Embryological basis of some aspects of cerebral vascular fistulas and malformations

1996 ◽  
Vol 85 (1) ◽  
pp. 1-8 ◽  
Author(s):  
Sean Mullan ◽  
Saeid Mojtahedi ◽  
Douglas L. Johnson ◽  
R. Loch Macdonald
Keyword(s):  
Cavernous Sinus ◽  
Cerebral Vein ◽  
Cerebral Veins ◽  
Vein Of Galen Aneurysm ◽  
Content Type ◽  
Clinical Observations ◽  
Internal Cerebral Veins ◽  
Superior Petrosal Sinus ◽  
Frequent Absence ◽  
Frequent Failure

✓ The literature on the formation of cerebral veins is reviewed to obtain a better understanding of some cerebrovascular anomalies. Clinical observations such as the entry of the superior ophthalmic vein into the cavernous sinus through the inferior rather than the superior orbital fissure, the relative infrequency of middle cerebral vein backflow in the presence of an extensive cavernous fistula, and the relative infrequency of hemorrhage in relation to the inferior petrosal fistula all relate to the persistence of an older venous pathway. The frequent occurrence of hemorrhage in association with the superior petrosal sinus fistula and the frequent failure of the superior petrosal sinus to connect to the cavernous sinus similarly have an embryological explanation. The frequent association of the vein of Galen aneurysm and an absent or deformed straight sinus probably relates to the time at which the paired internal cerebral veins fuse into one channel. It is speculated that the origins of cerebral venous malformations (CVMs) and arteriovenous malformations (AVMs) probably relate to sequential formation and absorption of surface veins, which occur in human embryonic development mainly in the 40- to 80-mm length interval, although persistent AVM growth is possible even after birth. The frequent absence or anomaly of the middle cerebral vein and its failure to communicate with the cavernous sinus in the presence of both CVMs and AVMs are linked to the late development of that vein and to its even later connection to the cavernous sinus.

The subtemporal, transcavernous, anterior transpetrosal approach to the upper brain stem and clivus

1992 ◽  
Vol 77 (5) ◽  
pp. 709-717 ◽  
Author(s):  
Griffith R. Harsh ◽  
Laligam N. Sekhar
Keyword(s):  
Brain Stem ◽  
Cavernous Sinus ◽  
Petrous Bone ◽  
Petrous Apex ◽  
Content Type ◽  
Advantages And Disadvantages ◽  
Anterior Transpetrosal Approach ◽  
Surgical Access ◽  
Superior Petrosal Sinus ◽  
Fine Print

✓ The temporal lobe, posterolateral cavernous sinus, tentorium, and petrous apex restrict anterolateral surgical access to lesions of the upper brain stem and clivus. The authors describe a modified transpetrosal approach that enhances the exposure of clival chordomas and aneurysms of the basilar artery bifurcation. An intradural and extradural subtemporal approach is combined with division of the tentorium and superior petrosal sinus, posterolateral dissection of the cavernous sinus, and intradural removal of the petrous bone from its apex to the cochlea. The indications, advantages, and disadvantages of this subtemporal, transcavernous, anterior transpetrosal approach are described in detail, along with its use in six patients.

Microsurgical anatomy of the great cerebral vein of Galen and its tributaries

2003 ◽  
Vol 99 (6) ◽  
pp. 1028-1038 ◽  
Author(s):  
Patrick Chaynes
Keyword(s):  
Venous Drainage ◽  
Pineal Region ◽  
Surgical Approaches ◽  
Cerebral Vein ◽  
Cerebral Veins ◽  
Microsurgical Anatomy ◽  
Vein Of Galen ◽  
Content Type ◽  
Deep Cerebral Veins ◽  
Fine Print

Object. The deep cerebral veins may pose a major obstacle in operative approaches to deep-seated lesions, especially in the pineal region where multiple veins converge on the great cerebral vein of Galen. Because undesirable sequelae may occur from such surgery, the number of veins and branches to be sacrificed during these approaches should kept to a minimum. The purpose of this study was to examine venous drainage into the vein of Galen with a view to surgical approaches. If a vein hampering surgical access must be sacrificed, it can therefore be selected according to the smallest draining territory. Methods. The deep cerebral veins and their surrounding neural structures were examined in 50 cerebral hemispheres from 25 adult cadavers in which the arteries and veins had been perfused with red and blue silicone, respectively. Special consideration was given to the size and location of drainage of the vein of Galen and its tributaries. Conclusions. When a surgeon approaches the pineal region, several veins may hamper the access route. From posterior to anterior, these include the following: the superior vermian and the precentral or superior cerebellar veins, which drain into the posteroinferior aspect of the vein of Galen; and the tectal and pineal veins, which drain into its anterosuperior aspect. The internal occipital vein is the main vessel draining into the lateral aspect of the vein of Galen. It may be joined by the posterior pericallosal vein, and in that case has an extensive territory. To avoid intraoperative venous infarction, it is important to use angiography to determine the venous organization before surgery and to estimate the permeability and size of the branches of the deep venous system.

Aminergic innervation of cerebral veins

1984 ◽  
Vol 60 (1) ◽  
pp. 140-144 ◽  
Author(s):  
Toru Itakura ◽  
Kazuo Nakakita ◽  
Ichiro Kamei ◽  
Yutaka Naka ◽  
Kunio Nakai ◽  
...  
Keyword(s):  
Distribution Pattern ◽  
Femoral Vein ◽  
Nerve Fibers ◽  
Dural Sinus ◽  
Cerebral Vein ◽  
Cerebral Veins ◽  
Content Type ◽  
Internal Cerebral Vein ◽  
Aminergic Innervation ◽  
Longitudinal Pattern

✓ The density and distribution pattern of aminergic nerve fibers in intracranial and extracranial veins were compared by means of catecholamine histofluorescence studies. Extracranial veins (internal jugular, inferior caval, portal, renal, internal iliac, and femoral veins) showed quite a uniform distribution pattern. Large veins (jugular, caval, renal, and iliac veins) revealed a spiral pattern, and small veins presented as a meshwork (femoral vein) or in a longitudinal pattern (a branch of the femoral vein). In contrast, intracranial veins displayed more complex patterns: the dural sinus showed a longitudinal pattern and the internal cerebral vein and the superficial vein of Labbé revealed a meshwork of nerve fibers. The aminergic fibers were denser in cerebral veins (dural sinus and internal cerebral vein) than in extracranial veins. The complex distribution and the density of aminergic fibers in cerebral veins suggest that the aminergic innervation of the circulatory system may be more important in the brain than in the extracranial organs.

scholarly journals Meningioma of the pineal region: a surgical series of 10 cases

1996 ◽  
Vol 85 (4) ◽  
pp. 586-590 ◽  
Author(s):  
Alexander Nikolaevich Konovalov ◽  
Aldo Spallone ◽  
David Iraklevich Pitzkhelauri
Keyword(s):  
Venous Occlusion ◽  
Pineal Region ◽  
Cerebral Veins ◽  
Tumor Removal ◽  
Pineal Tumors ◽  
Content Type ◽  
Internal Cerebral Veins ◽  
Microsurgical Approach ◽  
Quadrigeminal Plate ◽  
Total Tumor Removal

✓ Ten cases of meningioma of the pineal region were histologically verified at a single institution during an 8-year period. These represented 0.3% of 3061 intracranial meningiomas, as well as 6.2% of 164 pineal tumors. Patients were predominantly women. Symptoms and signs of increased intracranial pressure were most common, whereas Parinaud's syndrome was observed in only one case. Computerized tomography (CT) was the main diagnostic test used in the present series. It usually revealed a hyperdense mass with high-intensity contrast enhancement and a calcified mass eccentrically located at the periphery, which returned to its central location postsurgically and was likely to represent a calcified pineal gland. Magnetic resonance imaging was performed in the more recent cases and confirmed the suspicion raised by CT of a meningioma with a calcified mass at its periphery. Surgery was performed using an occipital transtentorial microsurgical approach with the patient placed in the semisitting position. Gross-total tumor removal was achieved in all cases, although this required sacrifice of the vein of Galen in six patients. Venous occlusion was performed only after adequate intraoperative verification of functional occlusion and blood flow diversion from the galenic system and had no consequences in any case but one. This latter patient had an infiltrative meningioma that was removed at the expense of intraoperative sacrifice of the two internal cerebral veins, as well as unavoidable trauma to the region of the quadrigeminal plate. All the remaining patients improved postsurgery, and only one had a permanent visual field deficit as a result of the surgical approach. Pineal meningiomas represent a rare subgroup of pineal tumors that can be treated surgically with reasonably good results. Sacrifice of major basal veins may be required to achieve radical tumor removal and can be tolerated by the patient provided that functional occlusion of the galenic system, as indicated by preoperative angiography, is verified during surgery.

Gamma knife radiosurgery in the management of cavernous sinus meningiomas

2000 ◽  
Vol 93 (supplement_3) ◽  
pp. 68-73 ◽  
Author(s):  
Pierre-Hugues Roche ◽  
Jean Régis ◽  
Henry Dufour ◽  
Henri-Dominique Fournier ◽  
Christine Delsanti ◽  
...  
Keyword(s):  
Mr Imaging ◽  
Tumor Growth ◽  
Gamma Knife ◽  
Cavernous Sinus ◽  
Gamma Knife Radiosurgery ◽  
Surgical Removal ◽  
Content Type ◽  
Cavernous Sinus Meningioma ◽  
The Mean ◽  
Fine Print

Object. The authors sought to assess the functional tolerance and tumor control rate of cavernous sinus meningiomas treated by gamma knife radiosurgery (GKS). Methods. Between July 1992 and October 1998, 92 patients harboring benign cavernous sinus meningiomas underwent GKS. The present study is concerned with the first 80 consecutive patients (63 women and 17 men). Gamma knife radiosurgery was performed as an alternative to surgical removal in 50 cases and as an adjuvant to microsurgery in 30 cases. The mean patient age was 49 years (range 6–71 years). The mean tumor volume was 5.8 cm3 (range 0.9–18.6 cm3). On magnetic resonance (MR) imaging the tumor was confined in 66 cases and extensive in 14 cases. The mean prescription dose was 28 Gy (range 12–50 Gy), delivered with an average of eight isocenters (range two–18). The median peripheral isodose was 50% (range 30–70%). Patients were evaluated at 6 months, and at 1, 2, 3, 5, and 7 years after GKS. The median follow-up period was 30.5 months (range 12–79 months). Tumor stabilization after GKS was noted in 51 patients, tumor shrinkage in 25 patients, and enlargement in four patients requiring surgical removal in two cases. The 5-year actuarial progression-free survival was 92.8%. No new oculomotor deficit was observed. Among the 54 patients with oculomotor nerve deficits, 15 improved, eight recovered, and one worsened. Among the 13 patients with trigeminal neuralgia, one worsened (contemporary of tumor growing), five remained unchanged, four improved, and three recovered. In a patient with a remnant surrounding the optic nerve and preoperative low vision (3/10) the decision was to treat the lesion and deliberately sacrifice the residual visual acuity. Only one transient unexpected optic neuropathy has been observed. One case of delayed intracavernous carotid artery occlusion occurred 3 months after GKS, without permanent deficit. Another patient presented with partial complex seizures 18 months after GKS. All cases of tumor growth and neurological deficits observed after GKS occurred before the use of GammaPlan. Since the initiation of systematic use of stereotactic MR imaging and computer-assisted modern dose planning, no more side effects or cases of tumor growth have occurred. Conclusions. Gamma knife radiosurgery was found to be an effective low morbidity—related tool for the treatment of cavernous sinus meningioma. In a significant number of patients, oculomotor functional restoration was observed. The treatment appears to be an alternative to surgical removal of confined enclosed cavernous sinus meningioma and should be proposed as an adjuvant to surgery in case of extensive meningiomas.

scholarly journals Non-Pathological Opacification of the Cavernous Sinus on Brain CT Angiography: Comparison with Flow-Related Signal Intensity on Time-of-Flight MR Angiography

Healthcare ◽  
2021 ◽  
Vol 9 (1) ◽  
pp. 94
Author(s):  
Sun Ah Heo ◽  
Eun Soo Kim ◽  
Yul Lee ◽  
Sang Min Lee ◽  
Kwanseop Lee ◽  
...  
Keyword(s):  
Cavernous Sinus ◽  
Signal Intensity ◽  
Time Of Flight ◽  
Weighted Kappa ◽  
Wilcoxon Test ◽  
Tof Mra ◽  
Superior Petrosal Sinus ◽  
Grade Difference ◽  
Diagnostic Modalities ◽  
The Right

Purpose: To investigate the non-pathological opacification of the cavernous sinus (CS) on brain computed tomography angiography (CTA) and compare it with flow-related signal intensity (FRSI) on time-of-flight magnetic resonance angiography (TOF-MRA). Methods: Opacification of the CS was observed in 355 participants who underwent CTA and an additional 77 participants who underwent examination with three diagnostic modalities: CTA, TOF-MRA, and digital subtraction angiography (DSA). Opacification of the CS, superior petrosal sinus (SPS), inferior petrosal sinus (IPS), and pterygoid plexus (PP) were also analyzed using a five-point scale. The Wilcoxon test was used to determine the frequencies of the findings on each side. Additionally, the findings on CTA images were compared with those on TOF-MRA images in an additional 77 participants without dural arteriovenous fistula (DAVF) using weighted kappa (κ) statistics. Results: Neuroradiologists identified non-pathological opacification of the CS (n = 100, 28.2%) on brain CTA in 355 participants. Asymmetry of opacification in the CS was significantly correlated with the grade difference between the right and left CS, SPS, IPS, and PP (p < 0.0001 for CS, p < 0.0001 for SPS, p < 0.0001 for IPS, and p < 0.05 for PP). Asymmetry of the opacification and FRSI in the CS was observed in 77 participants (CTA: n = 21, 27.3%; TOF-MRA: n = 22, 28.6%). However, there was almost no agreement between CTA and TOF-MRA (κ = 0.10, 95% confidence interval: −0.12–0.32). Conclusion: Asymmetry of non-pathological opacification and FRSI in the CS may be seen to some extent on CTA and TOF-MRA due to anatomical variance. However, it shows minimal reliable association with the FRSI on TOF-MRA.

Electrothrombosis of carotid-cavernous fistula

1975 ◽  
Vol 42 (1) ◽  
pp. 76-85 ◽  
Author(s):  
Yoshio Hosobuchi
Keyword(s):  
Posterior Segment ◽  
Cerebral Vein ◽  
Superior Ophthalmic Vein ◽  
Carotid Cavernous Fistula ◽  
Content Type ◽  
Cavernous Fistula ◽  
Arterial Circulation ◽  
Inferior Portion ◽  
Pterygoid Plexus ◽  
Fine Print

✓ The author describes a technique for directly closing a carotid cavernous fistula with electrothrombosis while preserving the intracranial arterial circulation. Copper wires are introduced through the superior ophthalmic vein or a frontotemporal craniotomy, and thus directly into the portion of the sinus into which the fistula drains; if posterior, into the posterior segment of Parkinson's triangle, if inferior, into the pterygoid plexus, and if anterior, through the sphenoparietal sinus and/or middle cerebral vein to the anterior-inferior portion of the sinus. A direct current is applied until a thrombus is confirmed angiographically and the wires are left in place. Four patients treated by this method are presented.

Internal cerebral veins varix due to midline arteriovenous malformation: how much is the risk of bleeding?

2011 ◽  
Vol 32 (6) ◽  
pp. 1253-1254 ◽  
Author(s):  
Carmelo Lucio Sturiale ◽  
Alfredo Puca ◽  
Alessio Albanese ◽  
Enrico Marchese ◽  
Giulio Maira
Keyword(s):  
Arteriovenous Malformation ◽  
Cerebral Veins ◽  
Risk Of Bleeding ◽  
Internal Cerebral Veins

Venous rupture during transvenous approach to a carotid-cavernous fistula

1989 ◽  
Vol 71 (1) ◽  
pp. 133-137 ◽  
Author(s):  
Wesley A. King ◽  
Grant B. Hieshima ◽  
Neil A. Martin
Keyword(s):  
Carotid Artery ◽  
Cavernous Sinus ◽  
Balloon Occlusion ◽  
Alternative Methods ◽  
Ocular Motility ◽  
Carotid Cavernous Fistula ◽  
Content Type ◽  
Cavernous Fistula ◽  
A Minor ◽  
Transvenous Approach

✓ An attempt at transfemoral transarterial balloon occlusion of a high-flow spontaneous carotid-cavernous fistula was unsuccessful because the carotid artery rent was too small for this approach. During a subsequent transvenous approach to the cavernous sinus through the jugular vein, the inferior petrosal sinus was perforated. A minor subarachnoid hemorrhage occurred before the tear could be sealed by the deposition of three Gianturco coils in the vein. The patient was taken to the operating room for emergency obliteration of the fistula and petrosal sinus in order to remove the risk of further hemorrhage. Under the guidance of intraoperative digital subtraction angiography, isobutyl-2-cyanoacrylate was injected directly into the surgically exposed cavernous sinus. Successful obliteration of the fistula was achieved with preservation of the carotid artery, and the angiography catheter was removed safely from the petrosal sinus. Although initially after surgery the patient had nearly complete ophthalmoplegia, at her 1-year follow-up examination she had normal ocular motility and visual acuity. The transvenous approach to the cavernous sinus and alternative methods of treatment of carotid-cavernous fistulas are discussed.

scholarly journals Pregnancy Causes Diminished Myogenic Tone and Outward Hypotrophic Remodeling of the Cerebral Vein of Galen

2013 ◽  
Vol 33 (4) ◽  
pp. 542-542 ◽  
Author(s):  
Anne-Eva van der Wijk ◽  
Malou PH Schreurs ◽  
Marilyn J Cipolla
Keyword(s):  
Cerebral Arteries ◽  
Venous Blood ◽  
Blood Stasis ◽  
Wall Stress ◽  
Myogenic Tone ◽  
Cerebral Vein ◽  
Cerebral Veins ◽  
Vein Of Galen ◽  
First Time ◽  
Serotonergic Innervation

Pregnancy increases the risk of several complications associated with the cerebral veins, including thrombosis and hemorrhage. In contrast to the cerebral arteries and arterioles, few studies have focused on the effect of pregnancy on the cerebral venous side. Here, we investigated for the first time the effect of pregnancy on the function and structure of the cerebral vein of Galen in rats. Our major finding was that cerebral veins from late-pregnant (LP, n = 11) rats had larger lumen diameters and thinner walls than veins from nonpregnant (NP, n = 13) rats, indicating that pregnancy caused outward hypotrophic remodeling of the vein of Galen. Moreover, veins from NP animals had a small amount of myogenic tone at 10 mm Hg (3.9 ± 1.0%) that was diminished in veins during pregnancy (0.8 ± 0.3%; P < 0.01). However, endothelium-dependent and -independent vasodilation of the veins was unchanged during pregnancy. Using immunohistochemistry, we show that the vein of Galen receives perivascular innervation, and that serotonergic innervation of cerebral veins is significantly higher in veins from LP animals. Outward hypotrophic remodeling and diminished tone of cerebral veins during pregnancy may contribute to the development of venous pathology through elevated wall tension and wall stress, and possibly by promoting venous blood stasis.

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