Microsurgical Anatomy of the Venous Drainage into the Superior Sagittal Sinus

ABSTRACT Ten unfixed human brains were examined under an operating microscope to evaluate the feasibility of reimplanting the parasagittal veins into the superior sagittal sinus. On average, there were 6.5 veins draining the surface of each hemisphere in the anterior frontal region, 3 veins draining each posterior frontal region, 4 veins draining each parietal region, and 1 vein draining each occipital region. The veins were most frequently 0.1 to 1.0 mm in diameter, but were as large as 3.0 mm in the anterior frontal and occipital regions, 3.5 mm in the parietal region, and 5.0 mm in the posterior frontal region. The mean vein length between the superior sagittal sinus and the first lateral attachment was 3.0 to 7.4 mm; individual veins were as long as 30.0 mm. The 20 hemispheres contained a total of 5 veins in the anterior frontal region. 7 veins in the posterior frontal region, and 8 veins in the parietal region that appeared to have an adequate diameter and length for microsurgical reimplantation into the superior sagittal sinus. The superior sagittal sinus had a mean width of 4.3 mm and depth of 3.6 mm in the midanterior frontal region and enlarged to a mean width of 9.9 mm and depth of 6.8 mm in the midoccipital region. In all sites, the sinus appeared to be structurally compatible with vein reimplantation. In 3 cases, veins 2.8 to 4.6 mm in diameter were reimplanted microsurgically into the sinus; in each case, the anastomosis was technically satisfactory and patent. These results support the feasibility of reimplanting parasaggital veins into the superior sagittal sinus for such problems as trauma, tumors, and cortical venous thrombosis. Veins suitable for reimplantation are located primarily in the posterior frontal and parietal regions.

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Microsurgical anatomy of the venous drainage into the superior sagittal sinus

Neurosurgery ◽

10.1097/00006123-198904000-00005 ◽

1989 ◽

Vol 24 (4) ◽

pp. 514???20 ◽

Cited By ~ 1

Author(s):

B T Andrews ◽

M Dujovny ◽

H G Mirchandani ◽

J I Ausman

Keyword(s):

Superior Sagittal Sinus ◽

Venous Drainage ◽

Microsurgical Anatomy ◽

Sagittal Sinus

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Relationship of superior sagittal sinus with sagittal midline: A surgical application

Surgical Neurology International ◽

10.25259/sni_509_2020 ◽

2020 ◽

Vol 11 ◽

pp. 309

Author(s):

Dan Zimelewicz Oberman ◽

Nícollas Nunes Rabelo ◽

Jorge Luiz Amorim Correa ◽

Pablo Ajler

Keyword(s):

Magnetic Resonance ◽

Superior Sagittal Sinus ◽

Third Ventricle ◽

Safety Margin ◽

Neurological Deficits ◽

Sagittal Sinus ◽

Mean Width ◽

Significant Difference ◽

The Mean ◽

The Right

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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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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Anatomical Variations in the Location of Veins Draining Into the Anterior Superior Sagittal Sinus: Implications for the Transbasal Approach

Operative Neurosurgery ◽

10.1093/ons/opz339 ◽

2019 ◽

Cited By ~ 2

Author(s):

Hamid Borghei-Razavi ◽

Alankrita Raghavan ◽

Aldo Eguiluz-Melendez ◽

Krishna Joshi ◽

Juan C Fernandez-Miranda ◽

...

Keyword(s):

Superior Sagittal Sinus ◽

Clinical Importance ◽

Anatomical Variations ◽

Sagittal Sinus ◽

Skull Base Approach ◽

Anterior Fossa ◽

Cranial Fossa ◽

The Mean ◽

Level 1 ◽

Subfrontal Approach

Abstract BACKGROUND Many approaches are used for midline anterior cranial fossa meningioma resection. In the subfrontal approach, the anterior superior sagittal sinus (SSS) is commonly ligated to release the anterior falx. The transbasal approach allows access to the origin of the anterior SSS, allowing for maximum venous preservation. OBJECTIVE To investigate variations in the first and second veins draining into the SSS. METHODS We performed stepwise dissections for a transbasal level 1 approach on 8 anatomic specimens. We visualized the first and second veins draining into the sinus and measured the distance from the foramen cecum to these veins. We also measured the orbital bar height to determine the length of sagittal sinus that could be preserved with orbital bar removal. RESULTS The distance between the foramen cecum and the first vein ranged from 4 to 36 mm while the distance to the second vein ranged from 6 to 48 mm. The mean orbital bar height was 26.4 mm. Based on these measurements, with a traditional bicoronal craniotomy without orbital bar removal, 81% of first veins and 58% of second veins would be sacrificed. CONCLUSION A supraorbital bar or nasofrontal osteotomy, part of the transbasal skull base approach, is helpful to preserve the first and second veins when ligating the anterior SSS. Based on this study, it may be difficult to preserve these veins without orbital bar removal. Preservation of these veins may be of clinical importance when approaching midline anterior fossa pathologies.

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The pathophysiology of otitic hydrocephalus

The Journal of Laryngology & Otology ◽

10.1017/s002221510013854x ◽

1997 ◽

Vol 111 (8) ◽

pp. 757-759 ◽

Cited By ~ 18

Author(s):

A. Tomkinson ◽

R. G. S. Mills ◽

P. J. Cantrell

Keyword(s):

Magnetic Resonance Imaging ◽

Superior Sagittal Sinus ◽

Venous Pressure ◽

Venous Drainage ◽

Mural Thrombus ◽

Resonance Imaging ◽

Subsequent Increase ◽

Sagittal Sinus ◽

Magnetic Resonance Imaging Mri ◽

Cerebral Venous Pressure

AbstractThe pathophysiology of otitic hydrocephalus remains controversial. It has been argued that involvement of the superior sagittal sinus, by, at least, a mural thrombus is a necessary component of this disease.We present a case of otitic hydrocephalus where on magnetic resonance imaging (MRI) normal luminal and mural flow within the superior sagittal sinus is demonstrated. The presence of thrombus in the lateral venous sinus alone appears sufficient in this case to impede venous drainage of the intracranial contents into the neck and produce a rise in the cerebral venous pressure and a subsequent increase in the CSF pressure. The presence of a superior sagittal sinus mural thrombus is not required.

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Doppler ultrasound measurements of superior sagittal sinus blood velocity

Journal of Neurosurgery ◽

10.3171/jns.1972.37.3.0312 ◽

1972 ◽

Vol 37 (3) ◽

pp. 312-315 ◽

Cited By ~ 5

Author(s):

Ronald Brisman ◽

Sadek K. Hilal ◽

Michael Tenner

Keyword(s):

Intracranial Pressure ◽

Superior Sagittal Sinus ◽

Mass Effect ◽

Blood Velocity ◽

Doppler Measurement ◽

Content Type ◽

Sagittal Sinus ◽

The Mean ◽

Sagittal Sinus Occlusion ◽

The Relationship

✓ Transcutaneous Doppler recordings from the patent anterior fontanel were used to measure superior sagittal sinus blood velocity (SSSV). In 15 cases it ranged from 4.5 to 18.1 cm/sec. In five of these patients with no mass effect and normal intracranial pressure, the mean SSSV was 13.6 cm/sec. An independent arteriographic measurement of SSSV was 4.5 cm/sec in a hydrocephalic patient with elevated intracranial pressure whose Doppler measurement of SSSV was 6.6 cm/ sec. The Doppler technique may be used to diagnose sagittal sinus occlusion. SSSV tended to be low when CSF pressure was elevated, but the relationship was not constant.

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Parietal Foramen as A Landmark to Locate Intracranial Vascular and Parenchymal Structures

10.21203/rs.3.rs-114662/v1 ◽

2020 ◽

Author(s):

Pedro Brainer-Lima ◽

Alessandra Brainer-Lima ◽

Maria Rosana Ferreira ◽

Paulo Brainer-Lima ◽

Marcelo Valença

Keyword(s):

Parietal Lobe ◽

Superior Sagittal Sinus ◽

Average Distance ◽

Air Embolism ◽

Neurosurgical Procedures ◽

Parietal Region ◽

Sagittal Suture ◽

Emissary Vein ◽

Sagittal Sinus ◽

The Right

Abstract The aim of this study was to define the location of the parietal foramina (PF) with reference to skull landmarks and correlate the PF with cerebral and vascular structures to optimize neurosurgical procedures in the intracranial compartment. Two hundred and thirty-eight parietal bones studied by magnetic resonance imaging (MRI) of 119 patients were reviewed. The cephalometric points, inion, bregma, sagittal suture and lambda were used as anatomical references to locate the PF and define its anatomical relationships to parenchymal cerebral structures, especially some eloquent areas. The PF was identified in the MRI in 83 of the 119 individuals (69.7%) and was located at an average distance of 9.5 ± 0.8 cm (mean ± SD) posteriorly and 0.9 ± 0.3cm laterally to the Bregma. In over 90% of cases, the PF was located within a 2 cm radius of the bregma-PF distance’s mean value. Surgeons operating in the parietal region should be aware of the frequency of PF (69.7%), its location (superolateral to lambda) and its stable relationship with underlying anatomical structures. 88% of the 62 left PF’s were situated within 1cm, laterally to the left margin of the superior sagittal sinus (SSS). 60% of the right PF were situated within 1.3 cm laterally from the right margin of the SSS, while 40% were directly above the SSS. We propose that the PF should be used as the reference for the superior sagittal sinus during its course through the parietal lobe, as its constancy overtakes other commonly used landmarks (sagittal suture and midline). In conclusion, clinicians should be aware of the PF to both avoid iatrogenic injury to an emissary vein that courses through it that can lead to air embolism and as a guide to maneuvering through the parietal region.

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