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Shapiro M, Chung C, Sharashidze V, Nossek E, Nelson PK, Raz E. Venous Anatomy of the Central Nervous System. Neurosurg Clin N Am 2024; 35:273-286. [PMID: 38782520 DOI: 10.1016/j.nec.2024.03.001] [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: 05/25/2024]
Abstract
Comprehensive understanding of venous anatomy is a key factor in the approach to a multitude of conditions. Moreover, the venous system has become the center of attention as a new frontier for treatment of diseases such as idiopathic intracranial hypertension (IIH), arteriovenous malformation (AVM), pulsatile tinnitus, hydrocephalus, and cerebrospinal fluid (CSF) venous fistulas. Its knowledge is ever more an essential requirement of the modern brain physician. In this article, the authors explore the descriptive and functional anatomy of the venous system of the CNS in 5 subsections: embryology, dural sinuses, cortical veins, deep veins, and spinal veins.
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Affiliation(s)
- Maksim Shapiro
- Department of Radiology and Neurosurgery, NYU Langone Health, New York, NY 10016, USA; Department of Radiology and Neurosurgery, Bellevue Hospital Center, New York, NY 10016, USA
| | - Charlotte Chung
- Department of Radiology and Neurosurgery, NYU Langone Health, New York, NY 10016, USA; Department of Radiology and Neurosurgery, Bellevue Hospital Center, New York, NY 10016, USA
| | - Vera Sharashidze
- Department of Radiology and Neurosurgery, NYU Langone Health, New York, NY 10016, USA; Department of Radiology and Neurosurgery, Bellevue Hospital Center, New York, NY 10016, USA
| | - Erez Nossek
- Department of Radiology and Neurosurgery, NYU Langone Health, New York, NY 10016, USA; Department of Radiology and Neurosurgery, Bellevue Hospital Center, New York, NY 10016, USA
| | - Peter Kim Nelson
- Department of Radiology and Neurosurgery, NYU Langone Health, New York, NY 10016, USA; Department of Radiology and Neurosurgery, Bellevue Hospital Center, New York, NY 10016, USA
| | - Eytan Raz
- Department of Radiology and Neurosurgery, NYU Langone Health, New York, NY 10016, USA; Department of Radiology and Neurosurgery, Bellevue Hospital Center, New York, NY 10016, USA.
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Giammattei L, Peters D, Cadas H, Fava A, Schranz S, George M, Sabatasso S, Messerer M, Starnoni D, Daniel RT. Combined Petrosal Intertentorial Approach: A Cadaveric Study of Comparison With the Standard Combined Petrosectomy. Oper Neurosurg (Hagerstown) 2024:01787389-990000000-01203. [PMID: 38917345 DOI: 10.1227/ons.0000000000001244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 04/22/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND AND OBJECTIVES The combined petrosal intertentorial approach (CPIA) has been proposed as an alternative to standard combined petrosal approach (SCPA). CPIA has been designed to maintain integrity of the temporal dura with a view to reduce temporal lobe morbidity and venous complications. This study has been designed to perform a quantitative comparison between these approaches. METHODS Five human specimens were used for this study. CPIA was performed on one side and SCPA on the opposite side. The area of exposure (petroclival and brainstem), surgical freedom, and angles of attack to a predefined target were measured and compared. RESULTS SCPA provided a significantly larger petroclival area of exposure (6.81 ± 0.60 cm2) over the CPIA (5.59 ± 0.59 cm2), P = .012. The area of brainstem exposed with SCPA was greater than with CPIA (7.17 ± 0.84 vs 5.63 ± 0.72, P = .014). The area of surgical freedom was greater in SCPA rather than in CPIA (8.59 ± 0.55 and 7.13 ± 0.96 cm2, respectively, P = .019). There was no significative difference between CPIA and SCPA in the vertical angles of attack for the Meckel cave, Dorello canal, and root entry zone of cranial nerve VII. Conversely, the horizontal angles of attack permitted by the CPIA were significantly smaller for the Meckel cave (52.36° ± 5.01° vs 64.4° ± 5.3°, P = .006) and root entry zone of cranial nerve VII (30.7° ± 4.4° vs 40.1° ± 6.2°, P = .025). CONCLUSION CPIA is associated with a reduction in terms of the area of surgical freedom (22%), skull base (18%), brainstem exposure (17%), and horizontal angles of attack (18%-23%) when compared with SCPA. This loss in terms of exposure is counterbalanced by the advantage of keeping the temporal lobe covered by an extra layer of meningeal tissue, thus possibly reducing the risk of temporal lobe injury and venous infarction. These results need to be validated with adequate clinical experience.
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Affiliation(s)
- Lorenzo Giammattei
- Department of Neurosurgery, Lausanne University Hospital, Lausanne, Switzerland
| | - David Peters
- Department of Neurosurgery, Atrium Health, Charlotte, North Carolina, USA
| | - Hugues Cadas
- Unité Facultaire d'Anatomie et de Morphologie (UFAM), University Center of Legal Medicine Lausanne-Geneva (CURML), Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Arianna Fava
- Department of Neurosurgery, IRCCS Neuromed, Pozzilli, Italy
| | - Sami Schranz
- Unité Facultaire d'Anatomie et de Morphologie (UFAM), University Center of Legal Medicine Lausanne-Geneva (CURML), Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Mercy George
- Department of Otorhinolaryngology and Head and Neck Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - Sara Sabatasso
- Unité Facultaire d'Anatomie et de Morphologie (UFAM), University Center of Legal Medicine Lausanne-Geneva (CURML), Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Mahmoud Messerer
- Department of Neurosurgery, Lausanne University Hospital, Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Daniele Starnoni
- Department of Neurosurgery, Lausanne University Hospital, Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Roy T Daniel
- Department of Neurosurgery, Lausanne University Hospital, Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
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Loo JK, Hu YS, Kao WL, Yang HC, Lee CC, Wu HM, Luo CB, Guo WY, Liu KD, Chung WY, Lin CJ. Shortened Cerebral Circulation Time Predicts Resistance to Obliteration in High-Flow Brain Arteriovenous Malformations After Stereotactic Radiosurgery. Neurosurgery 2024:00006123-990000000-01220. [PMID: 38899888 DOI: 10.1227/neu.0000000000003036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 04/06/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Treatment selection for brain arteriovenous malformations (BAVMs) is complicated by BAVM size, location, and hemodynamics. Quantitative digital subtraction angiography is used to quantify the hemodynamic impact of BAVMs on cerebral circulation. This study investigated the association between cerebral circulation time and the complete obliteration (CO) rate of BAVMs after stereotactic radiosurgery (SRS). METHODS We analyzed the data of 143 patients who underwent SRS for BAVMs between January 2011 and December 2019 in our institute. Their pre-SRS magnetic resonance imaging and angiography images were analyzed to acquire BAVM characteristics and quantitative digital subtraction angiography parameters. Modified cerebral circulation time (mCCT) was defined as the time difference between the bolus arrival time of the ipsilateral cavernous internal carotid artery and that of the parietal vein, as determined from the lateral view of images obtained using digital subtraction angiography. Cox regression with hazard ratios and Kaplan-Meier analyses were conducted to determine the associations between the parameters and BAVM CO after SRS. RESULTS Of the 143 patients, 101 (70.6%) achieved BAVM CO. According to the multivariate analyses, an increased mCCT (hazard ratio: 1.24, P = .041) was the independent factor associated with BAVM CO after adjustment for age, sex, hemorrhagic presentation, a BAVM volume of >5 cm3, and a margin dose of >18 Gy. Individuals with an mCCT of ≤2.32 s had a lower 36-month probability of BAVM CO than did those with an mCCT of >2.32 s (44.1% ± 6.8% vs 63.3% ± 5.6%, P = .034). CONCLUSION The hemodynamic impact of high-flow BAVM demonstrated by a shortened mCCT is associated with a lower BAVM CO rate after SRS.
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Affiliation(s)
- Jing Kai Loo
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yong-Sin Hu
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Radiology, Taipei Hospital, Ministry of Health and Welfare, New Taipei, Taiwan
| | - Wei-Lun Kao
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Huai-Che Yang
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Cheng-Chia Lee
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hsiu-Mei Wu
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chao-Bao Luo
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Wan-Yuo Guo
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Kang-Du Liu
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wen-Yuh Chung
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Neurosurgery, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Chung-Jung Lin
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
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Yan H, He J, Li A, Wang D, Yao Y, Guo X, Zhang X, Jiang B. Tigroid Enhancement: A Characteristic Enhancement Pattern of the Cerebellar Hemisphere on MRI With Intracranial Dural Arteriovenous Fistulas. J Endovasc Ther 2024:15266028241246646. [PMID: 38624167 DOI: 10.1177/15266028241246646] [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: 04/17/2024]
Abstract
PURPOSE This study aims to investigate a characteristic cerebellar hemisphere enhancement pattern on magnetic resonance imaging (MRI) that could aid in early and specific diagnosis of intracranial dural arteriovenous fistulas (DAVFs). MATERIALS AND METHODS Pretreatment MR images of 57 patients with intracranial DAVFs between January 1, 2017, and February 28, 2023, were retrospectively analyzed. A total of 128 patients with confirmed alternative cerebellar lesions during the same period were included as a control group. All patients underwent enhanced MRI with a 3.0T scanner. The presence or absence of parallel enhanced linear striations on the surface of the cerebellar lesions was documented. Statistically significant differences were determined by the Fisher exact test. RESULTS Cerebellar lesions were identified in 4 intracranial DAVF patients (7.0%). All 4 patients were male, with an average age of 64 years (range: 58-76 years). The pretreatment MR images of all 4 DAVF patients with cerebellar lesions demonstrated the characteristic tigroid enhancement pattern. Tortuous flow voids were present in the MR images of 3 of the 4 patients. Tigroid enhancement pattern was not observed in the remaining 53 intracranial DAVF patients and all control patients. The differences in the incidence of the pattern were significant (p=0.01). CONCLUSION A characteristic tigroid enhancement pattern of the cerebellar hemisphere on MRI may aid in the early and specific diagnosis of intracranial DAVFs, allowing timely treatment and improving outcomes. CLINICAL IMPACT The identification of a characteristic tigroid enhancement pattern on MRI for cerebellar hemisphere lesions holds significant promise for clinical practice. This pattern serves as a distinctive marker aiding in the early and specific diagnosis of intracranial dural arteriovenous fistulas (DAVFs). Clinicians can now utilize this innovative finding to expedite diagnostic workflows, enabling timely intervention and management strategies. The incorporation of this novel imaging feature enhances diagnostic accuracy, potentially reducing misdiagnosis rates and preventing delays in treatment initiation. Ultimately, this advancement may lead to improved patient outcomes and quality of care in neurosurgical and neuroradiological practice.
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Affiliation(s)
- Hua Yan
- Department of Gastroenterology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Shandong, China
| | - Jingzhen He
- Department of Radiology, Qilu Hospital of Shandong University, Shandong, China
| | - Anning Li
- Department of Radiology, Qilu Hospital of Shandong University, Shandong, China
| | - Dawei Wang
- Department of Radiology, Qilu Hospital of Shandong University, Shandong, China
| | - Yuan Yao
- Department of Radiology, Qilu Hospital of Shandong University, Shandong, China
| | - Xiaoqin Guo
- Department of Radiology, Qilu Hospital of Shandong University, Shandong, China
| | - Xiaoming Zhang
- Department of Radiology, Qilu Hospital of Shandong University, Shandong, China
| | - Baodong Jiang
- Department of Radiology, Qilu Hospital of Shandong University, Shandong, China
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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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Patel LD, Raghavan P, Tang S, Choi S, Harrison DM. Imaging of the meningeal lymphatic network in healthy adults: A 7T MRI study. J Neuroradiol 2023; 50:369-376. [PMID: 36918053 PMCID: PMC10981496 DOI: 10.1016/j.neurad.2023.03.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/08/2023] [Accepted: 03/08/2023] [Indexed: 03/13/2023]
Abstract
BACKGROUND AND PURPOSE Meningeal lymphatic vessels (MLVs) along the dural venous sinuses are suspected to be important in connecting the glymphatic and peripheral lymphatic system. Understanding the topography of MLVs may clarify the role of the glymphatic system in neurological diseases. The aim of this analysis was to use high resolution pre- and post-contrast FLAIR 7T MRI to identify and characterize the morphology of MLV in a cohort of healthy volunteers. MATERIALS AND METHODS MRI examinations of seventeen healthy volunteers enrolled as controls in a larger 7T MRI study were reviewed. Pre- and post-contrast 3-D FLAIR subtractions and MP2RAGE sequences were spatially normalized and reviewed for signal intensity and enhancement patterns within putative MLVs along pre-determined dural and venous structures. Frequency of occurrence of MLVs at the above-described locations and patterns of their enhancement were analyzed. RESULTS Putative MLVs are commonly located along the superior sagittal sinus (SSS) and cortical veins. A "fixed enhancement" signal pattern was more frequent at these locations (p<.05). The morphology of MLVs along the SSS qualitatively changes in an antero-posterior direction. Lack of signal was more frequent along the straight and transverse sinuses (p<.05). CONCLUSION Putative MLVs in healthy individuals are concentrated along the SSS and cortical veins. FLAIR signal and enhancement characteristics suggest these structures may transport proteinaceous fluid. Pathways connecting MLVs to cervical lymph nodes however remain unclear.
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Affiliation(s)
- Lakir D Patel
- University of Maryland School of Medicine, Department of Diagnostic Radiology and Nuclear Medicine, Baltimore, Maryland, USA.
| | - Prashant Raghavan
- University of Maryland School of Medicine, Department of Diagnostic Radiology and Nuclear Medicine, Baltimore, Maryland, USA.
| | - Shiyu Tang
- University of Maryland School of Medicine, Department of Diagnostic Radiology and Nuclear Medicine, Baltimore, Maryland, USA; University of Maryland School of Medicine, Center for Advanced Imaging Research (CAIR), Baltimore, Maryland, USA.
| | - Seongjin Choi
- University of Maryland School of Medicine, Department of Neurology, Baltimore, Maryland, USA.
| | - Daniel M Harrison
- University of Maryland School of Medicine, Department of Neurology, Baltimore, Maryland, USA; Baltimore VA Medical Center, Baltimore, Maryland, USA.
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Ott KN, Chaiyamoon A, Cardona JJ, Reina F, Carrera A, Iwanaga J, Dumont AS, Small JE, Tubbs RS. Revisiting the Tentorial Venous Sinuses: Anatomical and Histological Study. World Neurosurg 2023; 173:e677-e682. [PMID: 36889638 DOI: 10.1016/j.wneu.2023.02.132] [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: 01/10/2023] [Accepted: 02/27/2023] [Indexed: 03/08/2023]
Abstract
BACKGROUND Anatomical studies of the tentorial sinuses (TS) are scant, and to our knowledge, histological studies of this structure have not been reported. Therefore, we aim to better elucidate this anatomy. METHODS In 15 fresh frozen, latex injected, adult cadaveric specimens, the TS were evaluated with microsurgical dissection and histology. RESULTS The superior layer had a mean thickness of 0.22 mm, and the inferior layer had a mean thickness of 0.26 mm. Two types of TS were identified. Type 1 was a small intrinsic plexiform sinus with no obvious connections to the draining veins with gross examination. Type 2 was a larger tentorial sinus with direct connections to the bridging veins from the cerebral and cerebellar hemispheres. In general, type 1 sinuses were located more medially than type 2 sinuses. The inferior tentorial bridging veins drained directly into the TS along with connections to the straight and transverse sinuses. In 53.3% of specimens, superficial and deep sinuses were seen, with superior and inferior groups draining the cerebrum and cerebellum, respectively. CONCLUSIONS We identified novel findings for the TS which can be considered surgically and when diagnosing pathology involves these venous sinuses.
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Affiliation(s)
- Keaton N Ott
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Arada Chaiyamoon
- Department of Anatomy, Faculty of Medicine, Khon Kaen, Thailand.
| | - Juan J Cardona
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Francisco Reina
- Medical Sciences Department. Clinical Anatomy, Embryology and Neurosciences Research Group. University of Girona, Girona, Spain
| | - Ana Carrera
- Medical Sciences Department. Clinical Anatomy, Embryology and Neurosciences Research Group. University of Girona, Girona, Spain
| | - 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
| | - Aaron S Dumont
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Juan E Small
- Department of Neuroradiology, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - 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, Grenada; Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, LA, USA; University of Queensland, Brisbane, Australia
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Raz E, Sharashidze V, Grossman S, Ali A, Narayan V, Nossek E, Stein E, Nelson PK, Shapiro M. Access to cavernous dAVF via occluded superior petrosal Sinus. Interv Neuroradiol 2023:15910199231158912. [PMID: 36843545 DOI: 10.1177/15910199231158912] [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: 02/28/2023] Open
Abstract
There are multiple treatment alternatives for cavernous dAVFs, with transvenous routes being most common. Among these routes, occluded inferior petrosal sinus is well-described, and, apart from being imaginative and elegant, it is also safe and effective. Herein we describe the application of this method to reach the fistulous pouch of a cavernous dAVF via an occluded superior petrosal sinus.
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Affiliation(s)
- Eytan Raz
- Department of Radiology, 12297NYU Langone Health, New York, NY, USA
| | - Vera Sharashidze
- Department of Radiology, 12297NYU Langone Health, New York, NY, USA
| | - Scott Grossman
- Department of Neurology, 12297NYU Langone Health, New York, NY, USA
| | - Aryan Ali
- Department of Radiology, 12297NYU Langone Health, New York, NY, USA
- Department of Neurosurgery, 12297NYU Langone Health, New York, NY, USA
| | - Vinayak Narayan
- Department of Radiology, 12297NYU Langone Health, New York, NY, USA
| | - Erez Nossek
- Department of Neurosurgery, 12297NYU Langone Health, New York, NY, USA
| | - Evan Stein
- Department of Radiology, 12297NYU Langone Health, New York, NY, USA
| | - Peter Kim Nelson
- Department of Radiology, 12297NYU Langone Health, New York, NY, USA
- Department of Neurosurgery, 12297NYU Langone Health, New York, NY, USA
| | - Maksim Shapiro
- Department of Radiology, 12297NYU Langone Health, New York, NY, USA
- Department of Neurology, 12297NYU Langone Health, New York, NY, USA
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9
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Overview of multimodal MRI of intracranial Dural arteriovenous fistulas. J Interv Med 2022; 5:173-179. [DOI: 10.1016/j.jimed.2022.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 04/05/2022] [Accepted: 04/16/2022] [Indexed: 11/29/2022] Open
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10
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Tentorial peeling during combined petrosal approach: a cadaveric dissection. Acta Neurochir (Wien) 2022; 164:2833-2839. [PMID: 36163381 DOI: 10.1007/s00701-022-05370-z] [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: 08/26/2022] [Accepted: 09/15/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND The combined petrosal approach is an excellent method to access the petroclival region but has the inherent risk of injury to the temporal lobe and Vein of Labbé. Tentorial peeling has the potential to largely eliminate these risks during the classic combined transpetrosal approach. METHODS Anatomical dissection of three adult injected non-formalin fixed cadaveric heads was performed. Combined petrosal approach with tentorial peeling was completed. A tentorial incision just superior and parallel to the superior petrosal sinus was made to enable peeling of the tentorium into two layers, the posterior fossa tentorial leaf (PFTL), and the temporal tentorial leaf (TTL). RESULTS Tentorial peeling clearly exposed the continuity between the temporal dura and the TTL as well as the continuity between the presigmoid dura and the PFTL. This enabled the creation of a large dural flap extending to the tentorial incisura, providing wide access to the petroclival region without any exposure of the temporal lobe and/or basal temporal veins. Techniques to create the dural flap without trochlear nerve injury were also explored. CONCLUSION The technique of tentorial peeling into two distinct layers has the potential to reduce the morbidity associated with temporal lobe retraction and venous injury. Further cadaveric studies and surgical case series are needed to validate this important surgical nuance in transpetrosal approaches.
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Miyake S, Nakai Y, Suenaga J, Akimoto T, Uemura K, Funakoshi K, Yamamoto T. Characteristic of Non–Sinus-Type Parasagittal Dural Arteriovenous Fistulas: Clinical and Cadaveric Experiences. NEUROSURGERY OPEN 2022. [DOI: 10.1227/neuopn.0000000000000019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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12
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Blumentritt M, Simgen A, Naziri W, Reith W, Dietrich P. [Cerebral dural arteriovenous fistulas]. RADIOLOGIE (HEIDELBERG, GERMANY) 2022; 62:659-665. [PMID: 35736997 DOI: 10.1007/s00117-022-01036-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/09/2022] [Indexed: 06/15/2023]
Abstract
CLINICAL ISSUE The cerebral dural arteriovenous (AV) fistula is a rare cerebral vascular malformation. Clinical presentation varies from asymptomatic to acute intracranial bleeding. Classification is based on the venous drainage with a risk assessment of bleeding. The carotid-cavernous fistula is a subtype with its own classification and treatment approaches. PRACTICAL RECOMMENDATIONS Nowadays, dural fistulas can be diagnosed using high-resolution and time-resolved tomographic methods. Catheter angiography with subsequent interdisciplinary discussion should be performed for precise classification and therapy planning. Both endovascular and surgical treatment methods are available.
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Affiliation(s)
- M Blumentritt
- Klinik für Neuroradiologie, Westpfalz-Klinikum GmbH, Hellmut-Hartert-Str. 1, 67655, Kaiserslautern, Deutschland.
| | - A Simgen
- Klinik für Neuroradiologie, Westpfalz-Klinikum GmbH, Hellmut-Hartert-Str. 1, 67655, Kaiserslautern, Deutschland
| | - W Naziri
- Klinik für Neuroradiologie, Westpfalz-Klinikum GmbH, Hellmut-Hartert-Str. 1, 67655, Kaiserslautern, Deutschland
| | - W Reith
- Klinik für Diagnostische und Interventionelle Neuroradiologie, Universitätsklinikum des Saarlandes, Kirrberger Str. 1, 66424, Homburg/Saar, Deutschland
| | - P Dietrich
- Klinik für Neuroradiologie, Westpfalz-Klinikum GmbH, Hellmut-Hartert-Str. 1, 67655, Kaiserslautern, Deutschland
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Raz E, Nossek E, Sahlein DH, Sharashidze V, Narayan V, Ali A, Esparza R, Peschillo S, Chung C, Diana F, Syed S, Nelson PK, Shapiro M. Principles, techniques and applications of high resolution cone beam CT angiography in the neuroangio suite. J Neurointerv Surg 2022; 15:600-607. [PMID: 35835462 DOI: 10.1136/jnis-2022-018722] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 06/20/2022] [Indexed: 11/03/2022]
Abstract
The aim of this review is to describe the acquisition and reformatting of state of the art high resolution cone beam CT (HR-CBCT) and demonstrate its role in multiple neurovascular conditions as a tool to improve the understanding of disease and guide therapeutic decisions. First, we will review the basic principle of CBCT acquisition, followed by the injection protocols and the reformatting paradigms. Next, multiple applications in different pathological conditions such as aneurysms, arteriovenous malformations, dural arteriovenous fistulas, and stroke will be described. HR-CBCT angiography, widely available, is uniquely useful in certain clinical scenarios to improve the understanding of disease and guide therapeutic decisions. It rapidly is becoming an essential tool for the contemporary neurointerventionalist.AChoAho.
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Affiliation(s)
- Eytan Raz
- Department of Radiology, NYU Langone Health, New York, New York, USA
| | - Erez Nossek
- Department of Neurosurgery, NYU Langone Health, New York, New York, USA
| | - Daniel H Sahlein
- Neuroendovascular, Goodman Campbell Brain and Spine, Carmel, Indiana, USA
| | - Vera Sharashidze
- Department of Radiology, NYU Langone Health, New York, New York, USA
| | - Vinayak Narayan
- Department of Radiology, NYU Langone Health, New York, New York, USA
| | - Aryan Ali
- Department of Radiology, NYU Langone Health, New York, New York, USA
| | - Rogelio Esparza
- Department of Neurosurgery, NYU Langone Health, New York, New York, USA
| | - Simone Peschillo
- Department of Neurology and Psychiatry, Endovascular Neurosurgery, University of Catania, Catania, Italy
| | - Charlotte Chung
- Department of Radiology, NYU Langone Health, New York, New York, USA
| | - Francesco Diana
- Department of Neuroradiology, Azienda Ospedaliera Universitaria 'San Giovanni di Dio e Ruggi d'Aragona', Salerno, Italy
| | - Safia Syed
- Department of Radiology, NYU Langone Health, New York, New York, USA
| | - Peter Kim Nelson
- Department of Radiology, NYU Langone Health, New York, New York, USA.,Department of Neurosurgery, NYU Langone Health, New York, New York, USA
| | - Maksim Shapiro
- Department of Radiology, NYU Langone Health, New York, New York, USA
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14
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Shapiro M, Raz E, Nossek E, Srivatanakul K, Young M, Narayan V, Ali A, Sharashidze V, Esparza R, Nelson PK. Cerebral venous anatomy: implications for the neurointerventionalist. J Neurointerv Surg 2022; 15:452-460. [PMID: 35803732 DOI: 10.1136/neurintsurg-2022-018917] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 06/12/2022] [Indexed: 11/03/2022]
Abstract
Meaningful contributions to neurointerventional practice may be possible by considering the dynamic aspects of angiography in addition to fixed morphologic information. The functional approach to venous anatomy requires integration of the traditional static anatomic features of the system-deep, superficial, posterior fossa, medullary veins, venous sinuses, and outflow routes into an overall appreciation of how a classic model of drainage is altered, embryologically, or pathologically, depending on patterns of flow-visualization made possible by angiography. In this review, emphasis is placed on balance between alternative venous networks and their redundancy, and the problems which arise when these systems are lacking. The role of veins in major neurovascular diseases, such as dural arteriovenous fistulae, arteriovenous malformations, pulsatile tinnitus, and intracranial hypertension, is highlighted, and deficiencies in knowledge emphasized.
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Affiliation(s)
- Maksim Shapiro
- Department of Radiology and Neurology, NYU, New York, New York, USA .,Department of Radiology and Neurology, Bellevue Hospital Center, New York, New York, USA
| | - Eytan Raz
- Department of Radiology, NYU, New York, New York, USA.,Department of Radiology, Bellevue Hospital Center, New York, New York, USA
| | - Erez Nossek
- Department of Neurosurgery, NYU, New York, New York, USA.,Department of Neurosurgery, Bellevue Hospital Center, New York, New York, USA
| | - Kittipong Srivatanakul
- Department of Neurosurgery, Tokai University School of Medicine Graduate School of Medicine, Isehara, Japan
| | - Matthew Young
- Department of Radiology, NYU, New York, New York, USA.,Department of Radiology, Bellevue Hospital Center, New York, New York, USA
| | - Vinayak Narayan
- Department of Radiology, NYU, New York, New York, USA.,Department of Radiology, Bellevue Hospital Center, New York, New York, USA
| | - Aryan Ali
- Department of Radiology, NYU, New York, New York, USA.,Department of Radiology, Bellevue Hospital Center, New York, New York, USA
| | - Vera Sharashidze
- Department of Radiology, NYU, New York, New York, USA.,Department of Radiology, Bellevue Hospital Center, New York, New York, USA
| | - Rogelio Esparza
- Department of Neurosurgery, NYU, New York, New York, USA.,Department of Neurosurgery, Bellevue Hospital Center, New York, New York, USA
| | - Peter Kim Nelson
- Department of Radiology and Neurology, Bellevue Hospital Center, New York, New York, USA.,Department of Radiology and Neurosurgery, NYU, New York, New York, USA
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Abstract
This paper aims to make simple the evaluation of the main veins related to the brainstem and cerebellum. Posterior fossa venous drainage is best understood in context with its three main collectors: superior: toward the Vein of Galen; posterior: toward the torcular complex; and anterior: toward the superior petrosal sinus. A fourth possible drainage path, often harder to distinguish, is directed toward the inferior petrosal sinus. Veins of these four systems are frequently connected to one another. Despite traditionally being considered less regular than its arterial disposition, posterior fossa venous anatomy follows specific patterns that are easy to identify. The three more representative veins of each venous confluent have been selected, to help in recognizing them angiographically. Since pial large veins are primarily located over the surface of the encephalon, most related anatomical structures can be confidently identified. This is of special interest when angiographic 2D or 3D studies are evaluated and provide fundamental assistance in locating precise structures. To better aid in understanding venous disposition, an overview of embryologic and fetal development is also discussed.
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Affiliation(s)
- María Angeles de Miquel
- Department of Radiology, Interventional Neuroradiology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
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16
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Baltsavias G, Paterno V, Lanfermann H. The So-Called Cranial Dural Channels and Their Relationship with the Bridging Veins. AJNR Am J Neuroradiol 2021; 42:E29-E30. [PMID: 33766828 DOI: 10.3174/ajnr.a6972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Gerasimos Baltsavias
- International Neuroscience InstituteHannover, GermanyNeuroradiology DepartmentMedical School HannoverHannover, Germany
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Oberman DZ, Rabelo NN, Correa JLA, Ajler P. Relationship of superior sagittal sinus with sagittal midline: A surgical application. Surg Neurol Int 2020; 11:309. [PMID: 33093986 PMCID: PMC7568091 DOI: 10.25259/sni_509_2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 08/28/2020] [Indexed: 11/19/2022] Open
Abstract
Background: Interhemispheric approach is widely used to surgical management of midline tumors and vascular lesion in and around the third ventricle. Complete exposure of the superior sagittal sinus to obtain adequate working space of midline lesion is difficult, because of the risk to inadvertent injury to the sinus and bridging veins, which may cause several neurological deficits. Understanding the SSS neuroanatomy and its relationships with external surgical landmarks avoid such complications. The objective of this study is to accurately describe the position of SSS and its displacement in relation with sagittal midline by magnetic resonance imaging. Methods: A retrospective cross-sectional, observational study was performed. Magnetic resonance image of 76 adult patients with no pathological imaging was analyzed. The position of the halfway between nasion and bregma, bregma, halfway between bregma and lambda, and lambda was performed. The width and the displacement of the superior sagittal sinus accordingly to the sagittal midline were assessed in those landmarks. Results: The mean width of superior sagittal sinus at halfway between nasion and bregma, bregma, halfway between bregma and lambda, and lambda was 5.62 ± 2.5, 6.5 ± 2.8, 7.4 ± 3.2, and 8.5 ± 2.1 mm, respectively, without gender discrepancy. The mean displacement according to the midline at those landmarks showed a statistically significant difference to the right side among sexes. Conclusion: In this study, we demonstrate that sagittal midline may approximate external location of the superior sagittal sinus. Our data showed that in the majority of the cases, the superior sagittal sinus is displaced to the right side of sagittal midline as far as 16.3 mm. The data we obtained provide useful information that suggest that neurosurgeons should use safety margin to perform burr holes and drillings at the sagittal midline.
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Affiliation(s)
| | | | | | - Pablo Ajler
- Department of Neurosurgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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