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.

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.

Dural arteriovenous fistula of the anterior condylar confluence and hypoglossal canal mimicking a jugular foramen tumor

2008 ◽  
Vol 109 (2) ◽  
pp. 335-340 ◽  
Author(s):  
James K. Liu ◽  
Kelly Mahaney ◽  
Stanley L. Barnwell ◽  
Sean O. McMenomey ◽  
Johnny B. Delashaw
Keyword(s):  
Nerve Palsy ◽  
Hypoglossal Nerve ◽  
Transarterial Embolization ◽  
Jugular Foramen ◽  
Jugular Bulb ◽  
Venous Plexus ◽  
Hypoglossal Nerve Palsy ◽  
Hypoglossal Canal ◽  
Arteriovenous Fistulas ◽  
Dural Arteriovenous Fistulas

The anterior condylar confluence (ACC) is located on the external orifice of the canal of the hypoglossal nerve and provides multiple connections with the dural venous sinuses of the posterior fossa, internal jugular vein, and the vertebral venous plexus. Dural arteriovenous fistulas (DAVFs) of the ACC and hypoglossal canal (anterior condylar vein) are extremely rare. The authors present a case involving an ACC DAVF and hypoglossal canal that mimicked a hypervascular jugular bulb tumor. This 53-year-old man presented with right hypoglossal nerve palsy. A right pulsatile tinnitus had resolved several months previously. Magnetic resonance imaging demonstrated an enhancing right-sided jugular foramen lesion involving the hypoglossal canal. Cerebral angiography revealed a hypervascular lesion at the jugular bulb, with early venous drainage into the extracranial vertebral venous plexus. This was thought to represent either a glomus jugulare tumor or a DAVF. The patient underwent preoperative transarterial embolization followed by surgical exploration via a far-lateral transcondylar approach. At surgery, a DAVF was identified draining into the ACC and hypoglossal canal. The fistula was surgically obliterated, and this was confirmed on postoperative angiography. The patient's hypoglossal nerve palsy resolved. Dural arteriovenous fistulas of the ACC and hypoglossal canal are rare lesions that can present with isolated hypoglossal nerve palsies. They should be included in the differential diagnosis of hypervascular jugular bulb lesions. The authors review the anatomy of the ACC and discuss the literature on DAVFs involving the hypoglossal canal.

Unusual Transoral Penetrating Injury of the Foramen Magnum: Case Report

Neurosurgery ◽  
2003 ◽  
Vol 53 (4) ◽  
pp. 989-991 ◽  
Author(s):  
Bradley J. Bartholomew ◽  
Charla Poole ◽  
Emilio C. Tayag
Keyword(s):  
Cerebrospinal Fluid ◽  
Unusual Case ◽  
Spinal Injury ◽  
Foramen Magnum ◽  
Penetrating Injuries ◽  
Computed Tomographic ◽  
Foreign Objects ◽  
Computed Tomographic Scan ◽  
Posterior Pharynx ◽  
The Right

Abstract OBJECTIVE AND IMPORTANCE Penetrating injuries of the cranium and spine are frequent to the civilian neurosurgical practice. Although a variety of unusual objects have been reported, to our knowledge, there has never been a craniocerebral or spinal injury caused by a fish. An unusual case of transoral penetration of the foramen magnum by a billed fish is described. The history, radiographic studies, and treatment are presented. CLINICAL PRESENTATION A fisherman struck by a jumping fish initially presented with severe neck pain and stiffness, bleeding from the mouth, and a laceration in the right posterior pharynx. A computed tomographic scan of the cervical spine revealed a wedge-shaped, hyperdense object extending from the posterior pharynx into the spinal canal between the atlas and the occiput. Because of the time factor involved, the fisherman was brought directly to surgery for transoral removal of the object. INTERVENTION The patient was placed under general anesthesia, and with a tonsillar retractor, a kipner, and hand-held retractors, the object was visualized and identified as a fish bill. Further dissection above the anterior aspect of the atlas permitted removal of the object by means of a grabber from an arthroscopic set. No expression of cerebrospinal fluid was noted, and a Penrose drain was placed. CONCLUSION The patient was treated under the assumption that penetrating foreign objects in continuity with the cerebrospinal fluid space and the outside environment should be removed as soon as possible. The patient was provided appropriate antibiotics to treat potential infection of normal pharyngeal flora and organisms unique to the marine environment. The patient recovered and did not experience any residual neurological deficit.

Solitary Paraganglioma of the Hypoglossal Nerve: Case Report

Neurosurgery ◽  
2011 ◽  
Vol 68 (4) ◽  
pp. E1170-E1174 ◽  
Author(s):  
Kazim Raza ◽  
Chandrasekaran Kaliaperumal ◽  
Michael Farrell ◽  
John A. O'Dwyer ◽  
Christopher Pidgeon
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Hypoglossal Nerve ◽  
Jugular Foramen ◽  
Low Grade ◽  
Resonance Imaging ◽  
Stereotactic Radiation ◽  
Hypoglossal Canal ◽  
Suboccipital Craniotomy ◽  
History Of

Abstract BACKGROUND AND IMPORTANCE: We report the case history of solitary hypoglossal paraganglioma in a 64-year-old woman. The surgical difficulties encountered in the removal of this challenging tumor are discussed and as a literature review provided. CLINICAL PRESENTATION: A 64-year-old woman presented with a short history of dysphonia, occasional dysphagia, tinnitus, altered taste, and unilateral left-sided tongue wasting. On examination, there was left lower motor hypoglossal paralysis. Imaging showed a discrete enhancing lobulated mass, measuring 2 × 2 cm, in the region of the hypoglossal nerve extending into the hypoglossal canal suggestive of hypoglossal paraganglioma. A left dorsolateral suboccipital craniotomy was performed with the patient in the sitting position. The hypoglossal nerve appeared to be enlarged, and the jugular foramen was normal. Complete surgical debulking of the tumor was not attempted because of its vascular nature. The nerve was decompressed, and neuropathology confirmed a low-grade paraganglioma arising from the hypoglossal nerve. The patient was scheduled to receive stereotactic radiation for further management. CONCLUSION: When a case of solitary hypoglossal paraganglioma is encountered in clinical practice, the aim of management should be mainly focused on achieving a diagnosis and preserving the hypoglossal nerve function. If there is evidence of vascularity in the lesion noted on magnetic resonance imaging, a preoperative angiogram should be obtained with a view for embolization. We decompressed the hypoglossal canal and achieved good improvement in the patient's symptoms. We recommend stereotactic radiosurgery for remnant and small hypoglossal tumors and regular follow-up with magnetic resonance imaging scans.

Abstract 1122‐000232: The Importance of Performing Venous Pressure Measurements Following Venous Sinus Stenting for Idiopathic Intracranial Hypertension

2021 ◽  
Vol 1 (S1) ◽  
Author(s):  
Yazan Radaideh
Keyword(s):  
Pressure Gradient ◽  
Intracranial Hypertension ◽  
Stent Placement ◽  
Idiopathic Intracranial Hypertension ◽  
Venous Pressure ◽  
Sigmoid Sinus ◽  
Venous Sinus ◽  
Pressure Measurements ◽  
Sinus Stenosis ◽  
The Right

Introduction : Although venous sinus stenting is an established treatment for medically refractory idiopathic intracranial hypertension, a subset of patients shows little or no improvement of symptoms after stenting. While this could be related to a number of factors, failure to sufficiently address the pressure gradient is one that can be recognized during the treatment procedure. We describe two patients who had a persistent venous pressure gradient after stent placement. Once identified, a second stent was placed with subsequent resolution of the pressure gradient. Methods : This retrospective chart review identified patients at a single institution who underwent venous sinus stenting and required immediate placement of a second venous sinus stent for a persistent pressure gradient. Results : Two patients with refractory idiopathic intracranial hypertension underwent cerebral angiography with venous manometry. In the first patient, unilateral venous sinus stenosis was present with a maximum pressure of 50 mmHg, which only decreased to 30 mmHg after placement of a right transverse‐sigmoid sinus stent. Subsequent manometry revealed a persistent gradient between the superior sagittal sinus and the right transverse sinus, which resolved after placement of a second stent in this location. In the second patient, bilateral stenosis was observed at the transverse‐sigmoid sinus junction; the maximum venous pressure was 40 mmHg, and a gradient of 30 mmHg was measured at the right transverse‐sigmoid junction, where a venous sinus stent was placed. Venous sinus pressure measurements performed immediately after the stent placement demonstrated a persistent pressure gradient of 20 mmHg in the contralateral transverse‐sigmoid sinus junction, which resolved after contralateral stent placement. Both patients showed sustained improvement in their symptoms at 1 year follow up. Conclusions : In some patients with idiopathic intracranial hypertension and venous sinus stenosis, a single stent may not sufficiently reduce the pressure gradient. A second stent may be required; however, this is only detectable with post‐stent pressure measurements. Performing manometry after stent placement should be routinely performed in order to detect persistent venous pressure gradient.

scholarly journals Congenital choledochal cyst

1973 ◽  
Vol 13 (1) ◽  
pp. 31
Author(s):  
Heyder Bin Heyder
Keyword(s):  
Bile Duct ◽  
Choledochal Cyst ◽  
Medical Literature ◽  
Personal Contact ◽  
Congenital Choledochal Cyst ◽  
Unusual Condition ◽  
The Pacific ◽  
The Common ◽  
The Right ◽  
Upper Abdomen

Although congenital choledochal cyst, a localized dilatation of the common bile duct, is an unusual condition in many countries, it should be expected in any infant who presents the triad of jaundice, tumor and pain in the right upper abdomen. Not less than 500 cases have been reported in the medical literature. Recently it is pointed out, that the congenital chledochal cyst is more common in Japan than in Europe or American countries. A personal contact with the Japanese delegation attending the meeting of the Pacific Association of Pediatric Surgeons in Vancouver, May 1971, confirmed it.

scholarly journals Extracranial invasion of a recurrent, transformed anaplastic pleomorphic xanthoastrocytoma: a case report

2018 ◽  
Vol 45 (S1) ◽  
pp. S2-S3
Author(s):  
K.D. Langdon ◽  
D. Krivosheya ◽  
M.O. Hebb ◽  
B. Wehrli ◽  
L.C. Ang
Keyword(s):  
Posterior Fossa ◽  
Jugular Foramen ◽  
Jugular Bulb ◽  
Neck Mass ◽  
Pleomorphic Xanthoastrocytoma ◽  
Braf V600e ◽  
Rare Tumour ◽  
Who Grade ◽  
Original Tumour ◽  
The Right

Pleomorphic xanthoastrocytoma (PXA) is a rare tumour comprising <1% of all primary central nervous system tumours and the majority (~98%) occur supratentorially. We report on a 40-year-old female with a past medical history of a rare posterior fossa/cerebellar PXA who presented with a right-sided neck mass, decreased shoulder power and longstanding right tongue deviation with right-sided hemi-atrophy. The patient had prior tumour debulking. Recent MRI demonstrated an enhancing posterior fossa mass extending to the skull base at the jugular foramen and another mass in the upper neck along the jugular bulb with displacement and encasement of the right common carotid artery down to C5. Resection of the neck mass reveals an anaplastic PXA. The tumour has close approximation with adjacent peripheral nerves and is positive in 2 lymph nodes. Comparison with the original tumour molecular and immunohistochemical profiles reveals a conserved BRAF V600E mutation but the transformed malignant glioma now expresses dot-like EMA positivity and ATRX is completely lost (mutated). Transformation of a PXA (WHO Grade II) into an anaplastic PXA (WHO Grade III) has been well documented, but extracranial extension is extraordinarily rare. We report herein the first documented case of a posterior fossa PXA that underwent malignant transformation and extracranial invasion to the parapharyngeal space.

Scimitar syndrome associated with absence of the right pulmonary artery and a persistent primitive hepatic venous plexus

2005 ◽  
Vol 15 (2) ◽  
pp. 216-218 ◽  
Author(s):  
Gabriella Agnoletti ◽  
Damien Bonnet ◽  
Jacques De Blic
Keyword(s):  
Pulmonary Artery ◽  
Scimitar Syndrome ◽  
Venous Plexus ◽  
Caval Vein ◽  
Inferior Caval Vein ◽  
Right Pulmonary Artery ◽  
Unusual Variant ◽  
The Right

An 18-month-old boy, referred because of an infection of the airways, was found to have a right-sided heart, a hypoplastic right lung, absence of the right pulmonary artery, and persistence of the hepatic venous plexus. The benign association of this unusual variant of the scimitar syndrome and persistence of the hepatic venous plexus needs to be recognised in order to avoid extensive investigations and surgery involving the inferior caval vein.

scholarly journals Persistent Enlarged Occipital Sinus with Absent Unilateral Transverse Sinus

2019 ◽  
Vol 10 (03) ◽  
pp. 519-521
Author(s):  
Guru Dutta Satyarthee ◽  
Luis Rafael Moscote-Salazar ◽  
Amit Agrawal
Keyword(s):  
Rare Condition ◽  
Surgical Excision ◽  
Transverse Sinus ◽  
Venous Sinus ◽  
Occipital Sinus ◽  
Suboccipital Craniotomy ◽  
Acoustic Schwannoma ◽  
The Right ◽  
Dural Opening ◽  
Selection Of

AbstractThe occipital sinus may occasionally remain patent, but the incidence is extremely low and observed in less than 10% of cases. A persistent patent occipital sinus (POS) may be associated with other venous sinus abnormality. The absence of transverse sinus in association with POS is an extremely rare condition and not reported yet. The neuroradiologist, neurosurgeons, otolaryngologist, and neurologist must be aware of the possible existence of POS and other associated venous sinus anomaly, as its warrants very crucial modification of surgical planning, selection of appropriate approaches, and, additionally, may also critically limit the extent of surgical exposure of target, and may hinder intended extent of surgical excision of tumor and associated possibility of injury to POS, which may produce catastrophic hemorrhage, brain swelling, and neurosurgical morbidity. The authors report a 35-year-old male who underwent suboccipital craniotomy for right-side giant acoustic schwannoma. Following the raising bone flap, a markedly prominent, turgid, occipital sinus was observed, not placed exactly in the midline but deviated to the right side, causing further restraining of dural opening. Surgical nuances and intraoperative difficulty encountered along with pertinent literature is reviewed briefly.

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