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Al-Shuaili A, Al-Ajmi E, Mogali SR, Al-Qasmi S, Al-Mufargi Y, Kariyattil R, Sirasanagandla SR. Computed-tomography evaluation of parietal foramen topography in adults: a retrospective analysis. Surg Radiol Anat 2024; 46:263-270. [PMID: 38280004 DOI: 10.1007/s00276-023-03284-8] [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: 09/21/2023] [Accepted: 12/13/2023] [Indexed: 01/29/2024]
Abstract
BACKGROUND The parietal foramen (PF) of the skull is a variable anatomic feature with important implications for venous drainage, infection, and injury. Its topography is clinically relevant for neurosurgeons for intracranial navigation and preoperative planning. METHODS PF topography was investigated in a series of 440 head computed-tomography scans of Omani subjects at Sultan Qaboos University Hospital. The mean age of the patients was 52 ± 17 years and there were 160 males and 280 females. The topography features of the PF, including frequency, diameter, patency, and relative position in relation to the superior sagittal sinus (SSS), were recorded. Additionally, sex and laterality differences in PF parameters were analyzed using a Chi-square test. RESULTS The overall prevalence of PF was 72.3% (318/440). The bilateral presence of PF was identified in 34% of skulls. Unilateral right-side prevalence was 18.2%, while left prevalence was 13.2% (p = 0.62). The prevalence of unilateral accessory PF on the right side was 1.8%, while it was 1.1% on the left (p = 0.69). PF within the sagittal suture/or intra-sutural PF was observed in 6.8% of skulls, with a frequency of 9.4% in men and 5.4% in women (p = 0.29). The diameter of the PF was 1.45 ± 0.74 mm on the right side, and 1.54 ± 0.99 mm on the left side (p = 0.96). There were 2% of incomplete PF. The PF was located over the SSS in 70.3% on the right side and 53.8% on the left side. No significant differences were observed between the PF topography parameters and sex or laterality. CONCLUSION The present study for the first time reports the baseline data of PF topography in a large sample of CT scans in the Arab population. The geography and race influence the PF topography differences. PF may be used as a reliable landmark of SSS. The morphological characteristics and distribution of PF reported in this study have clinical implications for imaging diagnosis, intracranial navigation of vascular disorders, and treatment.
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Affiliation(s)
- Anwar Al-Shuaili
- Radiology Residency Program, Oman Medical Specialty Board, Muscat, Oman
| | - Eiman Al-Ajmi
- Department of Radiology and Molecular Imaging, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | | | - Sara Al-Qasmi
- College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | | | - Rajeev Kariyattil
- Department of Surgery, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Srinivasa Rao Sirasanagandla
- Department of Human and Clinical Anatomy, College of Medicine and Health Sciences, Sultan Qaboos University, Al-Khoudh 123, Muscat, Oman.
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Zhao F, Xu K, Zhou Z, Yu J. Morphometric CT angiographic study of the SSS and its adjacent structures: A comparative analysis between elderly and nonelderly individuals of a Han Chinese population. Heliyon 2024; 10:e23609. [PMID: 38173530 PMCID: PMC10761763 DOI: 10.1016/j.heliyon.2023.e23609] [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] [Received: 02/24/2023] [Revised: 10/13/2023] [Accepted: 12/07/2023] [Indexed: 01/05/2024] Open
Abstract
Objective The superior sagittal sinus (SSS) is an important structure, but few studies have analyzed it using computed tomography angiography (CTA). Methods This study was performed to examine the angiographic anatomy of the SSS and its adjacent structures using CTA in Han Chinese participants. According to age, participants were divided into elderly and nonelderly groups. The parameters of the SSS and adjacent structures were measured, recorded and analyzed statistically. Results A total of 500 Han Chinese participants were enrolled in this study, including 346 in the elderly group and 154 in the nonelderly group. In the elderly group, regarding inferior sagittal sinus (ISS) development, 187 ISSs were absent, 85 were visible, and 74 were clear. In the nonelderly group, 62 ISSs were absent, 54 were visible, and 38 were clear. In the elderly group, the Rolandic bridging vein diameter was 3.6 ± 0.8 mm; in the nonelderly group, the diameter was 3.9 ± 1.1 mm. The statistical results showed a difference in ISS development between the elderly and nonelderly groups (P < 0.05). The relationship of age with ISS development was assessed using linear regression analysis, and the results indicated that ISS became gradually occluded with age (P < 0.05). The statistical results also showed a difference in the Rolandic bridging vein diameter between the elderly and nonelderly groups (P < 0.05). The relationship of age with the Rolandic bridging vein diameter was assessed using linear regression analysis, and the results indicated that the Rolandic bridging vein tended to become thinner with age (P < 0.05). Conclusion This study found that more ISSs may become occluded and that the Rolandic bridging vein may become thinner with age. Other parameters of the SSS and its adjacent structures may not be affected by aging. In addition, our study also provided normal CTA parameters of the SSS and its adjacent structures in Han Chinese people.
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Affiliation(s)
- Fasheng Zhao
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, 130021, China
| | - Kan Xu
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, 130021, China
| | - Zibo Zhou
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, 130021, China
| | - Jinlu Yu
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, 130021, China
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Juskys R, Rocka S, Suchomlinov A. Anatomical Variations of Superior Sagittal Sinus and Tributary Bridging Veins: A Cadaveric Study. Cureus 2022; 14:e21979. [PMID: 35282528 PMCID: PMC8906194 DOI: 10.7759/cureus.21979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2022] [Indexed: 11/05/2022] Open
Abstract
Background and objective Injuries to the parasagittal cerebrovenous structures may lead to devastating complications. Being aware of the inherent anatomical heterogeneity in the region might lower the rate of undesirable outcomes. In this study, our goal was to characterize the superior sagittal sinus (SSS) positioning in relation to the midline and depict tributary bridging veins (BVs) distribution over the lateral surface of the cerebral hemispheres. Methods We performed anatomical dissections of the brain in 10 cadaveric specimens (five females and five males; median age: 52 years, range: 44-74 years). Measurements (in mm) of the SSS width and deviation of its lateral margin from the midline were obtained along the entire length of the structure at six craniometric points [at mid-distance between Nasion and Bregma (½ N-B); at Bregma (B); in the middle of the Bregma-Lambda segment (½ B-L); at Lambda (L); halfway between Lambda and Inion (½ L-I); and at Inion (I)]. The count, diameter, and lateral insertion points of the draining BVs were also documented in three segments [Nasion-Bregma (N-B), Bregma-Lambda (B-L), and Lambda-Inion (L-I)]. Results The width of the SSS increased progressively along the direction of the blood flow (p<0.01). There was an SSS lateral deviation bias to the right, but the comparison failed to reach the significance level (p=0.12). The maximal lateralization of the SSS in the pre-Lambdal interval was 13.1 mm on the right side and 11.7 mm on the left side. These values increased up to 19.8 mm and 15.1 mm in the torcular area on the right and left sides, respectively. A total of 191 BVs were identified (a mean of 19.1 ± 2.5 per individual). The L-I segment showed a lower number of BVs as compared to its N-B and B-L counterparts (mean: 0.9 ± 0.6 vs. 8 ± 1.8 and 10.2 ± 2, respectively, p<0.01). Along the entire span of the SSS, the average diameter of the BVs was larger on the right side (mean: 1.4 ± 0.9 mm vs. 1.1 ± 0.8 mm on the left, p<0.01). The average lateralization of BVs dural entry points was lower on the left side in the B-L segment (mean: 5.6 ± 6.4 mm vs. 8.8 ± 6.7 mm on the right, p<0.01). There was a statistically significant trend of decreasing BVs lateralization with each consecutive SSS segment (mean: 10.9 ± 7.4 mm in the N-B segment, 7.3 ± 6.7 mm in B-L, and 1.6 ± 1.2 mm in L-I, p<0.01). The maximal lateral deviation of BVs insertion points was 33.6 mm in N-B, 30 mm in B-L, and 4.1 mm in L-I portions of the SSS. Conclusions In most cases, the SSS deviated laterally from the midline, up to 13 mm in the pre-Lambdal segment and up to 20 mm in the torcular area. Right-sided BVs were of larger average diameters. The lateral insertion points of BVs decreased along the rostrocaudal span of the SSS.
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Barath AS, Rusheen AE, Cabrera JMR, Shin H, Blaha CD, Bennet KE, Goerss SJ, Lee KH, Oh Y. Development and validation of a rapidly deployable CT-guided stereotactic system for external ventricular drainage: preclinical study. Sci Rep 2021; 11:17492. [PMID: 34471205 PMCID: PMC8410845 DOI: 10.1038/s41598-021-97080-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 08/20/2021] [Indexed: 11/18/2022] Open
Abstract
External ventricular drainage (EVD) is an emergency neurosurgical procedure to decrease intracranial pressure through a catheter mediated drainage of cerebrospinal fluid. Most EVD catheters are placed using free hands without direct visualization of the target and catheter trajectory, leading to a high rate of complications- hemorrhage, brain injury and suboptimal catheter placement. Use of stereotactic systems can prevent these complications. However, they have found limited application for this procedure due to their long set-up time and expensive hardware. Therefore, we have developed and pre-clinically validated a novel 3D printed stereotactic system for rapid and accurate implantation of EVD catheters. Its mechanical and imaging accuracies were found to be at par with clinical stereotactic systems. Preclinical trial in human cadaver specimens revealed improved targeting accuracy achieved within an acceptable time frame compared to the free hand technique. CT angiography emulated using cadaver specimen with radio-opaque vascular contrast showed vessel free catheter trajectory. This could potentially translate to reduced hemorrhage rate. Thus, our 3D printed stereotactic system offers the potential to improve the accuracy and safety of EVD catheter placement for patients without significantly increasing the procedure time.
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Affiliation(s)
- Abhijeet S Barath
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, 55905, USA.,Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic, Rochester, MN, 55905, USA
| | - Aaron E Rusheen
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, 55905, USA.,Medical Scientist Training Program, Mayo Clinic, Rochester, MN, 55905, USA
| | | | - Hojin Shin
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, 55905, USA
| | - Charles D Blaha
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, 55905, USA
| | - Kevin E Bennet
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, 55905, USA.,Division of Engineering, Mayo Clinic, Rochester, MN, 55905, USA.,NaviNetics Inc., Rochester, MN, 55905, USA
| | | | - Kendall H Lee
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, 55905, USA. .,Department of Biomedical Engineering, Mayo Clinic, Rochester, MN, 55905, USA.
| | - Yoonbae Oh
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, 55905, USA. .,Department of Biomedical Engineering, Mayo Clinic, Rochester, MN, 55905, USA.
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Oberman DZ, Rabelo NN, Correa JLA, Ajler P. Relationship of superior sagittal sinus with sagittal midline: A surgical application. Surg Neurol Int 2020; 11:309. [PMID: 33093986 PMCID: PMC7568091 DOI: 10.25259/sni_509_2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 08/28/2020] [Indexed: 11/19/2022] Open
Abstract
Background: Interhemispheric approach is widely used to surgical management of midline tumors and vascular lesion in and around the third ventricle. Complete exposure of the superior sagittal sinus to obtain adequate working space of midline lesion is difficult, because of the risk to inadvertent injury to the sinus and bridging veins, which may cause several neurological deficits. Understanding the SSS neuroanatomy and its relationships with external surgical landmarks avoid such complications. The objective of this study is to accurately describe the position of SSS and its displacement in relation with sagittal midline by magnetic resonance imaging. Methods: A retrospective cross-sectional, observational study was performed. Magnetic resonance image of 76 adult patients with no pathological imaging was analyzed. The position of the halfway between nasion and bregma, bregma, halfway between bregma and lambda, and lambda was performed. The width and the displacement of the superior sagittal sinus accordingly to the sagittal midline were assessed in those landmarks. Results: The mean width of superior sagittal sinus at halfway between nasion and bregma, bregma, halfway between bregma and lambda, and lambda was 5.62 ± 2.5, 6.5 ± 2.8, 7.4 ± 3.2, and 8.5 ± 2.1 mm, respectively, without gender discrepancy. The mean displacement according to the midline at those landmarks showed a statistically significant difference to the right side among sexes. Conclusion: In this study, we demonstrate that sagittal midline may approximate external location of the superior sagittal sinus. Our data showed that in the majority of the cases, the superior sagittal sinus is displaced to the right side of sagittal midline as far as 16.3 mm. The data we obtained provide useful information that suggest that neurosurgeons should use safety margin to perform burr holes and drillings at the sagittal midline.
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Affiliation(s)
| | | | | | - Pablo Ajler
- Department of Neurosurgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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Iyer RR, Wu A, Macmillan A, Musavi L, Cho R, Lopez J, Jallo GI, Dorafshar AH, Ahn ES. Use of computer-assisted design and manufacturing to localize dural venous sinuses during reconstructive surgery for craniosynostosis. Childs Nerv Syst 2018; 34:137-142. [PMID: 28921242 DOI: 10.1007/s00381-017-3601-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 09/10/2017] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Cranial vault remodeling surgery for craniosynostosis carries the potential risk of dural venous sinus injury given the extensive bony exposure. Identification of the dural venous sinuses can be challenging in patients with craniosynostosis given the lack of accurate surface-localizing landmarks. Computer-aided design and manufacturing (CAD/CAM) has allowed surgeons to pre-operatively plan these complex procedures in an effort to increase reconstructive efficiency. An added benefit of this technology is the ability to intraoperatively map the dural venous sinuses based on pre-operative imaging. We utilized CAD/CAM technology to intraoperatively map the dural venous sinuses for patients undergoing reconstructive surgery for craniosynostosis in an effort to prevent sinus injury, increase operative efficiency, and enhance patient safety. Here, we describe our experience utilizing this intraoperative technology in pediatric patients with craniosynostosis. METHODS We retrospectively reviewed the charts of children undergoing reconstructive surgery for craniosynostosis using CAD/CAM surgical planning guides at our institution between 2012 and 2016. Data collected included the following: age, gender, type of craniosynostosis, estimated blood loss, sagittal sinus deviation from the sagittal suture, peri-operative outcomes, and hospital length of stay. RESULTS Thirty-two patients underwent reconstructive cranial surgery for craniosynostosis, with a median age of 11 months (range, 7-160). Types of synostosis included metopic (6), unicoronal (6), sagittal (15), lambdoid (1), and multiple suture (4). Sagittal sinus deviation from the sagittal suture was maximal in unicoronal synostosis patients (10.2 ± 0.9 mm). All patients tolerated surgery well, and there were no occurrences of sagittal sinus, transverse sinus, or torcular injury. CONCLUSIONS The use of CAD/CAM technology allows for accurate intraoperative dural venous sinus localization during reconstructive surgery for craniosynostosis and enhances operative efficiency and surgeon confidence while minimizing the risk of patient morbidity.
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Affiliation(s)
- Rajiv R Iyer
- Division of Pediatric Neurosurgery, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Phipps 560A, Baltimore, MD, 21287, USA
| | - Adela Wu
- Division of Pediatric Neurosurgery, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Phipps 560A, Baltimore, MD, 21287, USA
| | - Alexandra Macmillan
- Department of Plastic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Leila Musavi
- Department of Plastic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Regina Cho
- Department of Plastic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Joseph Lopez
- Department of Plastic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - George I Jallo
- Division of Pediatric Neurosurgery, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Phipps 560A, Baltimore, MD, 21287, USA
| | - Amir H Dorafshar
- Department of Plastic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Edward S Ahn
- Division of Pediatric Neurosurgery, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Phipps 560A, Baltimore, MD, 21287, USA.
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Craniotomy of the Fused Sagittal Suture Over the Superior Sagittal Sinus Is a Safe Procedure. J Craniofac Surg 2017; 28:650-653. [DOI: 10.1097/scs.0000000000003440] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Oliveira MFD, Teixeira MJ, Reis RC, Petitto CE, Gomes Pinto FC. Failed Ventriculoperitoneal Shunt: Is Retrograde Ventriculosinus Shunt a Reliable Option? World Neurosurg 2016; 92:445-453. [PMID: 27237416 DOI: 10.1016/j.wneu.2016.05.038] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 05/13/2016] [Accepted: 05/14/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Currently, the treatment of hydrocephalus is mainly carried out through a ventriculoperitoneal shunt (VPS) insertion. However, in some cases, there may be surgical revisions and requirement of an alternative distal site for shunting. There are several described distal sites, and secondary options after VPS include ventriculopleural and ventriculoatrial shunt, which have technical difficulties and harmful complications. OBJECTIVES In this preliminary report we describe our initial experience with retrograde ventriculosinus shunt (RVSS) after failed VPS. RESULTS In 3 consecutive cases we applied RVSS to treat hydrocephalus in shunt-dependent patients who had previously undergone VPS revision and in which peritoneal space was full of adhesions and fibrosis. RVSS was performed as described by Shafei et al., with some modifications to each case. All 3 patients kept the same clinical profile after RVSS, with no perioperative or postoperative complications. However, revision surgery was performed in the first operative day in 1 out of 3 patients, in which the catheter was not positioned in the superior sagittal sinus. CONCLUSIONS We propose that in cases where VPS is not feasible, RVSS may be a safe and applicable second option. Nevertheless, the long-term follow-up of patients and further learning curve must bring stronger evidence.
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Affiliation(s)
- Matheus Fernandes de Oliveira
- Group of Cerebral Hydrodynamics, Division of Functional Neurosurgery of the Institute of Psychiatry, Hospital das Clinicas, University of Sao Paulo School of Medicine, Sao Paulo, Brazil.
| | - Manoel Jacobsen Teixeira
- Group of Cerebral Hydrodynamics, Division of Functional Neurosurgery of the Institute of Psychiatry, Hospital das Clinicas, University of Sao Paulo School of Medicine, Sao Paulo, Brazil; Division of Neurological Surgery, Hospital das Clinicas, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | - Rodolfo Casimiro Reis
- Group of Cerebral Hydrodynamics, Division of Functional Neurosurgery of the Institute of Psychiatry, Hospital das Clinicas, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | - Carlo Emanuel Petitto
- Group of Cerebral Hydrodynamics, Division of Functional Neurosurgery of the Institute of Psychiatry, Hospital das Clinicas, University of Sao Paulo School of Medicine, Sao Paulo, Brazil; Division of Neurological Surgery, Hospital das Clinicas, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | - Fernando Campos Gomes Pinto
- Group of Cerebral Hydrodynamics, Division of Functional Neurosurgery of the Institute of Psychiatry, Hospital das Clinicas, University of Sao Paulo School of Medicine, Sao Paulo, Brazil; Division of Neurological Surgery, Hospital das Clinicas, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
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