scholarly journals Drainage patterns of the superficial middle cerebral vein: Effects on perioperative managements of petroclival meningioma

2015 ◽  
Vol 6 (1) ◽  
pp. 130 ◽  
Author(s):  
Masafumi Fukuda ◽  
Akihiko Saito ◽  
Tetsuro Takao ◽  
Tetsuya Hiraishi ◽  
Naoki Yajima ◽  
...  
Keyword(s):  
Cerebral Vein ◽  
Petroclival Meningioma ◽  
Drainage Patterns ◽  
Superficial Middle Cerebral Vein

scholarly journals Various patterns of the middle cerebral vein and preservation of venous drainage during the anterior transpetrosal approach

2016 ◽  
Vol 124 (2) ◽  
pp. 432-439 ◽  
Author(s):  
Shunsuke Shibao ◽  
Masahiro Toda ◽  
Maaya Orii ◽  
Hirokazu Fujiwara ◽  
Kazunari Yoshida
Keyword(s):  
Venous Drainage ◽  
Anatomical Variations ◽  
Cerebral Vein ◽  
Drainage Patterns ◽  
Anterior Transpetrosal Approach ◽  
Superficial Middle Cerebral Vein ◽  
Anterior Petrosectomy ◽  
Type 3

OBJECT The drainage of the superficial middle cerebral vein (SMCV) has previously been classified into 4 subtypes. Extradural procedures and dural incisions during the anterior transpetrosal approach (ATPA) may interrupt the route of drainage from the SMCV. In this study, the authors examined the relationship between anatomical variations in the SMCV and the corresponding surgical modifications to the ATPA that are necessary for venous preservation. METHODS This study included 48 patients treated via the ATPA in whom the SMCV was examined using 3D CT venography. The drainage patterns of the SMCV were classified into 3 types: cavernous or absent (Type 1), sphenobasal (Type 2), and sphenopetrosal (Type 3). Type 2 was subdivided into medial (Type 2a) and lateral (Type 2b), and Type 3 was subdivided into vein (Type 3a), vein and sinus (Type 3b), and sinus (Type 3c). The authors performed 3 ATPA modifications to preserve the SMCV: epidural anterior petrosectomy with subdural visualization of the sphenobasal vein (SBV), modification of the dural incision, and subdural anterior petrosectomy. Standard ATPA can be performed with Type 1, Type 2a, and Type 3a drainage. With Type 2b drainage, an epidural anterior petrosectomy with subdural SBV visualization is appropriate. The dural incision should be modified in Type 3b. With Type 3c, a subdural anterior petrosectomy is required. RESULTS The frequency of each type was 68.7% (33/48) in Type 1, 8.3% (4/48) in Type 2a, 4.2% (2/48) in Type 2b, 14.6% (7/48) in Type 3a, 2.1% (1/48) in Type 3b, and 2.1% (1/48) in Type 3c. No venous complications were found. CONCLUSIONS The authors propose an SMCV modified classification based on ATPA modifications required for venous preservation.

scholarly journals Anatomic Variations of the Superficial Middle Cerebral Vein: Embryologic Aspects of the Regressed Embryonic Tentorial Sinus

2005 ◽  
Vol 11 (2) ◽  
pp. 115-122 ◽  
Author(s):  
J. I. Chung ◽  
Y. C. Weon
Keyword(s):  
Cavernous Sinus ◽  
Venous Drainage ◽  
Middle Cranial Fossa ◽  
Transverse Sinus ◽  
Cerebral Vein ◽  
Anatomic Variations ◽  
Drainage Patterns ◽  
Developmental Regression ◽  
Superficial Middle Cerebral Vein ◽  
Tentorial Sinus

The embryonic tentorial sinus usually regressses during postnatal development, but its typical prenatal drainage patterns and intradural anastomoses can be depicted as various developmental phenotypic representations. Here, we tried to clarify the variant types of the superficial middle cerebral vein (SMCV) associated with the embryonic tentorial sinus. Total 41 patients and 82 hemispheres were included in this study. CT angiography was performed in all patients as screening for cerebrovascular disease or other intracranial disorders. A separate workstation and 3D software were used to evaluate the cranial venous systems with 3D volume rendering techniques, thin-slice MIP images, and MPR techniques for the analysis of its complicated angioarchitecture. Variations of the SMCV were classified according to the developmental alterations of the embryonic tentorial sinus, including sphenoparietal sinus (cranial remnant of tentorial sinus), basal sinus (floor of middle cranial fossa), petrosal and caudal remnant of the tentorial sinus. Secondary intradural anastomoses of cavernous and superior petrosal sinuses were also evaluated for the efferent pathways. The most frequent type of remnant tentorial sinus, sphenoparietal sinus was present in 49% (40/82) of hemispheres examined. Other regressed patterns of embryonic tentorial sinus were also identified in 38% (31/82): nine caudal remnant type around the transverse sinus, 12 petrosal type, one basal type, five unclassified cases, and mixed type were found in four cases. Secondary intradural cavernous sinus anastomosis was seen in 44% (36/82), however the most prevalent pattern was no anastomosis (46/82) with cavernous sinus. Only one case of superior petrosal sinus anastomosis was found in this series associated with basal sinus type. Anatomic variations of SMCV can be clearly demonstrated with embryologic aspects of the tentorial sinus according to its developmental regression and postnatal secondary adaptations of cerebral venous drainage.

Combined Surgical and Endovascular Access of the Superficial Middle Cerebral Vein to Occlude a High-Grade Cavernous Dural Arteriovenous Fistula: Case Report

Neurosurgery ◽  
2011 ◽  
Vol 69 (2) ◽  
pp. E475-E482 ◽  
Author(s):  
Michael C. Hurley ◽  
Rudy J. Rahme ◽  
Andrew J. Fishman ◽  
H. Hunt Batjer ◽  
Bernard R. Bendok
Keyword(s):  
Arteriovenous Fistula ◽  
Dural Arteriovenous Fistula ◽  
Venous Drainage ◽  
Uneventful Recovery ◽  
Cerebral Vein ◽  
High Grade ◽  
Direct Puncture ◽  
Superficial Middle Cerebral Vein ◽  
Endovascular Approach ◽  
Cortical Venous Drainage

Abstract BACKGROUND AND IMPORTANCE: High-grade cavernous sinus (CS) dural arteriovenous fistulae with cortical venous drainage often have a malignant presentation requiring urgent treatment. In the absence of a venous access to the lesion, transarterial embolization can potentially cure these lesions; however, the high concentration of eloquent arterial territories adjacent to the fistula creates a precarious risk of arterial-arterial reflux. In such cases, a combined surgical and endovascular approach may provide the least invasive option. CLINICAL PRESENTATION: We describe a patient presenting with a venous hemorrhagic infarct caused by a high-grade CS dural arteriovenous fistula (Barrow type D caroticocavernous fistula) with isolated drainage via the superficial middle cerebral vein into engorged perisylvian cortical veins. No transfemoral or ophthalmic strategy was angiographically apparent, and the posterior location of the involved CS compartment mitigated a direct puncture. The patient underwent direct puncture of the superficial middle cerebral vein via an orbitozygomatic craniotomy and the CS was catheterized under fluoroscopic guidance. The CS was coil-embolized back into the distal superficial middle cerebral vein with complete obliteration of the fistula. The patient did well with no new deficits and made an uneventful recovery. CONCLUSION: This novel combined open surgical and endovascular approach enables obliteration of a CS dural arteriovenous fistula with isolated cortical venous drainage and avoids the additional manipulation with direct dissection and puncture of the CS itself.

scholarly journals Venous Anatomy of the Sphenoparietal Sinus: Evaluation by MR Imaging

2007 ◽  
Vol 13 (1_suppl) ◽  
pp. 84-89 ◽  
Author(s):  
S. Takahashi ◽  
I. Sakuma ◽  
T. Otani ◽  
K. Yasuda ◽  
N. Tomura ◽  
...  
Keyword(s):  
Cavernous Sinus ◽  
Three Dimensional ◽  
Venous Sinus ◽  
Cerebral Vein ◽  
Venous Anatomy ◽  
Anterior Branch ◽  
Bony Canal ◽  
Superficial Middle Cerebral Vein ◽  
Magnetic Resonance Imaging Mri ◽  
Spgr Sequence

The termination of the superficial middle cerebral vein (SMCV) has been described as entering or being partially equivalent to the venous sinus coursing under the lesser sphenoid wing, which has classically been called the sphenoparietal sinus. However, the recent literature reports that the SMCV is not connected to the sphenoparietal sinus. In this study, the venous anatomy was evaluated to clarify the anatomy of the sphenoparietal sinus and the termination of the SMCV. Magnetic resonance imaging (MRI) was performed on 1.5-T superconductive units using a three-dimensional fast spoiled gradient-recalled acquisition in the steady state (3-D fast SPGR) sequence with fat suppression in a total of 48 sides of 24 patients. Coronal source images and reconstructed axial images were displayed on the Advantage Window Console, and connections to the cavernous sinus were then evaluated for the venous sinus coursing under the lesser sphenoid wing (hereafter called the sinus of the lesser sphenoid wing), the middle meningeal vein, and the SMCV. The following findings were observed bilaterally in all patients. The sinus of the lesser sphenoid wing was connected medially with the cavernous sinus and laterally with the anterior branch of the middle meningeal vein near the pterion. The anterior branch of the middle meningeal vein entered the bony canal laterally above the junction with the sinus of the lesser sphenoid wing and coursed along the inner table of the skull or emerged into the diploic vein, indicating its parietal portion. Although the termination of the SMCV had several patterns, the SMCV was not connected with the sinus of the lesser sphenoid wing in any of the patients. The sphenoparietal sinus is considered to consist of the sinus of the lesser sphenoid wing and the parietal portion of the anterior branch of the middle meningeal vein; these were identified as venous structures distinct to the SMCV.

Squamosal type superficial middle cerebral vein: A rare venous drainage pattern

2012 ◽  
Vol 60 (5) ◽  
pp. 546 ◽  
Author(s):  
PS Chandra ◽  
DipankerS Mankotia ◽  
Manjari Tripathi ◽  
Ajay Garg ◽  
AshokK Mahapatra ◽  
...  
Keyword(s):  
Venous Drainage ◽  
Cerebral Vein ◽  
Drainage Pattern ◽  
Superficial Middle Cerebral Vein

scholarly journals Prognostic Evaluation Based on Cortical Vein Score Difference in Stroke

Stroke ◽  
2013 ◽  
Vol 44 (10) ◽  
pp. 2748-2754 ◽  
Author(s):  
Rajsrinivas Parthasarathy ◽  
Mahesh Kate ◽  
Jeremy L. Rempel ◽  
David S. Liebeskind ◽  
Thomas Jeerakathil ◽  
...  
Keyword(s):  
Ct Angiography ◽  
Odds Ratio ◽  
Arterial Occlusion ◽  
Venous Drainage ◽  
Cerebral Vein ◽  
Anterior Circulation ◽  
Prognostic Evaluation ◽  
Cortical Vein ◽  
Score Difference ◽  
Superficial Middle Cerebral Vein

Background and Purpose— Multimodal imaging in acute ischemic stroke defines the extent of arterial collaterals, resultant penumbra, and associated infarct core, yet limitations abound. We identified superficial and deep venous drainage patterns that predict outcomes in patients with a proximal arterial occlusion of the anterior circulation. Methods— An observational study that used computed tomography (CT) angiography to detail venous drainage in a consecutive series of patients with a proximal anterior circulation arterial occlusion. The principal veins that drain the cortex (superficial middle cerebral, vein of Trolard, vein of Labbé, and basal vein of Rosenthal) and deep structures were scored with a categorical scale on the basis of degree of contrast enhancement. The Prognostic Evaluation based on Cortical vein score difference In Stroke score encompassing the interhemispheric difference of the composite scores of the veins draining the cortices (superficial middle cerebral+vein of Trolard+vein of Labbé+basal vein of Rosenthal) was analyzed with respect to 90-day modified Rankin Scale outcomes. Results— Thirty-nine patients were included in the study. A Prognostic Evaluation based on Cortical vein score difference In Stroke score of 4 to 8 accurately predicted poor outcomes (modified Rankin Scale, 3–6; odds ratio, 20.53; P <0.001). On stepwise logistic regression analyses adjusted for CT Alberta stroke program early CT score, CT angiography collateral grading and National Institutes of Health Stroke Scale score, a Prognostic Evaluation based on Cortical vein score difference In Stroke score of 4 to 8 (odds ratio, 23.598; P =0.009) and an elevated admission National Institutes of Health Stroke Scale (odds ratio, 1.423; P =0.023) were independent predictors of poor outcome. Conclusions— The Prognostic Evaluation based on Cortical vein score difference In Stroke score, a novel measure of venous enhancement on CT angiography, accurately predicts clinical outcomes. Venous features on computed tomography angiography provide additional characterization of collateral perfusion and prognostication in acute ischemic stroke.

Deep venous communication in vein of Galen malformations: incidence, Imaging, and Implications for treatment

2020 ◽  
pp. neurintsurg-2020-016224
Author(s):  
Hans Kortman ◽  
Ershad Navaei ◽  
Charles A Raybaud ◽  
Kartik Dev Bhatia ◽  
Manohar Shroff ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Venous Drainage ◽  
Cerebral Vein ◽  
Cerebral Veins ◽  
Vein Of Galen ◽  
Mri Imaging ◽  
Alternative Pathways ◽  
Sagittal Sinus ◽  
Drainage Patterns ◽  
Optimal Quality

BackgroundFailure to appreciate deep venous drainage pathways is a major cause of severe complications in the endovascular treatment of vein of Galen aneurysmal malformations (VOGMs).ObjectiveTo report deep venous drainage patterns in patients with VOGM, emphasizing the internal cerebral veins, and to describe the challenges in evaluating these.MethodsPatients with VOGM presenting to our institute between 2000 and 2018 were retrospectively analyzed. Patients with complete and good quality imaging datasets were included in the study. Three neuroradiologists with expertise in the subject independently analyzed the deep venous drainage patterns on multi-sequence MRI and digital subtraction angiography. Follow-up imaging studies were analyzed for alterations in deep venous drainage patterns that occurred following endovascular treatment. Descriptive statistics were used to report findings.ResultsTwenty-three patients had optimal quality MRI imaging and 25 had optimal quality DSA imaging available. In 14/23 (61%) patients, internal cerebral vein (ICV) communication could be reliably identified on MRI and in 8/25 (32%) patients on DSA. Deep venous communication with the VOGM was demonstrated in 8/26 (30.8%) patients. One (3.8%) patient demonstrated ICV communication with the VOGM only on postoperative imaging, while in 2 (8%) patients the ICV drainage route changed from VOGM to alternative pathways after the procedure. Other variant pathways included lateral mesencephalic vein, superior or inferior sagittal sinus, anterior mesencephalic vein, tentorial sinus, deep Sylvian vein, and superior vermian vein.ConclusionICV communication with the VOGM is not uncommon and requires dedicated preprocedural imaging to identify it. However, there are significant challenges in assessing this communication in the presence of high-flow fistulae, vessel tortuosity and size, and contrast limitations in this population.

Transcortical Venous Approach for Direct Embolization of a Cavernous Sinus Dural Arteriovenous Fistula: Technical Case Report

2011 ◽  
Vol 70 (suppl_2) ◽  
pp. onsE343-onsE348 ◽  
Author(s):  
Navjot Chaudhary ◽  
Stephen P. Lownie ◽  
Miguel Bussière ◽  
David M. Pelz ◽  
David Nicolle
Keyword(s):  
Cavernous Sinus ◽  
Transarterial Embolization ◽  
Middle Cranial Fossa ◽  
External Carotid ◽  
Cerebral Vein ◽  
Arteriovenous Fistulas ◽  
Coil Occlusion ◽  
Superficial Middle Cerebral Vein ◽  
Cortical Venous Reflux ◽  
Cranial Fossa

ABSTRACT BACKGROUND AND IMPORTANCE: Dural arteriovenous fistulas (dAVFs) represent 10% to 15% of all intracranial arteriovenous malformations. Most often, embolization is accomplished with transfemoral catheter techniques. We present a case in which embolization of a cavernous sinus dAVF was made possible through transcranial cannulation of a cortical draining vein. CLINICAL PRESENTATION: An 82-year-old woman presented with diplopia, left sixth cranial nerve palsy, intraocular hypertension, and bilateral chemosis. Angiography revealed a complex cavernous dAVF with cortical venous reflux, supplied by both external carotid arteries and the left meningohypophyseal trunk. Percutaneous transvenous access failed, and only partial occlusion was achieved by transarterial embolization. A frontotemporal craniotomy was performed to access the superficial middle cerebral vein in the left sylvian fissure. Under fluoroscopic guidance, a microcatheter was advanced through this vein to the floor of the middle cranial fossa and into the dAVF, permitting coil occlusion. CONCLUSION: This transcranial vein technique may be a useful adjunct in dAVF therapy when percutaneous transarterial or transvenous approaches fail or are not possible.

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