The Marginal Sinus Normal Anatomy and Involvement with Arteriovenous Fistulae

1996 ◽  
Vol 2 (3) ◽  
pp. 215-221 ◽  
Author(s):  
A.J. Evans ◽  
D.F. Kallmes ◽  
M.E. Jensen ◽  
J.E. Dion
Keyword(s):  
Venous Drainage ◽  
Transverse Sinus ◽  
Foramen Magnum ◽  
Venous Sinus ◽  
Venous Plexus ◽  
Treatment Results ◽  
Arteriovenous Fistulae ◽  
Marginal Sinus ◽  
Dural Venous Sinus ◽  
Lateral Margins

Rationale and Objectives The marginal sinus is an infrequently recognized dural venous sinus at the rim of the foramen magnum. Recognition of this sinus and knowledge of its anatomy will enable the neurointerventionalist to treat dural arteriovenous fistulae (AVF) involving the marginal sinus. Methods We present a report of the signs, symptoms, angiographic appearance, and treatment results of two patients with marginal sinus dural AVF. In addition, we review the literature concerning the marginal sinus and describe the anatomy of this region. Angiograms depicting normal variants are presented to illustrate the various patterns that may be encountered when the marginal sinus participates in the venous drainage of the cranium. Results In two patients with dural arteriovenous fistulae (AVF) the marginal sinus was found to be the venous receptacle. The marginal sinuses are dural venous sinuses located at the lateral margins of the foramen magnum. Superiorly, the marginal sinus connects to the occipital sinus, a single or paired midline venous channel arising at the torcular Herophili or the medial transverse sinus. The marginal sinus typically drains into the sigmoid sinus, and may connect to the condylar veins, the superior aspect of the internal venous plexus, or the occipital plexus. Occasionally, the occipital-marginal sinus system represents the primary drainage pathway of the cranium, completely replacing the transverse sinus. In the two patients we treated with dural AVF in this location, simple transvenous packing of the sinus effectively cured the lesion. Conclusions The marginal sinus is a dural venous sinus that can rarely be involved with a dural AVF. Recognition that a dural AVF involves the marginal sinus can facilitate safe, effective therapy.

The marginal sinus

2006 ◽  
Vol 104 (3) ◽  
pp. 429-431 ◽  
Author(s):  
R. Shane Tubbs ◽  
Kevin Ammar ◽  
Peter Liechty ◽  
John C. Wellons ◽  
Jeffrey P. Blount ◽  
...  
Keyword(s):  
Hypoglossal Nerve ◽  
Medical Literature ◽  
Jugular Foramen ◽  
Foramen Magnum ◽  
Venous Sinus ◽  
Venous Plexus ◽  
Lateral Aspect ◽  
Marginal Sinus ◽  
The Right ◽  
Vertical Height

Object Descriptions of the marginal venous sinus are lacking in the extant medical literature. The aim of this study was to characterize the anatomy of this intracranial venous sinus. Methods The authors examined the marginal sinuses in 15 adult cadavers following the injection of latex into the intracranial venous system. The maximal vertical height of the sinuses, which ranged from 7 to 15 mm (mean 10 mm), was located at the lateral aspect of the foramen magnum at or near the region at which the spinal accessory nerve crossed en route to the jugular foramen. In all specimens the sinus tapered as it traveled both anteriorly and posteriorly. Ninety-three percent of the specimens demonstrated significant drainage into the veins of the hypoglossal canal. The hypoglossal nerve rootlets pierced the sinus and its tributaries in 11 (73%) of 15 specimens. The marginal sinus communicated with the basilar venous plexus in 12 (80%) of 15 specimens and with the occipital sinus in all specimens (100%). There was venous communication with the sigmoid sinus in all specimens. The vertebral artery coursed through the marginal sinus as it pierced the posterior atlantooccipital membrane in all left sides and in 87% of the right sides. Conclusions These quantitative data will be useful to the neurosurgeon who operates in the region of the marginal sinus.

scholarly journals Traumatic injury of dural venous sinus as cause of epidural hematoma: importance of recognition and adequate surgical planning

2021 ◽  
Vol 47 (1) ◽  
pp. 40-43
Author(s):  
Guilherme Brasileiro de Aguiar ◽  
Leonardo Henrique da Silva Rodrigues ◽  
Paulo Adolfo Wessel Xander ◽  
Tiago Marques Avelar ◽  
Guilherme Henrique Ferreira da Costa ◽  
...  
Keyword(s):  
Epidural Hematoma ◽  
Traumatic Injury ◽  
Middle Meningeal Artery ◽  
Transverse Sinus ◽  
Venous Sinus ◽  
Cranial Trauma ◽  
Level Of Consciousness ◽  
Dural Venous Sinus ◽  
The Many ◽  
Acute Epidural Hematoma

Background: Although most traumatic epidural hematomas are secondary to arterial injuries, particularly rupture of the middle meningeal artery, around 9.7% of cases are associated with dural venous sinus injury, leading to poorer prognosis and greater complications. We report a case of a patient presenting cranial trauma with bone fracture and laceration of the transverse sinus producing epidural hematoma, and discuss the main aspects of this condition. Case description: A 47-year-old man struck by a motorcycle was admitted to the Emergency Room with a score of 15 on the Glasgow Coma Scale, evolving over 5 hours with reduced level of consciousness. A cranial CT scan was performed disclosing right parieto- occipital hyperdensity, consistent with acute epidural hematoma, and a parieto-occipital fracture line crossing the path of the ipsilateral transverse sinus. Parietal craniotomy was performed to drain the hematoma, revealing a venous sinus injury requiring immediate repair. Conclusions: This case and discussion highlight the many details and technical specificities to be taken into account by neurosurgeons when encountering intracranial hematoma caused by traumatic injury of the dural venous sinus, and which are pivotal in determining the efficacy of the treatment approach and prognosis of the patient.

Abstract TP329: Venous Collateral Drainage Patterns Predict Clinical Worsening in Dural Venous Sinus Thrombosis

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Sunil A Sheth ◽  
Harry Trieu ◽  
David S Liebeskind ◽  
Jeffrey L Saver ◽  
Viktor Szeder ◽  
...  
Keyword(s):  
Sinus Thrombosis ◽  
Complete Recovery ◽  
Transverse Sinus ◽  
Venous Hypertension ◽  
Venous Sinus ◽  
Venous Sinus Thrombosis ◽  
Sagittal Sinus ◽  
Dural Venous Sinus ◽  
Dural Venous Sinus Thrombosis ◽  
Clinical Worsening

Background: Dural venous sinus thrombosis (DVST) is an increasingly recognized cause of a wide array of neurological symptoms, with outcomes that range from complete recovery to death. Approximately 23% of patients with DVST will worsen after initial presentation, as a result of restricted venous outflow and venous hypertension, but early identification of this subset is challenging. A venous collateral scale (VCS) that grades alternative drainage routes may improve prediction of clinical deterioration. Methods: From our institutional database, we identified patients with documented DVST on dedicated venous imaging (MR, CT or catheter angiography) from January 2010 to July 2016. Patients were excluded for thrombosis related to arteriovenous fistulae. The VCS (Table) was created and scores were determined from cerebrovascular venous imaging at presentation by two reviewers blinded to subsequent imaging and clinical data. Results: Among 28 patients that met criteria, median age was 42 (IQR 24-57) and 50% (14/28) were female. Presentation symptoms included intracranial hemorrhage in 40% (11/28) and headache without hemorrhage in 18% (5/28). Transverse sinus occlusion was present in 68% (19/28), and superior sagittal sinus occlusion in 39% (11/28). 82% (23/28) of patients were treated with anticoagulation, and 18% (5/28) with endovascular thrombectomy. New hemorrhage or expansion of initial hemorrhage occurred in 21% (6/28). In-hospital mortality occurred in 18% (5/28). VCS was 0 in 18% (5/28), 1 in 39% (11/28), and 2 in 46% (12/28). Lower VCS was significantly associated with development of new hemorrhage or expansion of initial hemorrhage (62% vs. 0%, VCS 0-1 vs. 2, p<0.01). VCS demonstrated excellent discrimination for in-hospital clinical worsening (C-statistic 0.85). Conclusions: The type and quality of venous collaterals influence outcome in DVST. VCS helps identify patients who are likely to deteriorate and may need additional early interventions.

Transverse Sinus Arteriovenous Fistula Presenting with Tinnitus

2019 ◽  
pp. 241-250
Author(s):  
John F. Morrison ◽  
Adnan H. Siddiqui
Keyword(s):  
Arteriovenous Fistula ◽  
Successful Treatment ◽  
Surgical Techniques ◽  
Venous Drainage ◽  
Transverse Sinus ◽  
Classification Systems ◽  
Arteriovenous Fistulae ◽  
The Brain

Abstract: Arteriovenous fistulae present in any of a number of characteristic locations in the brain, such as the ethmoidal region, the petrosal sinus, and the transverse sinus and torcula. The fistula is an abnormal connection between an artery and vein. While there are multiple accepted classification systems, the risk they represent to the patient depends primarily on the degree of reflux of the venous drainage back to the cortex of the brain. While the inflow and outflow may be very complex, isolation of the fistulous point where this abnormal connection occurs is the key to successful treatment. This may be achieved through either endovascular or open surgical techniques deoending on the anatomy.

The Natural History and Management of Intracranial Dural Arteriovenous Fistulae

1997 ◽  
Vol 3 (4) ◽  
pp. 295-302 ◽  
Author(s):  
M.A. Davies ◽  
J. Saleh ◽  
K. ter Brugge ◽  
R. Willinsky ◽  
M.C. Wallace
Keyword(s):  
Natural History ◽  
Predictive Ability ◽  
Venous Drainage ◽  
Middle Cranial Fossa ◽  
Foramen Magnum ◽  
Symptom Improvement ◽  
Arteriovenous Fistulae ◽  
History Of ◽  
Intracranial Dural Arteriovenous Fistulae

The recently proposed classification scheme of Borden, Wu, and Shucart (Borden*) should have the ability to identify those intracranial dural arteriovenous fistulae (ICDAVF) which will continue to behave in a benign fashion. We examine for the first time the natural history of benign ICDAVF, including the predictive ability of this grading scale, and the implications for lesion management. A cohort of 55 Borden* grade I lesions was selected from a heterogeneous series of 102 consecutive ICDAVF seen at one institution between 1984 and 1995. Data were collected prospectively from 1991. Grade I lesions were those whose nidus drained directly into a dural venous sinus (DVS) or meningeal vein. The absence of retrograde leptomeningeal venous drainage (RLVD) was an important feature. Intracranial haemorrhage (ICH), non haemorrhagic neurological deficit (NHND), and death were considered aggressive features. There were 23 cavernous sinus, 2 foramen magnum, 1 middle cranial fossa, and 29 transverse sinus lesions. One patient received obliterative surgical treatment. Thirty-two lesions were observed only, and 22 patients developed symptoms or signs requiring palliative embolisation. Two minor complications occurred following embolisation: transient pulmonary aedema (1), and an asymptomatic pericallosal artery embolus (1). Follow-up was available on 48 (89%) patients for a total of 133 patient years (mean 33 months). This included 26 of the 32 patients observed and all 22 of the patients embolised. Aggressive interval behavior was seen in only one patient. Symptom improvement or resolution was observed in the majority of patients, whether observed only [21/26 (81%)], or whether they required embolisation for symptom palliation [19/22 (86%)]. Overall, 53 of the 54 (98%) of ICDAVF behaved in a benign fashion in the follow-up period. The predictable benign natural history of patients identified as Borden* grade I at presentation mandates a conservative approach to these ICDAVF. In some patients, when symptom severity demands, palliative embolisation is an effective and safe therapy.

Neonatal giant dural sinus ectasia: a multimodality imaging approach

2021 ◽  
Vol 14 (9) ◽  
pp. e242439
Author(s):  
Ralph Rommualdo Abareta Zuniega ◽  
Julian Alejandro Santos ◽  
Romelito Jose Galvan Galsim ◽  
Jonathan Saputil Elevazo
Keyword(s):  
Multimodality Imaging ◽  
Case Reports ◽  
Case Series ◽  
Transverse Sinus ◽  
Venous Sinus ◽  
Cardiac Insufficiency ◽  
Dural Sinus ◽  
Dural Sinuses ◽  
Sagittal Sinus ◽  
Dural Venous Sinus

Dural venous sinus ectasia is a rare anomaly characterised by the formation of a large vascular lake within the leaves of the dural sinuses, usually associated with thrombosis. These lesions can cause brain compression, cardiac insufficiency and disseminated intravascular coagulation, which may lead to poor prognosis. We present the case of a neonate who presented with an intracranial mass on prenatal ultrasound. Postnatal transcranial ultrasonography, cranial CT and cranial MRI demonstrated a large lesion predominantly occupying the dural sinus confluence, extending into the sagittal sinus, straight sinus and right transverse sinus. The left marginal sinus remains unfused and patent. Concomitant arteriovenous malformations were evident in the median interhemispheric fissure and the left Sylvian fissure. There are several published case reports and case series describing malformations of the dural sinuses in perinatal and neonatal patients in recent years, but this case is unique in that: (1) there is the presence of a vascular malformation concomitant to the dural sinus ectasia and (2) it highlights the importance of imaging in clinching the diagnosis of giant dural venous sinus ectasia, as it is often misdiagnosed as more common conditions such as extra-axial intracranial haemorrhage.

scholarly journals Interpositional dural graft technique for the treatment of dural arteriovenous fistulas

2007 ◽  
Vol 22 (3) ◽  
pp. 1-4 ◽  
Author(s):  
Michael Finn ◽  
Paul Klimo ◽  
William T. Couldwell
Keyword(s):  
Treatment Options ◽  
Venous Drainage ◽  
Venous Sinus ◽  
Illustrative Case ◽  
Pial Surface ◽  
Arteriovenous Fistulas ◽  
Arteriovenous Shunts ◽  
Dural Graft ◽  
Dural Arteriovenous Fistulas ◽  
Dural Venous Sinus

✓Dural arteriovenous fistulas (dAVFs) are acquired direct arteriovenous shunts that often drain into the dural venous sinus. Treatment options generally involve disrupting the abnormal vascular conduits by using a combination of modalities, including surgical disconnection, radiosurgery, and transarterial and transvenous embolization. Often these modalities provide only partial treatment of fistulous lesions, and thus the fistula recurs and symptoms result. The authors report on a novel surgical technique in which the involved venous sinuses are skeletonized and an interpositional dural substitute is placed between the disconnected sinus and native dura mater and over the pial surface adjacent to the sinus. The technique, which is demonstrated in an illustrative case, is intended to preserve native venous drainage and to prevent recruitment of new vascularization to the venous sinus postoperatively. The authors have not observed reconstitution of fistulas over areas treated with this technique, which offers the advantage of inhibiting vascular ingrowth (refistulization) while maintaining venous sinus patency.

scholarly journals Operative Nuances of Blind Catheterization of Occluded Sinuses Using Negative Road Map Technique: 2-Dimensional Operative Video

2020 ◽  
Author(s):  
Denise Brunozzi ◽  
Ali Alaraj
Keyword(s):  
Transverse Sinus ◽  
Venous Sinus ◽  
External Carotid ◽  
Road Map ◽  
Institutional Review ◽  
First Case ◽  
Patient Consent ◽  
Cortical Venous Reflux ◽  
Retrospective Nature ◽  
Dural Venous Sinus

Abstract Dural arteriovenous fistula (DAVF) are often treated with endovascular transvenous embolization. DAVFs though, are often associated with intracranial venous sinus occlusion, which limits the transvenous route.  Here, we present the operative nuances of blind catheterization of an occluded dural venous sinus in 2 different cases with DAVF. First case is a 72-yr-old patient with indirect right carotid-cavernous fistula associated with an occluded inferior petrosal sinus, with severe orbital congestion. Second patient is a 79-yr-old patient with a new external carotid to a trapped transverse sinus fistula (Cognard IIA + B), extensive cortical venous reflux in the setting of an occluded sigmoid sinus. In both cases, the transarterial route was limited because of small arterial feeders thus, after obtaining patients’ consent, we performed transvenous sacrifice of the isolated sinus. In both cases, the occluded sinus was transvenously blindly retrograde probed using a 0.035 inch Terumo Glidewire (Terumo Medical Corporation, Somerset, New Jersey). Once the occluded segment was probed, a dark roadmap was acquired with the wire in place. This created a negative roadmap once the guidewire is removed. This negative roadmap is used to navigate the microcatheter-microwire into the isolated sinus. In the first case, the cavernous sinus and the superior ophthalmic veins were sacrificed with coils. In the second patient, the entrapped left transverse sinus was embolized using Onyx. In both cases, complete occlusion of the fistula was attained.  In this neuroendovascular video, we demonstrate the nuances of blind catheterization of an occluded sinus using a negative roadmap technique as guidance for the micro-catheterization.  Institutional Review Board approved. Patient consent not required due to retrospective nature of manuscript, based on medical chart and imaging reviews, anonymized in the video.

scholarly journals Staged transarterial endovascular embolization of a malignant dural arteriovenous fistula using Onyx and n-butyl cyanoacrylate

2019 ◽  
Vol 46 (Suppl_2) ◽  
pp. V1
Author(s):  
Silvia Gesheva ◽  
William T. Couldwell ◽  
Vance Mortimer ◽  
Philipp Taussky ◽  
Ramesh Grandhi
Keyword(s):  
Arteriovenous Malformations ◽  
Dural Arteriovenous Fistula ◽  
Transarterial Embolization ◽  
Venous Drainage ◽  
Transverse Sinus ◽  
Endovascular Embolization ◽  
Intracranial Arteriovenous Malformations ◽  
Dural Venous Sinus ◽  
Cortical Venous Drainage ◽  
Primary Modality

Dural arteriovenous fistulae (dAVFs) are vascular anomalies formed by abnormal connections between branches of dural arteries and dural veins or dural venous sinus(es). These pathologic shunts constitute 10%–15% of all intracranial arteriovenous malformations. The hallmark of malignant dAVFs is the presence of cortical venous drainage, a finding that increases the likelihood of nonhemorrhagic neurologic deficit, intracranial hemorrhage, and mortality if left unaddressed. Endovascular approaches have become the primary modality for the treatment of dAVFs. The authors present a case of staged endovascular transarterial embolization of a malignant dAVF running parallel to the left transverse sinus in a patient with headaches and pulsatile tinnitus. The fistula was completely treated using Onyx and n-butyl cyanoacrylate.The video can be found here: https://youtu.be/GSAto_wlC3I.

scholarly journals MRV BRAIN NORMALANATOMICAL VARIANTS IN INDIA POPULATION

2020 ◽  
pp. 59-62
Author(s):  
Vemireddy Sreechand Reddy ◽  
Apoorva. C ◽  
Ankamma Rao. D
Keyword(s):  
Sinus Thrombosis ◽  
Anatomical Variation ◽  
Anatomical Variations ◽  
Transverse Sinus ◽  
Cerebral Venous Sinus Thrombosis ◽  
Venous Sinus ◽  
Mr Venography ◽  
Medical College ◽  
Sagittal Sinus ◽  
Dural Venous Sinus

Introduction Knowledge of variations in the cerebral dural venous sinus anatomy seen on magnetic resonance (MR) venography is essential to avoid over-diagnosis of cerebral venous sinus thrombosis (CVST). Very limited data is available on gender difference of the cerebral dural venous sinus anatomy variations Materials and Methods A retrospective study was conducted in NRI medical college in the Department of Radiodiagnosis for a duration of 3 years to study the normal anatomy of the intracranial venous system and its normal variation, as depicted by 3D MR venography, in normal adults and any gender-related differences. Results A total of (46 men, 54 women, age range 12 to 81 years), were included in the study. Most common indication for MR venography was headache (80%). Hypoplastic left transverse sinus was the most common anatomical variation in (25%) patients. Left transverse sinus was hypoplastic in more commonly in male in comparison to females (13 versus 12). Most common variation of superior sagittal sinus (SSS) was hypoplastic anterior one third SSS ,. Conclusion Hypoplastic left transverse sinus is the most common anatomical variation and more common in male compared to female in the present study. Other anatomical variations of dural venous sinuses are not significantly differ among both genders.

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