Imaging features of severe unilateral transverse sinus and sigmoid sinus thromboses and efficacy and safety of intravascular interventional therapy in them / 中华神经医学杂志

Objective:To summarize the imaging features of severe unilateral transverse sinus and sigmoid sinus thromboses, and evaluate the efficacy and safety of intravascular interventional therapy in them.Methods:Thirty-seven patients with severe unilateral transverse sinus and sigmoid sinus thromboses clinically mainly manifested as intracranial hypertension and accepted endovascular intervention in Department of Interventional Radiology, First Affiliated Hospital of Zhengzhou University from June 2012 to September 2022 were chosen; their clinical data were retrospectively analyzed and imaging features were summarized. Short-term efficacy was evaluated according to blood flow restoration degrees and pressure gradient reduction in the occlusive sinus and modified neurological symptoms before and after endovascular intervention. Hospitalized complications were observed; safety and long-term efficacy were evaluated according to postoperative clinical follow-up and imaging results 6-12 months after endovascular intervention.Results:(1) Preoperative brain MRI and (or) CT showed different degrees of swelling of the brain tissues, with the affected side as the target; mixed signals/density shadow could be seen in the blocked transverse sinus and sigmoid sinus; venous cerebral infarction or post-infarction cerebral hemorrhage could be combined in some patients. MRV, CTV and DSA showed poor or completely occluded transverse sinus and sigmoid sinus while normal in the contralateral side; obvious thrombus filling-defect was observed in the occluded venous sinus after mechanical thrombolysis. (2) Occlusive sinus blood flow was restored in all patients after endovascular intervention, and pressure gradient of the occlusive segment decreased from (16.6±3.3) mmHg before to (2.8±0.8) mmHg after endovascular intervention. Before discharge, clinical symptoms of all patients were significantly improved (modified Rankin scale [mRS] scores of 0 in 30 patients, 1 in 5 patients, 2 in 1 patient and 3 in 1 patient), and 2 patients had unilateral limb movement disorder (muscle strength grading III and IV, respectively). All patients received clinical follow-up for (9.6±3.0) months. At the last follow-up, neurological function obviously improved compared with that before endovascular intervention, without new neurosystem-related symptoms (mRS scores of 0 in 30 patients, 1 in 6, and 2 in 1 patient). In 34 patients received MRV or DSA follow-up, 28 had complete recanalization of occlusive sinus and 6 had partial recanalization, without obvious stenosis or recurrent occlusion.Conclusions:Severe unilateral transverse sinus and sigmoid sinus thrombosis can cause local intracranial venous blood stasis, and then cause "increased regional venous sinus pressure", which is manifested as unilateral brain tissue swelling and even venous cerebral infarction or post-infarction cerebral hemorrhage. Early diagnosis and endovascular intervention can obviously improve the prognosis of these patients, enjoying good safety.

Tratamiento de la hipertensión endocraneana idiopática con angioplastía de seno transverso / Transverse Sinus Stenting: A Treatment for Idiopathic Intracranial Hypertension. Technical Note

Introducción: La hipertensión endocraneana idiopática (HEI) o pseudotumor cerebri es una enfermedad de origen y fisiopatología desconocida que puede generar graves consecuencias. El abordaje terapéutico clásico inicial es la dieta hipocalórica y la acetazolamida. La fenestración de la vaina del nervio óptico y la colocación de un sistema de derivación de LCR constituyen procedimientos quirúrgicos clásicos aceptados para esta entidad en los casos sin respuesta al manejo farmacológico. En 1995 se describió la asociación de la HEI y la estenosis de senos transversos y en 2002 se publicó el primer caso de angioplastía de seno transverso como tratamiento exitoso de la HEI en un paciente. En los últimos 20 años se han reportado múltiples casos y series de casos con excelentes resultados pasando a formar parte de las herramientas válidas para el tratamiento de esta entidad. Objetivo: Describir la técnica de angioplastía e implantación de stent en el seno transverso como tratamiento de la hipertensión endocraneana idiopática. Material y métodos: Descripción de la técnica quirúrgica y los dispositivos utilizados para la angioplastía del seno transverso en un paciente con HEI asociado a estenosis del mismo. Conclusiones: Se describe la técnica de angioplastía e implantación de un stent en el seno transverso en una paciente con diagnóstico de HEI asociado a estenosis de seno trasverso con buena evolución(AU)

Background: Idiopathic intracranial hypertension (IIH) is a disease of unknown etiology and physiopathology that can generate serious consequences. The initial classical treatment is weight loss and acetazolamide. Optic nerve fenestration surgery and CSF diversion are accepted as surgical procedures for the treatment of this entity. In 1995, the association of IIH and dural sinus stenosis by venography was described and in 2002 the first case of stent implantation in transverse sinus as a successful treatment of IIH in a patient was published. In the last 20 years have been published multiple case reports and case series with excellent results, becoming part of the valid tools for the treatment of this disease. Objective: To describe surgical technique of stenting the transverse sinus in a patient with IIH diagnosis. Material and methods: Description of diagnosis steps and stenting technique of transverse sinus in a patient with IIH associated to transverse sinus stenosis. Conclusions: We describe stenting technique of transverse sinus in a patient with IIH diagnosis(AU)

Trombose Venosa Cerebral Acometendo Seio Transverso em Paciente Pediátrico: Relato de Caso e Revisão de Literatura / Cerebral Venous Thrombosis Occuring in a Transverse Sinus in Pediatric Patient: Case Report and Literature Review

Objetivo: A trombose venosa cerebral é um tipo raro de doença cerebrovascular que acomete todas as idades, sendo extremamente rara, em crianças. O objetivo deste trabalho foi relatar um caso de trombose venosa cerebral acometendo seio transverso em uma paciente de 3 anos. Métodos: Trata-se de uma pesquisa qualitativa, descritiva e exploratória, do tipo Relato de caso, realizada por meio da coleta de dados clínicos, laboratoriais e radiológicos em prontuário no Hospital Universitário Santa Terezinha ­ HUST. Resultados: Paciente, com 3 anos, apresentava cefaleia, vômitos, anorexia e sonolência há 4 dias. Na admissão em emergência, foram realizados exames laboratoriais e exames de imagem, tomografia computadorizada de crânio e angiorressonância cerebral, os quais confirmaram o diagnóstico de trombose venosa cerebral. Na discussão entre vascular, neurocirurgião e pediatra, optou-se pelo tratamento conservador com anticoagulante Enoxaparina, apresentando melhora significativa na clínica e na angiorressonância após 30 dias de tratamento. Conclusão: Apesar de ser rara em crianças, a suspeita clínica é fundamental para o diagnóstico precoce, e posterior estabelecimento de condutas adequadas, a fim de evitar complicações e reduzir a mortalidade. Não há consenso na literatura sobre o uso dos antitrombóticos, porém estudos mostram efeitos benéficos.

Objective: Cerebral venous thrombosis is a rare type of cerebrovascular disease that affects all ages, and is extremely rare in children. The objective of this study was to report a case of cerebral venous thrombosis affecting the transverse sinus of a 3-year-old patient. Methods: This is a qualitative, descriptive, and exploratory study of the case report type, carried out by collecting clinical, laboratory, and radiological data from medical records at the Santa Terezinha University Hospital (Hospital Universitário Santa Terezinha [HUST]). Results: A 3-year-old patient presented headache, vomiting, anorexia, and somnolence for four days. On emergency admission, laboratory tests and imaging exams, skull computed tomography, and cerebral angioresonance were performed, which confirmed the diagnosis of cerebral venous thrombosis. In the discussion between the vascular, the neurosurgeon, and the pediatrician, conservative treatment with anticoagulant Enoxaparin was chosen, showing significant improvement in clinical and angioresonance after 30 days of treatment. Conclusion: Despite being rare in children, clinical suspicion is essential for early diagnosis and the subsequent establishment of appropriate conduct to avoid complications and reduce mortality. There is no consensus in the literature on using antithrombotic agents, but studies show beneficial effects.

Medical image software in anatomical measurements and precision craniotomy via suboccipital retrosigmoid sinus approach / 中华神经医学杂志

Objective:To evaluate the application of a medical image software (RadiAnt) in anatomical measurements and precision craniotomy via suboccipital retrosigmoid sinus approach.Methods:A total of 43 inpatients who underwent craniocerebral CT venography (CTV) in our hospital from June 2020 to June 2021 were selected for the study; the CTV data of 35 patients was used to measure the spatial relations between transverse sigmoid sinus junction (TSSJ) and asterion; the preoperative planning in suboccipital retrosigmoid sinus craniotomy with the software was performed in the left 8 patients. Craniotomy time (subjected to exposure of venous sinus margin), venous sinus injury and incidence of complications within 2 weeks of craniotomy in these 8 patients were recorded.Results:(1) Anatomic measurement: for the left side, TSSJ was located at (0.89±0.33) cm lateral and (0.63±0.46) cm inferior to the asterion, and their direct distance was (1.15±0.42) cm; TSSJ was located at (0.76±0.49) cm interior and (1.97±0.52) cm superior to the starting point of the mastoid notch, and their direct distance was (2.18±0.49) cm; about 29% asterion were located superior to the transverse sinus, 37% were located on the surface of the transverse sinus, and 34% were located inferior to the transverse sinus. For the right side, TSSJ was located at (0.88±0.39) cm lateral and (0.64±0.43) cm inferior to the asterion, and their direct distance was (1.12±0.54) cm; TSSJ was located at (0.74±0.40) cm interior and (1.93±0.45) cm superior to the starting point of the mastoid notch, and their direct distance was (2.16±0.43) cm; about 26% asterion were located superior to the transverse sinus, 40% were located on the surface of the transverse sinus, and 34% were located inferior to the transverse sinus. (2) Preoperative planning and surgeries: in these 8 patients, the key-hole was located at (0.96±0.49) cm lateral and (0.53±0.18) cm inferior to the asterion, and (0.46±0.35) cm interior and (1.76±0.47) superior to the starting point of mastoid notch. The interior of sigmoid sinus was located (0.13±0.51) cm interior and (0.21±0.46) cm superior to the starting point of mastoid notch. The inferior of the transverse sinus was located (2.17±0.45) cm interior and (0.53±0.35) cm inferior to the asterion. An accurate localization of the real position of TSSJ, inferior of transverse sinus and interior of sigmoid sinus was performed in all 8 surgical patients. The distance between the margin of the bone window and the interior of sigmoid sinus was (3.5±1.0) mm, and the craniotomy time was (25.7±4.1) min; no sinus injury was noted. Post-operative CT showed good reposition of the bone flaps and less bone defect. There was no cerebrospinal fluid leakage or subcutaneous effusion during the 2 weeks of follow-up.Conclusion:Anatomical measurements and preoperative planning can be quickly finished with low cost with Radiant ?, which provides an efficient and safe method for accurate craniotomy via suboccipital retrosigmoid approach.

Modified surgical method for supra- and infratentorial epidural hematoma and related anatomical study of the squamosal part of the occipital bone / 西安交通大学学报(医学版)

Objective: To explore the modified surgical method of supra- and infratentorial epidural hematoma (SIEDH) and analyze the related anatomy of the occipital bone. Methods: CT scan data of 30 adult patients with no history of craniocerebral trauma were collected in our hospital from January to August 2019. The median sagittal plane was taken to define line A (from lambdoid suture to the extraoccipital turbercle) and line B (from extraoccipital turbercle to the posterior edge of the foramen magmun). The angle θ was defined between the two lines. The mean value of θ was analyzed for comparison between genders and for exploration of the anatomical basis of single supratentorial craniotomy for SIEDH. Eight patients with SIEDH were recruited in the same period to analyze the procedure and results of the modified surgical method. Results: The average angle of the θ was (117.4±4.3)° for men and (130.0 ±4.9)° for women; the minimum was 108.3° for men and the maximum was 138.7 ° for women. The θ was smaller in men than in women (P<0.001). The smaller the angle was, the more conductive it was to detect the lesions from superior to inferior tentorial apartment. The bone flaps of the eight patients were designed above the transverse sinus. During the operation, epidural hematoma was completely removed, and no skull defects occurred like in conventional supra-inferior tentorial craniotomy. Conclusion: The supratentorial craniotomy above the tranverse sinus has reliable anatomical basis and is an effective surgical method for SIEDH.

Persistent fetal superficial middle cerebral vein: an anatomical study / 대한해부학회지

The superficial middle cerebral vein (SMCV) drains the venous blood from most of the superolateral surface of the brain and drains typically into the cavernous sinus as mentioned in standard textbooks. But the drainage of the SMCV is variable as indicated by various radiological studies. Although variations in the drainage of the SMCV exist, there is a shortage in the literature providing cadaveric evidence for the same. The present study was designed to identify the variations in the drainage pattern of the SMCV in fetal cadavers. During the dissection of formalin-fixed full-term fetuses, deviation in the drainage of the SMCV was observed in five out of 30 cases. In three out of 30 specimens (10%), SMCV was observed draining into superior petrosal sinus; and in two specimens (6.6%) into the transverse sinus. In the remaining specimens, the SMCV drained directly into the cavernous sinus. Knowledge of the variations noted in the present study is essential, not only for diagnosing several diseases involving the cavernous sinus or paracavernous sinuses but also in surgeries of paracavernous sinus lesions and endovascular treatment of arteriovenous fistulas. The SMCV and superior petrosal sinus can be a venous refluxing route in patients with arteriovenous fistulas.

Clinical analysis of the correlation between transverse sinus drainage dominance and aneurysm formation and rupture / 中国神经精神疾病杂志

To investigate the clinical correlation between transverse sinus classification and variation and aneurysm formation and rupture and to determine the risk factors of intracranial aneurysm rupture. Methods A retrospective data analysis was conducted on a total of 345 cases of intracranial aneurysms from January to December 2018. Clinical characteristics were compared between ruptured aneurysm group (RAG, n=230) and unruptured aneurysms group (URAG, n=115). Logistic regression analysis was performed to analyze the anatomy of venous sinus and clinical features including smoking history, hypertension, diabetes, location and size of the aneurysm in patients with intracranial aneurysm rupture. Results There were significant differences in had statistical significance with the patients' drinking history, smoking history, hypertension, diabetes, location and size of the aneurysm, as well as the dominant venous sinus on the same side as the aneurysm between rupture of intracranial aneurysm group and unruptured aneurysms group (P＜0.05). Multivariate logistic regression analysis suggested that diabetes (OR=10.567), anterior communication (OR=2.214), posterior communication (OR=2.932), small aneurysms (OR=3.841), dominant venous sinus on the same side as the aneurysm (OR=1.736) were independent risk factors for rupture of the unruptured aneurysm. In addition, the dominant side of transverse sinus were more likely to form intracranial aneurysms (P＜0.001). Conclusion The predisposing factors for rupture of intracranial aneurysms are anterior communication, posterior communication, small aneurysms and dominant lateral venous sinuses on the same side as aneurysms. Ipsilateral aneurysms are more likely to form in patients with dominant venous sinuses and can be used to accurately predict aneurysm rupture.

Thrombophilia Profile In Cerebral Venous Sinus Thombosis: A Study From Eastern India

Background: Cereal venous sinus thrombosis (CVST) is the formation of blood clot in the dural venous and/or sinuses, which drain blood from the ain. It is one of the commonest causes of stroke in young. In most cases it hypercoagulable factors are responsible for it. Materials & methods: prospective observational hospital based study in the department of Neurology, S.C.B. Medical College & Hospital, Cuttack, odisha from October 2015 to September 2017. Those patients with diagnosis of CVST with magnetic resonance imaging and venogram confirmation with thrombophilia profile were included in the study. Thrombophilia assay was done. They were treated with recent guidelines. All the data were analyzed according to spss software version 20.0. Results: Total 24 patients did the profile. Most common age group was 21–40 yrs. Protein s was the most common factor. Transverse sinus was the most common sinus. Multifactorial thrombofilia patients were more resistant to therapy. Conclusion: All the CVST patients must be exposed to thrombophilia profile assay. It will not only help treatment of the disease but also it will help in prognosticate the outcome. In our area protein S deficiency is the most common factor abnormality. Further large studies are needed to obtain further knowledge about the factors and their clinicoradiological correlation.

Study of bilateral transverse sinus diameter with spiral CT / 实用放射学杂志

Objective To explore the value of spiral CT in venous phase in measuring the diameter of bilateral transverse sinus.Methods The CT vascular imaging findings of 200 cases at torcular herophili area in our hospital were analyzed retrospectively.The resource images, volume rendering (VR) and maximum intensity projection (MIP) were performed to observe the presentation of vascular anatomy in the torcular herophili area, and to determine the dominant transverse sinus and types of torcular herophili (typeⅠ-Ⅵ).The diameters of bilateral transverse sinus were measured by original CT images.Two groups were categorized according to the genders, and four ones (20-30 years, 30-40 years, 40-50 years and 50-60 years) according to the age.Results Between different genders, there was significant difference in right transverse diameter (P0.05).There was no significant difference among four age groups in bilateral transverse diameter (P>0.05).Conclusion Spiral CT is helpful for the evaluation of the diameter of bilateral transverse sinus.These findings can provide anatomical basis for clinical disease with significant implication.

Infantile Dural Arteriovenous Fistula of the Transverse Sinus Presenting with Ocular Symptoms, Case Reports and Review of Literature

Dural arteriovenous fistula (DAVF) of the transverse sinus with ophthalmic manifestations in young children are rare. We reviewed two cases of direct AVF of the transverse sinus with ocular manifestations managed at our institution. The first, a 2.5 years old male child presented with left exophthalmos. Angiography revealed AVF between the occipital artery and the transverse sinus. The second, a 2 years old female child, complained of left exophthalmos. Imaging studies showed bilateral direct AVFs of the transverse sinus with bilateral dysmaturation of the sigmoid sinus. Transarterial embolization was done in both cases. Clinical and radiological follow up revealed complete cure.This report suggests that DAVF of the transverse sinus supplied by the external carotid branches can present with ophthalmic manifestations especially if there is distal venous stenosis or obliteration involving sigmoid sinus. Transarterial embolization using coils and liquid embolic agents could be safe and feasible to obliterate the fistula.

Anatomical Variations of Cerebral MR Venography: Is Gender Matter? / 신경중재치료의학

PURPOSE: Knowledge of variations in the cerebral dural venous sinus anatomy seen on magnetic resonance (MR) venography is essential to avoid over-diagnosis of cerebral venous sinus thrombosis (CVST). Very limited data is available on gender difference of the cerebral dural venous sinus anatomy variations. MATERIALS AND METHODS: A retrospective study was conducted to study the normal anatomy of the intracranial venous system and its normal variation, as depicted by 3D MR venography, in normal adults and any gender-related differences. RESULTS: A total of 1654 patients (582 men, 1072 women, age range 19 to 86 years, mean age: 37.98±13.83 years) were included in the study. Most common indication for MR venography was headache (75.4%). Hypoplastic left transverse sinus was the most common anatomical variation in 352 (21.3%) patients. Left transverse sinus was hypoplastic in more commonly in male in comparison to female (24.9% versus 19.3%, p = 0.009). Most common variation of superior sagittal sinus (SSS) was atresia of anterior one third SSS (15, 0.9%). Except hypoplastic left transverse sinus, rest of anatomical variations of the transverse and other sinuses were not significantly differ among both genders. CONCLUSION: Hypoplastic left transverse sinus is the most common anatomical variation and more common in male compared to female in the present study. Other anatomical variations of dural venous sinuses are not significantly differ among both genders.

Morphometric features of asterion in adult human skulls.

Background: Asterion is the meeting point of temporal, occipital and parietal bones on the posterolateral surface of skull and surgically an important point of reference for approaching the posterior cranial fossa structures. However surgeons have been skeptical about its reliability due to population based differences in its morphology, distance with other external landmarks and also to sigmoid and transverse sinuses. Methods: In this study 50 (27 male & 23 female) adult skulls were investigated to determine the type of asterion, its distance from important bony landmarks and also the nearby venous sinuses were measured. Results: Our study revealed that type II (absence of sutural bones) was commoner than type I (presence of sutural bones) asterion. The asterion was 4.82 ± 0.58 cm from tip of the mastoid process on the right side and 4.70 ± 0.70 cm on the left. It was greater in males than in females, p value being statistically significant (P = 0.00 & P = 0.02 for right & left sides respectively). The distance of asterion from supramastoid crest was 4.22 ± 0.73 cm on the right and 4.23+/-0.58 cm on the left. The distance in males was more than in females. The P value 0.00 was statistically significant on the right side. Regarding the position of the asterion in relation to transverse sinus, it was on the transverse sinus in 62% cases, below it in 32% and above in 6%. Conclusions: The data obtained shows that the asterion is located either at the level or below the level of the transverse sinus in majority of the cases. This information is useful to neurosurgeons to reduce the risk during posterior cranial fossa surgeries. This work will also be useful to anthropologists, forensic science experts for determination of sex of the skull along with other parameters.

The localization of the asterion according to the anatomical landmarks of posterior cranial fossa in newborns: clinical implications / Localización del asterión de acuerdo con los puntos anatómicos de la fosa craneal posterior en recién nacidos: implicaciones clínicas

The purpose of this study was to determine the localization of the asterion according to the anatomical landmarks of posterior cranial fossa and its relation with sinuses for posterolateral surgical approaches in newborns. On 70 head-halves, a needle about 2 mm with diameter was placed on the centre point of asterion (posterolateral fontanel) by inserting into the whole cranial bony tissue by forming an right angle with the bony surface. Various localizations of asterion and its measurements from the internal and external anatomical landmarks were investigated on term neonatal cadavers. The localization of asterion was found as on the sigmoid-transverse sinus junction (STJ) (5., 6., 7., 8. squares) in 40% of cases on right side and in 34%, on left side. Additionally, it was located below the STJ (9., 10., 11., 12. squares) in 60% of cases, on right side and in 63% of cases on left side. We determined that the most frequent localization of asterion as the 11. square both for the right and left sides 12 (34%) cases for the right side and 11 (31,4%) cases for the left side. The asterion was not located on 1., 2., 3., 4., 5. and 12. squares on right side and 1., 3., 4., 8. and 9. squares on left side. It has been found that the region of asterion has an average distance value of 19.9 mm to internal acoustic meatus (MI), 31.7 mm to posterior clinoid process (PC), 34.4 to dorsum sellae (DS), 19.2 mm to jugular foramen (FJ), 23.0 mm to hypoglossal canal (HC), internally. The distance of asterion as 28.8 mm to zygoma root (ZR) and 22.3 mm to Henle's spine (HS) and 15.8 mm to mastoid tip (MT) and 35.9 mm to external occipital protuberance (PE) were observed. By the guide of point asterion on newborns the area of 1cm2 on this point which was placed on superior 4 squares of our scale diagram is suggested as a safe area of placement of first burr hole to avoid from the risk of bleeding of sigmoid and transverse sinuses on craniotomies of posterior fossa.

El propósito de este estudio fue determinar la localización del asterion de acuerdo con los puntos anatómicos de la fosa craneal posterior y su relación con los senos de abordajes quirúrgicos posterolaterales en los recién nacidos. Fueron utilizadas 70 hemicabezas y se colocó una aguja de alrededor de 2 mm de diámetro en el punto central del asterion (fontanela posterolateral) en todo el tejido óseo craneal produciéndose la formación de un ángulo recto con la superficie ósea. La localización del asterion y las mediciones de los puntos de referencia anatómicos internos y externos fueron investigados en cadáveres de neonatos a término. La localización del asterion se encontró en la unión sinusal transverso sigmoide (STJ) (cuadrados 5., 6., 7., 8.) en el 40% de los casos en el lado derecho y en el 34%, en el lado izquierdo. Además, se encontró por debajo del STJ (cuadrados 9., 10., 11., 12.) en un 60% de los casos en el lado derecho y en el 63% de los casos en el lado izquierdo. Se determinó que la localización más frecuente del asterion fue 11., tanto para los lados derecho e izquierdo, 12 casos (34%) para el lado derecho y 11 casos (31,4%) para el lado izquierdo. El asterion no se encuentra en los cuadrados 1., 2., 3., 4., 5. y 12. del lado derecho y 1., 3., 4., 8. y 9. del lado izquierdo. Se determinó que la región del asterion tiene una distancia promedio de 19,9 mm al meato acústico interno, 31,7 mm al proceso clinoides posterior, 34,4 mm al dorso selar, 19,2 mm al foramen yugular y 23,0 mm al canal hipogloso, internamente. La distancia del asterion a la raíz del hueso cigomático fue 28,8 mm y 22,3 mm a la columna vertebral, siendo de 15,8 mm al proceso mastoides y 35,9 mm a la protuberancia occipital externa. En los recién nacidos, se sugiere un área de 1cm2 y se colocan en 4 casillas superiores de nuestro diagrama a escala, como una zona segura para la realización de la primera trepanación para evitar el riesgo de sangrado de los senos sigmoide y transverso en craneotomías de fosa posterior.

Abordaje retrosigmoideo / Retrogigmoid approach

OBJETIVO: describir en forma detallada, paso a paso, la realización de un abordaje retrosigmoideo. DESCRIPCIÓN: posición: existen 3 posiciones descritas para la realización de este abordaje, semisentada, decubito dorsal y en banco de plaza. Incisión: se extiende desde la parte superior del pabellón auricular hasta 2 cm por debajo del vertice mastoideo, y 1 cm medial a la ranura digástrica. Disección de partes blandas: se realiza una disección subperiostica, teniendo especial cuidado con la vena hemisaria mastoidea (posible fuente de embolia aérea). Craniectomía: es necesario identificar previamente algunos puntos anatómicos de referencia para la ubicación de los senos transverso y sigmoides. En la etapa final de la remoción ósea, se procede al fresado de la porción más superior y lateral del abordaje, con la necesaria exposición de la porción inferior del seno transverso y de la porción medial del seno sigmoides. Apertura dural: se realiza una apertura en forma de letra "C" (lado izquierdo), o letra "C invertida" (lado derecho), con base medial, comenzando en la porción superior y medial de duramadre expuesta. Disección microquirúrgica: dependiendo de la ubicación de la patologia a abordar se debe realizar una retracción gentil del hemisferio cerebeloso hacia medial. En la mayoría de los casos es necesario abrir la cisterna cerebelobulbar, con el objeto de evacuar LCR. CONCLUSIÓN: el refinamiento alcanzado actualmente hace que el abordaje retrosigmoideo sea el más utilizado para el tratamiento de las múltiples patologías ubicadas en la región del ángulo pontocerebeloso. El acceso que proporciona esta vía a la mayoría de los nervios craneales que se encuentran en la fosa posterior, y a sus complejos neurovasculares correspondientes, lo convierte en un abordaje de obligatorio aprendizaje para todo neurocirujano

OBJECTIVE: the aim of this paper is to describe, step by step, the retrosigmoid approach to accessing the cerebellopontine angle (CPA). DESCRIPTION: patient position: three potential positions have been described for this approach: semi-sitting, dorsal decubitus and park bench. Incision: The incision extends from the top of the ear to 2 cm below the mastoid apex, and 1 cm medial to the digastric groove. Soft tissue dissection: A subperiosteal dissection is performed, taking special care to avoid the mastoid emissary vein. CRANIOTOMY: At the outset, it is necessary to identify certain anatomical landmarks to localize the transverse and sigmoid sinuses. Dural opening: The dural incision is made in the shape of the letter "C" on the left side or an inverted letter "C" on the right. Microsurgical dissection: Depending on the location of the pathology being treated, it may be necessary to perform gentle cerebellar retraction medially. CONCLUSIONS: the refinements now achieved with the retrosigmoid approach make it the most widely-used approach for the treatment of lesions located within the CPA. The access provided by this approach to the vast majority of the cranial nerves in the posterior fossa, as well as their neurovascular complexes, makes it a mandatory approach for all neurosurgeons to learn

Application value of minimally-invasive surgical treatment in patients with traumatic epidural hematoma straddling transverse sinus / 中国医师进修杂志

Objective To investigate the application value of minimally-invasive surgical treatment in patients with traumatic epidural hematoma(EDH)straddling transverse sinus.Methods Forty-eight patients with traumatic EDH straddling transverse sinus were chosen and preoperative Glasgow Coma Scale (GCS)score ≥8 scores were managed with minimally-invasive drainage under CT location.CT scanning was performed 1 h,3 d after operation and hematoma volume was calculated,and Glasgow Outcome Scale(GOS)score was evaluated 3 months after operation.Results CT scanning showed that the hematoma volume preoperative was(46 ± 14)ml,postoperative of 1 h was(21 ± 4)ml,and 3 d was(16 ± 3)ml,decreased more obviously than preoperative,and there was significant difference(P ＜ 0.05).The GCS score preoperative was(8 ± 4)scores,postoperative of 3 d was(12 ± 2)scores,increased more obviously than preoperative,and there was significant difference(P ＜ 0.05).Three months after operation in 48 patients,GOS score 5 points 37 cases(77.1％,37/48),4 points 7 cases(14.6％,7/48),2 points 2 cases(4.2％,2/48),1 point two cases(4.2％,2/48).Conclusion Minimally-invasive drainage is effective in the treatment of traumatic EDH straddling transverse sinus with GCS score ≥ 8 scores.

Surgical strategies for epidural hematoma straddling the transverse sinus: clinical analysis of 58 cases / 中华神经医学杂志

Objective To analyze the clinical management, surgical indications and surgical approaches for epidural hematoma straddling the transverse sinus. Methods The clinical data were collected from 58 patients with epidural hematoma straddling the transverse sinus treated between September, 2001 and December, 2007. Of these patients, the hematoma was found by the initial head CT scan in 42 cases; 10 patients had delayed hematoma, and 6 showed delayed hematoma during craniotomy. All the patients were scanned using 16-slice spiral CT for coronal and sagittal three-dimensional reconstruction, and the total hematoma volume and the supratentorial and infratentorial hematoma volumes were calculated. Forty-two patients were found to have the straddling hematoma volume no less than 30 mL or infratentorial hematoma volume over 15 mL. According to the extension of the hemotoma, a bone flap spanning the transverse sinus was taken, and after hematoma removal, the bone flap was reduced and fixed with cranial screws. In 8 patients with other hematomas or severe intracranial hypertension, routine removal of the hematoma or decompressive craniectomy was performed. Results Fifty-four of the patients recovered, 3 were capable of independent living, and 1 sustained severe disabilities after the operations. No death occurred in these patients. Conclusion In patients with epidural hematoma straddling the transverse sinus, conservative treatment can be administered in cases with the straddling hematoma volume < 30 mL or infratentorial hematoma volume < 15 mL, otherwise timely surgical interventions should be performed. One-step preparation of the bone flap spanning the transverse sinus is safe but secure internal fixation is necessitated after reduction of the bone flap.

A Case of Pulsatile Tinnitus by Sigmoid Sinus Diverticulum / 대한이비인후과학회지

The pulsatile tinnitus is characterized by a rhythmic sound that is synchronous with the patient's heart beat. Accurate diagnosis is imperative, because in many patients, a treatable underlying etiology can be identified. Sigmoid sinus diverticulum is known to be one of the treatable causes of venous pulsatile tinnitus, but rarely reported in the literature. We experienced a case of sigmoid sinus diverticulum in a 58-year-old female presenting a pulsatile tinnitus. So we report this case with a review of literature.

The Experience of Ligation of Transverse or Sigmoid Sinus in Surgery of Large Petroclival Meningiomas

The authors present the experience of ligation of transverse or sigmoid sinus in the surgical removal of petroclival meningiomas. We reviewed the medical records and venograms of 14 patients with petroclival meningiomas, in whom the intraoperative ligation of transverse or sigmoid sinus had been done at our hospital between 1986 and 1999. All patients passed the intraoperative test clamping of the sinus. The drainage pattern of confluence of Herophili was classified into four types: type A, confluence and equal drainage on both transverse sinuses; type B, confluence and non-dominant transverse sinus on the tumor side; type C, confluence and dominant transverse sinus on the tumor side; and type D, unilateral transverse sinus only. Among the 14 cases, four cases were in type A, five cases in type B, and two were type C. There was no evidence of brain swelling after intraoperative test clamping of the sinus for more than 30 min. None of the patients experienced postoperative complications related with sinus ligation. Our observation suggests that the transverse or sigmoid sinus ligation is tolerable to patients sinus. who show the drainage patterns of type A, type B, and type C, if the test clamping proves to be safe.

A Case of Orbital Cavernous Angioma Associated with Intracranial Venous Anomalies

The authors present a rare case of orbital cavernous malformation associated with intracranial venous anomalies. A 7-year-old female patient was admitted to our hospital complaining of headache and progressive diplopia. Neurologic examination revealed a painful proptosis and limited movement of right eye. Magnetic resonance images demonstrated a cavernous malformation in the right orbit, intracerebral cystic cavernous malformation, and well-enhancing vascular marking in the right temporal lobe. On the cerebral angiography, dilated vein of Labb and duplicated transverse sinus were noted. The patient showed marked improvement of her vision after the total removal of the orbital lesion. We believe this is an another evidence that cavernous malformation may be derived from increased burden of cerebral blood flow and/or venous pressure.

Drainage of Transverse Sinus and Vein of Labbe in Cerebral Angiography

Recent advances in neurosurgical field have markedly reduced the mortality and morbidity after skull base surgery. Despite of new skills of skull base surgery, the complication rates remain high. Postoperative cerebral infarction is a main cause of complication. Although arterial compromise is responsible for a majority of these events, the venous side of the circulation can also play a role in producing cerebral infarction. One of the key areas of cerebral venous drainage is at the junction of the transverse sinus and vein of Labbe. We have analyzed 50 cases of cerebral angiograms performed to rule out several vascular diseases. The results are as follows: 1) The selected carotid artery influences opacification patterns of the transverse sinus. 2) The incidence of transverse sinus atresia is about 14%. 3) Anterior and posterior circulation may have different opacification patterns of the transverse sinus. We concluded that neurosurgeons must perform complete 4-vessel angioraphy and analyze various opacification patterns of the transverse sinus and the vein of Labbe to prevent venous infarction after skull base surgery.