Superficial surgical landmarks for the transverse sinus and torcular herophili

2000 ◽  
Vol 93 (2) ◽  
pp. 279-281 ◽  
Author(s):  
R. Shane Tubbs ◽  
George Salter ◽  
W. Jerry Oakes
Keyword(s):  
Anatomical Study ◽  
Transverse Sinus ◽  
Craniocervical Junction ◽  
Anatomical Structures ◽  
Content Type ◽  
Medial Segment ◽  
External Landmark ◽  
Inferior Edge ◽  
Formalin Fixed ◽  
Fine Print

Object. The purpose of this anatomical study is to identify reliable external landmarks that can be used to determine accurately the lower border of the proximal segment of the transverse sinus (TS).Methods. The authors used 15 formalin-fixed cadaveric specimens for this project. Various anatomical structures were dissected and measurements of the distance between these structures and the proximal TS were obtained.The data collected in this study demonstrate that the inion is not always a reliable external landmark to use when determining the internal location of the very proximal TS and its drainage into the area of the torcular herophili. In addition, the authors found that the most accurate external landmark to use in reliably estimating the internal placement of the proximal TS is the point of insertion of the musculus semispinalis capitus and not the superior nuchal line. In the present study, this muscle never covered more than 5 mm of the inferior edge of the TS and was found to be a reliable anatomical structure for avoiding the medial segment of the TS.Conclusions. These findings could aid the surgeon in localizing the TS with various midline approaches to the posterior fossa and the craniocervical junction.

Circumferential fracture of the skull base causing craniocervical dislocation

2002 ◽  
Vol 97 (1) ◽  
pp. 118-122 ◽  
Author(s):  
Ganesh Rao ◽  
Adam S. Arthur ◽  
Ronald I. Apfelbaum
Keyword(s):  
High Speed ◽  
Unusual Case ◽  
Motor Vehicle ◽  
Neurological Impairment ◽  
Craniocervical Junction ◽  
Motor Vehicle Accidents ◽  
Review Of The Literature ◽  
Content Type ◽  
Vehicle Accidents ◽  
Fine Print

✓ Fractures of the craniocervical junction are common in victims of high-speed motor vehicle accidents; indeed, injury to this area is often fatal. The authors present the unusual case of a young woman who sustained a circumferential fracture of the craniocervical junction. Despite significant trauma to this area, she suffered remarkably minor neurological impairment and made an excellent recovery. Her injuries, treatment, and outcome, as well as a review of the literature with regard to injuries at the craniocervical junction, are discussed.

Dural sinus thrombosis and pseudotumor cerebri: unexpected complications of suboccipital craniotomy and translabyrinthine craniectomy

1999 ◽  
Vol 91 (2) ◽  
pp. 192-197 ◽  
Author(s):  
Glenn L. Keiper ◽  
Jonathan D. Sherman ◽  
Thomas A. Tomsick ◽  
John M. Tew
Keyword(s):  
Sinus Thrombosis ◽  
Pseudotumor Cerebri ◽  
Transverse Sinus ◽  
Dural Sinus ◽  
Posterior Fossa Surgery ◽  
Dural Sinus Thrombosis ◽  
Mr Venography ◽  
Content Type ◽  
Suboccipital Craniotomy ◽  
Fine Print

Object. The goal of this study was to document the hazards associated with pseudotumor cerebri resulting from transverse sinus thrombosis after tumor resection. Dural sinus thrombosis is a rare and potentially serious complication of suboccipital craniotomy and translabyrinthine craniectomy. Pseudotumor cerebri may occur when venous hypertension develops secondary to outflow obstruction. Previous research indicates that occlusion of a single transverse sinus is well tolerated when the contralateral sinus remains patent.Methods. The authors report the results in five of a total of 107 patients who underwent suboccipital craniotomy or translabyrinthine craniectomy for resection of a tumor. Postoperatively, these patients developed headache, visual obscuration, and florid papilledema as a result of increased intracranial pressure (ICP). In each patient, the transverse sinus on the treated side was thrombosed; patency of the contralateral sinus was confirmed on magnetic resonance (MR) imaging. Four patients required lumboperitoneal or ventriculoperitoneal shunts and one required medical treatment for increased ICP. All five patients regained their baseline neurological function after treatment. Techniques used to avoid thrombosis during surgery are discussed.Conclusions. First, the status of the transverse and sigmoid sinuses should be documented using MR venography before patients undergo posterior fossa surgery. Second, thrombosis of a transverse or sigmoid sinus may not be tolerated even if the sinus is nondominant; vision-threatening pseudotumor cerebri may result. Third, MR venography is a reliable, noninvasive means of evaluating the venous sinuses. Fourth, if the diagnosis is made shortly after thrombosis, then direct endovascular thrombolysis with urokinase may be a therapeutic option. If the presentation is delayed, then ophthalmological complications of pseudotumor cerebri can be avoided by administration of a combination of acetazolamide, dexamethasone, lumbar puncture, and possibly lumboperitoneal shunt placement.

Transkull focal lesions in cat brain produced by ultrasound

1981 ◽  
Vol 54 (5) ◽  
pp. 659-663 ◽  
Author(s):  
Francis J. Fry ◽  
Stephen A. Goss ◽  
James T. Patrick
Keyword(s):  
Focused Ultrasound ◽  
Ultrasonic Beam ◽  
Acoustical Parameters ◽  
Focal Lesions ◽  
Content Type ◽  
Histological Appearance ◽  
Cat Brain ◽  
Ultrasonic Techniques ◽  
Formalin Fixed ◽  
Fine Print

✓ Focused ultrasound has been used for focal modifications of brain tissue and in preliminary studies of the application of ultrasonic techniques for tissue modification in human stereotaxic neurosurgery; however, the technique has been seriously compromised by the necessity of removal of intervening skull. Such removal was necessary to avoid distortion and extremely large attenuation of the ultrasonic beam which resulted from passage through bone. Recent studies have shown that under proper conditions focal beams of ultrasound can be transmitted with tolerable distortion and attenuation through skull, suggesting the possibility of transkull lesion production in brain. This report describes the acoustical parameters and histological features of focal brain lesions produced in 10 craniectomized cats with intense focal ultrasonic beams which first had passed through a formalin-fixed human skull overlay. The histological appearance of these lesions produced to date is similar to that produced previously without intervening skull.

Anatomical data on the craniocervical junction and their correlation with degenerative changes in 30 cadaveric specimens

2005 ◽  
Vol 3 (5) ◽  
pp. 379-385 ◽  
Author(s):  
Stefan A. König ◽  
Axel Goldammer ◽  
Hans-Ekkehart Vitzthum
Keyword(s):  
Articular Cartilage ◽  
Articular Surface ◽  
Craniocervical Junction ◽  
Degenerative Changes ◽  
Content Type ◽  
Articular Surfaces ◽  
Anatomical Data ◽  
Grade Ii ◽  
Grade Iii ◽  
Fine Print

>Object. The goal of this project was to measure vertebral dimensions at the craniocervical junction and to investigate degenerative changes in this region and their correlations with the anatomical data. These studies will assist in an understanding of biomechanical conditions in this region, which are clinically relevant in cases of cervicogenic headaches and vertigo. Methods. The authors examined 30 cadaveric specimens obtained from patients ranging in age from 24 to 88 years at death. Measurements of angles of the vertebrae were conducted using an imprint method. Microsections of osseous endplates and articular cartilage were graded according to their degrees of degeneration by using the Petersson classification (0, no sign of degeneration; I, superficial degeneration with several fragmentations; II, deeper degeneration with cartilaginous disintegration and penetrating ulceration; or III, complete cartilaginous degeneration with the appearance of subchondral bone in > 50% of the articular surface). The authors found Grade I changes in 100% of the occiput specimens. In the superior articular cartilage of C-1 no changes (Grade 0) were found in two specimens, whereas 6% of the specimens exhibited Grade II changes and 89% exhibited Grade I changes. In the inferior articular cartilage of C-1, 57% of the specimens displayed Grade I changes, 14% Grade II, and 20% Grade III changes. In the superior articular cartilage of C-2, 62.5% of the specimens displayed Grade I changes and 25% Grade II changes. At the occiput—C1 level the authors found a higher frequency of degeneration at the upper left articular surface of the atlas (Quadrants 1 and 3), and at the C1–2 level they found a higher frequency of degeneration at the upper left and upper right articular surfaces of the axis (Quadrants 2 and 3, respectively). Using the McNemar test, the authors investigated the frequency of affection of single quadrants in a left—right side comparison (lateral reversal). Significant differences were identified for Quadrant 2 of the upper left articular surface of C-2 and Quadrant 3 of the upper right articular surface of C-2. These results correlate with the analysis of single articular surfaces of the axis, but contradict the results for the atlas, in which no significant difference in the left—right side comparison was found. Conclusions. Severe degeneration in the atlantooccipital joints appears to be a rare condition, with no Grade II or III degeneration found in the occipital condyles and 6% Grade I, 89% Grade II, but no Grade III changes in the superior articular cartilage of the atlas. Degeneration of the inferior articular cartilage of C-1 and the superior articular cartilage of C-2 indicates that the atlantoaxial joint faces more intense mechanical exposure, which is increased at the upper joint surfaces.

Congenital arthrogryposis associated with atlantoaxial subluxation and dysraphic abnormalities

2000 ◽  
Vol 93 (1) ◽  
pp. 130-132
Author(s):  
Wolf O. Luedemann ◽  
Marcos S. Tatagiba ◽  
Sami Hussein ◽  
Madjid Samii
Keyword(s):  
Traffic Accident ◽  
Craniocervical Junction ◽  
Atlantoaxial Subluxation ◽  
Arthrogryposis Multiplex Congenita ◽  
Good Clinical Outcome ◽  
Content Type ◽  
Dorsal Stabilization ◽  
A Minor ◽  
Transoral Decompression ◽  
Fine Print

✓ The authors report the case of a 27-year-old woman with an arthrogryposis multiplex congenita (AMC) associated with atlantoaxial subluxation. To the authors' knowledge, this is the first report of its kind. The authors review the literature with reference to dysraphic abnormalities associated with atlantoaxial subluxation and with AMC. The patient presented with severe tetraparesis following a minor traffic accident. She underwent a procedure in which transoral decompression and dorsal stabilization were performed and, postoperatively, made a good clinical outcome. The authors stress the need for diagnostic neuroimaging of the craniocervical junction in patients with AMC.

Transcranial surgical approaches to the orbital part of the optic nerve: an anatomical study

1986 ◽  
Vol 65 (1) ◽  
pp. 44-47 ◽  
Author(s):  
Samuil M. Blinkov ◽  
Gabib A. Gabibov ◽  
Vassiliy A. Tcherekayev
Keyword(s):  
Optic Nerve ◽  
Anatomical Study ◽  
Surgical Approaches ◽  
Content Type ◽  
Orbital Part ◽  
Fine Print

✓ The authors have identified and described three transcranial approaches to the intraorbital portion of the optic nerve. The structures encountered in these approaches are demonstrated under magnification in cadavers, and the exposure of the optic nerve is discussed.

Dural arteriovenous shunts at the craniocervical junction

1998 ◽  
Vol 89 (5) ◽  
pp. 755-761 ◽  
Author(s):  
Hiroyuki Kinouchi ◽  
Kazuo Mizoi ◽  
Akira Takahashi ◽  
Yoshihide Nagamine ◽  
Keiji Koshu ◽  
...  
Keyword(s):  
Venous Drainage ◽  
Craniocervical Junction ◽  
Vertebral Angiography ◽  
Content Type ◽  
Arteriovenous Shunts ◽  
Dural Arteriovenous Shunts ◽  
Intradural Space ◽  
Tomography Scanning ◽  
Fine Print

Object. A retrospective analysis was conducted of 10 patients (three women and seven men) who were treated for spinal dural arteriovenous shunts (AVSs) located at the craniocervical junction. This analysis was performed to evaluate the characteristics of this unusual location in contrast with those of the more common thoracic and lumbar AVSs. Methods. Seven patients presented with subarachnoid hemorrhage (SAH) and one with slowly progressive quadriparesis and dyspnea due to myelopathy. The other two cases were detected incidentally and included a transverse—sigmoid dural AVS and a cerebellar arteriovenous malformation. Angiographic studies revealed that the spinal dural AVSs at the C-1 and/or C-2 levels were fed by the dural branches of the radicular arteries that coursed from the vertebral artery and drained into the medullary veins. Venous drainage was caudally directed in the patient with myelopathy. In contrast, the shunt flow drained mainly into the intracranial venous system in patients with SAH. Furthermore, in four of these patients a varix was found on the draining vein. In all patients, the draining vein was interrupted surgically at the point at which this vessel entered the intradural space, using intraoperative digital subtraction angiography to monitor flow. The postoperative course was uneventful in all patients and no recurrence was confirmed on follow-up angiographic studies obtained in seven patients at 6 months after discharge. Conclusions. If computerized tomography scanning shows SAH predominantly in the posterior fossa and no abnormalities are found on intracranial four-vessel angiographic study, proximal vertebral angiography should be performed to detect dural AVS at the craniocervical junction. The results of surgical intervention for this disease are quite satisfactory.

Computerized tomography of cranial sutures

1984 ◽  
Vol 61 (1) ◽  
pp. 53-58 ◽  
Author(s):  
Yoshimi Furuya ◽  
Michael S. B. Edwards ◽  
Charles E. Alpers ◽  
Brian M. Tress ◽  
Douglas K. Ousterhout ◽  
...  
Keyword(s):  
High Resolution ◽  
Computerized Tomography ◽  
Developmental Changes ◽  
Cranial Sutures ◽  
Skull Fractures ◽  
Anatomical Structures ◽  
Content Type ◽  
Print Knowledge ◽  
Tomography Scanning ◽  
Fine Print

✓ Knowledge of normal suture anatomy and development is vital in order to understand abnormal suture development and to be able to distinguish sutures radiographically from normal anatomical structures and possible skull fractures. The anatomy of the sutures and synchrondroses of 150 normal pediatric and adult patients was studied using high-resolution computerized tomography scanning. Sutures of both the calvaria and skull base were most accurately identified in axial and coronal high-resolution thin-section scans when bone window algorithms were used. Developmental changes of the sutures and synchodroses, the inner and outer tables, and the diploic space were all well delineated. Vault sutures could be identified routinely in children, but their presence in adults varied considerably. With increasing age, parasutural sclerosis developed and sutures were more closely apposed.

Inclination of the odontoid process in the pediatric Chiari I malformation

2003 ◽  
Vol 98 (1) ◽  
pp. 43-49 ◽  
Author(s):  
R. Shane Tubbs ◽  
John C. Wellons ◽  
Jeffrey P. Blount ◽  
Paul A. Grabb ◽  
W. Jerry Oakes
Keyword(s):  
Odontoid Process ◽  
Postoperative Outcome ◽  
Craniocervical Junction ◽  
Foramen Magnum ◽  
Chiari I Malformation ◽  
Magnetic Resonance Images ◽  
Posterior Aspect ◽  
Content Type ◽  
Chiari I ◽  
Fine Print

Object. The quantitative analysis of odontoid process angulation has had scant attention in the Chiari I malformation population. In this study the authors sought to elucidate the correlation between posterior angulation of the odontoid process and patients with Chiari I malformation. Methods. Magnetic resonance images of the craniocervical junction obtained in 100 children with Chiari I malformation and in 50 children with normal intracranial anatomy (controls) were analyzed. Specific attention was focused on measuring the degree of angulation of the odontoid process and assigning a score to the various degrees. Postoperative outcome following posterior cranial fossa decompression was then correlated to grades of angulation. Other measurements included midsagittal lengths of the foramen magnum and basiocciput, the authors' institutions' previously documented pB—C2 line (a line drawn perpendicular to one drawn between the basion and the posterior aspect of the C-2 body), level of the obex from a midpoint of the McRae line, and the extent of tonsillar herniation. Higher grades of odontoid angulation (retroflexion) were found to be more frequently associated with syringomyelia and particularly holocord syringes. Higher grades of angulation were more common in female patients and were often found to have obices that were caudally displaced greater than three standard deviations below normal. Conclusions. These results not only confirm prior reports of an increased incidence of a retroflexed odontoid process in Chiari I malformation but quantitatively define grades of inclination. Grades of angulation were not found to correlate with postoperative outcome. It is the authors' hopes that these data add to our current limited understanding of the mechanisms involved in hindbrain herniation.

The suboccipital cavernous sinus

1997 ◽  
Vol 86 (2) ◽  
pp. 252-262 ◽  
Author(s):  
Kenan I. Arnautović ◽  
Ossama Al-Mefty ◽  
T. Glenn Pait ◽  
Ali F. Krisht ◽  
Muhammad M. Husain
Keyword(s):  
Cavernous Sinus ◽  
Internal Carotid ◽  
Microsurgical Anatomy ◽  
Transverse Foramen ◽  
Cross Sectional ◽  
Anatomical Structures ◽  
Content Type ◽  
Arterial Walls ◽  
Pathological Conditions ◽  
Fine Print

✓ The authors studied the microsurgical anatomy of the suboccipital region, concentrating on the third segment (V3) of the vertebral artery (VA), which extends from the transverse foramen of the axis to the dural penetration of the VA, paying particular attention to its loops, branches, supporting fibrous rings, adjacent nerves, and surrounding venous structures. Ten cadaver heads (20 sides) were fixed in formalin, their blood vessels were perfused with colored silicone rubber, and they were dissected under magnification. The authors subdivided the V3 into two parts, the horizontal (V3h) and the vertical (V3v), and studied the anatomical structures topographically, from the superficial to the deep tissues. In two additional specimens, serial histological sections were acquired through the V3 and its encircling elements to elucidate their cross-sectional anatomy. Measurements of surgically and clinically important features were obtained with the aid of an operating microscope. This study reveals an astonishing anatomical resemblance between the suboccipital complex and the cavernous sinus, as follows: venous cushioning; anatomical properties of the V3 and those of the petrous—cavernous internal carotid artery (ICA), namely their loops, branches, supporting fibrous rings, and periarterial autonomic neural plexus; adjacent nerves; and skull base locations. Likewise, a review of the literature showed a related embryological development and functional and pathological features, as well as similar transitional patterns in the arterial walls of the V3 and the petrous-cavernous ICA. Hence, due to its similarity to the cavernous sinus, this suboccipital complex is here named the “suboccipital cavernous sinus.” Its role in physiological and pathological conditions as they pertain to various clinical and surgical implications is also discussed.

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