Sensitivity and Specificity of Double-Track Sign in the Detection of Transverse Sinus Stenosis: A Multicenter Retrospective Study

Anatomical basis of erector spinae plane block: a dissection and histotopographic pilot study

Purpose

Erector spinae plane (ESP) block is an interfascial blockade used in different clinical scenarios. This study investigated the ventral extent of dye diffusion in ESP block.

Methods

The ultrasound-guided ESP block was bilaterally performed with an injection at the T5 vertebral level (21-Gauge, 50 mm needle), using diluted black tissue marking dye (20 mL; 1:4 ratio with standard saline solution) instead of local anesthetic on two fresh-frozen corpses within the body donation program of the University of Padova. Subsequently, the gross anatomical dissection was performed by a combined posterior plus anterior approach, and the histotopographic examination completed.

Results

Macroscopically by gross anatomical dissection, the dye spreading ranged on the dorsal side of the chest from T2/3 to T10/11 with an extension up to 10 cm laterally, and on the ventral side of the chest from T2/3–T9/10. Microscopically by histotopographic examination, the dye diffused ventrally to the intercostal spaces (2–3 and 5–6 spaces on the right and left, respectively) by following the blood vessels coupled to the dorsal nerve passing through the costotransverse foramen.

Conclusions

The anterior pathway of dye diffusion from the site of injection within the erector spinae muscle group during an ESP block seems to follow the blood vessels and dorsal rami of spinal nerves, suggesting the passing through the costotransverse foramen to reach the anterior paravertebral space and the intercostal nerves. These findings display an anterior histotopographic diffusion of dye resembling a paravertebral block.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00540-020-02881-w.

Value of double - track sign in differentiating primary from thrombosed transverse sinus stenosis in patients presumed to have idiopathic intracranial hypertension

Background

Idiopathic intracranial hypertension (IIH) is primarily a disorder of young obese women of unknown etiology. The clinical presentation of IIH is similar to that of sinus thrombosis. The incidence of transverse sinus stenosis (TSS) reaches up to 90% of patients with IIH compared with normal subjects, and venous sinus thrombosis was reported in 11.4% of patients previously diagnosed as having IIH. Patients with thrombosis showed an abnormal region of double- track pattern on gadolinium (Gd) – enhanced T1WI within the dural sinus.

Aim

This study aims to evaluate whether double - track sign can differentiate primary TSS from thrombosed TSS in patients presumed to have IIH based on Gd - enhanced MRI.

Methods

This study was a retrospective multicenter observational case control study. The clinical and radiological data for all adult patients with presumed IIH were collected. The diagnosis of TSS was made based on further evaluation by DSA or MRV.

Results

Fifty-nine sinuses were diagnosed as a transverse sinus stenosis. Eight sinuses (13.6%) were partially occluded by recanalized thrombus. Double track sign was detected in seven (87.5%) of the thrombosed sinuses.

Conclusion

The double track sign remains much sensitive for the detection of transverse sinus thrombosis (TST) and it might provide an early clue for the dural sinus thrombosis in patients presumed to have IIH.