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Singh R. Prevalence and Morphometry of Occipital Foramen in Dry Skulls and its Clinical Implications. J Craniofac Surg 2024; 35:e391-e394. [PMID: 38722329 DOI: 10.1097/scs.0000000000010264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 04/04/2024] [Indexed: 06/04/2024] Open
Abstract
The occipital emissary foramen (OEF) located on the occipital bone transmits the occipital emissary vein, which connects the occipital vein to the confluence of cranial venous sinuses. The OEF varies in incidence, number, size, and location. Knowledge of this foramen is essential for carrying out suboccipital and transcondylar surgeries without clinical implications. Hence, the study was planned. The aim of the present study is to elaborate on incidence, location, and morphometry consisting of the number and size of this foramen in light of clinical bearing in the context of the Indian population. The study was carried out in the Department of Anatomy using 80 skulls of unknown age and sex. The occipital bone of the skull was observed for the incidence, number, size, and location of the occipital emissary vein and associated clinical implications were elaborated. The incidence of occipital foramen was 36.25% and detected in 29 skulls. All these occipital foramina were patent. The mean diameter of this foramen was 0.6 mm. The most common location of these foramina was the left side of the foramen magnum, followed by the left side of the external occipital crest. The information about the incidence, number, size, and location of OEF is important to prevent catastrophic bleeding during surgery in the region of the occipital bone. The awareness of differential morphometry and morphology of occipital foramina is of great importance for neurosurgeons during suboccipital craniotomy and skull base surgeries, including far lateral and transcondylar approaches to access posterior cranial fossa for management of pathologies in the cranial cavity.
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Affiliation(s)
- Rajani Singh
- Department of Anatomy, UP University of Medical Sciences Saifai, Etawah, Uttar Pradesh, India
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Senturk YE, Peker A, Aydin K, Ozmen E, Aygun MS, Ozen Atalay H, Oner AY. Tortuous occipital emissary vein combined with dural venous sinus stenosis in contrast-enhanced MRV for evaluation of idiopathic intracranial hypertension. Jpn J Radiol 2024:10.1007/s11604-024-01598-0. [PMID: 38805118 DOI: 10.1007/s11604-024-01598-0] [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: 02/26/2024] [Accepted: 05/17/2024] [Indexed: 05/29/2024]
Abstract
PURPOSE Venous outflow impediment is increasingly recognized in idiopathic intracranial hypertension (IIH). We aim to search for the value of tortuous occipital emissary vein (OEV) in IIH by integrating measurable transverse sinus (TS) stenosis in contrast-enhanced MR venography (CE-MRV). METHODS Twenty-one IIH patients were evaluated with CE-MRV. Each patient had high LP opening pressure (> 25 cm.H2O), and presented papilledema. Age- and sex-matched 21 control subjects who underwent cranial CE-MRV were selected. The OEV and the following features: intraosseous diameter of more than 3 mm, twisted course, and continuous with prominent sub-occipital extracranial veins were named tortuous OEV. TS stenosis was measured by utilizing the coronal T1-VIBE series to calculate quantitative metrics such as TS max./min.. The tortuous OEV and TS max./min. were registered to create a bivariate logistic regression model to assess the performance of tortuous OEV for IIH when accompanied by TS stenosis. RESULTS Six (29%) tortuous OEVs were observed in the IIH group, while no tortuous OEV was identified in the control group (p = 0.021). The mean TSmax./min. was 2.48 ± 1.19 in patients with IIH and 1.23 ± 0.33 in the control group (p < 0.001). According to regression analysis, tortuous OEV is not predictive of IIH (p = 0.999), while the higher TSmax./min. (> 1.69) is predictive of IIH (p = 0.022, OR: 8.9; %95 CI; 1.4-59.0) when accompanied together. CONCLUSION Tortuous occipital emissary vein is more frequently seen in patients with IIH. However, the tortuous appearance alone does not predict idiopathic intracranial hypertension unless associated with measurable transverse sinus narrowing in CE-MRV.
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Affiliation(s)
- Yunus Emre Senturk
- Department of Radiology, Koç University Hospital, Topkapı, Davutpaşa Caddesi, 34010, Istanbul, Turkey.
| | - Ahmet Peker
- Department of Radiology, Koç University Hospital, Topkapı, Davutpaşa Caddesi, 34010, Istanbul, Turkey
| | - Kubilay Aydin
- Department of Radiology, Koç University Hospital, Topkapı, Davutpaşa Caddesi, 34010, Istanbul, Turkey
| | - Evrim Ozmen
- Department of Radiology, Koç University Hospital, Topkapı, Davutpaşa Caddesi, 34010, Istanbul, Turkey
| | - Murat Serhat Aygun
- Department of Radiology, Koç University Hospital, Topkapı, Davutpaşa Caddesi, 34010, Istanbul, Turkey
| | - Hande Ozen Atalay
- Department of Radiology, Koç University Hospital, Topkapı, Davutpaşa Caddesi, 34010, Istanbul, Turkey
| | - Ali Yusuf Oner
- Department of Radiology, Koç University Hospital, Topkapı, Davutpaşa Caddesi, 34010, Istanbul, Turkey
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Singh R. Mastoid Emissary Foramina in Dry Skulls: Its Morphometry, Topography, and Associated Clinical Implications. J Craniofac Surg 2024:00001665-990000000-01471. [PMID: 38687087 DOI: 10.1097/scs.0000000000010142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 02/12/2024] [Indexed: 05/02/2024] Open
Abstract
Mastoid emissary foramen transmitting mastoid emissary vein connects the posterior auricular vein with the sigmoid sinus. This foramen and so the mastoid emissary vein varies in prevalence, number, size and location, knowledge of which is essential for carrying out uneventful surgeries, especially retrosigmoid, mastoidectomy, and skull base surgeries. There is a paucity of literature on this foramen in the Indian context, so the study was done. The purpose of the study is to elaborate on the prevalence, number, size, and location of mastoid foramen in dry adult skulls. The study was conducted in the Department of Anatomy using 90 dry skulls of unknown age and sex, and prevalence, number, size, and location in these skulls were noted. The mastoid foramen was detected in 27.8% of skulls, with an incidence of 31.1% and 12.2% on right and left sides of skulls, respectively. The number of foramina ranged between 1 and 4. The mean diameter of this foramen was 0.9 mm, and the most frequent location was mastoid process. The detailed morphology and morphometry of mastoid foramen are of utmost use to neurosurgeons, ENT surgeons, radiologists, and vascular surgeons as it transmits mastoid emissary vein and meningeal branch of the occipital artery, which may be injured during various surgical procedures involving mastoid region and skull base causing catastrophic hemorrhage. In addition to this, mastoid emissary vein may be the source of thrombus, causing thrombus of sigmoid sinus creating helm of neurological complications.
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Affiliation(s)
- Rajani Singh
- Department of Anatomy, UP University of Medical Sciences Saifai, Etawah, Uttar Pradesh, India
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Hashikata H, Maki Y, Terada Y, Yoshimoto N, Goto M, Ishibashi R, Miki Y, Ikeda N, Hayashi H, Nishida N, Taki J, Iwasaki K, Toda H. Risk of Bone Wax Migration During Retrosigmoid Craniotomy for Microvascular Decompression: Case-Control Study. Oper Neurosurg (Hagerstown) 2024; 26:406-412. [PMID: 37934925 DOI: 10.1227/ons.0000000000000988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 09/26/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Bone wax is a flexible hemostatic agent commonly used for surgery in the posterior cranial fossa to control bleeding from the mastoid emissary vein. A large amount of bone wax can migrate into the sigmoid sinus through the mastoid emissary canal (MEC). We aimed to identify clinical factors related to intraoperative bone wax migration through the MEC during microvascular decompression (MVD) surgery, which may result in sigmoid sinus thrombosis. METHODS We retrospectively collected the clinical data of patients with trigeminal neuralgia, hemifacial spasm, or trigeminal neuralgia accompanied by painful tic convulsif who underwent MVD. Basic information and the residual width and length (from the bone surface to the sigmoid sinus) of the MEC on computed tomography images were collected. We compared the collected clinical data between 2 groups of cases with and without intraoperative bone wax migration in the sigmoid sinus. RESULTS Fifty-four cases with intraoperative bone wax migration and 187 patients without migration were enrolled. The t -test revealed significant differences in the width and length of the MEC ( P = .013 and P = .003, respectively). These variables were identified as significant factors in predicting intraoperative bone wax migration using multivariate logistic regression analysis. CONCLUSION The large size of the MEC may be related to intraoperative bone wax migration into the sigmoid sinus in MVD. Neurosurgeons should be aware of these risks. Bone wax should be applied appropriately and hemostasis should be considered to control bleeding from the mastoid emissary vein in patients with a large MEC.
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Affiliation(s)
- Hirokuni Hashikata
- Department of Neurosurgery, Medical Research Institute KITANO HOSPITAL, PIIF Tazuke-Kofukai, Osaka , Japan
| | - Yoshinori Maki
- Department of Neurosurgery, Hikone Chuo Hospital, Hikone City , Shiga , Japan
- Department of Rehabilitation, Hikari Hospital, Otsu City , Shiga , Japan
| | - Yukie Terada
- Department of Neurosurgery, Medical Research Institute KITANO HOSPITAL, PIIF Tazuke-Kofukai, Osaka , Japan
| | - Naoya Yoshimoto
- Department of Neurosurgery, Medical Research Institute KITANO HOSPITAL, PIIF Tazuke-Kofukai, Osaka , Japan
| | - Masanori Goto
- Department of Neurosurgery, Medical Research Institute KITANO HOSPITAL, PIIF Tazuke-Kofukai, Osaka , Japan
| | - Ryota Ishibashi
- Department of Neurosurgery, Medical Research Institute KITANO HOSPITAL, PIIF Tazuke-Kofukai, Osaka , Japan
| | - Yoshihito Miki
- Department of Neurosurgery, Medical Research Institute KITANO HOSPITAL, PIIF Tazuke-Kofukai, Osaka , Japan
| | - Naokado Ikeda
- Department of Neurosurgery, Medical Research Institute KITANO HOSPITAL, PIIF Tazuke-Kofukai, Osaka , Japan
| | - Hideki Hayashi
- Department of Neurosurgery, Medical Research Institute KITANO HOSPITAL, PIIF Tazuke-Kofukai, Osaka , Japan
| | - Namiko Nishida
- Department of Neurosurgery, Medical Research Institute KITANO HOSPITAL, PIIF Tazuke-Kofukai, Osaka , Japan
| | - Junya Taki
- Department of Neurosurgery, Medical Research Institute KITANO HOSPITAL, PIIF Tazuke-Kofukai, Osaka , Japan
| | - Koichi Iwasaki
- Department of Neurosurgery, Medical Research Institute KITANO HOSPITAL, PIIF Tazuke-Kofukai, Osaka , Japan
| | - Hiroki Toda
- Department of Neurosurgery, Medical Research Institute KITANO HOSPITAL, PIIF Tazuke-Kofukai, Osaka , Japan
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Korte J, Klopp ES, Berg P. Multi-Dimensional Modeling of Cerebral Hemodynamics: A Systematic Review. Bioengineering (Basel) 2024; 11:72. [PMID: 38247949 PMCID: PMC10813503 DOI: 10.3390/bioengineering11010072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 12/23/2023] [Accepted: 01/06/2024] [Indexed: 01/23/2024] Open
Abstract
The Circle of Willis (CoW) describes the arterial system in the human brain enabling the neurovascular blood supply. Neurovascular diseases like intracranial aneurysms (IAs) can occur within the CoW and carry the risk of rupture, which can lead to subarachnoid hemorrhage. The assessment of hemodynamic information in these pathologies is crucial for their understanding regarding detection, diagnosis and treatment. Multi-dimensional in silico approaches exist to evaluate these hemodynamics based on patient-specific input data. The approaches comprise low-scale (zero-dimensional, one-dimensional) and high-scale (three-dimensional) models as well as multi-scale coupled models. The input data can be derived from medical imaging, numerical models, literature-based assumptions or from measurements within healthy subjects. Thus, the most realistic description of neurovascular hemodynamics is still controversial. Within this systematic review, first, the models of the three scales (0D, 1D, 3D) and second, the multi-scale models, which are coupled versions of the three scales, were discussed. Current best practices in describing neurovascular hemodynamics most realistically and their clinical applicablility were elucidated. The performance of 3D simulation entails high computational expenses, which could be reduced by analyzing solely the region of interest in detail. Medical imaging to establish patient-specific boundary conditions is usually rare, and thus, lower dimensional models provide a realistic mimicking of the surrounding hemodynamics. Multi-scale coupling, however, is computationally expensive as well, especially when taking all dimensions into account. In conclusion, the 0D-1D-3D multi-scale approach provides the most realistic outcome; nevertheless, it is least applicable. A 1D-3D multi-scale model can be considered regarding a beneficial trade-off between realistic results and applicable performance.
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Affiliation(s)
- Jana Korte
- Research Campus STIMULATE, University of Magdeburg, 39106 Magdeburg, Germany
- Department of Fluid Dynamics and Technical Flows, University of Magdeburg, 39106 Magdeburg, Germany
| | - Ehlar Sophie Klopp
- Research Campus STIMULATE, University of Magdeburg, 39106 Magdeburg, Germany
- Department of Medical Engineering, University of Magdeburg, 39106 Magdeburg, Germany
| | - Philipp Berg
- Research Campus STIMULATE, University of Magdeburg, 39106 Magdeburg, Germany
- Department of Medical Engineering, University of Magdeburg, 39106 Magdeburg, Germany
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Chaiyamoon A, Schneider K, Iwanaga J, Donofrio CA, Badaloni F, Fioravanti A, Tubbs RS. Anatomical study of the mastoid foramina and mastoid emissary veins: classification and application to localizing the sigmoid sinus. Neurosurg Rev 2023; 47:16. [PMID: 38110768 DOI: 10.1007/s10143-023-02229-4] [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: 08/24/2023] [Revised: 11/06/2023] [Accepted: 11/24/2023] [Indexed: 12/20/2023]
Abstract
The mastoid foramen (MF) is located on the mastoid process of the temporal bone, adjacent to the occipitomastoid suture or the parietomastoid suture, and contains the mastoid emissary vein (MEV). In retrosigmoid craniotomy, the MEV has been used to localize the position of the sigmoid sinus and, thus, the placement of the initial burr hole. Therefore, this study aimed to examine the exact location and variants of the MF and MEV to determine if their use in localizing the sigmoid sinus is reasonable. The sample in this study comprised 22 adult dried skulls (44 sides). MF were identified and classified into five types based on location, prevalence, whether they communicated with the sigmoid sinus and exact entrance into the groove of the sigmoid sinus. The diameters and relative locations of the MF in the skull were measured and recorded. Finally, the skulls were drilled to investigate the course of the MEV. Additionally, ten latex-injected sides from human cadavers were also dissected to follow the MEV, especially in cases with more than one vein. We found that type I MFs (single foramen) were the most prevalent (50%). These MFs were mainly located on the occipitomastoid suture; only one case on the right side was adjacent to the parietomastoid suture. Type II (paired foramina) was the second most prevalent (22.73%), followed by type III (13.64%), type 0 (9.09%), and type IV (4.55%). The diameter of the external opening in a connecting MF (2.43 ± 0.79) was twice that of a non-connecting MF (1.14 ± 0.56). Interestingly, on one side, two MFs on the external surface shared a single internal opening; the MEV bifurcated. MFs followed three different courses: ascending, almost horizontal, and descending. Regardless of how many external openings there were for the MF, these all ended at a single opening in the groove for the sigmoid sinus. For cadaveric specimens with multiple MEVs, all terminated in the sigmoid sinus as a single vein, with the more medial veins terminating more medially into the sinus. Based on our study, the MF/MEV can guide the surgeon and help localize the deeper-lying sigmoid sinus. Knowledge of this anatomical relationship could be an adjunct to neuronavigational technologies.
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Affiliation(s)
- Arada Chaiyamoon
- Department of Anatomy, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, 131 S. Robertson St., Suite 1300, New Orleans, LA, 70112, USA
| | | | - Joe Iwanaga
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, 131 S. Robertson St., Suite 1300, New Orleans, LA, 70112, USA.
- Department of Neurology, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, USA.
- Department of Oral and Maxillofacial Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.
- Department of Structural & Cellular Biology, Tulane University School of Medicine, New Orleans, LA, USA.
| | - Carmine Antonio Donofrio
- Neurosurgery Department, ASST Cremona, Viale Concordia 1, 26100, Cremona, Italy
- Division of Biology and Genetics, Department of Molecular and Translational Medicine, Faculty of Medicine, University of Brescia, Viale Europa 11, 25123, Brescia, Italy
| | - Filippo Badaloni
- Department of Neurosurgery, IRCCS Istituto Delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Antonio Fioravanti
- Neurosurgery Department, ASST Cremona, Viale Concordia 1, 26100, Cremona, Italy
| | - R Shane Tubbs
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, 131 S. Robertson St., Suite 1300, New Orleans, LA, 70112, USA
- Tulane University School of Medicine, New Orleans, LA, USA
- Department of Neurology, Tulane Center for Clinical Neurosciences, 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 Anatomical Sciences, St. George's University, St. George's, Grenada
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
- Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, LA, USA
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Iwanaga J, Jackson N, Komune N, Johnson K, Donofrio CA, Badaloni F, Fioravanti A, Dumont AS, Tubbs RS. An anatomical study of the sigmoid sinus artery: Application to the transmastoid approach. Neurosurg Rev 2023; 47:4. [PMID: 38062247 DOI: 10.1007/s10143-023-02245-4] [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: 10/10/2023] [Revised: 11/06/2023] [Accepted: 12/05/2023] [Indexed: 12/18/2023]
Abstract
INTRODUCTION We aimed to investigate the morphological features of the artery that traverse the sigmoid sinus's lateral surface and to discuss this structure's clinical relevance. METHODS Ten sides from five cadaveric Caucasian heads were used for gross anatomical dissection to investigate the morphological features of the sigmoid sinus artery (SSA), and additional five sides were used for histological observation. RESULTS The SSA was found on eight out of ten sides (80%). The mean diameter of the SSA was 0.3 mm. The mean distance from the tip of the mastoid process to the artery was 20.3 mm. Histological observation identified extradural and intradural courses of SSA. The intradural course was further categorized into protruding and non-protruding types. In the protruding type, the SSA traveled within the dura but indented into the bone, making it more or less an intraosseous artery. In the non-protruding type, the SSA traveled within the dura but did not protrude into the bone but rather indented into the lumen of the SS. In all sections, both intradural and extradural courses were identified simultaneously. CONCLUSIONS When the mastoid foramen is observed, it does not always only carry an emissary vein but also an artery. The SSA could be considered a "warning landmark" during bone drilling for the transmastoid approach.
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Affiliation(s)
- Joe Iwanaga
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, USA.
- Department of Neurology, Tulane Center for Clinical Neurosciences, 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 Oral and Maxillofacial Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.
- Division of Gross and Clinical Anatomy, Department of Anatomy, Kurume University School of Medicine, 67 Asahi-Machi, Kurume, Fukuoka, Japan.
- Dental and Oral Medical Center, Kurume University School of Medicine, 67 Asahi-Machi, Kurume, Fukuoka, Japan.
| | - Neal Jackson
- Departments of Otolaryngology and Neurosurgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Noritaka Komune
- Department of Otorhinolaryngology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kendrick Johnson
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, USA
| | - Carmine Antonio Donofrio
- Department of Neurosurgery, ASST Cremona, Cremona, Italy
- Division of Biology and Genetics, Department of Molecular and Translational Medicine, Faculty of Medicine, University of Brescia, Brescia, Italy
| | - Filippo Badaloni
- Department of Neurosurgery, IRCCS Instituto Delle Scienze Neurologiche Di Bologna, Bologna, Italy
| | - Antonio Fioravanti
- Division of Biology and Genetics, Department of Molecular and Translational Medicine, Faculty of Medicine, University of Brescia, Brescia, Italy
| | - Aaron S Dumont
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, USA
| | - R Shane Tubbs
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, USA
- Department of Neurology, Tulane Center for Clinical Neurosciences, 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 Anatomical Sciences, St. George's University, St. George's, Grenada
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Ochsner Health System, New Orleans, LA, USA
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
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Lim JH, Han JS, Aliyeva A, Seo JH, Park SY, Park SN. Surgical Outcomes of Sigmoid Sinus Resurfacing for Pulsatile Tinnitus: The Predictive Value of the Water Occlusion Test and Imaging Studies. Clin Exp Otorhinolaryngol 2023; 16:244-250. [PMID: 37475140 PMCID: PMC10471903 DOI: 10.21053/ceo.2023.00388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 06/19/2023] [Accepted: 07/12/2023] [Indexed: 07/22/2023] Open
Abstract
OBJECTIVES Sigmoid sinus resurfacing (SS-R) is one of the most effective surgical treatments for patients with pulsatile tinnitus (PT) originating from anatomical variants of the vascular walls in the temporal bone. This study aimed to provide updated information on the clinical outcomes of SS-R and evaluate the efficacy of the water occlusion test (WOT) as an additional diagnostic modality. METHODS We retrospectively reviewed medical records including tinnitus questionnaires, temporal bone computed tomography (TBCT) scans, audiologic tests, and preoperative WOT. RESULTS from patients who underwent SS-R. RESULTS In total, 26 patients were included in the study. The mean age was 44 years, and the mean symptom duration was 3 months. Fourteen patients (53.8%) were completely cured, seven (26.9%) significantly improved, and five (19.2%) remained stable. The mean visual analog scale loudness score decreased from 5.26 to 1.34 (P<0.001) and the mean Tinnitus Handicap Inventory score also improved from 50.23 to 5.5 (P<0.001) after SS-R surgery. In 10 patients with discrepancies between the preoperative TBCT and intraoperative findings, WOT showed a significant additive effect in predicting surgical outcomes. No patients experienced severe intraoperative or postoperative complications during the entire follow-up period. CONCLUSION SS-R provides significant symptom improvement in patients with sigmoid sinus dehiscence who had a positive WOT without other sigmoid sinus variants. A combined diagnostic approach with TBCT, WOT, and intraoperative findings is crucial for achieving better surgical outcomes in patients with PT caused by sigmoid sinus variants.
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Affiliation(s)
- Ji Hyung Lim
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jae Sang Han
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Aynur Aliyeva
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Department of Otorhinolaryngology-Head and Neck Surgery, Private Körfez Hospital, Edremit, Türkiye
| | - Jae-Hyun Seo
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - So Young Park
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Shi Nae Park
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Singh R. Prevalence, morphology, morphometry and associated clinical implications of mastoid emissary veins: narrative review. J Vasc Bras 2023; 22:e20230036. [PMID: 37576721 PMCID: PMC10421580 DOI: 10.1590/1677-5449.202300362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 05/10/2023] [Indexed: 08/15/2023] Open
Abstract
The mastoid emissary vein connects the posterior auricular vein to the sigmoid sinus and varies in size, number, location, and course, resulting in clinical complications. This study was conducted in response to the vast clinical implications associated with this vein. The aim of this review is to highlight and describe the prevalence, varied morphology, and morphometry of the mastoid emissary vein, how these varied parameters cause clinical complications, and how these can be rectified and avoided. A literature survey was conducted using various databases and different terms related to mastoid emissary vein were used to search the literature. Pitfalls related to surgery in the vicinity of this vein and their remedies were elucidated. The literature search revealed that the prevalence, morphology, and morphometry of mastoid emissary veins vary immensely and are responsible for morbidity and mortality. Pre-operative identification of mastoid veins is thus essential and so multidetector computed tomography of the temporal bone should be scheduled before planning surgery.
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Affiliation(s)
- Rajani Singh
- Uttar Pradesh University of Medical Sciences, Department of Anatomy, Saifai, Etawah, Uttar Pradesh, India.
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10
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Temiz M, Ozen DC, Duman SB, Bayrakdar IS, Kazan O, Jagtap R, Altun O, Z. Abdelkarim A, Syed AZ, Orhan K. Morphometric and morphological evaluation of mastoid emissary canal using cone-beam computed tomography. Sci Prog 2023; 106:368504231178382. [PMID: 37262004 PMCID: PMC10450264 DOI: 10.1177/00368504231178382] [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: 06/03/2023]
Abstract
OBJECTIVES This study aimed to determine mastoid emissary canal's (MEC) and mastoid foramen (MF) prevalence and morphometric characteristics on cone-beam computed tomography (CBCT) images to underline its clinical significance and discuss its surgical consequences. METHODS In the retrospective analysis, two oral and maxillofacial radiologists analyzed the CBCT images of 135 patients (270 sides). The biggest MF and MEC were measured in the images evaluated in MultiPlanar Reconstruction (MPR) views. The MF and MEC mean diameters were calculated. The mastoid foramina number was recorded. The prevalence of MF was studied according to gender and side of the patient. RESULTS The overall prevalence of MEC and MF was 119 (88.1%). The prevalence of MEC and MF is 55.5% in females and 44.5% in males. MEC and MF were identified as bilateral in 80 patients (67.20%) and unilateral in 39 patients (32.80%). The mean diameter of MF was 2.4 ± 0.9 mm. The mean height of MF was 2.3 ± 0.9. The mean diameter of the MEC was 2.1 ± 0.8, and the mean height of the MEC was 2.1 ± 0.8. There is a statistical difference between the genders (p = 0.043) in foramen diameter. Males had a significantly larger mean diameter of MF in comparison to females. CONCLUSION MEC and MF must be evaluated thoroughly if the surgery is contemplated. Radiologists and surgeons should be aware of mastoid emissary canal morphology, variations, clinical relevance, and surgical consequences while operating in the suboccipital and mastoid areas to avoid unexpected and catastrophic complications. CBCT may be a reliable imaging diagnostic technique.
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Affiliation(s)
- Mustafa Temiz
- Department of Oral and Maxillofacial Surgery, Istanbul Medipol University, Istanbul, Turkey
| | - Duygu Celik Ozen
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Inonu University, Malatya, Turkey
| | - Suayip Burak Duman
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Inonu University, Malatya, Turkey
| | - Ibrahim Sevki Bayrakdar
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Eskisehir Osmangazi University, Eskisehir, Turkey
- Division of Oral and Maxillofacial Radiology, Department of Care Planning and Restorative Sciences, University of Mississippi Medical Center School of Dentistry, Jackson, MS, USA
- Eskisehir Osmangazi University Center of Research and Application for Computer-Aided Diagnosis and Treatment in Health, Eskisehir, Turkey
| | - Orhan Kazan
- Health Services Vocational School, Gazi University, Ankara, Turkey
| | - Rohan Jagtap
- Division of Oral and Maxillofacial Radiology, Department of Care Planning and Restorative Sciences, University of Mississippi Medical Center School of Dentistry, Jackson, MS, USA
| | - Oguzhan Altun
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Inonu University, Malatya, Turkey
| | - Ahmed Z. Abdelkarim
- Division of Oral & Maxillofacial Radiology, College of Dentistry, The Ohio State Universiy, Columbus, OH, USA
| | - Ali Z. Syed
- Department of Oral and Maxillofacial Medicine and Diagnostic Sciences, School of Dental Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Kaan Orhan
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Ankara University, Ankara, Turkey
- Ankara University Medical Design Application and Research Center (MEDITAM), Ankara, Turkey
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Yurdabakan ZZ, Okumuş Ö, Orhan K. The morphometric analysis of mastoid foramen and mastoid emissary canal on cone-beam computed tomography (CBCT). Surg Radiol Anat 2023; 45:303-314. [PMID: 36692538 DOI: 10.1007/s00276-023-03089-9] [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: 11/29/2022] [Accepted: 01/16/2023] [Indexed: 01/25/2023]
Abstract
PURPOSE The purpose of this retrospective study was to assess the prevalence and morphometric features of the mastoid foramen (MF) and mastoid emissary canal (MEC) using cone-beam computed tomography (CBCT), as well as their relationship with age, sex, and side. METHODS CBCT scans of 500 patients aged 8-87 years were examined retrospectively. The presence and number of MF, mean diameter of the MEC and MF, MF location, and the distance between MF and asterion were all examined. The collected data were subjected to appropriate statistical analysis. P values < 0.05 were accepted as statistically significant at a 95% confidence interval. RESULTS The study included 472 patients. MF was present in 82% and absent bilaterally in 18% of the 472 patients. The prevalence of MF was 67.8% on the right side and 65.7% on the left. The mean diameter of the MF was 3.39 ± 1.48 mm and the number of the MF ranged from zero to four. The mean diameter of the MEC was 2.05 ± 1.06 mm and the distance between MF and asterion was 22,46 ± 5,18 mm. 52.4% of the MF was observed on the occipito-mastoid suture. CONCLUSION To prevent surgical complications, particularly those that concern the temporal and mastoid areas, radiologists should report the results of the preoperative examination of the morphometry of the MF and MEC. CBCT imaging is a reliable diagnostic method that can be used to evaluate the MEC and MF before surgical procedures.
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Affiliation(s)
- Zeliha Zuhal Yurdabakan
- Department of Oral and Dentomaxillofacial Radiology, Faculty of Dentistry, Altınbaş University, 34147, Istanbul, Turkey.
| | - Özlem Okumuş
- Department of Oral and Dentomaxillofacial Radiology, Faculty of Dentistry, Altınbaş University, 34147, Istanbul, Turkey
| | - Kaan Orhan
- Department of Oral and Dentomaxillofacial Radiology, Faculty of Dentistry, Ankara University, Ankara, Turkey
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12
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Lv S, Yuan JT, Xie QW, Tang SX, Wang YW. Analysis of Etiology, Diagnosis, and Treatment Strategy and Efficacy of Pulsatile Tinnitus Caused by Abnormal Vascular Anatomy. Curr Med Sci 2023; 43:173-183. [PMID: 36867361 DOI: 10.1007/s11596-022-2691-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 12/06/2022] [Indexed: 03/04/2023]
Abstract
OBJECTIVE To investigate the etiology, clinical characteristics, diagnosis, and treatment strategies and efficacy of pulsatile tinnitus (PT) caused by vascular anatomy abnormality. METHODS The clinical data of 45 patients with PT in our hospital from 2012 to 2019 were collected and retrospectively analyzed. RESULTS All 45 patients had vascular anatomical abnormalities. The patients were divided into 10 categories according to the different locations of vascular abnormalities: sigmoid sinus diverticulum (SSD), sigmoid sinus wall dehiscence (SSWD), SSWD with high jugular bulb, pure dilated mastoid emissary vein, aberrant internal carotid artery (ICA) in the middle ear, transverse-sigmoid sinus (TSS) transition stenosis, TSS transition stenosis with SSD, persistent occipital sinus stenosis, petrous segment stenosis of ICA, and dural arteriovenous fistula. All patients complained of PT synchronous with heartbeat rhythm. Endovascular interventional therapy and extravascular open surgery were used according to the location of the vascular lesions. Tinnitus disappeared in 41 patients, was significantly relieved in 3 patients, and was unchanged in 1 patient postoperatively. Except for one patient with transient headache postoperatively, no obvious complications occurred. CONCLUSION PT caused by vascular anatomy abnormalities can be identified by detailed medical history and physical and imaging examination. PT can be relieved or even completely alleviated after appropriate surgical treatments.
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Affiliation(s)
- Sha Lv
- Department of Otolaryngology, Ningbo First Hospital, Ningbo, 315000, China
| | - Jia-Tian Yuan
- Department of Otolaryngology, Ningbo First Hospital, Ningbo, 315000, China
| | - Qi-Wei Xie
- Department of Otolaryngology, Ningbo First Hospital, Ningbo, 315000, China
| | - Shi-Xiong Tang
- Department of Otolaryngology, Ningbo First Hospital, Ningbo, 315000, China
| | - Yao-Wen Wang
- Department of Otolaryngology, Ningbo First Hospital, Ningbo, 315000, China.
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13
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Eisová S, Menéndez LP, Velemínský P, Bruner E. Craniovascular variation in four late Holocene human samples from southern South America. Anat Rec (Hoboken) 2023; 306:143-161. [PMID: 35684986 DOI: 10.1002/ar.25017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 05/31/2022] [Accepted: 06/04/2022] [Indexed: 01/29/2023]
Abstract
Craniovascular traits in the endocranium (traces of middle meningeal vessels and dural venous sinuses, emissary foramina) provide evidence of vascular anatomy in osteological samples. We investigate the craniovascular variation in four South American samples and the effect of artificial cranial modifications (ACM). CT scans of human adult crania from four archeological samples from southern South America (including skulls with ACM) are used for the analyses. The craniovascular features in the four samples are described, skulls with and without ACM are compared, and additionally, South Americans are compared to a previously analyzed sample of Europeans. Of the four South American samples, the Southern Patagonian differs the most, showing the most distinct cranial dimensions, no ACM, and larger diameters of the emissary foramina. Unlike previous studies, we did not find any major differences in craniovascular features between modified and non-modified skulls, except that the skulls with ACM present somewhat smaller foramina. South Americans significantly differed from Europeans, especially in the anteroposterior dominance of the middle meningeal artery, in the pattern of sinus confluence, in the occurrence of enlarged occipito-marginal sinuses, and in foramina frequencies and diameters. Craniovascular morphology is not affected by the cranial size, even in skulls with ACM, indicating a minor or null influence of structural topological factors. Concerning the samples from distinct geographic and climatic environments, it must be evaluated whether the craniovascular morphogenesis might be partially influenced by specific functions possibly associated with thermoregulation, intracranial pressure, and the maintenance of intracranial homeostasis.
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Affiliation(s)
- Stanislava Eisová
- Antropologické oddělení, Přírodovědecké muzeum, Národní muzeum, Prague, Czech Republic.,Katedra antropologie a genetiky člověka, Přírodovědecká fakulta, Univerzita Karlova, Prague, Czech Republic
| | - Lumila Paula Menéndez
- Konrad Lorenz Institute for Evolution and Cognition Research, Klosterneuburg, Austria.,Department of Anthropology of the Americas, Universität Bonn, Bonn, Germany
| | - Petr Velemínský
- Antropologické oddělení, Přírodovědecké muzeum, Národní muzeum, Prague, Czech Republic
| | - Emiliano Bruner
- Programa de Paleobiología, Centro Nacional de Investigación sobre la Evolución Humana, Burgos, Spain
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14
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Zhou W, Di G, Rong J, Hu Z, Tan M, Duan K, Jiang X. Clinical applications of the mastoid emissary vein. Surg Radiol Anat 2023; 45:55-63. [PMID: 36520166 PMCID: PMC9849190 DOI: 10.1007/s00276-022-03060-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 12/05/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE During retrosigmoid craniotomy, the mastoid emissary vein (MEV) can be a source of considerable bleeding during the operation, especially when the larger diameter MEV or sigmoid sinus is torn. In this study, we evaluated the relevant structure of the MEV for their anatomy and applied the data in surgery to summarize their clinical significance. METHODS The posterior craniocervical regions of 15 silicon-injected Chinese human cadaver specimens were dissected to expose the MEV and adjacent structures. Fifty-one patients who were scheduled to undergo retrosigmoid craniotomy were selected. All patients underwent preoperative routine CT of the head. The relevant data were collected on cadaveric anatomy and CT. Eventually, all patients underwent retrosigmoid craniotomy and the MEV was observed during the operation. RESULTS In cadaver specimens, the prevalence of the MEV was 90.0%. It originated from the middle and lower parts of the posterior wall of the sigmoid sinus and extended in the posterior direction in the mastoid process, usually having 1-2 external openings (86.7%) and only 1 internal opening. The intraosseous courses of the MEV were classified as straight and curved. The straight type accounted for 57.9%, and the curved type for 42.1%. The mean diameter of the MEV was 1.84 ± 0.85 mm, and the straight length of the MEV inside the mastoid process was 11.93 ± 3.58 mm. In 16.7% and 6.7% of all cadaver specimens, the MEV diameter was greater than 2.5 and 4 mm, respectively. In 51 patients (bilateral), routine head CT scan showed the MEV in 49.0% of the patients, and the MEV diameter was greater than 2.5 and 4 mm, respectively, in 17.6% (18/102) and 3.9% (4/102) of the cases. During surgery (unilateral) in the 51 patients, 48 had the MEV and 3 had no MEV. None of the patients had sigmoid sinus tears or massive bleeding. CONCLUSION In the process of retrosigmoid craniotomy, detailed anatomical knowledge of the MEV, well-planned CT scan, and meticulous microsurgical techniques are key for successful operation, which can reduce the occurrence of complications.
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Affiliation(s)
- Wei Zhou
- Department of Neurosurgery, The Translational Research Institute for Neurological Disorders of Wannan Medical College, The First Affiliated Hospital of Wannan Medical College (Yijishan Hospital of Wannan Medical College), Wuhu, 241001 People’s Republic of China
| | - Guangfu Di
- Department of Neurosurgery, The Translational Research Institute for Neurological Disorders of Wannan Medical College, The First Affiliated Hospital of Wannan Medical College (Yijishan Hospital of Wannan Medical College), Wuhu, 241001 People’s Republic of China
| | - Jun Rong
- Department of Neurosurgery, The Translational Research Institute for Neurological Disorders of Wannan Medical College, The First Affiliated Hospital of Wannan Medical College (Yijishan Hospital of Wannan Medical College), Wuhu, 241001 People’s Republic of China
| | - Zongwen Hu
- Department of Neurosurgery, The Translational Research Institute for Neurological Disorders of Wannan Medical College, The First Affiliated Hospital of Wannan Medical College (Yijishan Hospital of Wannan Medical College), Wuhu, 241001 People’s Republic of China
| | - Mingze Tan
- Department of Neurosurgery, The Translational Research Institute for Neurological Disorders of Wannan Medical College, The First Affiliated Hospital of Wannan Medical College (Yijishan Hospital of Wannan Medical College), Wuhu, 241001 People’s Republic of China
| | - Kaiqiang Duan
- Department of Neurosurgery, The Translational Research Institute for Neurological Disorders of Wannan Medical College, The First Affiliated Hospital of Wannan Medical College (Yijishan Hospital of Wannan Medical College), Wuhu, 241001 People’s Republic of China
| | - Xiaochun Jiang
- Department of Neurosurgery, The Translational Research Institute for Neurological Disorders of Wannan Medical College, The First Affiliated Hospital of Wannan Medical College (Yijishan Hospital of Wannan Medical College), Wuhu, 241001 People’s Republic of China
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15
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Saha KL, Joarder MAH, Bhowmik B, Chowdhury D. An unusual presentation of Griesinger's sign in lateral sinus thrombosis. OTOLARYNGOLOGY CASE REPORTS 2022. [DOI: 10.1016/j.xocr.2022.100504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
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16
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Alghamdi MA, Honnegowda TM, Nautiyal A, Deepanjan M. Radiological and Morphometric Study of the Emissary Foramens and Canal in the Posterior Cranial Fossa of the Human Skull with Its Neurosurgical Significance. Asian J Neurosurg 2022; 17:588-594. [PMID: 36570755 PMCID: PMC9771628 DOI: 10.1055/s-0042-1757429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Objective The posterior condylar canals (PCCs), posterior condylar veins (PCVs), occipital foramen (OF), and occipital emissary vein (OEV) are potential anatomical landmarks for surgical approaches through the lateral foramen magnum. We performed the study to make morphometric and radiological analyses of the various emissary foramens and vein in the posterior cranial fossa. Methods Morphometric study were performed on 95 dry occipital bones and radiological analyses on computed tomography (CT) angiography images of 150 patients. The number of OFs on both sides was recorded and PCC length and mean diameters of the internal and external orifices of PCC were measured for bony specimens. Prevalence of PCV and PCV size was investigated using CT angiography. Results Mean PCC length was higher in the left side (9.85 ± 2.5). Mean diameter of the internal orifice and the external orifice diameter were almost the same. The majority of PCCs (75-79.33%) had 2 to 5 mm diameter; only 4 to 9.2% were small in size (< 2 mm). In CT angiography, PCV was not identified in 23 (15.33%) patients. PCVs were located bilaterally in 105 (70%) and unilaterally in 22 (20.5%) patients. Only 11.3% of PCVs were large in size (> 5 mm), 80% of PCVs were medium sized (2-5 mm), and 8.6% were small sized (< 2 mm). Conclusion Normal values of OF, PCC, PCV, and OEV could serve as a future reference for the understanding of the physiology of craniocervical venous drainage, which is necessary to avoid surgical complications and can also serve as a guide to surgical interventions for pathologies of the posterior cranial fossa, such as tumors and injuries.
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Affiliation(s)
- Mansour A. Alghamdi
- Department of Anatomy, College of Medicine, King Khalid University, Abha, Saudi Arabia,Genomics and Personalized Medicine Unit, College of Medicine, King Khalid University, Abha, Saudi Arabia
| | - Thittamaranahalli Muguregowda Honnegowda
- Department of Anatomy, Siddaganga Medical College and Research Institute, Tumakuru, Karnataka, India,Address for correspondence Thittamaranahalli Muguregowda Honnegowda, MS, PhD Department of Anatomy, Siddaganga Medical College and Research InstituteTumakuru, 572102, KarnatakaIndia
| | - Amit Nautiyal
- Department of Nuclear Medicine, Institute of Nuclear Medicine and Molecular Imaging, AMRI Hospitals, Dhakuria, Kolkata, West Bengal, India
| | - Mitra Deepanjan
- Department of Nuclear Medicine, Institute of Nuclear Medicine and Molecular Imaging, AMRI Hospitals, Dhakuria, Kolkata, West Bengal, India
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17
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Eisová S, Velemínský P, Velemínská J, Bruner E. Diploic vein morphology in normal and craniosynostotic adult human skulls. J Morphol 2022; 283:1318-1336. [PMID: 36059180 DOI: 10.1002/jmor.21505] [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: 07/11/2022] [Revised: 08/10/2022] [Accepted: 08/17/2022] [Indexed: 11/06/2022]
Abstract
Diploic veins (DV) run within the cranial diploe, where they leave channels that can be studied in osteological samples. This study investigates overall DV variability in human adults and the effects of sex, age, cranial dimensions, and dysmorphogenesis associated with craniosynostosis (CS). The morphology of macroscopic diploic channels was analyzed in a set of the qualitative and quantitative variables in computed tomography-images of crania of anatomically normal and craniosynostotic adult individuals. Macroscopic diploic channels occur most frequently in the frontal and parietal bones, often with a bilaterally symmetrical pattern. DV-features (especially DV-pattern) are characterized by high individual diversity. On average, there are 5.4 ± 3.5 large macroscopic channels (with diameters >1 mm) per individual, with a mean diameter of 1.7 ± 0.4 mm. Age and sex have minor effects on DV, and cranial proportions significantly influence DV only in CS skulls. CS is associated with changes in the DV numbers, distributions, and diameters. Craniosynostotic skulls, especially brachycephalic skulls, generally present smaller DV diameters, and dolichocephalic skulls display increased number of frontal DV. CS, associated with altered cranial dimensions, suture imbalance, increased intracranial pressure, and with changes of the endocranial craniovascular system, significantly also affects the macroscopic morphology of DV in adults, in terms of both structural (topological redistribution) and functional factors. The research on craniovascular morphology and CS may be of interest in biological anthropology, paleopathology, medicine (e.g., surgical planning), but also in zoology and paleontology.
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Affiliation(s)
- Stanislava Eisová
- Antropologické oddělení, Přírodovědecké muzeum, Národní muzeum, Prague, Czech Republic.,Katedra antropologie a genetiky člověka, Přírodovědecká fakulta, Univerzita Karlova, Prague, Czech Republic
| | - Petr Velemínský
- Antropologické oddělení, Přírodovědecké muzeum, Národní muzeum, Prague, Czech Republic
| | - Jana Velemínská
- Katedra antropologie a genetiky člověka, Přírodovědecká fakulta, Univerzita Karlova, Prague, Czech Republic
| | - Emiliano Bruner
- Programa de Paleobiología, Centro Nacional de Investigación sobre la Evolución Humana, Burgos, Spain
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18
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Scullen T, Mathkour M, Tubbs RS, Dumont A, Wang A. Characteristics and Management of Dilated Mastoid Emissary Veins: A Case Report and Literature Review. World Neurosurg 2022; 165:100-105. [PMID: 35772705 DOI: 10.1016/j.wneu.2022.06.106] [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: 04/21/2022] [Revised: 06/20/2022] [Accepted: 06/21/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The mastoid emissary vein (MEV) describes a transosseous connection between the sigmoid dural venous sinus and the suboccipital venous plexus. In cases of outflow stenosis or malformation, the MEV may become dilated and a source of pulsatile tinnitus (PT) amenable to treatment. We describe a case of PT secondary to MEV treated successfully via endovascular coil embolization and conduct a systematic review of the literature. METHODS We performed a systematic review without meta-analysis of studies involving management of dilated MEV on January 14, 2022, and describe a case of PT secondary to an enlarged MEV treated via coil embolization. RESULTS A total of 13 studies were selected for full review. Reports identified MEV presenting as PT in 60% (12 of 20) of cases, intraoperative hemorrhage in mastoid surgery in 15% (3 of 20), a compressive scalp mass in 10% (2 of 20), and thrombophlebitis, facial swelling, or an incidental finding in 5% (1 of 20) each. Forty-five percent (9 of 20) underwent treatment, with all experiencing symptom resolution or improvement. Surgery included transvenous coil embolization in 33.3% (3 of 9), flap reconstruction in 22.2% (2 of 9), and surgical packing, ligation, and thrombectomy in 11.1% (1 of 9) each. Dilated MEV was reported concurrently with impeded drainage pathways in 35% (7 of 20) of reports. CONCLUSIONS Dilated MEV has been reported as an etiology of pulsatile tinnitus and appears amenable to treatment via open and endovascular means. Endovascular coil embolization appears to offer effective symptom resolution, however, available literature exists only in case reports and small series. Further investigation is highly warranted.
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Affiliation(s)
- Tyler Scullen
- Department of Neurological Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Mansour Mathkour
- Department of Neurological Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - R Shane Tubbs
- Department of Neurological Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Aaron Dumont
- Department of Neurological Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Arthur Wang
- Department of Neurological Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA.
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Correlation of the external occipital protuberance with venous sinuses: a magnetic resonance imaging study. Surg Radiol Anat 2022; 44:999-1006. [PMID: 35737086 DOI: 10.1007/s00276-022-02969-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: 04/04/2022] [Accepted: 06/03/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE To date, no study has explored the external occipital protuberance (EOP) using neuroimaging modalities. This study aims to characterize them using magnetic resonance imaging (MRI). METHODS A total of 96 patients underwent thin-sliced, post-contrast MRI. The sagittal images were analyzed. RESULTS In 97%, the EOPs were delineated as a focal external protrusion of the midline region of the occiput with varying morphologies. In 89% of 93 patients with identifiable EOPs, parts of the intracranial dural sinuses were found to lie just below the inion, the most prominent point of the EOP. The most frequently targeted dural sinus was the confluence of sinuses that was found in 57%, followed by the superior sagittal sinus. In 16%, a bony foramen and transmitting vessel were detected in the EOP, connecting between the diploic channels and the subcutaneous veins. Furthermore, in 33%, bony foramina and transmitting venous structures were identified in the region just below the EOPs, connecting between the diploic channels and the subcutaneous veins. CONCLUSIONS The intracranial dural venous sinus is located just below the EOP with a high probability. Most bony foramina in the EOP and midline suboccipital region may transmit veinous structures connecting to the diploic channel.
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Aberrant drainage of posterior condylar emissary vein and abnormal orifice of hypoglossal canal: surgical implications in the transcondylar fossa approach for VA-PICA junction aneurysm. Acta Neurochir (Wien) 2022; 164:2119-2126. [PMID: 35701645 DOI: 10.1007/s00701-022-05263-1] [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: 10/21/2021] [Accepted: 05/18/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND The posterior condylar emissary vein (PCEV) and posterior condylar canal (PCC) are anatomical landmarks for identifying important structures like jugular tubercle and occipital condyle in surgical approach to the foramen magnum and condylar fossa. Several anatomical variations have been described. Drainage into the jugular bulb is found to be commonest. METHOD A 70-year-old patient with unruptured vertebral artery-posterior inferior cerebellar artery (PICA) junction aneurysm-underwent surgical clipping via transcondylar fossa approach. RESULT Preoperative computed tomography demonstrated an abnormal communication existed between the left-sided PCC and hypoglossal canal (HC). The PCEV was identified draining into a dilated venous channel/pouch at the "hip" of sigmoid sinus (junction of sigmoid sinus and jugular bulb). Intra-operatively, an occipital artery-PICA bypass was performed. The PCEV was skeletonized, coagulated, and divided to achieve hemostasis. The lateral and cranial drilling around PCC was successful at safeguarding the underlying contents of HC (in medial and caudal extent). CONCLUSION Preoperative angiography and detailed morphometric analysis of the PCC were helpful in planning surgical approach-identifying and controlling the PCEV, and skeletonization of the PCC without compromising the hypoglossal nerve and anterior condylar emissary vein.
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21
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Eisová S, Naňka O, Velemínský P, Bruner E. Craniovascular traits and braincase morphology in craniosynostotic human skulls. J Anat 2021; 239:1050-1065. [PMID: 34240418 PMCID: PMC8546506 DOI: 10.1111/joa.13506] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 06/16/2021] [Accepted: 06/18/2021] [Indexed: 11/28/2022] Open
Abstract
Middle meningeal vessels, dural venous sinuses, and emissary veins leave imprints and canals in the endocranium, and thus provide evidence of vascular patterns in osteological samples. This paper investigates whether craniovascular morphology undergoes changes in craniosynostotic human skulls, and if specific alterations may reflect structural and functional relationships in the cranium. The analyzed osteological sample consists of adult individuals with craniosynostoses generally associated with dolichocephalic or brachycephalic proportions, and a control sample of anatomically normal adult skulls. The pattern and dominance of the middle meningeal artery, the morphology of the confluence of the sinuses, and the size and number of the emissary foramina were evaluated. Craniovascular morphology was more diverse in craniosynostotic skulls than in anatomically normal skulls. The craniosynostotic skulls often displayed enlarged occipito-marginal sinuses and more numerous emissary foramina. The craniosynostotic skulls associated with more brachycephalic morphology often presented enlarged emissary foramina, while the craniosynostotic skulls associated with dolichocephalic effects frequently displayed more developed posterior branches of the middle meningeal artery. The course and morphology of the middle meningeal vessels, dural venous sinuses, and emissary veins in craniosynostotic skulls can be related to the redistribution of growth forces, higher intracranial pressure, venous hypertension, or thermal constraints. These functional and structural changes are of interest in both anthropology and medicine, involving epigenetic traits that concern the functional and ontogenetic balance between soft and hard tissues.
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Affiliation(s)
- Stanislava Eisová
- Katedra antropologie a genetiky člověkaPřírodovědecká fakultaUniverzita KarlovaPragueCzech Republic
- Antropologické odděleníPřírodovědecké muzeum, Národní muzeumPragueCzech Republic
| | - Ondřej Naňka
- Anatomický ústav1. lékařská fakultaUniverzita KarlovaPragueCzech Republic
| | - Petr Velemínský
- Antropologické odděleníPřírodovědecké muzeum, Národní muzeumPragueCzech Republic
| | - Emiliano Bruner
- Programa de PaleobiologíaCentro Nacional de Investigación sobre la Evolución HumanaBurgosSpain
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22
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Essibayi MA, Oushy SH, Lanzino G, Brinjikji W. Venous Causes of Pulsatile Tinnitus: Clinical Presentation, Clinical and Radiographic Evaluation, Pathogenesis, and Endovascular Treatments: A Literature Review. Neurosurgery 2021; 89:760-768. [PMID: 34392338 DOI: 10.1093/neuros/nyab299] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 06/09/2021] [Indexed: 12/19/2022] Open
Abstract
Tinnitus is an abnormal perception of a sound without external stimulation. Venous pulsatile tinnitus (VPT) is a specific form of tinnitus characterized by an objective and often subjective bruit that occurs as a result of localized venous abnormalities. Clinical evaluation relies on sound quality, duration, and precipitating factors. Idiopathic intracranial hypertension (IIH) and transverse sinus stenosis (TSS) are among the most common causes of VPT. Other causes include sigmoid sinus wall abnormalities (SSWAs), jugular vein anomalies (JVAs), and emissary veins anomalies. These anomalies can be detected on magnetic resonance imaging, magnetic resonance angiography/magnetic resonance venography, and high-resolution temporal bone computed tomography. The pathogenesis behind the VPT includes turbulent blood flow as a result of luminal stenosis or abnormal dilation, amplification of internal sound due to temporal bone defects, and abnormal position of the venous sinus system structures adjacent to the bony structures of the auditive apparatus. Based on these theories, different interventional treatment modalities can be applied to treat the underlying causes. Endovascular treatments have shown high efficacy and safety among those treatments which include stenting of the lateral sinus stenosis in IIH and TSS, coiling of the SSWA and JVA, and embolization of emissary veins anomalies. Further studies are needed to understand the natural history of these anomalies and the efficacy of treatments of VPT, which-unlike other types of tinnitus-can be cured with proper treatment.
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Affiliation(s)
| | - Soliman H Oushy
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Giuseppe Lanzino
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA.,Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Waleed Brinjikji
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA.,Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
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23
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Ortiz-Rafael J, Chakravarthi SS, Revuelta-Gutiérrez R, Kassam A, Monroy-Sosa A. Microsurgical anatomy of the cranial nerve-centric triangles of the posterior cranial base: cadaveric and radiological anatomical study. Anat Sci Int 2021; 96:531-543. [PMID: 34132987 DOI: 10.1007/s12565-021-00620-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 06/09/2021] [Indexed: 11/26/2022]
Abstract
Tumors in the posterior fossa can be situated either dorsal and lateral, ventral and medial, or occupying both regions in relation to the cranial nerves, with the latter position being especially challenging. In an effort to organize neurovascular complexes contained within, anatomically based triangles have been proposed to serve as guiding landmarks for locating critical neurovascular structures. The objectives of this study were to: (1) provide a review of historical anatomically based vascular-centric triangles of the posterior fossa based on respective neurovascular complexes; (2) introduce a more organized alternative system of triangles with the conceptualization of a projection system from superficial to deep; and (3) propose and describe two new triangles of the posterior fossa: Petrous-Acousticofacial and Acousticofacial-Trigeminal. Five cadavers were studied. Neurovascular complexes were described with the use of anatomically guided cranial nerve-centric triangles, each of which was formed by cranial nerves, petrous bone, brainstem, tentorium, and superior petrosal vein. All triangles were measured and anatomical boundaries confirmed by neuronavigation. Two circumferential frameworks were created to correlate superficial and deep anatomy: (1) Outer circumference and (2) Inner circumference. Posterior fossa was divided into the following: (1) Superior complex-corresponds to the sub-asterional region, which was projected to the trigeminal nerve; (2) Middle complex-corresponds to the mastoid emissary vein foramen, which was projected to the facial and vestibulocochlear nerves; and (3) Inferior complex-corresponds to the posterior condylar canal, which projects to the lower cranial nerves. Neuronavigation confirmed these landmarks. Two new triangles were proposed: (1) The Petrous-Acousticofacial triangle, and (2) The Acousticofacial-Trigeminal triangle. Triangles provide a useful anatomical guide to the posterior fossa. We have introduced an organized schema, as well as proposed two new triangles, with the intent to minimize manipulation of neurovascular structures.
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Affiliation(s)
| | - Srikant S Chakravarthi
- Department of Neurosurgery, Aurora Neuroscience Innovation Institute, Aurora St. Luke's Medical Center, W Kinnikinic River Pkwy #680, 2801, Milwaukee, WI, 53215, USA
- Skull Base, and Cerebrovascular Lab Aurora Research Institute, Milwaukee, WI, USA
| | - Rogelio Revuelta-Gutiérrez
- Department of Neurosurgery, National Institute of Neurology and Neurosurgery "Manuel Velasco Suárez", México City, Mexico
| | | | - Alejandro Monroy-Sosa
- Department of Neurosurgery, Aurora Neuroscience Innovation Institute, Aurora St. Luke's Medical Center, W Kinnikinic River Pkwy #680, 2801, Milwaukee, WI, 53215, USA.
- Skull Base, and Cerebrovascular Lab Aurora Research Institute, Milwaukee, WI, USA.
- Department of Neurosurgery, Institute for Social Security and Services for State Workers Tláhuac, Mexico City, Mexico.
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24
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Rodriguez Rubio R, Xie W, Vigo V, Lee A, Tomasi OS, El-Sayed IH, Abla A. Immersive Surgical Anatomy of the Retrosigmoid Approach. Cureus 2021; 13:e16068. [PMID: 34367740 PMCID: PMC8336623 DOI: 10.7759/cureus.16068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 06/30/2021] [Indexed: 11/20/2022] Open
Abstract
The retrosigmoid approach (RS) approach is the workhorse of the posterolateral neurosurgical techniques to access various posterior fossa structures and even extends into the middle fossa. Many studies have detailed two-dimensional (2D) descriptions of the RS technique from either the lateral or posterior view. This study is the first to provide a comprehensive analysis of the RS technique, soft tissue, extracranial landmarks, and intracranial structures of the posterolateral region using interactive three-dimensional (3D) volumetric models (VMs). The visuospatial understanding of the neuroanatomical structures and landmarks of the RS approach is critical for successful surgeries with minimal complications. This study aims to create a collection of VMs and stereoscopic media for the relevant layer-by-layer soft tissue anatomy and step-by-step surgical technique of the RS approach using cadaveric dissections. Five embalmed heads and one dry skull were used to generate stereoscopic images and VMs using 3D scanning technology (i.e., photogrammetry and structured light scanning) to illustrate and simulate the RS approach. The extracranial structures were divided into myofascial, superficial vascular, superficial nerve, and bony anatomy. The RS approach was divided into seven major steps: patient positioning, incision of the skin, dissection of the scalp flap, dissection of the muscles, craniotomy, dural opening, and closure. Additionally, we described an anatomical classification of surgical corridors based on the cisternal segments of the cranial nerves exposed during the RS approach. We discussed the nuances of the keyhole variations of the RS approach and intradural modifications of the RS approach using 3D VMs to illustrate the surgical corridors and the intradural structures accessed. These interactive VMs allow for clear visualization and dynamically immersive experience for neuroanatomical studies of the RS approach in 360-degrees and virtual reality (VR). Computer graphics can be implemented in neurosurgery to facilitate our topographic knowledge, which is crucial for anatomical education, surgical planning, intraoperative decision making, and postoperative care.
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Affiliation(s)
| | - Weipeng Xie
- Neurological Surgery, University of California San Francisco, San Francisco, USA
| | - Vera Vigo
- Neurological Surgery, University of California San Francisco, San Francisco, USA
| | - Anthony Lee
- Neurological Surgery, University of California San Francisco, San Francisco, USA
| | | | - Ivan H El-Sayed
- Otolaryngology, University of California San Francisco, San Francisco, USA
| | - Adib Abla
- Neurological Surgery, University of California San Francisco, San Francisco, USA
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25
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Abdalkader M, Nguyen TN, Norbash AM, Raz E, Shapiro M, Lenck S, Brinjikji W, Weber P, Sakai O. State of the Art: Venous Causes of Pulsatile Tinnitus and Diagnostic Considerations Guiding Endovascular Therapy. Radiology 2021; 300:2-16. [PMID: 34032509 DOI: 10.1148/radiol.2021202584] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Venous variants and pathologic abnormalities are the most common causes of pulsatile tinnitus. These conditions include causes of turbulence within normally located veins and sinuses, and abnormally enlarged or abnormally located veins in close transmissive proximity to the conductive auditory pathway. Such disorders include pathologic abnormalities of the lateral sinus (transverse sinus stenosis and sigmoid sinus wall anomalies), abnormalities and variants of the emissary veins, and anomalies of the jugular bulb and jugular vein. Despite being the most common causes for pulsatile tinnitus, venous variants and pathologic abnormalities are often overlooked in the workup of pulsatile tinnitus. Such oversights can result in delayed patient care and prolonged patient discomfort. Advances in both cerebrovascular imaging and endovascular techniques allow for improved diagnostic accuracy and an increasing range of endovascular therapeutic options to address pulsatile tinnitus. This review illustrates the venous causes of pulsatile tinnitus and demonstrates the associated endovascular treatment. © RSNA, 2021.
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Affiliation(s)
- Mohamad Abdalkader
- From the Departments of Radiology (M.A., T.N.N., O.S.), Neurology (T.N.N.), Neurosurgery (T.N.N.), Otolaryngology-Head and Neck Surgery (P.W., O.S.), and Radiation Oncology (O.S.), Boston Medical Center, Boston University School of Medicine, 820 Harrison Ave, FGH Building, 3rd Floor, Boston, MA 02118; Department of Radiology, University of California San Diego School of Medicine, UC San Diego Health, San Diego, Calif (A.M.N.); Departments of Radiology (E.R., M.S.) and Neurology (M.S.), NYU Langone Health, New York, NY; Department of Neuroradiology, Groupe Hospitalier Pitié Salpêtrière, Sorbonne University, Paris, France (S.L.); and Departments of Radiology and Neurosurgery, Mayo Clinic Rochester, Rochester, Minn (W.B.)
| | - Thanh N Nguyen
- From the Departments of Radiology (M.A., T.N.N., O.S.), Neurology (T.N.N.), Neurosurgery (T.N.N.), Otolaryngology-Head and Neck Surgery (P.W., O.S.), and Radiation Oncology (O.S.), Boston Medical Center, Boston University School of Medicine, 820 Harrison Ave, FGH Building, 3rd Floor, Boston, MA 02118; Department of Radiology, University of California San Diego School of Medicine, UC San Diego Health, San Diego, Calif (A.M.N.); Departments of Radiology (E.R., M.S.) and Neurology (M.S.), NYU Langone Health, New York, NY; Department of Neuroradiology, Groupe Hospitalier Pitié Salpêtrière, Sorbonne University, Paris, France (S.L.); and Departments of Radiology and Neurosurgery, Mayo Clinic Rochester, Rochester, Minn (W.B.)
| | - Alexander M Norbash
- From the Departments of Radiology (M.A., T.N.N., O.S.), Neurology (T.N.N.), Neurosurgery (T.N.N.), Otolaryngology-Head and Neck Surgery (P.W., O.S.), and Radiation Oncology (O.S.), Boston Medical Center, Boston University School of Medicine, 820 Harrison Ave, FGH Building, 3rd Floor, Boston, MA 02118; Department of Radiology, University of California San Diego School of Medicine, UC San Diego Health, San Diego, Calif (A.M.N.); Departments of Radiology (E.R., M.S.) and Neurology (M.S.), NYU Langone Health, New York, NY; Department of Neuroradiology, Groupe Hospitalier Pitié Salpêtrière, Sorbonne University, Paris, France (S.L.); and Departments of Radiology and Neurosurgery, Mayo Clinic Rochester, Rochester, Minn (W.B.)
| | - Eytan Raz
- From the Departments of Radiology (M.A., T.N.N., O.S.), Neurology (T.N.N.), Neurosurgery (T.N.N.), Otolaryngology-Head and Neck Surgery (P.W., O.S.), and Radiation Oncology (O.S.), Boston Medical Center, Boston University School of Medicine, 820 Harrison Ave, FGH Building, 3rd Floor, Boston, MA 02118; Department of Radiology, University of California San Diego School of Medicine, UC San Diego Health, San Diego, Calif (A.M.N.); Departments of Radiology (E.R., M.S.) and Neurology (M.S.), NYU Langone Health, New York, NY; Department of Neuroradiology, Groupe Hospitalier Pitié Salpêtrière, Sorbonne University, Paris, France (S.L.); and Departments of Radiology and Neurosurgery, Mayo Clinic Rochester, Rochester, Minn (W.B.)
| | - Maksim Shapiro
- From the Departments of Radiology (M.A., T.N.N., O.S.), Neurology (T.N.N.), Neurosurgery (T.N.N.), Otolaryngology-Head and Neck Surgery (P.W., O.S.), and Radiation Oncology (O.S.), Boston Medical Center, Boston University School of Medicine, 820 Harrison Ave, FGH Building, 3rd Floor, Boston, MA 02118; Department of Radiology, University of California San Diego School of Medicine, UC San Diego Health, San Diego, Calif (A.M.N.); Departments of Radiology (E.R., M.S.) and Neurology (M.S.), NYU Langone Health, New York, NY; Department of Neuroradiology, Groupe Hospitalier Pitié Salpêtrière, Sorbonne University, Paris, France (S.L.); and Departments of Radiology and Neurosurgery, Mayo Clinic Rochester, Rochester, Minn (W.B.)
| | - Stéphanie Lenck
- From the Departments of Radiology (M.A., T.N.N., O.S.), Neurology (T.N.N.), Neurosurgery (T.N.N.), Otolaryngology-Head and Neck Surgery (P.W., O.S.), and Radiation Oncology (O.S.), Boston Medical Center, Boston University School of Medicine, 820 Harrison Ave, FGH Building, 3rd Floor, Boston, MA 02118; Department of Radiology, University of California San Diego School of Medicine, UC San Diego Health, San Diego, Calif (A.M.N.); Departments of Radiology (E.R., M.S.) and Neurology (M.S.), NYU Langone Health, New York, NY; Department of Neuroradiology, Groupe Hospitalier Pitié Salpêtrière, Sorbonne University, Paris, France (S.L.); and Departments of Radiology and Neurosurgery, Mayo Clinic Rochester, Rochester, Minn (W.B.)
| | - Waleed Brinjikji
- From the Departments of Radiology (M.A., T.N.N., O.S.), Neurology (T.N.N.), Neurosurgery (T.N.N.), Otolaryngology-Head and Neck Surgery (P.W., O.S.), and Radiation Oncology (O.S.), Boston Medical Center, Boston University School of Medicine, 820 Harrison Ave, FGH Building, 3rd Floor, Boston, MA 02118; Department of Radiology, University of California San Diego School of Medicine, UC San Diego Health, San Diego, Calif (A.M.N.); Departments of Radiology (E.R., M.S.) and Neurology (M.S.), NYU Langone Health, New York, NY; Department of Neuroradiology, Groupe Hospitalier Pitié Salpêtrière, Sorbonne University, Paris, France (S.L.); and Departments of Radiology and Neurosurgery, Mayo Clinic Rochester, Rochester, Minn (W.B.)
| | - Peter Weber
- From the Departments of Radiology (M.A., T.N.N., O.S.), Neurology (T.N.N.), Neurosurgery (T.N.N.), Otolaryngology-Head and Neck Surgery (P.W., O.S.), and Radiation Oncology (O.S.), Boston Medical Center, Boston University School of Medicine, 820 Harrison Ave, FGH Building, 3rd Floor, Boston, MA 02118; Department of Radiology, University of California San Diego School of Medicine, UC San Diego Health, San Diego, Calif (A.M.N.); Departments of Radiology (E.R., M.S.) and Neurology (M.S.), NYU Langone Health, New York, NY; Department of Neuroradiology, Groupe Hospitalier Pitié Salpêtrière, Sorbonne University, Paris, France (S.L.); and Departments of Radiology and Neurosurgery, Mayo Clinic Rochester, Rochester, Minn (W.B.)
| | - Osamu Sakai
- From the Departments of Radiology (M.A., T.N.N., O.S.), Neurology (T.N.N.), Neurosurgery (T.N.N.), Otolaryngology-Head and Neck Surgery (P.W., O.S.), and Radiation Oncology (O.S.), Boston Medical Center, Boston University School of Medicine, 820 Harrison Ave, FGH Building, 3rd Floor, Boston, MA 02118; Department of Radiology, University of California San Diego School of Medicine, UC San Diego Health, San Diego, Calif (A.M.N.); Departments of Radiology (E.R., M.S.) and Neurology (M.S.), NYU Langone Health, New York, NY; Department of Neuroradiology, Groupe Hospitalier Pitié Salpêtrière, Sorbonne University, Paris, France (S.L.); and Departments of Radiology and Neurosurgery, Mayo Clinic Rochester, Rochester, Minn (W.B.)
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26
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MacPhee R, Del Pino SH, Kramarz A, Forasiepi AM, Bond M, Sulser RB. Cranial Morphology and Phylogenetic Relationships of Trigonostylops wortmani, an Eocene South American Native Ungulate. BULLETIN OF THE AMERICAN MUSEUM OF NATURAL HISTORY 2021. [DOI: 10.1206/0003-0090.449.1.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- R.D.E. MacPhee
- Department of Mammalogy/Vertebrate Zoology and Richard Gilder Graduate School, American Museum of Natural History
| | | | - Alejandro Kramarz
- Sección Paleontología de Vertebrados, Museo Argentino de Ciencias Naturales Bernardino Rivadavia, CONICET, Buenos Aires, Argentina
| | | | - Mariano Bond
- Departamento Científico de Paleontología Vertebrados, Museo de La Plata, Paseo del Bosque s/n, 1900 La Plata, Argentina
| | - R. Benjamin Sulser
- Department of Mammalogy/Vertebrate Zoology and Richard Gilder Graduate School, American Museum of Natural History
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27
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de Souza Ferreira MR, Galvão APO, de Queiroz Lima PTMB, de Queiroz Lima AMB, Magalhães CP, Valença MM. The parietal foramen anatomy: studies using dry skulls, cadaver and in vivo MRI. Surg Radiol Anat 2021; 43:1159-1168. [PMID: 33399919 DOI: 10.1007/s00276-020-02650-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 12/05/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The aim of this study was to describe the anatomical features encountered in the parietal foramen in a series of 178 human bones and 123 head MRI examinations. A cadaveric specimen was also dissected to demonstrate the trajectory of a superficial scalp vein through the parietal foramen as far as the dura mater. A literature review was performed regarding prevalence of parietal foramen in different populations. METHODS Totally, 178 paired adult bones were used to investigate the presence, shape and number of the parietal foramina. In addition, 123 brain MRI examinations were also studied. RESULTS The parietal foramina were encountered in 75/89 (84.3%) skulls [32/38 (84.2%) in women vs. 43/51 (84.3%) in men, p > 0.05]. The parietal foramen was present bilaterally in 44.73% of females and 54.9% of males. Regarding unilaterality of the parietal foramen, a right or left laterality was observed in female 21% right versus 18% left; and 16% versus 14% (left) in males (p > 0.05). The accessory parietal foramen was present in the right parietal in 2.6% and in 7.9% on the left side of the females, while 5.9% and 3.9% of the males on the right or left sides, respectively. The parietal foramina located in the proximity of the sagittal suture (male 7.1 ± 2.5 mm vs. female, 7.4 ± 2.7 mm). There was a positive correlation between the right and left parietal foramina regarding the distance from the median line. The distance from a foramen to the contralateral one was 16 ± 4 mm in men and 18 ± 5 mm in women, respectively (p > 0.05). CONCLUSION No major differences were encountered between sexes regarding the anatomical features of parietal foramen.
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Affiliation(s)
- Maria Rosana de Souza Ferreira
- Departamento of Anatomy, Academic Center of Vitória of Santo Antão, Vitória, Pernambuco, Brazil. .,Neurosurgery Unit, Federal University of Pernambuco, Recife, Pernambuco, Brazil. .,Departamento of Anatomy and Neurosurgery Unit, Federal University of Pernambuco, Recife, Pernambuco, Brazil.
| | - André Pukey Oliveira Galvão
- Departamento of Anatomy, Academic Center of Vitória of Santo Antão, Vitória, Pernambuco, Brazil.,Vitória de Santo Antão, Facol University Center, Vitória, Pernambuco, Brazil
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28
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Abdalkader M, Ma A, Cohen M, Aliphas A, Sakai O, Nguyen TN. Endovascular coiling of large mastoid emissary vein causing pulsatile tinnitus. Interv Neuroradiol 2020; 26:821-825. [PMID: 32408784 PMCID: PMC7724599 DOI: 10.1177/1591019920926333] [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: 02/07/2020] [Revised: 03/24/2020] [Accepted: 04/03/2020] [Indexed: 12/19/2022] Open
Abstract
The association of large mastoid emissary veins and pulsatile tinnitus has been reported. However, therapeutic options for this condition remain limited. We report a case of endovascular coiling of a large mastoid emissary vein in a patient with disabling pulsatile tinnitus with significant improvement of symptoms. To our knowledge, endovascular coiling of large mastoid emissary vein causing pulsatile tinnitus has not been reported.
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Affiliation(s)
- Mohamad Abdalkader
- Department of Radiology, Boston Medical Center, Boston University-School
of Medicine, Boston, MA, USA
| | - Alice Ma
- Department of Radiology, Boston Medical Center, Boston University-School
of Medicine, Boston, MA, USA
| | - Michael Cohen
- Department of Otolaryngology, Boston Medical Center, Boston
University-School of Medicine, Boston, MA, USA
| | - Avner Aliphas
- Department of Otolaryngology, Boston Medical Center, Boston
University-School of Medicine, Boston, MA, USA
| | - Osamu Sakai
- Department of Radiology, Boston Medical Center, Boston University-School
of Medicine, Boston, MA, USA
- Department of Otolaryngology, Boston Medical Center, Boston
University-School of Medicine, Boston, MA, USA
- Department of Neurosurgery, Boston Medical Center, Boston
University-School of Medicine, Boston, MA, USA
| | - Thanh N Nguyen
- Department of Radiology, Boston Medical Center, Boston University-School
of Medicine, Boston, MA, USA
- Department of Otolaryngology, Boston Medical Center, Boston
University-School of Medicine, Boston, MA, USA
- Department of Neurology, Boston Medical Center, Boston University-School
of Medicine, Boston, MA, USA
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29
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Wang C, Lockwood J, Iwanaga J, Dumont AS, Bui CJ, Tubbs RS. Comprehensive review of the mastoid foramen. Neurosurg Rev 2020; 44:1255-1258. [PMID: 32507931 DOI: 10.1007/s10143-020-01329-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 05/27/2020] [Accepted: 05/28/2020] [Indexed: 11/28/2022]
Abstract
Anatomical variations of the mastoid foramen have been observed to vary in a number of qualities including size, number, and location. These variants have the potential to become problematic during surgical approaches to the posterior cranial fossa and mastoid part of the temporal bone, and should thus be appreciated by the surgeon. Herein, we discuss the mastoid foramen in detail including issues with such foramina that should be known to the neurosurgeon.
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Affiliation(s)
- Cindy Wang
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, 131 S. Robertson St. Suite 1300, New Orleans, LA, 70112, USA
| | - Joseph Lockwood
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, 131 S. Robertson St. Suite 1300, New Orleans, LA, 70112, USA
- Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, LA, USA
| | - Joe Iwanaga
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, 131 S. Robertson St. Suite 1300, New Orleans, LA, 70112, USA.
| | - Aaron S Dumont
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, 131 S. Robertson St. Suite 1300, New Orleans, LA, 70112, USA
| | - C J Bui
- Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, LA, USA
| | - R Shane Tubbs
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, 131 S. Robertson St. Suite 1300, New Orleans, LA, 70112, USA
- Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, LA, USA
- Department of Structural & Cellular Biology, Tulane University School of Medicine, New Orleans, LA, USA
- Department of Anatomical Sciences, St. George's University, St. George's, West Indies, Grenada
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30
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Eliezer M, Freitas RK, Fantoni M, Guedon A, Houdart E. Selective embolization of the mastoid emissary vein for pulsatile tinnitus treatment: when is it indicated? J Neurointerv Surg 2020; 12:999-1001. [DOI: 10.1136/neurintsurg-2020-015855] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 03/09/2020] [Accepted: 03/11/2020] [Indexed: 12/28/2022]
Abstract
BackgroundVenous pulsatile tinnitus (PT) can be caused by the perception of blood flow through the mastoid emissary vein (MEV). However, the causal relationship of this anomaly has not been established as selective occlusion of this vein has never been performed. The aim of this study was to report on a small series of patients suspected of having PT caused by an MEV, who underwent MEV embolization as treatment for PT, and to identify the correct indications for this procedure.MethodsThis was a single center retrospective study (CNIL 2215065) including six patients with isolated disabling PT treated by embolization of the MEV, recruited between December 2017 and August 2019. Patient charts were systematically reviewed. All patients underwent non-contrast temporal bone CT and MRI.ResultsMean age of the patients (five women, one male) was 56.3 years (range 40–71 years). Two patients presented with venous PT and four had neutral PT. The MEV was in direct contact with the mastoid air cells on temporal bone CT in all patients. Based on clinical examination, two patients presented with venous PT while four patients had neutral PT. In all cases of venous PT, selective embolization of the MEV caused the tinnitus to disappear, suggesting technical success. In contrast, embolization of the MEV had no effect in patients with neutral PT.ConclusionsWe demonstrated that MEV could be a source of venous PT. Embolization of the MEV was effective only in cases of clinical venous PT.
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Manjila S, Bazil T, Thomas M, Mani S, Kay M, Udayasankar U. A review of extraaxial developmental venous anomalies of the brain involving dural venous flow or sinuses: persistent embryonic sinuses, sinus pericranii, venous varices or aneurysmal malformations, and enlarged emissary veins. Neurosurg Focus 2019; 45:E9. [PMID: 29961384 DOI: 10.3171/2018.5.focus18107] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This paper is a narrative review of extraaxial developmental venous anomalies (eDVAs) of the brain involving dural venous flow or sinuses: persistent embryonic sinuses, sinus pericranii, enlarged emissary veins, and venous varices or aneurysmal malformations. The article highlights the natural history, anatomy, embryology, imaging, clinical implications, and neurosurgical significance of these lesions, which the authors believe represent a continuum, with different entities characterized by distinct embryopathologic features. The indications and surgical management options are discussed for these individual intracranial pathologies with relevant illustrations, and a novel classification is proposed for persistent falcine sinus (PFS). The role of neurointervention and/or microsurgery in specific cases such as sinus pericranii and enlarged emissary veins of the skull is highlighted. A better understanding of the pathophysiology and developmental anatomy of these lesions can reduce treatment morbidity and mortality. Some patients, including those with vein of Galen malformations (VOGMs), can present with the added systemic morbidity of a high-output cardiac failure. Although VOGM is the most studied and classified of the above-mentioned eDVAs, the authors believe that grouping the former with the other venous anomalies/abnormalities listed above would enable the clinician to convey the exact morphophysiological configuration of these lesions, predict their natural history with respect to evolving venous hypertension or stroke, and extrapolate invaluable insights from VOGM treatment to the treatment of other eDVAs. In recent years, many of these symptomatic venous malformations have been treated with endovascular interventions, although these techniques are still being refined. The authors highlight the broad concept of eDVAs and hope that this work will serve as a basis for future studies investigating the role of evolving focal venous hypertension/global intracranial hypertension and possibilities of fetal surgical intervention in these cases.
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Affiliation(s)
- Sunil Manjila
- 1Department of Neurosurgery, McLaren Bay Region Medical Center, Bay City, Michigan
| | - Timothy Bazil
- 1Department of Neurosurgery, McLaren Bay Region Medical Center, Bay City, Michigan
| | - Matthew Thomas
- 1Department of Neurosurgery, McLaren Bay Region Medical Center, Bay City, Michigan
| | - Sunithi Mani
- 2Department of Radiology, Christian Medical College, Vellore, Tamil Nadu, India; and
| | - Matthew Kay
- 3Department of Medical Imaging, University of Arizona College of Medicine, Tucson, Arizona
| | - Unni Udayasankar
- 3Department of Medical Imaging, University of Arizona College of Medicine, Tucson, Arizona
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Eisová S, Píšová H, Velemínský P, Bruner E. Normal craniovascular variation in two modern European adult populations. J Anat 2019; 235:765-782. [PMID: 31236921 PMCID: PMC6742892 DOI: 10.1111/joa.13019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2019] [Indexed: 01/06/2023] Open
Abstract
The vascular networks running into the meningeal layers, between the brain and braincase, leave imprints on the endocranial surface. These traces are visible in osteological specimens and skeletal collections, providing indirect evidence of vascular patterns in those cases in which bone remains are the only source of anatomical information, such as in forensic science, bioarchaeology and paleontology. The main vascular elements are associated with the middle meningeal artery, the venous sinuses of the dura mater, and the emissary veins. Most of these vascular systems have been hypothesized to be involved in endocranial thermal regulation. Although these traits deal with macroanatomical features, much information on their variation is still lacking. In this survey, we analyze a set of craniovascular imprints in two European dry skull samples with different neurocranial proportions: a brachycephalic Czech sample (n = 103) and a mesocephalic Italian sample (n = 152). We analyzed variation and distribution, correlation with cranial metrics, and sex differences in the dominance of the branches of the middle meningeal artery, the patterns of confluence of the sinuses, and the size of the emissary foramina. The descriptive statistics provide a reference to compare specimens and samples from different case studies. When compared with the Italian skulls, the Czech skulls display a greater dominance of the anterior branch of the middle meningeal artery and more asymmetric right-dominance of the confluence of the venous sinuses. There is no sex difference in the middle meningeal vessels, but males show a greater prevalence of the occipito-marginal draining system. Differences in the middle meningeal vessels or venous sinuses are apparently not influenced by cranial dimensions or proportions. The mastoid foramina are larger in larger and more brachycephalic skulls, which increases the emissary potential flow in the Czech sample and males, when compared with the Italian samples and females, respectively. The number of mastoid foramina increases in wider skulls. This anatomic information is necessary to develop further morphological and functional inferences on the relationships between neurocranial bones and vessels at the genetic, ontogenetic, and phylogenetic levels.
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Affiliation(s)
- Stanislava Eisová
- Department of Anthropology and Human GeneticsCharles UniversityPragueCzech Republic
- Department of AnthropologyNational MuseumPragueCzech Republic
| | - Hana Píšová
- Department of Anthropology and Human GeneticsCharles UniversityPragueCzech Republic
| | - Petr Velemínský
- Department of AnthropologyNational MuseumPragueCzech Republic
| | - Emiliano Bruner
- Centro Nacional de Investigación sobre la Evolución HumanaBurgosSpain
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Freeman CW, Lazor JW, Loevner LA, Nabavizadeh SA. Variations of the CNS Venous System Mimicking Pathology: Spectrum of Imaging Findings. J Neuroimaging 2019; 29:673-688. [DOI: 10.1111/jon.12664] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 09/05/2019] [Accepted: 09/06/2019] [Indexed: 12/18/2022] Open
Affiliation(s)
- Colbey W. Freeman
- Department of RadiologyHospital of the University of Pennsylvania Philadelphia PA
| | - Jillian W. Lazor
- Division of Neuroradiology, Department of RadiologyHospital of the University of Pennsylvania Philadelphia PA
| | - Laurie A. Loevner
- Division of Neuroradiology, Department of RadiologyHospital of the University of Pennsylvania Philadelphia PA
| | - Seyed Ali Nabavizadeh
- Division of Neuroradiology, Department of RadiologyHospital of the University of Pennsylvania Philadelphia PA
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Hedjoudje A, Piveteau A, Gonzalez-Campo C, Moghekar A, Gailloud P, San Millán D. The Occipital Emissary Vein: A Possible Marker for Pseudotumor Cerebri. AJNR Am J Neuroradiol 2019; 40:973-978. [PMID: 31072972 DOI: 10.3174/ajnr.a6061] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 04/03/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Transverse sinus stenosis can lead to pseudotumor cerebri syndrome by elevating the cerebral venous pressure. The occipital emissary vein is an inconstant emissary vein that connects the torcular herophili with the suboccipital veins of the external vertebral plexus. This retrospective study compares the prevalence and size of the occipital emissary vein in patients with pseudotumor cerebri syndrome with those in healthy control subjects to determine whether the occipital emissary vein could represent a marker of pseudotumor cerebri syndrome. MATERIALS AND METHODS The cranial venous system of 46 adult patients with pseudotumor cerebri syndrome (group 1) was studied on CT venography images and compared with a group of 92 consecutive adult patients without pseudotumor cerebri syndrome who underwent venous assessment with gadolinium-enhanced 3D-T1 MPRAGE sequences (group 2). The presence of an occipital emissary vein was assessed, and its proximal (intraosseous) and distal (extracranial) maximum diameters were measured and compared between the 2 groups. Seventeen patients who underwent transverse sinus stent placement had their occipital emissary vein diameters measured before and after stent placement. RESULTS Thirty of 46 (65%) patients in group 1 versus 29/92 (31.5%) patients in group 2 had an occipital emissary vein (P < .001). The average proximal and distal occipital emissary vein maximum diameters were significantly larger in group 1 (2.3 versus 1.6 mm, P <.005 and 3.3 versus 2.3 mm, P < .001). The average maximum diameters of the occipital emissary vein for patients who underwent transverse sinus stent placement were larger before stent placement than after stent placement: 2.6 versus 1.8 mm proximally (P < .06) and 3.7 versus 2.6 mm distally (P < .005). CONCLUSIONS Occipital emissary veins are more frequent and larger in patients with pseudotumor cerebri syndrome than in healthy subjects, a finding consistent with their role as collateral venous pathway in transverse sinus stenosis. A prominent occipital emissary vein is an imaging sign that should raise the suspicion of pseudotumor cerebri syndrome.
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Affiliation(s)
- A Hedjoudje
- From the Neuroradiology Unit (A.H., C.G.-C., D.S.M.), Service of Diagnostic and Interventional Imaging, Sion Hospital, Sion, Valais, Switzerland .,Department of Interventional Neuroradiology (A.H., P.G.).,Imaging Department (A.H.), University Hospital of Rouen, Rouen, France
| | - A Piveteau
- Imaging Department (A.P.), University Hospital of Geneva, Geneva, Switzerland
| | - C Gonzalez-Campo
- From the Neuroradiology Unit (A.H., C.G.-C., D.S.M.), Service of Diagnostic and Interventional Imaging, Sion Hospital, Sion, Valais, Switzerland
| | - A Moghekar
- Cerebral Fluid Center (A.M.), Department of Neurology, The Johns Hopkins Hospital, Baltimore, Maryland
| | - P Gailloud
- Department of Interventional Neuroradiology (A.H., P.G.)
| | - D San Millán
- From the Neuroradiology Unit (A.H., C.G.-C., D.S.M.), Service of Diagnostic and Interventional Imaging, Sion Hospital, Sion, Valais, Switzerland
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Gulmez Cakmak P, Ufuk F, Yagci AB, Sagtas E, Arslan M. Emissary veins prevalence and evaluation of the relationship between dural venous sinus anatomic variations with posterior fossa emissary veins: MR study. Radiol Med 2019; 124:620-627. [PMID: 30825075 DOI: 10.1007/s11547-019-01010-2] [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: 12/26/2018] [Accepted: 02/11/2019] [Indexed: 12/11/2022]
Abstract
PURPOSE The aim of this study was to find the prevalence of emissary veins and to compare the visibility of these emissary veins with the anatomic variations of the dural venous sinuses detected in magnetic resonance venography (MRV). MATERIALS AND METHODS All MR images of two hundred twenty patients were evaluated retrospectively. Posterior cranial fossa emissary veins diameter measurements were performed in the axial plane. The anatomic variations of the venous sinuses in MRVs of all patients were recorded. Accordingly, the presence of the emissary veins was compared with the dural venous sinus anatomic variations. p < 0.05 was considered statistically significant. An inter-observer reliability analysis was performed. RESULTS The prevalence of emissary veins in MRI was found in the right mastoid emissary vein (MEV) 82.7% and left MEV 81.4%. Occipital emissary vein (OEV) was present in 63 patients (28.6%) for the first radiologist (R1), and it was present in 61 patients (27.7%) for the second radiologist (R2) (K = 0.978). A statistically significant correlation was detected between the diameter of the left MEV and gender (p < 0.05) for both radiologists. There was a statistically significant difference between the left MEV and OEV and transverse sinus anatomic variations. CONCLUSION MR imaging is a noninvasive and irradiating imaging method for detecting posterior fossa major emissary veins, and we recommend using MR imaging for preoperative evaluation of posterior fossa major emissary veins and related dural venous sinuses.
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Affiliation(s)
- Pinar Gulmez Cakmak
- Department of Radiology, Faculty of Medicine, Pamukkale University, Kinikli Kampusu, 20100, Denizli, Turkey.
| | - Furkan Ufuk
- Department of Radiology, Faculty of Medicine, Pamukkale University, Kinikli Kampusu, 20100, Denizli, Turkey
| | - Ahmet Baki Yagci
- Department of Radiology, Faculty of Medicine, Pamukkale University, Kinikli Kampusu, 20100, Denizli, Turkey
| | - Ergin Sagtas
- Department of Radiology, Faculty of Medicine, Pamukkale University, Kinikli Kampusu, 20100, Denizli, Turkey
| | - Muhammet Arslan
- Department of Radiology, Faculty of Medicine, Pamukkale University, Kinikli Kampusu, 20100, Denizli, Turkey
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Hampl M, Kachlik D, Kikalova K, Riemer R, Halaj M, Novak V, Stejskal P, Vaverka M, Hrabalek L, Krahulik D, Nanka O. Mastoid foramen, mastoid emissary vein and clinical implications in neurosurgery. Acta Neurochir (Wien) 2018; 160:1473-1482. [PMID: 29779186 DOI: 10.1007/s00701-018-3564-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 05/09/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Mastoid emissary vein is especially important from the neurosurgical point of view, because it is located in variable number in the area of the occipitomastoid suture and it can become a source of significant bleeding in surgical approaches through the mastoid process, especially in retrosigmoid craniotomy, which is used for approaches to pathologies localized in the cerebellopontine angle. Ideal imaging method for diagnosis of these neglected structures when planning a surgical approach is high-resolution computed tomography. The aim of this work was to provide detailed information about this issue. METHODS We studied a group of 295 skulls obtained from collections of five anatomy departments and the National Museum. Both quantitative and qualitative parameters of the mastoid foramen were evaluated depending on side of appearance and gender. Individual distances of the mastoid foramen from clearly defined surface landmarks (asterion, apex of mastoid process, foramen magnum) and other anatomical structures closely related to this issue (width of groove for sigmoid sinus, diameters of internal and external openings of mastoid foramen) were statistically processed. RESULTS The most frequently represented type of the mastoid foramen is type II by Louis (41.2%). The differences between right and left sides were not statistically significant. In men there was a higher number of openings on the right side and in qualitative parameters the type III and IV predominated, whereas in women the types I and II were more frequent. In men, greater distances from the mastoid foramen were observed when evaluating qualitative parameters for defined surface landmarks. Mean size of the external opening diameter was 1.3 mm; however, several openings measured up to 7 mm. CONCLUSIONS Despite excellent knowledge of anatomy, however, good pre-operative examination using imaging methods and mastering of microsurgical techniques create the base for successful treatment of pathological structures in these anatomically complex areas.
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Affiliation(s)
- Martin Hampl
- Department of Neurosurgery, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Olomouc, Czech Republic
| | - David Kachlik
- Department of Anatomy, Second Faculty of Medicine, Charles University, U nemocnice 3, Praha 2, 12800, Prague, Czech Republic.
| | - Katerina Kikalova
- Department of Anatomy, Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, Czech Republic
| | - Roxane Riemer
- Department of Anatomy, Second Faculty of Medicine, Charles University, U nemocnice 3, Praha 2, 12800, Prague, Czech Republic
| | - Matej Halaj
- Department of Neurosurgery, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Olomouc, Czech Republic
| | - Vlastimil Novak
- Department of Neurosurgery, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Olomouc, Czech Republic
| | - Premysl Stejskal
- Department of Neurosurgery, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Olomouc, Czech Republic
| | - Miroslav Vaverka
- Department of Neurosurgery, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Olomouc, Czech Republic
| | - Lumir Hrabalek
- Department of Neurosurgery, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Olomouc, Czech Republic
| | - David Krahulik
- Department of Neurosurgery, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Olomouc, Czech Republic
| | - Ondrej Nanka
- Department of Anatomy, Second Faculty of Medicine, Charles University, U nemocnice 3, Praha 2, 12800, Prague, Czech Republic
- Institute of Anatomy, First Faculty of Medicine, Charles University, Prague, Czech Republic
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CT and MR Imaging of the Pediatric Temporal Bone: Normal Variants and Pitfalls. CURRENT RADIOLOGY REPORTS 2017. [DOI: 10.1007/s40134-017-0225-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Tsutsumi S, Ono H, Yasumoto Y. The mastoid emissary vein: an anatomic study with magnetic resonance imaging. Surg Radiol Anat 2016; 39:351-356. [DOI: 10.1007/s00276-016-1733-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 08/10/2016] [Indexed: 10/21/2022]
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CT findings of the temporal bone in CHARGE syndrome: aspects of importance in cochlear implant surgery. Eur Arch Otorhinolaryngol 2016; 273:4225-4240. [PMID: 27324890 PMCID: PMC5104824 DOI: 10.1007/s00405-016-4141-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Accepted: 06/11/2016] [Indexed: 11/23/2022]
Abstract
To provide an overview of anomalies of the temporal bone in CHARGE syndrome relevant to cochlear implantation (CI), anatomical structures of the temporal bone and the respective genotypes were analysed. In this retrospective study, 42 CTs of the temporal bone of 42 patients with CHARGE syndrome were reviewed in consensus by two head-and-neck radiologists and two otological surgeons. Anatomical structures of the temporal bone were evaluated and correlated with genetic data. Abnormalities that might affect CI surgery were seen, such as a vascular structure, a petrosquamosal sinus (13 %), an underdeveloped mastoid (8 %) and an aberrant course of the facial nerve crossing the round window (9 %) and/or the promontory (18 %). The appearance of the inner ear varied widely: in 77 % of patients all semicircular canals were absent and the cochlea varied from normal to hypoplastic. A stenotic cochlear aperture was observed in 37 %. The middle ear was often affected with a stenotic round (14 %) or oval window (71 %). More anomalies were observed in patients with truncating mutations than with non-truncating mutations. Temporal bone findings in CHARGE syndrome vary widely. Vascular variants, aberrant route of the facial nerve, an underdeveloped mastoid, aplasia of the semicircular canals, and stenotic round window may complicate cochlear implantation.
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Syed AZ, Sin C, Rios R, Mupparapu M. Incidental occurrence of an unusually large mastoid foramen on cone-beam computed tomography and review of the literature. Imaging Sci Dent 2016; 46:39-45. [PMID: 27051638 PMCID: PMC4816770 DOI: 10.5624/isd.2016.46.1.39] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 09/10/2015] [Accepted: 09/20/2015] [Indexed: 12/27/2022] Open
Abstract
The incidental finding of an enlarged mastoid foramen on the right posterior mastoid region of temporal bone is reported, together with a discussion of its clinical significance. A 67-year-old female underwent the pre-implant assessment of a maxillary left edentulous region. A cone-beam computed tomographic (CBCT) image was acquired and referred for consultation. Axial CBCT slices revealed a unilateral, well-defined, noncorticated, low-attenuation, transosseous defect posterior to the mastoid air cells in the right temporal bone. The borders of the osseous defect were smooth and continuous. No other radiographic signs suggestive of erosion or sclerosis were noted in the vicinity. The density within the defect was homogenous and consistent with a foramen and/or soft tissue. The patient's history and physical examination revealed no significant medical issues, and she was referred to a neuroradiologist for a second opinion. The diagnosis of an enlarged mastoid foramen was made and the patient was reassured.
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Affiliation(s)
- Ali Z Syed
- Department of Oral and Maxillofacial Medicine and Diagnostic Sciences, School of Dental Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Cleo Sin
- Department of Oral and Maxillofacial Medicine and Diagnostic Sciences, School of Dental Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Raquel Rios
- Department of Oral and Maxillofacial Medicine and Diagnostic Sciences, School of Dental Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Mel Mupparapu
- Division of Radiology, University of Pennsylvania School of Dental Medicine, Philadelphia, PA, USA
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Extraordinary cerebral venous drainage pathway with mastoid emissary and posterior external jugular veins detected by contrast-enhanced neck computed tomography. Surg Radiol Anat 2015; 37:1191-4. [PMID: 26026479 DOI: 10.1007/s00276-015-1496-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Accepted: 05/23/2015] [Indexed: 10/23/2022]
Abstract
An extraordinary cerebral venous drainage pathway and dilated vein at the left posterior cervical region were detected with routine contrast-enhanced neck computed tomography exam. The left sigmoid sinus was drained by dilated mastoid emissary vein (MEV). The MEV continued as posterior auricular and posterior external jugular veins (PEJVs). The left PEJV directly drained into subclavian vein. Atretic right transverse sinus, left facial vein forming the external jugular vein, atresia and hypoplasia of upper internal jugular veins at the right and left sides, respectively, were the other uncommon findings in our case. Detecting venous variations may prevent complications during surgical and interventional procedures, so the radiologists should examine the superficial cervical veins closely.
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Rangel de Lázaro G, de la Cuétara JM, Píšová H, Lorenzo C, Bruner E. Diploic vessels and computed tomography: Segmentation and comparison in modern humans and fossil hominids. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 2015; 159:313-24. [DOI: 10.1002/ajpa.22878] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 08/10/2015] [Accepted: 09/21/2015] [Indexed: 12/20/2022]
Affiliation(s)
- Gizéh Rangel de Lázaro
- Área de Prehistoria; Universitat Rovira I Virgili; Tarragona Spain
- Institut Català De Paleoecologia Humana I Evolució Social (IPHES); Tarragona Spain
| | | | - Hana Píšová
- Antropologické Oddělení; Univerzita Karlova and Národní Muzeum; Prague Czech Republic
| | - Carlos Lorenzo
- Área de Prehistoria; Universitat Rovira I Virgili; Tarragona Spain
- Institut Català De Paleoecologia Humana I Evolució Social (IPHES); Tarragona Spain
| | - Emiliano Bruner
- Grupo de Paleobiología; Centro Nacional De Investigación Sobre La Evolución Humana (CENIEH); Burgos Spain
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Müller LO, Toro EF, Haacke EM, Utriainen D. Impact of CCSVI on cerebral haemodynamics: a mathematical study using MRI angiographic and flow data. Phlebology 2015; 31:305-24. [DOI: 10.1177/0268355515586526] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Background The presence of abnormal anatomy and flow in neck veins has been recently linked to neurological diseases. The precise impact of extra-cranial abnormalities such as stenoses remains unexplored. Methods Pressure and velocity fields in the full cardiovascular system are computed by means of a global mathematical model that accounts for the relationship between pulsating cerebral blood flow and intracranial pressure. Results Our model predicts that extra-cranial strictures cause increased pressure in the cerebral venous system. Specifically, there is a predicted pressure increase of about 10% in patients with a 90% stenoses. Pressure increases are related to significant flow redistribution with flow reduction of up to 70% in stenosed vessels and consequent flow increase in collateral pathways. Conclusions Extra-cranial venous strictures can lead to pressure increases in intra-cranial veins of up to 1.3 mmHg, despite the shielding role of the Starling resistor. The long-term clinical implications of the predicted pressure changes are unclear.
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Affiliation(s)
- LO Müller
- Computer Science Department, National Laboratory for Scientific Computing, LNCC/MCTI, Petrópolis, RJ, Brazil
- Laboratory of Applied Mathematics, Department of Civil, Environmental and Mechanical Engineering, University of Trento, Trento, Italy
| | - EF Toro
- Laboratory of Applied Mathematics, Department of Civil, Environmental and Mechanical Engineering, University of Trento, Trento, Italy
| | - EM Haacke
- Department of Biomedical Engineering, Wayne State University, Detroit, MI, USA
- Magnetic Resonance Innovations, Inc. Detroit, MI, USA
| | - D Utriainen
- Magnetic Resonance Innovations, Inc. Detroit, MI, USA
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Abstract
Posterior fossa emissary veins are valveless veins that pass through cranial apertures. They participate in extracranial venous drainage of the posterior fossa dural sinuses. The mastoid emissary vein, condylar veins, occipital emissary vein, and petrosquamosal sinus are the major posterior fossa emissary veins. We believe that posterior fossa emissary veins can be detected by radiologists before surgery with a thorough understanding of their anatomy. Describing them using temporal bone computed tomography (CT), CT angiography, and cerebral magnetic resonance (MR) venography examinations results in more detailed and accurate preoperative radiological interpretation and has clinical importance. This pictorial essay reviews the anatomy of the major and clinically relevant posterior fossa emissary veins using high-resolution CT, CT angiography, and MR venography images and discusses the clinical importance of reporting these vascular variants.
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Affiliation(s)
- Yeliz Pekçevik
- From the Department of Radiology (Y.P. e-mail: ), İzmir Tepecik Training and Research Hospital, İzmir, Turkey; the Department of Radiology (R.P.), İzmir Bozyaka Training and Research Hospital, İzmir, Turkey
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Mundada P, Singh A, Lingam RK. CT arteriography and venography in the evaluation of Pulsatile tinnitus with normal otoscopic examination. Laryngoscope 2014; 125:979-84. [PMID: 25379666 DOI: 10.1002/lary.25010] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 09/13/2014] [Accepted: 10/08/2014] [Indexed: 12/18/2022]
Abstract
OBJECTIVES/HYPOTHESIS Our retrospective study aims to assess the ability of computed tomography arteriography and venography (CT A/V) to detect various findings that suggest a potential cause of pulsatile tinnitus and to examine the association between these findings and the side of pulsatile tinnitus. STUDY DESIGN A retrospective review of CT arteriography and venography of 32 patients with established pulsatile tinnitus and normal otoscopic examination was performed. The scans were performed using a 64-slice multidetector scanner and were reviewed to look for findings that are known to cause pulsatile tinnitus. RESULTS One or more findings that are known to cause pulsatile tinnitus were detected on the symptomatic side in 30 patients; on the asymptomatic side in 3 patients, one patient with bilateral pulsatile tinnitus showed a potential cause of symptoms only on one side, and in one patient no potential cause could be identified. There is a significant association seen between the side of pulsatile tinnitus and various potential causes of pulsatile tinnitus detected (P < 0.001), between the side of pulsatile tinnitus and various potential venous cause detected (P < 0.001), and between the side of pulsatile tinnitus and the side of dominant venous system (P = 0.02). CONCLUSION CT arteriography and venography is a useful tool in detecting many described potential causes of pulsatile tinnitus. Significant association is demonstrated between the side of pulsatile tinnitus and the potential causes of pulsatile tinnitus detected by CT arteriography and venography when the otoscopic examination is normal.
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Affiliation(s)
- Pravin Mundada
- Department of Radiology, Changi General Hospital, Singapore
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Murlimanju BV, Chettiar GK, Prameela MD, Tonse M, Kumar N, Saralaya VV, Prabhu LV. Mastoid emissary foramina: an anatomical morphological study with discussion on their evolutionary and clinical implications. Anat Cell Biol 2014; 47:202-6. [PMID: 25276480 PMCID: PMC4178196 DOI: 10.5115/acb.2014.47.3.202] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Revised: 07/11/2014] [Accepted: 07/15/2014] [Indexed: 12/02/2022] Open
Abstract
The identification of mastoidal emissary veins is of importance in the neurosurgical practice to diagnose abnormal and normal structures. In the present study, the objectives were to estimate the prevalence rate of mastoidal emissary foramina in the temporal bones of the adult skull and to study their number and morphology. The present study included 48 adult human skulls which were obtained from the gross anatomy laboratory of our institution. The mastoid parts of 96 temporal bones were macroscopically observed for the prevalence, number and morphology of the emissary foramina. It is observed that, the mastoidal emissary foramen was present in 88 temporal bones (91.7%) of our specimens. The foramen was observed single in 60 temporal bones (62.5%), double in 22 bones (22.9%), and triple in 6 temporal bones (6.2%). The mastoidal emissary foramen was absent in 8 (8.3%) temporal bones. The foramen was bilaterally absent in 3 (3.1%) skulls. It was unilaterally absent in 2 (2.1%) skulls and both were on the left side. The mastoidal emissary vein is prevalent in a large number (91.7%) of cases. It was observed that the accessory mastoidal emissary foramina were present in 29.1% of cases. Recognition of the mastoid emissary veins and accessory mastoid emissary veins during the otologic surgery is critical to avoid the significant bleeding. In the neurosurgical practice, the knowledge is important due to variability in the number of mastoidal emissary veins and their connection to the venous sinuses.
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Affiliation(s)
- B V Murlimanju
- Department of Anatomy, Kasturba Medical College, Manipal University, Mangalore, India
| | - Ganesh Kumar Chettiar
- Department of Anatomy, Kasturba Medical College, Manipal University, Mangalore, India
| | - M D Prameela
- Department of Anatomy, Kasturba Medical College, Manipal University, Mangalore, India
| | - Mamatha Tonse
- Department of Anatomy, Kasturba Medical College, Manipal University, Mangalore, India
| | - Naveen Kumar
- Department of Anatomy, Melaka Manipal Medical College, Manipal University, Manipal, India
| | - Vasudha V Saralaya
- Department of Anatomy, Kasturba Medical College, Manipal University, Mangalore, India
| | - Latha V Prabhu
- Department of Anatomy, Kasturba Medical College, Manipal University, Mangalore, India
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Müller LO, Toro EF. A global multiscale mathematical model for the human circulation with emphasis on the venous system. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2014; 30:681-725. [PMID: 24431098 DOI: 10.1002/cnm.2622] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Revised: 10/04/2013] [Accepted: 11/20/2013] [Indexed: 05/29/2023]
Abstract
We present a global, closed-loop, multiscale mathematical model for the human circulation including the arterial system, the venous system, the heart, the pulmonary circulation and the microcirculation. A distinctive feature of our model is the detailed description of the venous system, particularly for intracranial and extracranial veins. Medium to large vessels are described by one-dimensional hyperbolic systems while the rest of the components are described by zero-dimensional models represented by differential-algebraic equations. Robust, high-order accurate numerical methodology is implemented for solving the hyperbolic equations, which are adopted from a recent reformulation that includes variable material properties. Because of the large intersubject variability of the venous system, we perform a patient-specific characterization of major veins of the head and neck using MRI data. Computational results are carefully validated using published data for the arterial system and most regions of the venous system. For head and neck veins, validation is carried out through a detailed comparison of simulation results against patient-specific phase-contrast MRI flow quantification data. A merit of our model is its global, closed-loop character; the imposition of highly artificial boundary conditions is avoided. Applications in mind include a vast range of medical conditions. Of particular interest is the study of some neurodegenerative diseases, whose venous haemodynamic connection has recently been identified by medical researchers.
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Affiliation(s)
- Lucas O Müller
- Laboratory of Applied Mathematics, Department of Civil, Environmental and Mechanical Engineering, University of Trento, Via Mesiano 77, I-38100, Trento, Italy
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Kim LK, Ahn CS, Fernandes AE. Mastoid emissary vein: Anatomy and clinical relevance in plastic & reconstructive surgery. J Plast Reconstr Aesthet Surg 2014; 67:775-80. [DOI: 10.1016/j.bjps.2014.03.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 03/08/2014] [Indexed: 10/25/2022]
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Mastoid Findings Secondary to Posterior Fossa Dural Venous Sinus Thrombosis. AJR Am J Roentgenol 2013; 201:406-11. [DOI: 10.2214/ajr.12.9442] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Calligas JP, Todd NW. Hemorrhage from large mastoid emissary vein: pedicled, rotated, indented, periosteal-galeal flap. Laryngoscope 2013; 124:551-3. [PMID: 23775417 DOI: 10.1002/lary.24259] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Revised: 05/28/2013] [Accepted: 05/28/2013] [Indexed: 11/09/2022]
Affiliation(s)
- Jason P Calligas
- Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia, U.S.A
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