Angiographic classification of the inferior sagittal sinus based on the venous drainage patterns

BackgroundFailure to appreciate deep venous drainage pathways is a major cause of severe complications in the endovascular treatment of vein of Galen aneurysmal malformations (VOGMs).ObjectiveTo report deep venous drainage patterns in patients with VOGM, emphasizing the internal cerebral veins, and to describe the challenges in evaluating these.MethodsPatients with VOGM presenting to our institute between 2000 and 2018 were retrospectively analyzed. Patients with complete and good quality imaging datasets were included in the study. Three neuroradiologists with expertise in the subject independently analyzed the deep venous drainage patterns on multi-sequence MRI and digital subtraction angiography. Follow-up imaging studies were analyzed for alterations in deep venous drainage patterns that occurred following endovascular treatment. Descriptive statistics were used to report findings.ResultsTwenty-three patients had optimal quality MRI imaging and 25 had optimal quality DSA imaging available. In 14/23 (61%) patients, internal cerebral vein (ICV) communication could be reliably identified on MRI and in 8/25 (32%) patients on DSA. Deep venous communication with the VOGM was demonstrated in 8/26 (30.8%) patients. One (3.8%) patient demonstrated ICV communication with the VOGM only on postoperative imaging, while in 2 (8%) patients the ICV drainage route changed from VOGM to alternative pathways after the procedure. Other variant pathways included lateral mesencephalic vein, superior or inferior sagittal sinus, anterior mesencephalic vein, tentorial sinus, deep Sylvian vein, and superior vermian vein.ConclusionICV communication with the VOGM is not uncommon and requires dedicated preprocedural imaging to identify it. However, there are significant challenges in assessing this communication in the presence of high-flow fistulae, vessel tortuosity and size, and contrast limitations in this population.

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Evaluation of anterior third of superior sagittal sinus in normal population: Identifying the subgroup with dominant drainage

Journal of Neurosciences in Rural Practice ◽

10.4103/0976-3147.176201 ◽

2016 ◽

Vol 07 (02) ◽

pp. 257-261 ◽

Cited By ~ 2

Author(s):

Sushanta K. Sahoo ◽

Mandeep S. Ghuman ◽

Pravin Salunke ◽

Sameer Vyas ◽

Rahat Bhar ◽

...

Keyword(s):

Frontal Lobe ◽

Superior Sagittal Sinus ◽

Normal Population ◽

Three Dimensional ◽

Venous Drainage ◽

Anatomical Variations ◽

Frontal Lobes ◽

Drainage Pattern ◽

Sagittal Sinus ◽

Drainage Patterns

ABSTRACT Background/Object: The ligation and transection of anterior third of superior sagittal sinus (AT-SSS) is an important step to approach anterior skull base lesions. Some clinical studies have shown frontal lobe venous infarct following such surgical procedures questioning the safety of its ligation. We have studied the variations in venous drainage patterns to AT-SSS in the normal population using postcontrast magnetic resonance venogram (MRV). A novel scoring system to recognize the subgroup with dominant venous drainage from frontal lobes has been described. Materials and Methods: In this study, 60 three-dimensional contrast-enhanced (CE) MRVs were obtained from those cases being evaluated for a headache not harboring any intracranial mass lesion. The AT-SSS with all its draining veins was studied in detail. Morphology of individual veins such as length, caliber, tributaries, and angulation with AT-SSS was studied, and a numerical value of 0 or 1 was assigned for each of the above parameters. Summing up these scores derived from the individual cortical veins quantified the drainage of AT-SSS. Results: There are 3–4 veins on either side draining to AT-SSS. Barely, 3% of the veins had > 3 tributaries. Only 6.6% of veins had a caliber >3 mm, and 16.5% drained at acute angles to AT-SSS. About 26% of the veins did cross at least half of the lateral frontal lobe. We found in 26 individuals the AT-SSS score was 0–2, in 22 it was 3–5 and, in only in 12 (20%) the score was 6 or more (dominant drainage). Conclusion: There are anatomical variations in venous drainage of frontal lobes into AT-SSS. Those with dominant drainage are likely to develop venous congestion and complications if sacrificed. It is possible to identify these individuals on the basis of venous drainage pattern as shown in CE-MRV.

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Dural Arteriovenous Fistula within Superior Sagittal Sinus Wall with Direct Cortical Venous Drainage: A Systematic Literature Review

Journal of Clinical Interventional Radiology ISVIR ◽

10.1055/s-0041-1731594 ◽

2021 ◽

Author(s):

Rajendra Chavan ◽

Shreya Sethi ◽

Harsha Sahu ◽

Neeraj Rao ◽

Shivani Agarwal

Keyword(s):

Literature Review ◽

Treatment Option ◽

Systematic Literature Review ◽

Superior Sagittal Sinus ◽

English Literature ◽

Venous Drainage ◽

Sagittal Sinus ◽

Complete Obliteration ◽

Cortical Venous Drainage ◽

Special Subgroup

AbstractDural arteriovenous fistulas (DAVFs) located within superior sagittal sinus (SSS) wall with direct cortical venous drainage are rare. They are also known as variant DAVF (vDAVF) and form a special subgroup of DAVFs. Their chance of presenting with aggressive features is high compared with transverse sigmoid sinus fistula. They drain directly into cortical veins (Borden type 3, Cognard type III and IV). A systematic English literature review of SSS vDAVF was made. Systematic literature review revealed a total of 31 published cases. These were commonly seen in male population, (24 males, 77.41%, 24/31). Average age of patients was 54 years. A total of 24 patients (77.41%, 24/31) had aggressive clinical presentations with 13 patients (41.93%, 13/31) having intracranial hemorrhages (ICH). Two patients had rebleeding (15.38%, 2/13). Middle portion of SSS was commonly involved (15 cases, 75%). A total of 25 (96.15%, 25/26) cases had patent SSS. Most of the fistulas were idiopathic (65.38%, 17/26), with trauma being a frequent etiological factor (26.92%, 7/26). Venous ectasia was seen in 19 patients (59.37%, 19/32). Middle meningeal arterial (MMA) supply was seen in all patients (100%, 26/26), with bilateral MMA supply in 21 cases (80.76%), and unilateral in 5 cases (19.23%). Twenty patients (62.50%, 20/32) received only endovascular treatment (EVT), while four patients had EVT followed by surgery (12.5%, 4/32). Transarterial route via MMA was the preferred treatment option (79.16%). Complete obliteration of fistulas was noted in all cases (100%, 30/30). No immediate complication was noted after EVT. As much as 92.30% patients showed good recovery. Thus, SSS vDAVF forms a special subgroup of DAVF, with aggressive presentation, and warrants urgent treatment. EVT is effective treatment option and can produce complete obliteration.

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Study of Dural Arteriovenous Fistula Drains into Leptomeningeal Vein without Sinus Interposition

Interventional Neuroradiology ◽

10.1177/15910199040100s122 ◽

2004 ◽

Vol 10 (1_suppl) ◽

pp. 127-134 ◽

Cited By ~ 6

Author(s):

T. Kawaguchi ◽

M. Nakatani ◽

T. Kawano

Keyword(s):

Emergency Treatment ◽

Superior Sagittal Sinus ◽

Venous Drainage ◽

Craniocervical Junction ◽

Sigmoid Sinus ◽

Arteriovenous Fistulas ◽

Sagittal Sinus ◽

Dural Arteriovenous Fistulas ◽

Cranial Fossa ◽

Venous Ischemia

We evaluated dural arteriovenous fistulas (DAVF) drains into leptomeningeal vein (LMV) without the venous sinus interposition. This type of DAVF contained the extra-sinusal type DAVF and the DAVF with so-called pure leptomeningeal venous drainage (PLMVD). We studied 15 patients with DAVF that flows into LMVD without passing into the sinus. The subjects were 5 patients with DAVF in the anterior cranial fossa, 2 with DAVF in the tentorium cerebelli, and 3 with DAVF in the craniocervical junction as extra-sinusal type DAVF and 3 with DAVF in the transverse sigmoid sinus and 2 with DAVF in the superior sagittal sinus as DAVF with PLMVD. This type appears to take a very aggressive course. The arterial pressure of the shunt is directly applied to LMV, which causes bending and winding of the vein, eventually varices, inducing intracranial haemorrhage or venous ischemia in the LMV reflux area. Emergency treatment should be performed as soon as possible. Although it is recognized that interruption of the draining vein is very effective, treatment methods such as TAE, direct surgery, and g knife treatment, or their combinations should be carefully chosen for each case.

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Embolization of a superior sagittal sinus dural arteriovenous fistula under intrasinus balloon protection: A case report

Interventional Neuroradiology ◽

10.15274/inr-2014-10098 ◽

2015 ◽

Vol 21 (1) ◽

pp. 94-100 ◽

Cited By ~ 8

Author(s):

Yongxin Zhang ◽

Qiang Li ◽

Qing-hai Huang

Keyword(s):

Dural Arteriovenous Fistula ◽

Superior Sagittal Sinus ◽

Therapeutic Option ◽

Venous Drainage ◽

Endovascular Embolization ◽

Arteriovenous Fistulas ◽

Sagittal Sinus ◽

Dural Arteriovenous Fistulas ◽

Cerebral Venous Drainage ◽

Balloon Protection

Endovascular embolization has evolved to become the primary therapeutic option for dural arteriovenous fistulas (DAVFs). While guaranteeing complete occlusion of the fistula orifice, the goal of DAVF embolization is also to ensure the patency of normal cerebral venous drainage. This paper describes a case of successful embolization of a complex DAVF in the superior sagittal sinus with a multistaged approach using a combination of transvenous and transarterial tactics. The strategies and techniques are discussed.

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Venous Drainage Patterns in Carotid Cavernous Fistulas

ISRN Radiology ◽

10.1155/2014/760267 ◽

2014 ◽

Vol 2014 ◽

pp. 1-7 ◽

Cited By ~ 11

Author(s):

Ayse Aralasmak ◽

Kamil Karaali ◽

Can Cevikol ◽

Utku Senol ◽

Timur Sindel ◽

...

Keyword(s):

Treatment Approach ◽

Imaging Techniques ◽

Venous Drainage ◽

High Flow ◽

Digital Subtraction ◽

Carotid Cavernous Fistula ◽

Drainage Patterns ◽

Carotid Cavernous Fistulas ◽

Mixed Types ◽

Anterior Posterior

Purpose. The carotid-cavernous fistula (CCF) is an abnormal arteriovenous communication and its drainage pathways may affect the clinic presentation and change treatment approach. We evaluated drainage patterns of CCFs by digital subtraction angiography (DSA) and categorized drainage pathways according to their types and etiology. Materials and Methods. Venous drainage patterns of 13 CCFs from 10 subjects were studied and categorized as anterior, posterior, superior, inferior, and contralateral on DSA. Drainage patterns were correlated to types and etiology of CCFs. Diagnosis of CCFs was first made by noninvasive imaging techniques. Results. On DSA, traumatic CCFs were usually high flow, direct type while spontaneous CCFs were usually slow flow, indirect type. Bilaterality and mixed types were observed among the indirect spontaneous CCFs. In all CCFs, anterior and inferior drainages were the most common. Contrary to the literature, posterior and superior drainages were noted only in high flow and long standing direct fistulas. Contralateral drainage was not observed in all, supporting plausible compartmentalization of cavernous sinuses. Conclusion. Types, etiology, and duration of the CCFs may affect their drainage patterns. DSA is valuable for categorization of CCFs and verification of drainage patterns. Drainage pathways may affect the clinic presentation and also change treatment approach.

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Anatomical and embryological considerations in the repair of a large vertex cephalocele

Journal of Neurosurgery ◽

10.3171/jns.1999.90.3.0537 ◽

1999 ◽

Vol 90 (3) ◽

pp. 537-541 ◽

Cited By ~ 7

Author(s):

Eelco Hoving ◽

Susan Blaser ◽

Edmond Kelly ◽

James T. Rutka

Keyword(s):

Magnetic Resonance ◽

Venous Drainage ◽

Cyst Formation ◽

Preoperative Imaging ◽

Drainage Pattern ◽

Surface Ectoderm ◽

Content Type ◽

Sagittal Sinus ◽

Interhemispheric Fissure ◽

Cerebral Anomalies

✓ The case of a neonate with a large vertex cephalocele is presented. The anatomical features of this anomaly were evaluated by means of magnetic resonance imaging and magnetic resonance angiography. Fusion of the thalami, dysgenesis of the corpus callosum, and failure of adequate formation of the interhemispheric fissure were characteristics of the major cerebral anomalies associated with the cephalocele. The absence of a falx in the midline, a split configuration of the superior sagittal sinus, and a dysgenetic tentorium with a concomitant abnormal venous drainage pattern were found in association with a large dorsal cyst. Repair of the anomaly was undertaken on the 3rd postnatal day. A cerebrospinal fluid shunt was required to treat hydrocephalus on Day 30. The child is well at age 3 years, but with significant developmental delay. The pathogenesis of this vertex cephalocele relates to semilobar holoprosencephaly and dorsal cyst formation. In addition, a disturbance in the separation of the diencephalic portion of the neural tube from the surface ectoderm or skin during the final phases of neurulation had occurred to help create the large cephalocele. Detailed preoperative imaging studies and awareness of the embryology and anatomy of this lesion facilitated the repair of the cephalocele. The prognosis of the child is determined not only by the presence of hydrocephalus, but also by the number of associated major cerebral anomalies. Options for treatment are discussed.

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Lateralization of inferior petrosal sinus sampling in Cushing's disease correlates with cavernous sinus venous drainage patterns, but not tumor lateralization

Heliyon ◽

10.1016/j.heliyon.2020.e05299 ◽

2020 ◽

Vol 6 (10) ◽

pp. e05299

Author(s):

Mohammad Ghorbani ◽

Hamideh Akbari ◽

Christoph J. Griessenauer ◽

Christoph Wipplinger ◽

Alireza Dastmalchi ◽

...

Keyword(s):

Cavernous Sinus ◽

Cushing’S Disease ◽

Venous Drainage ◽

Cushing's Disease ◽

Inferior Petrosal Sinus ◽

Inferior Petrosal Sinus Sampling ◽

Drainage Patterns

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Dural arteriovenous fistulas presenting with brainstem dysfunction: diagnosis and surgical treatment

Neurosurgical FOCUS ◽

10.3171/2012.2.focus1217 ◽

2012 ◽

Vol 32 (5) ◽

pp. E10 ◽

Cited By ~ 14

Author(s):

Charles Kulwin ◽

Bradley N. Bohnstedt ◽

John A. Scott ◽

Aaron Cohen-Gadol

Keyword(s):

Dural Arteriovenous Fistula ◽

Venous Drainage ◽

Craniocervical Junction ◽

Rare Entity ◽

Arteriovenous Fistulas ◽

Drainage Patterns ◽

Clinical Presentations ◽

Wide Range ◽

Brainstem Dysfunction ◽

Dural Arteriovenous Fistulas

A cerebral dural arteriovenous fistula (DAVF) is an acquired abnormal arterial-to-venous connection within the leaves of the intracranial dura with a wide range of clinical presentations and natural history. The Cognard classification correlates venous drainage patterns with neurological course, identifying 5 DAVF types with increasing rates of symptomatic presentation. A spinal DAVF occurs when a radicular artery makes a direct anomalous shunt with a radicular vein within the dural leaflets of the nerve root sleeve. A cervical DAVF is a rare entity, as most spinal DAVFs present as thoracolumbar lesions with myelopathy. In this paper the authors present 2 patients presenting initially with brainstem dysfunction rather than myelopathy secondary to craniocervical DAVF. The literature is then reviewed for similar rare aggressive DAVFs at the craniocervical junction presenting with brainstem symptomatology.

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