Marginal sinus (foramen magnum)

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.

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Microsurgical Management of a Marginal Sinus Dural Arteriovenous Fistula: 2-Dimensional Operative Video

Operative Neurosurgery ◽

10.1093/ons/opab287 ◽

2021 ◽

Author(s):

Visish M Srinivasan ◽

Joshua S Catapano ◽

Fabio A Frisoli ◽

Michael A Mooney ◽

Michael T Lawton

Keyword(s):

Chronic Neck Pain ◽

Foramen Magnum ◽

Endovascular Embolization ◽

Venous Hypertension ◽

Indocyanine Green Videoangiography ◽

Marginal Sinus ◽

Arteriovenous Fistulas ◽

Full Resolution ◽

Complete Obliteration ◽

Life Threatening

Abstract Dural arteriovenous fistulas (DAVFs) are benign but may present with life-threatening hemorrhage or symptoms of venous hypertension (eg, progressive myelopathy).1-3 DAVFs follow well-described anatomic patterns.4 The marginal sinus is located between the layers of the dura, circumferentially around the foramen magnum. It communicates with the basal venous plexus of the clivus anteriorly and the occipital sinus posteriorly.5,6 Arterial supply to the dura in this region that fistulizes into the sinus arises from meningeal branches from the V3 or V4 segments. A man in his early 70s presented with chronic neck pain and new onset of left arm and face paresthesias. He had brisk patellar reflexes bilaterally and a marginal sinus DAVF, with numerous dilated veins around the cisterna magna, causing dorsal cervicomedullary compression. Angiography confirmed the diagnosis of DAVF rather than arteriovenous malformation. Endovascular embolization was considered, but surgery was preferable because of poor transarterial access. The patient underwent left far lateral craniotomy and C1 laminectomy with exposure of the condylar fossa. The dura was carefully elevated laterally, revealing a network of dilated tortuous veins, with multiple points of fistulous connection within the dura emanating in a large venous varix. Indocyanine green videoangiography showed the aberrant flow dynamics. The fistulous point was occluded with aneurysm clips on the venous side, then cauterized and interrupted. The patient was discharged within 3 d of surgery and had full resolution of symptoms at 6 wk. Angiography confirmed complete obliteration of the DAVF. The patient provided written informed consent for treatment. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.

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The Marginal Sinus Normal Anatomy and Involvement with Arteriovenous Fistulae

Interventional Neuroradiology ◽

10.1177/159101999600200307 ◽

1996 ◽

Vol 2 (3) ◽

pp. 215-221 ◽

Cited By ~ 2

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.

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