Cranial Emissary Veins (CEVs): Anatomy and Clinical-Surgical Implications

Purpose: Emissary foramens in the skull and emissary veins (EV), respectively, have been known for a long time, but their importance is often disregarded. In the present study, we introduce variants of occipital emissary foramens (OEF) unilaterally located on the left, close to оccipital condylе in a formation of three apertures that open together in a sinus near clivus. Material/Methods: Corpses of 30 dеad people were dissected in the Department of Anatomy, and standard techniques for soft tissue separation or maceration of the skull were used. After the removal of the calvaria, fixed bones of the skull were disarticulated. Foramens were cleaned using a double-ended probe, and depth and diameter measurements were performed using an atomical caliper. Results: We found variants of mastoid emissary foramens (MEF) situated into two groups, each of a couple of foramens. Their clinical significance is discussed, compared with existing experience and analysis of their phylogeny and embryogenesis. Conclusion: We introduce OEF and MEF to be important markers for detection of dural venous sinuses (DVS). The latter, together with EV, provide an important mechanism for decreasing intracranial pressure. This happens due to the absence of a valve apparatus in the veins of the brain, and the lack, or small amount, of muscle tissue. There is a possibility of existing varicose veins, such as those caused by arterio-venous fistulas and the pathology associated with it. We suggest the application of EV in imaging as an important study before surgery by lateral and transcondylar approach to the anterior foramen magnum.

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Emissary Veins

Bergman's Comprehensive Encyclopedia of Human Anatomic Variation ◽

10.1002/9781118430309.ch62 ◽

2016 ◽

pp. 817-820

Author(s):

R. Shane Tubbs ◽

Koichi Watanabe ◽

Marios Loukas

Keyword(s):

Emissary Veins

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Emissary Veins, Vascular-Containing Foramina, and Vascular Depressions of the Skull

Atlas of Normal Imaging Variations of the Brain, Skull, and Craniocervical Vasculature ◽

10.1007/978-3-319-39790-0_28 ◽

2017 ◽

pp. 859-885 ◽

Cited By ~ 1

Author(s):

Alexander M. McKinney

Keyword(s):

Emissary Veins

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Evaluation of the Mastoid Emissary Canals with Computerized Tomography in Patients with Chronic Otitis Media

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0039-3399518 ◽

2019 ◽

Vol 81 (01) ◽

pp. 082-087

Author(s):

Ozkan Ozen ◽

Caner Sahin

Keyword(s):

Otitis Media ◽

Chronic Otitis Media ◽

Venous Drainage ◽

Control Group ◽

Automation System ◽

High Resolution Computed Tomography ◽

Emissary Veins ◽

Pass Through ◽

Mastoid Foramen ◽

Mastoid Region

Abstract Background The mastoid emissary veins (MEVs) pass through the mastoid emissary canal-mastoid foramen (MEC-MF) in the mastoid region of the skull. MEVs can give rise to complications during surgical procedures. The purpose of our study was to investigate the morphological and morphometric characteristics of MECs of patients with clinical chronic otitis media (COM) using high-resolution computed tomography (HRCT). Methods Patients diagnosed with COM and undergoing temporal HRCT were identified by retrospectively scanning our hospital's automation system. Patients undergoing temporal HRCT for reasons other than COM, infection or tinnitus were identified for the control group by scanning the PACS archive. Sixty-two mastoid regions were examined in 38 unilateral and 12 bilateral COM patients, and 100 mastoid regions in the 50 patients in the control group. The presence of an accessory MEC-MF and MEC-MF diameters was evaluated in both groups. Results Main MEC diameters on the side of the ear with COM were 1.6 mm, and total accessory and main MEC diameters were 1.8 mm, both values being significantly higher than in the control group. Presence of accessory MEC on the side of the ear with COM was determined at 61.8%, significantly higher than in the control group. Conclusion Preoperative awareness of cranial venous drainage abnormalities is important to reduce surgical complications. Our study shows that MECs may be wider in diameter in patients with COM. MECs in COM patients must be identified before surgery to the mastoid region.

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Persistence of multiple emissary veins of posterior fossa with unusual origin of left petrosquamosal sinus from mastoid emissary

Surgical and Radiologic Anatomy ◽

10.1007/s00276-011-0822-x ◽

2011 ◽

Vol 33 (9) ◽

pp. 827-831 ◽

Cited By ~ 17

Author(s):

Narvir Singh Chauhan ◽

Yash Paul Sharma ◽

Tilak Bhagra ◽

Bindu Sud

Keyword(s):

Posterior Fossa ◽

Emissary Veins ◽

Unusual Origin

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Brain cooling via emissary veins: Fact or fancy?

Behavioral and Brain Sciences ◽

10.1017/s0140525x00079036 ◽

1990 ◽

Vol 13 (2) ◽

pp. 349-350 ◽

Cited By ~ 4

Author(s):

George L. Brengelmann

Keyword(s):

Brain Cooling ◽

Emissary Veins

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Percutaneous Transfacial Direct Embolization of an Intraosseous Dural Arteriovenous Fistula

Operative Neurosurgery ◽

10.1227/neu.0000000000000213 ◽

2013 ◽

Vol 10 (1) ◽

pp. E178-E182 ◽

Cited By ~ 1

Author(s):

John D. Nerva ◽

Danial K. Hallam ◽

Basavaraj V. Ghodke

Keyword(s):

Arteriovenous Fistula ◽

Image Guidance ◽

Dural Arteriovenous Fistula ◽

Venous Congestion ◽

Embolic Material ◽

Ocular Symptoms ◽

Novel Approach ◽

Liquid Embolic ◽

Emissary Veins

Abstract BACKGROUND AND IMPORTANCE: An intraosseous dural arteriovenous fistula (DAVF) is a rare cerebrovascular disease. The fistulous connection occurs within intraosseous diploic or transosseous emissary veins causing dilated intraosseous vascular pouches. To the authors' knowledge, this report describes the first percutaneous transfacial direct embolization of an intraosseous DAVF. CLINICAL PRESENTATION: A man in his 50s with blue rubber bleb nevus syndrome presented with headaches, imbalance, decreased visual acuity bilaterally, and left eye proptosis and chemosis. Imaging demonstrated an extensive intraosseous DAVF with dilated intraosseous vascular pouches throughout his cranial base and intraorbital venous congestion. He underwent staged endovascular treatment with the goal to improve his ocular symptoms. Transarterial and transvenous approaches failed to provide adequate access to the intraosseous vascular pouches. A direct, percutaneous transfacial approach was used to access the pouches for embolization with coils and liquid embolic material. Postoperative angiography demonstrated successful embolization of the pouch within the left pterygoid wing, reduced opacification of the intraosseous fistula, and elimination of intraorbital venous congestion. At 9-month follow-up, the patient's headaches had resolved, and his ocular symptomatology had improved. CONCLUSION: Endovascular access to an intraosseous DAVF is limited by the size and location of the intraosseous vascular pouches. In this case, a direct transfacial approach under image guidance facilitated access and embolization, which led to an improvement in the patient's symptoms. This technique is a novel approach for DAVF management.

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Prevalence of clinically important posterior fossa emissary veins on CT angiography

Journal of Neurosciences in Rural Practice ◽

10.4103/0976-3147.131654 ◽

2014 ◽

Vol 5 (02) ◽

pp. 135-138 ◽

Cited By ~ 6

Author(s):

Yeliz Pekcevik ◽

Hilal Sahin ◽

Ridvan Pekcevik

Keyword(s):

Computed Tomography ◽

Ct Angiography ◽

Posterior Fossa ◽

Emissary Vein ◽

Occipital Sinus ◽

Mastoid Emissary Vein ◽

Emissary Veins ◽

Posterior Condylar ◽

Mastoid Region

ABSTRACT Purpose: We assessed the prevalence of the clinically important posterior fossa emissary veins detected on computed tomography (CT) angiography. Materials and Methods: A total of 182 consecutive patients who underwent 64-slice CT angiography were retrospectively reviewed to determine the clinically important posterior fossa emissary veins. Results: Of 166 patients, the mastoid emissary vein (MEV) was not identified in 37 (22.3%) patients. It was found bilaterally in 82 (49.4%) and unilaterally in 47 (28.3%) patients. Only six patients had more than one MEV that were very small (<2 mm), and only five patients had very large (>5 mm) veins. The posterior condylar vein (PCV) was not identified in 39 (23.5%) patients. It was found bilaterally in 97 (58.4%) and unilaterally in 30 (18.1%) patients. Only 15 patients had a very large (>5 mm) PCV. The petrosquamosal sinus (PSS) was identified only in one patient (0.6%) on the left side. The occipital sinus was found in two patients (1.2%). Conclusions: The presence of the clinically important posterior fossa emissary veins is not rare. Posterior fossa emissary veins should be identified and systematically reported, especially prior to surgeries involving the posterior fossa and mastoid region.

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Management of Persistent Hypotension after Resection of Parasagittal Meningioma

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2014.086 ◽

2014 ◽

Vol 2 (3) ◽

pp. 483-487

Author(s):

Salih Gulsen

Keyword(s):

Frontal Sinus ◽

Air Embolism ◽

Sagittal Sinus ◽

Large Size ◽

Clinical Series ◽

Emissary Veins ◽

Cranial Mri ◽

Persistent Hypotension ◽

Normal Respiration ◽

Parasagittal Meningioma

Various complications including air embolism have been discussed in large clinical series regarding the parasagittal meningioma. We presented and discussed the patient suffering from persistent hypotension after excision of parasagittal meningioma. A 47-year-old man was admitted to our hospital with complaints of headache and frontal region swelling. His cranial MRI showed a bilaterally located parasagittal meningioma at the anterior one third of the sagittal sinus. Conspicuously, he had large frontal sinus and its length was about totally 7 cm in sagittal and transverse part.During cranitomy, we had to open frontal sinus because of its large size and open the sagittal sinus while removing of the tumor. So coincidental opening of the superior sagittal sinus and/or emissary veins located within diploe of the cranium and frontal sinus may cause hypotension after extubation due to normal respiration led to air escaping from the frontal sinus to the emissary veins placed next to the frontal sinus. Bilateral application of the tamponade embedded with vaseline inside to the nose prevents air escaping from the frontal sinus to the emissary veins.

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