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Erol G, Çavuşoğlu N, Sevgi UT, Fidan S, Canbolat Ç, Doğruel Y, Luzzi S, Cohen Gadol AA, Güngor A. Occipital Sinus-Sparing Linear Paramedian Dural Incision: A Technical Note and Case Series for Median Suboccipital Approach. World Neurosurg 2024; 184:e121-e128. [PMID: 38244681 DOI: 10.1016/j.wneu.2024.01.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 01/11/2024] [Accepted: 01/12/2024] [Indexed: 01/22/2024]
Abstract
BACKGROUND Durotomies, traditionally used during the midline suboccipital approach, involve sacrificing the occipital sinus (OS) with consequent shrinking of the dura, risk of venous complications, difficulty performing watertight closure, and a higher rate of postoperative cerebrospinal fluid (CSF) leaks. The present technical note describes the OS-sparing linear paramedian dural incision, which leads to a decrease in the risk of complications during the median suboccipital approach in our case series. METHODS The OS-sparing linear incision technique involves a dural incision placed 1 cm lateral to the OS. The angle of view of the microscope is frequently changed to overcome the narrowed exposure of the linear durotomy. Copious irrigation with saline prevents drying of the dura. A running watertight closure of the dura is performed. The overall results of 5 cases are reviewed. RESULTS The cases were 3 tumors and 2 cavernomas. The OS was preserved in all 5, and no duraplasty was needed. The average dura closure time was 16.8 minutes. No CSF leak occurred, and no wound complications were observed. A gross total resection of the lesion was achieved in all the patients. The mean follow-up was 10.2 months, and there were no late complications related to the dura closure. CONCLUSIONS In comparison to the types of durotomies conventionally used for the midline suboccipital approach, the OS-sparing linear paramedian dural incision entails lower risks of bleeding, venous complications, CSF leaks, and infections by avoiding duraplasty. Validation of this technical note on a larger patient cohort is needed.
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Affiliation(s)
- Gökberk Erol
- Department of Neurosurgery, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Neslihan Çavuşoğlu
- Department of Neurosurgery, Bakırköy Mazhar Osman Research and Training Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul, Turkey
| | - Umut Tan Sevgi
- Department of Neurosurgery, Tepecik Research and Training Hospital, Izmir, Turkey
| | - Semih Fidan
- Department of Neurosurgery, Bakırköy Mazhar Osman Research and Training Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul, Turkey
| | - Çağrı Canbolat
- Department of Neurosurgery, Liv Hospital Vad istanbul, Istanbul, Turkey
| | - Yücel Doğruel
- The Neurosurgical Atlas, Carmel, Indiana, USA; Department of Neurosurgery, Tunceli State Hospital, Tunceli, Turkey
| | - Sabino Luzzi
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy; Neurosurgery Unit, Department of Surgical Sciences, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Aaron A Cohen Gadol
- The Neurosurgical Atlas, Carmel, Indiana, USA; Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Abuzer Güngor
- Department of Neurosurgery, Liv Hospital Vad istanbul, Istanbul, Turkey; Faculty of Medicine, Department of Neurosurgery, Istinye University, Istanbul, Turkey.
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Zhou Z, Zhao F, Yu J. The effect of the occipital sinus on the torcular Herophili and neighboring structures. Heliyon 2024; 10:e25547. [PMID: 38375300 PMCID: PMC10875375 DOI: 10.1016/j.heliyon.2024.e25547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 12/23/2023] [Accepted: 01/29/2024] [Indexed: 02/21/2024] Open
Abstract
Objective The occipital sinus (OS) has many variations. It is unknown whether OS can change the angioarchitecture of torcular Herophili. Therefore, we performed magnetic resonance venography (MRV) in a cohort of Han Chinese individuals to determine whether OS can change the angioarchitecture of torcular Herophili. Methods Participants were divided into a normal OS group and a hyperplastic OS group. Parameters of the OS and torcular Herophili and its neighboring structures were recorded. Statistical analysis was used to determine the effects of OS on torcular Herophili and neighboring structures. Results One hundred forty-five healthy participants were enrolled. One hundred patients were in the normal OS group, and 45 were in the hyperplastic OS group. In the normal OS group, the diameters at the transverse sinus (TS) origin were 5.8 ± 2.3 mm on the left side and 7.5 ± 2.2 mm on the right side. In the hyperplastic OS group, the diameters at the TS origin were 6.0 ± 2.1 mm on the left side and 7.0 ± 2.7 mm on the right side. Fenestration was observed in 33% of the torculars in the normal OS group and 6.7% of the torculars in the hyperplastic group. An unpaired t-test revealed a significant difference between bilateral TSs in the normal OS group (P < 0.05) but no difference in the hyperplastic OS group. The chi-square test revealed a significant difference in torcular Herophili fenestration between the normal and hyperplastic OS groups (P < 0.05). Conclusions Hyperplastic OS makes bilateral TSs equal in diameter and weakens the predominance of the right TS. A hyperplastic OS reduces the occurrence of torcular Herophili fenestration.
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Affiliation(s)
- Zibo Zhou
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, 130021, China
| | - Fasheng Zhao
- 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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Affiliation(s)
- Naci Balak
- Dept of Neurosurgery, Istanbul Medeniyet University, Göztepe Education and Research Hospital, Istanbul, Turkey.
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Inui T, Shimanuki Y, Mori H, Haginoya K. Reply to: "Letter: Two cases of persistent falcine and occipital sinuses". Brain Dev 2021; 43:175. [PMID: 33067071 DOI: 10.1016/j.braindev.2020.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 09/22/2020] [Indexed: 11/20/2022]
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Inui T, Shibuya M, Miyabayashi T, Sato R, Okubo Y, Endo W, Togashi N, Shimanuki Y, Mori H, Haginoya K. Two cases of persistent falcine and occipital sinuses. Brain Dev 2021; 43:170-173. [PMID: 32762957 DOI: 10.1016/j.braindev.2020.07.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 07/03/2020] [Accepted: 07/14/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND The coexistence of falcine and occipital sinuses is rare and its natural course has not been reported. CASE REPORTS Two patients with persistent falcine and occipital sinuses are described. Both patients had straight sinuses. In one, both the transverse and sigmoid sinuses were hypoplastic and the patient had an acquired Chiari I malformation. The other patient had no other venous anomalies and had a normal posterior cranial fossa. CONCLUSION The coexistence of falcine and occipital sinuses can lead to an acquired Chiari I malformation. These cases suggest the importance of checking other venous and brain anomalies in this situation.
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Affiliation(s)
- Takehiko Inui
- Department of Pediatric Neurology, Miyagi Children's Hospital, 4-3-17 Ochiai, Aoba-ku, Sendai-shi, Miyagi 989-3126, Japan.
| | - Moriei Shibuya
- Department of Pediatric Neurology, Miyagi Children's Hospital, 4-3-17 Ochiai, Aoba-ku, Sendai-shi, Miyagi 989-3126, Japan
| | - Takuya Miyabayashi
- Department of Pediatric Neurology, Miyagi Children's Hospital, 4-3-17 Ochiai, Aoba-ku, Sendai-shi, Miyagi 989-3126, Japan
| | - Ryo Sato
- Department of Pediatric Neurology, Miyagi Children's Hospital, 4-3-17 Ochiai, Aoba-ku, Sendai-shi, Miyagi 989-3126, Japan
| | - Yukimune Okubo
- Department of Pediatric Neurology, Miyagi Children's Hospital, 4-3-17 Ochiai, Aoba-ku, Sendai-shi, Miyagi 989-3126, Japan
| | - Wakaba Endo
- Department of Pediatric Neurology, Miyagi Children's Hospital, 4-3-17 Ochiai, Aoba-ku, Sendai-shi, Miyagi 989-3126, Japan
| | - Noriko Togashi
- Department of Pediatric Neurology, Miyagi Children's Hospital, 4-3-17 Ochiai, Aoba-ku, Sendai-shi, Miyagi 989-3126, Japan
| | | | - Harushi Mori
- Department of Radiology, Jichi Medical University, School of Medicine, Tochigi, Japan
| | - Kazuhiro Haginoya
- Department of Pediatric Neurology, Miyagi Children's Hospital, 4-3-17 Ochiai, Aoba-ku, Sendai-shi, Miyagi 989-3126, Japan; Department of Pediatrics, Tohoku University School of Medicine, Sendai, Japan
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Candanedo C, Moscovici S, Kaye AH, Spektor S. The oblique occipital sinus - implications in posterior fossa approaches. J Clin Neurosci 2020; 76:202-4. [PMID: 32317189 DOI: 10.1016/j.jocn.2020.04.055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 04/06/2020] [Accepted: 04/12/2020] [Indexed: 11/22/2022]
Abstract
The retrosigmoid craniotomy is the standard approach to resect pathologies in the cerebellopontine angle (CPA). Following the craniotomy, the dura mater is opened in the inferolateral direction and the basal cistern arachnoid is dissected in order to release pressure by the outflow of cerebrospinal fluid (CSF) from the foramen magnum, so that the CPA compartment can be approached with minimal retraction of the cerebellum. We report two patients, both with vestibular schwannoma, in whom preoperative magnetic resonance imaging (MRI) revealed unusual large oblique occipital sinus (OOS) draining laterally into the sigmoid sinus - jugular bulb junction. The sinuses were preserved intact while dura mater was opened for CSF release. Careful preoperative imaging is essential prior to posterior fossa lesions approaches in order to evaluate the persistency of an OOS, especially in a retrosigmoid approach. Inadvertent OOS damage might result in, not only significant bleeding during dural opening, but also air embolism or venous hypertension, if the contralateral sigmoid sinus is small or absent.
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Mizutani K, Miwa T, Akiyama T, Sakamoto Y, Fujiwara H, Yoshida K. Fate of the three embryonic dural sinuses in infants: the primitive tentorial sinus, occipital sinus, and falcine sinus. Neuroradiology 2018; 60:325-33. [PMID: 29356857 DOI: 10.1007/s00234-018-1980-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 01/10/2018] [Indexed: 10/18/2022]
Abstract
PURPOSE The primitive tentorial, occipital, and falcine sinuses are thought to attain the adult pattern or regress between the fetal stage and adulthood. The anatomy of these three primitive dural sinuses has seldom been studied in the infant population, and it remains unclear when these dural sinuses reach the adult condition. Using computed tomography digital subtraction venography (CT-DSV), we analyzed the anatomy of these embryonic dural sinuses in infants. METHODS We included 13 infants who underwent CT-DSV prior to neurosurgery and 35 cases with unruptured cerebral aneurysms as normal adult controls. Three embryonic dural sinuses, i.e., the primitive tentorial, occipital, and falcine sinuses, were retrospectively analyzed in CT-DSV images of infants and adults. We also analyzed the drainage patterns of the superficial middle cerebral vein (SMCV), determined by the connection between the primitive tentorial sinus and the cavernous sinus. RESULTS The primitive tentorial, occipital, and falcine sinuses were present in 15.4%, 46.2%, and none of the infants, respectively, and in 10.0, 8.6, and 2.9% of the adults, respectively. The difference in SMCV draining pattern between infants and adults was insignificant. The incidence of the occipital sinus was significantly higher in infants than in adults. CONCLUSIONS The connection between the primitive tentorial sinus and the cavernous sinus appears to be established before birth. The occipital sinus is formed at the embryonic stage and mostly regresses after infancy. The falcine sinus is usually obliterated prenatally. Our findings form the basis for interventions by pediatric interventional neuroradiologists and neurosurgeons.
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Ota N, Tanikawa R, Yoshikane T, Miyama M, Miyazaki T, Kinoshita Y, Matsukawa H, Yanagisawa T, Sakakibara F, Suzuki G, Saito N, Miyata S, Noda K, Tsuboi T, Takeda R, Kamiyama H, Tokuda S, Kamada K. Surgical Microanatomy of the Posterior Condylar Emissary Vein and its Anatomical Variations for the Transcondylar Fossa Approach. Oper Neurosurg (Hagerstown) 2017; 13:382-391. [PMID: 28521354 DOI: 10.1093/ons/opw038] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 12/14/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND It is essential to identify and be aware of the anatomy of the posterior condylar emissary vein (PCEV) for achieving an adequate operative field for the transcondylar fossa approach (TCFA). OBJECTIVE To describe the variations in the drainage patterns of PCEVs and the technical issues encountered in such cases. METHODS This was a retrospective analysis of the anatomy of PCEVs in 104 sides in 52 cases treated by the TCFA. Preoperative findings of multidetector-row computed tomography (CT) and CT venography (CTV) were compared with the intraoperative findings. The drainage patterns were classified as 5 types: the sigmoid sinus (SS), jugular bulb (JB), occipital sinus (OS), anterior condylar emissary vein (ACEV), and marginal sinus (MS). RESULTS The SS, JB, ACEV, and OS types were observed in 33 (31.7%), 42 (40.3%), 8 (7.7%), and 1 (1.0%) side(s), respectively. One side (1.0%) each had combined drainage from MS and JB, and ACEV and JB, respectively. In 17 sides (16.3%), the PCEVs and posterior condylar canals could not be identified on CT and CTV. CONCLUSIONS Preoperative CT and CTV findings correlated well with the intraoperative findings. To make a sufficient operative field for TCFA, PCEVs should be appropriately dealt with based on the preoperative knowledge of their running course, pattern, and origin.
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Affiliation(s)
- Nakao Ota
- Stroke Center, Department of Neuros-urgery, Sapporo Teishinkai Hospital, Sapporo, Japan
| | - Rokuya Tanikawa
- Stroke Center, Department of Neuros-urgery, Sapporo Teishinkai Hospital, Sapporo, Japan
| | - Tsutomu Yoshikane
- Department of Neuro-surgery, Shimane University School of Medicine, Matsue, Japan
| | - Masataka Miyama
- Stroke Center, Department of Neuros-urgery, Sapporo Teishinkai Hospital, Sapporo, Japan
| | - Takanori Miyazaki
- Stroke Center, Department of Neuros-urgery, Sapporo Teishinkai Hospital, Sapporo, Japan
| | - Yu Kinoshita
- Stroke Center, Department of Neuros-urgery, Sapporo Teishinkai Hospital, Sapporo, Japan
| | - Hidetoshi Matsukawa
- Stroke Center, Department of Neuros-urgery, Sapporo Teishinkai Hospital, Sapporo, Japan
| | - Takeshi Yanagisawa
- Stroke Center, Department of Neuros-urgery, Sapporo Teishinkai Hospital, Sapporo, Japan
| | - Fumihiro Sakakibara
- Stroke Center, Department of Neuros-urgery, Sapporo Teishinkai Hospital, Sapporo, Japan
| | - Go Suzuki
- Stroke Center, Department of Neuros-urgery, Sapporo Teishinkai Hospital, Sapporo, Japan
| | - Norihiro Saito
- Stroke Center, Department of Neuros-urgery, Sapporo Teishinkai Hospital, Sapporo, Japan
| | - Shiro Miyata
- Stroke Center, Department of Neuros-urgery, Sapporo Teishinkai Hospital, Sapporo, Japan
| | - Kosumo Noda
- Stroke Center, Department of Neuros-urgery, Sapporo Teishinkai Hospital, Sapporo, Japan
| | - Toshiyuki Tsuboi
- Stroke Center, Department of Neuros-urgery, Sapporo Teishinkai Hospital, Sapporo, Japan
| | - Rihei Takeda
- Stroke Center, Department of Neuros-urgery, Sapporo Teishinkai Hospital, Sapporo, Japan
| | - Hiroyasu Kamiyama
- Stroke Center, Department of Neuros-urgery, Sapporo Teishinkai Hospital, Sapporo, Japan
| | - Sadahisa Tokuda
- Stroke Center, Department of Neuros-urgery, Sapporo Teishinkai Hospital, Sapporo, Japan
| | - Kyousuke Kamada
- Department of Neurosurgery, Asahikawa Medical University, Asahikawa, Japan
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Lee HC, Lee JY, Ryu SK, Lim JM, Chong S, Phi JH, Kim SK, Wang KC. A method of posterior fossa dural incision to minimize hemorrhage from the occipital sinus: the "mosquito" method. Childs Nerv Syst 2016; 32:2429-2431. [PMID: 27444295 DOI: 10.1007/s00381-016-3169-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Accepted: 07/04/2016] [Indexed: 11/27/2022]
Abstract
PURPOSE The posterior fossa dural opening requires the ligation of the occipital sinus to gain successful exposure. However, there could be a prominent occipital sinus which is functioning as the main drainage route and is harboring the risk of unpredictable massive hemorrhage during the dural opening. We introduce a safe method of posterior fossa dural incision to minimize hemorrhage from the occipital sinus using four curved hemostat clamps. METHODS For the dural incision at the midline part of the posterior cranial fossa, we used four curved hemostat clamps to occlude the prominent occipital sinus: one pair of clamps at the proximal part and the other pair at the distal part to occlude the occipital sinus. Dural incision was made between the two pairs of the curved hemostat clamps. RESULTS By clamping of the sinus, it allows observation of possible brain swelling after occlusion of the occipital sinus as well as minimizes hemorrhage during incision of the midline dura of the posterior fossa. CONCLUSION This method allows observation of brain swelling after occipital sinus occlusion and is an easy and safe incision of the midline dura minimizing hemorrhage in selected cases with a prominent occipital sinus.
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Affiliation(s)
- Hee Chang Lee
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Seoul National University Children's Hospital & Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of Korea
| | - Ji Yeoun Lee
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Seoul National University Children's Hospital & Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of Korea
| | - Seul Ki Ryu
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Seoul National University Children's Hospital & Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of Korea
| | - Jang Mi Lim
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Seoul National University Children's Hospital & Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of Korea
| | - Sangjoon Chong
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Seoul National University Children's Hospital & Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of Korea
| | - Ji Hoon Phi
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Seoul National University Children's Hospital & Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of Korea
| | - Seung-Ki Kim
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Seoul National University Children's Hospital & Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of Korea
| | - Kyu-Chang Wang
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Seoul National University Children's Hospital & Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of Korea.
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Lee DH, Hong JT, Sung JH, Jain A, Huh J, Kim SU, Kim JY, Kwon JY, Cho CB, Kim IS, Lee SW. Morphologic Analysis of Occipital Sinuses for Occipital Screw Fixation Using Digital Subtraction Angiography. World Neurosurg 2016; 91:279-84. [PMID: 27108024 DOI: 10.1016/j.wneu.2016.04.038] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 04/12/2016] [Accepted: 04/12/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND Numerous methods to achieve occipitocervical stabilization have been described, including the use of occipital plate/screw constructs. Bicortical screws may increase the pullout strength, but intracranial injuries to venous sinuses have been reported. This study was performed to analyze the variations in occipital sinuses to prevent sinus injury caused by the bicortical screw. METHODS Occipital sinuses of 1720 patients were examined using digital subtraction angiography. The data collected included patient age and sex, occipital sinus type, distance between occipital sinus and midline, depth from inion to occipital sinus, and distance between occipital sinus and midline occiput at different levels. RESULTS The mean age of patients was 57 years ± 13. There were 807 (46.9%) men and 913 (53.1%) women. The most common occipital sinus type was single occipital sinus off-midline (type B2). The least common occipital sinus type was absent occipital sinuses (type A; 8.7% of patients). There was no significant difference between age and occipital sinus type (P = 0.310). Also, the difference between sexes was not significant in regard to occipital sinus type in general. However, in subgroup analysis of type B1 and B2, there was a significant difference between sexes (P < 0.01). The mean depth from bone to occipital sinus was 19.913 mm ± 7.437. CONCLUSIONS The occipital sinus shows several variations, and many morphologic differences can be seen. Preoperative detailed examination by magnetic resonance venography or vertebral angiography may be required for cases in which bicortical occipital screw fixation is necessary to avoid occipital sinus-related complications.
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Beyrouti R, Mansour M, Kacem A, Zaouali J, Mrissa R. Occipital Sinus Thrombosis: An Exceptional Case Report. J Stroke Cerebrovasc Dis 2016; 25:e71-3. [PMID: 27036927 DOI: 10.1016/j.jstrokecerebrovasdis.2016.02.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 02/04/2016] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Variations of the dural venous sinuses may result in inaccurate imaging interpretation or complications during surgical approaches. One variation of the dural venous sinuses reported infrequently in the literature is the occipital sinus. We report an exceptional case of occipital sinus thrombosis. CASE REPORT A 48-year-old right-handed man with a 5-month history of hypertension and chronic renal failure presented with cephalalgia, vomiting, and blurred vision evolving over 48 hours. Neurological examination revealed papillary edema stage 1 with no others abnormalities. An initial brain computed tomography (CT) scan performed was normal. The opening pressure of cerebrospinal fluid (CSF) was 35 cmH2O with normal level of protein and no hypercellularity in CSF analysis. The evolution was marked by the occurrence of generalized tonic-clonic seizure. A second CT scan performed showed a hyperdensity of the occipital sinus. Magnetic resonance imaging and magnetic resonance venography studies confirmed the diagnosis with highlighting the thrombosis of the occipital sinus in association to an ectasia of the torcular. The patient received adequate anticoagulation for 6 months in association to antiepileptic drugs with a good evolution. DISCUSSION According to our review, such a thrombosis must be a rare condition, because our literature search has shown a lack of any report describing this condition. Herein, we review the anatomy of the occipital sinus and we illustrate the characteristics of this unusual thrombosis with multiple imaging modalities. CONCLUSION Understanding of the cerebral venous anatomy and recognition of venous variations essentially help when dealing with a pathology, which presents along with a particular venous variation, no matter how rare this combination is.
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Gaumont-Darcissac M, Viart L, Foulon P, Le Gars D, Havet E, Peltier J. [The occipital sinus: a radioanatomic study]. Morphologie 2015; 99:18-22. [PMID: 25660165 DOI: 10.1016/j.morpho.2015.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Revised: 12/18/2014] [Accepted: 01/05/2015] [Indexed: 06/04/2023]
Abstract
INTRODUCTION The aim of this study was to assess the presence of an occipital sinus in both children and adults, and to detail its main associated anatomical characteristics. METHODS One hundred of patients' MRI (3D T1 EG) between 0 and 86 years old were studied, in sagittal and axial sections, with the software DxMM. Occipital sinus length, perimeter, and cerebellar falx length measurements were performed with the software's tools. RESULTS Forty-three percent of patients had an occipital sinus (average perimeter was 3.02 mm, average length was 19.85 mm), and 23.26% of these patients had a cerebellar falx, 30.23% of these patients had one vein or more draining into the occipital sinus. Sixty-two percent of children had an occipital sinus (average perimeter was 2.87 mm, average length was 21.63 mm), and 29.03% of them had a cerebellar falx. Twenty-four percent of adults had an occipital sinus (average perimeter was 3.4mm, average length was 15.28 mm), and 8.33% of them had a cerebellar falx. CONCLUSION This work highlights a link between the age and the occipital sinus existence. The perimeter of this sinus seems to be superior for adults, but its length seems to be superior for children. A cerebellar falx with the occipital sinus was found more frequently for children.
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Affiliation(s)
- M Gaumont-Darcissac
- Laboratoire d'anatomie et d'organogenèse, faculté de médecine, 3, rue des Louvels, 80036 Amiens cedex 1, France.
| | - L Viart
- Laboratoire d'anatomie et d'organogenèse, faculté de médecine, 3, rue des Louvels, 80036 Amiens cedex 1, France
| | - P Foulon
- Laboratoire d'anatomie et d'organogenèse, faculté de médecine, 3, rue des Louvels, 80036 Amiens cedex 1, France
| | - D Le Gars
- Laboratoire d'anatomie et d'organogenèse, faculté de médecine, 3, rue des Louvels, 80036 Amiens cedex 1, France
| | - E Havet
- Laboratoire d'anatomie et d'organogenèse, faculté de médecine, 3, rue des Louvels, 80036 Amiens cedex 1, France
| | - J Peltier
- Laboratoire d'anatomie et d'organogenèse, faculté de médecine, 3, rue des Louvels, 80036 Amiens cedex 1, France
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