein and was sometimes connected to surrounding venous channels. We detected nine fistulous pouches in the seven patients with AC-DAVFs. The fistulous pouches were in the JTVC (33.3%), anterior condylar vein (33.3%), and other venous channels within the exoccipital region (33.3%). CONCLUSION Although the JTVC is a venous structure frequently found in normal people, it had not been investigated until now. The venous channel between the anterior condylar vein and JTVC is a common origin site for AC-DAVFs, and it was associated with 66.6% of the AC-DAVF cases in the current study.
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Affiliation(s)
- Katsuhiro Mizutani
- Department of Neurosurgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan.
| | - Takenori Akiyama
- Department of Neurosurgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
| | - Yasuhiro Minami
- Department of Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, Japan
| | - Masahiro Toda
- Department of Neurosurgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
| | - Hirokazu Fujiwara
- Department of Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, Japan
| | - Masahiro Jinzaki
- Department of Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, Japan
| | - Kazunari Yoshida
- Department of Neurosurgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
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