Natural History and Classification of Davf Second Case: SHA 1 2 3 4

Total Page:16

File Type:pdf, Size:1020Kb

Natural History and Classification of Davf Second Case: SHA 1 2 3 4 04.11.2019 • 63 yo • SHA • VII cn paresis , • Orbital pain • Dizziness Natural history and Salvatore Mangiafico Interventional Nurovascular unit classification of dAVF Careggi University Hospital Florence 12 34 second case: SHA 56 04.11.2019 Third Case: seizure 78 a problem is always made of several questions and its solution is always to anwser to each one of them • Is it a A‐V malformation ? • May this A‐V shunt explain the clincal presentation? the problem is how to treat it ? • Wich is its possible evolution ? • Where the A‐V shunt is it • Wich way to follow to occlude it ? 910 Dural Arterior Venous Fistulas (DAVF) are acquaided vascular «malformations» DAVF account for approximately 10–15% of all intracranial with un unknown aetiology or secondary vascular malformations due to trhombophilic state, phlogistitic or traumatic process in wich multiple 0.16 per 100 000 per year approximately 12.5%of all arteriovenous shunts develop inside dural intracranial AVMs vascular stuctures without the interposition of a malformative nidus. the mean age of presentation is between 50 and 60 years. DAVF are almost exclusively supplied by meningeal arteries arising from esternal , in Japan 0,29 a 100.000 su 1815 casi Acta Neuroch Suppl 2016 internal carotid and vertebral arteries and rarely from intracranial pial branches Venous drainage can be formed between dural sinus, cortical veins or both 11 12 04.11.2019 Etiopathogenesis : Neo vascularization and venous 3 theories Menigeal arteries have no connection dilatation are induced by an with the sinus and cortical veins (BV) inflammatory process 1)venous sinus occlusion precedes and is 2)DAVFs arise from naturally occurring dormant directly responsible for development of the channels between dural arteries and sinuses, which fistula. Venous sinus thrombosis results in the open when the sinus is occluded and venous pressure is release of angiogenic factors from increased(Pitonet al., 1984; Mullan, 1994). theorganizing thrombus, which subsequently leads to the invasion of small dural arteries and formation of small dural arterio venous 3) Venous hypertension may lead to tissue hypoxia shunts(Houseretal.,1979). and increased production of angiogenic factors, which promote endothelial proliferation and neoangiogenesis (Lawton et al., 1997; Tirakotai et al., 2004; Kojima et al., 2007). 13 14 sinus‐type DAV Fistulas no‐sinus type DAV Fistulas the inflammatory processes and the inflammatory processes throbososis effect a long segment of a and throbosis effect the dural dural sinus It starts from the wall segment of a bridging vein inside the sinus Opening of Dural AV Thrombosis of the EV shunt and increases the AV flow Sinus occlusion and penetration of dural Inside the Sinus and EV, reflux in BV arteries inside the Recruitment of other Recruitment of trans sinus Dural feeders osseus feeders 15 16 Hystology • Histologic studies suggests that microscopic thrombosis is always present and plays an important role in the release of growth factors and theformation o fDAVFs (Uranishi et al., 1999). Site od origin of the DAVF • In immuno‐histochemical studies, expression of basic fibroblast growth factor and vascular endothelial growth factor has been identified in the wall of the dural sinuses in patients withD AVFs (Teradaetal., 1996; Uranishi et al., 1999). 17 18 04.11.2019 • The exact site of the original lesion ( EV , DS , BV) may dictate the arterial CDAVF feeders of the lesions, their venous drainage pattern, and as a consequence, their tendency for a certain clinical behavior. • CDAVFs may develop in three distinct levels of the cranial venous system 3 • the bridging veins, BV ,(1) • the dural sinuses, DS ( 2) , • and the emissary veins, EV (3 ). 2 1 19 20 dural entrances of the BVs are 1) DAVF of the EV overlapped by a layer of ( osteodural sinus type DAVF) numerous small meningeal Emissary veins pass with cranial nerves through apertures in the cranial wall and veins and venous lacunae establish communication between the sinuses inside the skull and the veins external to it (arrowhead) • mastoid emissary vein • veins in the hypoglossal canal • The parietal emissary • Cavernous sinus • The occipital emissary vein • emissary veins of the middle fossa • posterior condylar vein through the foramen ovale, rotundum, lacerum, • temporal emissary • inferior petrosal sinus has also the • superficial petrosal vein position and function of an emissary • meningo‐orbital vein vein connecting the cavernous sinus with the jugular vein 21 22 2 ) DAVF of the SINUS wlall CDAVFs of an Emissary Vein (EV) pure sinus type DAVF • drain mostly to the sinus and not directly the cortical venous Periostal – dural sinus DAVF system Dural –dural sinus DAVF Sinus at the convexity • • Falcine sinus recruits additionally osseous • Superior sagittal sinus arterial feeders • Sinis rectus Base and posterior fossa sinus • adds“purely meningeal” • Tentorial sinus • Transverse sinus branches as the middle • Sigmoid sinus meningeal artery, posterior • Occipital sinus meningeal, or meningeal • branches of the ICA. Torcular 23 24 04.11.2019 3) DAVF of the BV( non‐sinus DAVF) (veno‐sinusal Junction) • The distal segment of a BV embryologically, anatomically, and histologically seems to be part of the dural system. • The BVs are closely attached to the inner dural surface and have a shorter or longer intradural course before they enter the sinus [75]. Therefore,from the embryological point of view, the distal BV segment, veno‐sinusal junction, appears to belong to the dural system. Tentorial sinus DAVF 25 26 Hui Han Neurosurgery 67; 2010 BV DAV shunt ( two subtypes) Comunicating vein • arteriovenous dural shunt can be primarily located on a bridging vein , the veno‐sinus junction is patent ; the A‐V fow is directed towards the sinus and mainly toward the pial vein • thrombosis of the venous –sinus Junction, the shunt venous drainage is exclusively cortical. a BV (arrow) from the occipital lobe (O) drains the BVs (arrows) directly entering the dural Disconneted bridging into the meningeal vein (arrowhead) in the sinuses (asterisks) in the middle cranial fossa. vein cerebral falx (F) before entering the SSS Arrowheads indicate the dural entrance sites (asterisk). vein) 27 28 Comunicanting BV Is the Sinus filling is syncronous with the BV’s 29 30 04.11.2019 Disconnected Bridging vein The Dural AV sunt is on the BV at the conjunction point with Sinus and it does not communicate with the sinus unique drainage trhotugh a pial vein that runs along the falx cerebri Sinus opacifization is delayed 31 32 The natural history of cranial dural arteriovenous malformations (AVM's) is highly variable Natural history • In adults the natural history of DAVFs is influenced by 1. the pattern of venous drainage 2. the presenting symptoms 3. localization 33 34 The natural history of cranial dural arteriovenous malformations (AVM's) is highly variable • In adults the natural history of DAVFs is influenced by 1. the pattern of venous drainage DAVFs without CVD 2. the presenting symptoms Sinus type DAVF 3. localization 35 36 04.11.2019 DAVF without CVD DAVF with CVD ( cerebral vein drainage) • a benign clinic course was observed in 98.5% of the patients • annual rate of conversion to a higher • Syntomatology : bruit grade DAVF of 1%‐1.5% angiographic progression to a more aggressive fistula • Managed conservatively • if treatment is contemplated it should not be too aggressive • Follow up of DAVF without VCD (Borden type I) fistulas is generally recommended Bridging vein type DAVF sinus type DAVF with CVD 37 38 • DAVFs that acquire cortical venin dreinage (CVD) can present with aggressive clinical features, including either ICH or nonhemorrhagic neurologic deficits (NHNDs) • The annual ICH, NHND, and related to focal or regional venous hypertension mortality rate was 7.6%, 11%, and • Or progressive clinical features 3.8% (Strom and colleagues (2009 in a dementia,seizures,parkinsonism,or ataxia due series of 28 patients with DAVFs with CVD) to cerebral edema or ischemia related to diffuse and extensive venous hypertension • annual ICH rate o f 8.1%,NHND rate (Barrow et al., 1985; Lasjaunias et al., 1986;Awad etal.,1990). of 6.9%, and a combined annual event rate of 15% • DAVFs draining into perimedullary spinal veins may cause myelopathy and progressive (Toronto Brain Vascular Malformation tetraplegia Group : 20 DAVFs with CVD that were followed over a 4‐year period ) (Hurst et al., 1999; Lv et al., 2011). 39 40 The natural history of cranial dural arteriovenous physiopathology malformations (AVM's) is highly variable Parenchimal Hem Parenchimal ischemia • In adults the natural history of DAVFs is influenced by ICH is believed to occur from rupture parenchymal ischemia is thought to occur from venous congestion and hypertension, of fragile parenchymal veins as a result 1. the pattern of venous drainage of exposure to increased pressure from Crhronic venous congestion prevents 2. the presenting symptoms retrograde venous reflux.. adequate arterial delivery of oxygen and removal of metabolic byproducts within the 3. localization surrounding parenchyma 41 42 04.11.2019 Difference in natural Hystory according to the clinical presentation • asymptmaic patients : Clinical features of CDVF presenting annual ICH, NHND, and mortality rate was 1.4%, 0%, and 0% with hemorrhage • symptomatic patients : • The vast majority of patients the annual ICH, NHND, and mortality rate was 7.6%, 11%, and 3.8% were male (86%), and the most respectively in common presenting symptom
Recommended publications
  • Why Should We Report Posterior Fossa Emissary Veins?
    Diagn Interv Radiol 2014; 20:78–81 NEURORADIOLOGY © Turkish Society of Radiology 2014 PICTORIAL ESSAY Why should we report posterior fossa emissary veins? Yeliz Pekçevik, Rıdvan Pekçevik ABSTRACT osterior fossa emissary veins pass through cranial apertures and par- Posterior fossa emissary veins are valveless veins that pass ticipate in extracranial venous drainage of the posterior fossa dural through cranial apertures. They participate in extracranial ve- sinuses. These emissary veins are usually small and asymptomatic nous drainage of the posterior fossa dural sinuses. The mas- P toid emissary vein, condylar veins, occipital emissary vein, in healthy people. They protect the brain from increases in intracranial and petrosquamosal sinus are the major posterior fossa emis- pressure in patients with lesions of the neck or skull base and obstructed sary veins. We believe that posterior fossa emissary veins can internal jugular veins (1). They also help to cool venous blood circulat- be detected by radiologists before surgery with a thorough understanding of their anatomy. Describing them using tem- ing through cephalic structures (2). Emissary veins may be enlarged in poral bone computed tomography (CT), CT angiography, patients with high-flow vascular malformations or severe hypoplasia or and cerebral magnetic resonance (MR) venography exam- inations results in more detailed and accurate preoperative aplasia of the jugular veins. They are associated with craniofacial syn- radiological interpretation and has clinical importance. This dromes (1, 3). Dilated emissary veins may cause tinnitus (4, 5). pictorial essay reviews the anatomy of the major and clini- We aim to emphasize the importance of reporting posterior fossa em- cally relevant posterior fossa emissary veins using high-reso- lution CT, CT angiography, and MR venography images and issary veins prior to surgeries that are related to the posterior fossa and discusses the clinical importance of reporting these vascular mastoid region.
    [Show full text]
  • Why Do Bridging Veins Rupture Into the Virtual Subdural Space?
    J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.47.2.121 on 1 February 1984. Downloaded from Journal of Neurology, Neurosurgery, and Psychiatry 1984;47:121-127 Why do bridging veins rupture into the virtual subdural space? T YAMASHIMA, RL FRIEDE From the Department ofNeuropathology, University of Gottingen, Gottingen, Federal Republic of Germany SUMMARY Electron microscopic data on human bridging veins show thin walls of variable thick- ness, circumferential arrangement of collagen fibres and a lack of outer reinforcement by arach- noid trabecules, all contributory to the subdural portion of the vein being more fragile than its subarachnoid portion. These features explain the laceration of veins and the subdural location of resultant haematomas. Most subdural haematomas due to venous bleeding walls are delicate, lacking muscle fibres, with only a have been attributed to lacerations in bridging veins. thin fibrous wall and a thin elastic lamina adjacent to These veins form short trunks passing directly from the endothelial layer. The conclusions of these two the brain to the dura mater, almost at right angles to authors, have gained wide acceptance, although guest. Protected by copyright. both. Between these two points, bridging veins take there was little evidence concerning the fragility of a straight course with no tortuosity to allow for the the vein walls. possible displacement of brain.' Trotter2 speculated The purpose of the present communication is to that subdural haematomas are invariably due to provide electron microscopic data on tissue fixed in trauma tearing large veins, an interpretation situ, which might throw some light on to the lacera- elaborated by Krauland.3 According to Leary,4 the tion mechanism of bridging veins and its relationship common sources of subdural haematomas are rup- to the development of subdural haematoma.
    [Show full text]
  • Gross Anatomy
    www.BookOfLinks.com THE BIG PICTURE GROSS ANATOMY www.BookOfLinks.com Notice Medicine is an ever-changing science. As new research and clinical experience broaden our knowledge, changes in treatment and drug therapy are required. The authors and the publisher of this work have checked with sources believed to be reliable in their efforts to provide information that is complete and generally in accord with the standards accepted at the time of publication. However, in view of the possibility of human error or changes in medical sciences, neither the authors nor the publisher nor any other party who has been involved in the preparation or publication of this work warrants that the information contained herein is in every respect accurate or complete, and they disclaim all responsibility for any errors or omissions or for the results obtained from use of the information contained in this work. Readers are encouraged to confirm the infor- mation contained herein with other sources. For example and in particular, readers are advised to check the product information sheet included in the package of each drug they plan to administer to be certain that the information contained in this work is accurate and that changes have not been made in the recommended dose or in the contraindications for administration. This recommendation is of particular importance in connection with new or infrequently used drugs. www.BookOfLinks.com THE BIG PICTURE GROSS ANATOMY David A. Morton, PhD Associate Professor Anatomy Director Department of Neurobiology and Anatomy University of Utah School of Medicine Salt Lake City, Utah K. Bo Foreman, PhD, PT Assistant Professor Anatomy Director University of Utah College of Health Salt Lake City, Utah Kurt H.
    [Show full text]
  • Dynamic Assessment of Venous Anatomy and Function in Neurosurgery with Real-Time Intraoperative Multimodal Ultrasound: Technical Note
    NEUROSURGICAL FOCUS Neurosurg Focus 45 (1):E6, 2018 Dynamic assessment of venous anatomy and function in neurosurgery with real-time intraoperative multimodal ultrasound: technical note Francesco Prada, MD,1,2 Massimiliano Del Bene, MD,1,3 Giovanni Mauri, MD,4 Massimo Lamperti, MD,5 Davide Vailati, MD,6 Carla Richetta, MD,7 Marco Saini, MD,1 Davide Santuari, MD,8 M. Yashar S. Kalani, MD, PhD,2 and Francesco DiMeco, MD1,9 1Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy; 2Department of Neurological Surgery, University of Virginia Health Science Center, Charlottesville, Virginia; Departments of 3Experimental Oncology and 4Radiology, European Institute of Oncology, Milan, Italy; 5Anesthesiology Unit, Cleveland Clinic, Abu Dhabi, United Arab Emirates; 6Anesthesiology Unit, Ospedale di Circolo di Melegnano, Presidio di Vizzolo Predabissi, Milan, Italy; 7Department of Neurosurgery, Sourasky Medical Center, Tel Aviv, Israel; 8Department of Vascular Surgery, Ospedale S. Carlo, Milan, Italy; and 9Department of Neurological Surgery, Johns Hopkins Medical School, Baltimore, Maryland The relevance of the cerebral venous system is often underestimated during neurosurgical procedures. Damage to this draining system can have catastrophic implications for the patient. Surgical decision-making and planning must consider each component of the venous compartment, from the medullary draining vein to the dural sinuses and extracranial veins. Intraoperative ultrasound (ioUS) permits the real-time study of venous compartments using different modalities, thus allowing complete characterization of their anatomical and functional features. The B-mode (brightness mode) offers a high-resolution anatomical representation of veins and their relationships with lesions. Doppler modalities (color, power, spectral) allow the study of blood flow and identification of vessels to distinguish their functional characteristics.
    [Show full text]
  • Dural Venous Channels: Hidden in Plain Sight–Reassessment of an Under-Recognized Entity
    Published July 16, 2020 as 10.3174/ajnr.A6647 ORIGINAL RESEARCH INTERVENTIONAL Dural Venous Channels: Hidden in Plain Sight–Reassessment of an Under-Recognized Entity M. Shapiro, K. Srivatanakul, E. Raz, M. Litao, E. Nossek, and P.K. Nelson ABSTRACT BACKGROUND AND PURPOSE: Tentorial sinus venous channels within the tentorium cerebelli connecting various cerebellar and su- pratentorial veins, as well as the basal vein, to adjacent venous sinuses are a well-recognized entity. Also well-known are “dural lakes” at the vertex. However, the presence of similar channels in the supratentorial dura, serving as recipients of the Labbe, super- ficial temporal, and lateral and medial parieto-occipital veins, among others, appears to be underappreciated. Also under-recog- nized is the possible role of these channels in the angioarchitecture of certain high-grade dural fistulas. MATERIALS AND METHODS: A retrospective review of 100 consecutive angiographic studies was performed following identification of index cases to gather data on the angiographic and cross-sectional appearance, location, length, and other features. A review of 100 consecutive dural fistulas was also performed to identify those not directly involving a venous sinus. RESULTS: Supratentorial dural venous channels were found in 26% of angiograms. They have the same appearance as those in the tentorium cerebelli, a flattened, ovalized morphology owing to their course between 2 layers of the dura, in contradistinction to a rounded cross-section of cortical and bridging veins. They are best appreciated on angiography and volumetric postcontrast T1- weighted images. Ten dural fistulas not directly involving a venous sinus were identified, 6 tentorium cerebelli and 4 supratentorial.
    [Show full text]
  • Anatomic Comparison of Veins of Labbé Between Autopsy, Digital Subtraction Angiography and Computed Tomographic Venography
    Fang et al. BioMed Eng OnLine (2017) 16:84 DOI 10.1186/s12938-017-0374-3 BioMedical Engineering OnLine RESEARCH Open Access Anatomic comparison of veins of Labbé between autopsy, digital subtraction angiography and computed tomographic venography Qiong Fang1, Anhong Jiang2, Wei Tao3* and Lin Xin4 *Correspondence: [email protected] Abstract 3 Department of Anatomy, Objective: The drainage portion of the vein of Labbé varies, and it is difcult to pre- School of Medicine, Anhui University of Science & dict whether the operation is likely to damage this vein. The aim of this study was to Technology, 25 Dongshan correlate the microanatomy of the vein of Labbé with digital subtraction angiography Road, Huainan 232001, China (DSA) and computed tomographic venography (CTV), in order to provide a basis for Full list of author information is available at the end of the the preservation of the vein of Labbé during a supratentorial surgical approach. article Methods: A total of 30 human cadavers (60 sides) and 61 living patients (110 sides) were examined in this study. Each cadaver head was injected with blue latex via the superior sagittal sinus and the internal jugular veins. The venograms of each patient were obtained from the venous phases of DSA (60 sides for 36 patients) or CTV (50 sides for 25 patients). Results: The patients were divided into four subgroups based on the location where a vein entered the dural sinus: the transverse sinus group, the tentorial group, the petrosal group, and the upper-transverse sinus group. The veins of Labbé in transverse sinus group and petrosal group directly entered dural sinus.
    [Show full text]
  • SŁOWNIK ANATOMICZNY (ANGIELSKO–Łacinsłownik Anatomiczny (Angielsko-Łacińsko-Polski)´ SKO–POLSKI)
    ANATOMY WORDS (ENGLISH–LATIN–POLISH) SŁOWNIK ANATOMICZNY (ANGIELSKO–ŁACINSłownik anatomiczny (angielsko-łacińsko-polski)´ SKO–POLSKI) English – Je˛zyk angielski Latin – Łacina Polish – Je˛zyk polski Arteries – Te˛tnice accessory obturator artery arteria obturatoria accessoria tętnica zasłonowa dodatkowa acetabular branch ramus acetabularis gałąź panewkowa anterior basal segmental artery arteria segmentalis basalis anterior pulmonis tętnica segmentowa podstawna przednia (dextri et sinistri) płuca (prawego i lewego) anterior cecal artery arteria caecalis anterior tętnica kątnicza przednia anterior cerebral artery arteria cerebri anterior tętnica przednia mózgu anterior choroidal artery arteria choroidea anterior tętnica naczyniówkowa przednia anterior ciliary arteries arteriae ciliares anteriores tętnice rzęskowe przednie anterior circumflex humeral artery arteria circumflexa humeri anterior tętnica okalająca ramię przednia anterior communicating artery arteria communicans anterior tętnica łącząca przednia anterior conjunctival artery arteria conjunctivalis anterior tętnica spojówkowa przednia anterior ethmoidal artery arteria ethmoidalis anterior tętnica sitowa przednia anterior inferior cerebellar artery arteria anterior inferior cerebelli tętnica dolna przednia móżdżku anterior interosseous artery arteria interossea anterior tętnica międzykostna przednia anterior labial branches of deep external rami labiales anteriores arteriae pudendae gałęzie wargowe przednie tętnicy sromowej pudendal artery externae profundae zewnętrznej głębokiej
    [Show full text]
  • The Human Central Nervous System
    The Human Central Nervous System A Synopsis and Atlas Bearbeitet von Rudolf Nieuwenhuys, Jan Voogd, Christiaan van Huijzen 4th ed. 2007. Buch. xiv, 967 S. Hardcover ISBN 978 3 540 34684 5 Format (B x L): 20,3 x 27,6 cm Weitere Fachgebiete > Psychologie > Allgemeine Psychologie / Grundlagenfächer > Biologische Psychologie, Neuropsychologie, Psychophysiologie Zu Inhaltsverzeichnis schnell und portofrei erhältlich bei Die Online-Fachbuchhandlung beck-shop.de ist spezialisiert auf Fachbücher, insbesondere Recht, Steuern und Wirtschaft. Im Sortiment finden Sie alle Medien (Bücher, Zeitschriften, CDs, eBooks, etc.) aller Verlage. Ergänzt wird das Programm durch Services wie Neuerscheinungsdienst oder Zusammenstellungen von Büchern zu Sonderpreisen. Der Shop führt mehr als 8 Millionen Produkte. 4 Blood Supply, Meninges and Cerebrospinal Fluid Circulation Introduction......................... 95 through the arachnoid villi to the venous sys- ArteriesoftheBrain................... 95 tem. The nervous tissue of the central nervous Meninges, Cisterns system and the CSF spaces remain segregated and Cerebrospinal Fluid Circulation ........110 from the rest of the body by barrier layers in Circumventricular Organs ................126 the meninges (the barrier layer of the arach- Veins of the Brain .....................126 noid), the choroid plexus (the blood-CSF bar- Vessels and Meninges of the Spinal Cord .....128 rier) and the capillaries (the blood-brain bar- rier). The circulation of the CSF plays an impor- tant role in maintaining the environment of the nervous tissue; moreover, the subarachnoidal space forms a bed that absorbs external shocks. Introduction The vascularization and the circulation of the Arteries of the Brain cerebrospinal fluid (liquor cerebrospinalis, CSF) of the brain and the spinal cord are of great clinical importance.
    [Show full text]
  • Structural and Mechanical Characterisation of Bridging Veins: a Review
    Structural and mechanical characterisation of bridging veins: a review Nele Famaeya,∗, Zhao Ying Cuia,∗, Grace Umuhire Musigazib, Jan Ivensc, Bart Depreitereb, Erik Verbekend, Jos Vander Slotena aBiomechanics Section, KU Leuven, Belgium bDepartment of Neurosurgery, University Hospital Gasthuisberg, KU Leuven, Belgium cComposite Materials Group, Department of Metallurgy and Materials Engineering, KU Leuven, Belgium dTranslational Cell & Tissue Research, KU Leuven, Belgium Abstract Bridging veins drain the venous blood from the cerebral cortex into the supe- rior sagittal sinus (SSS) and doing so they bridge the subdural space. Despite their importance in head impact biomechanics, little is known about their properties with respect to histology, morphology and mechanical behaviour. Knowledge of these characteristics is essential for creating a biofidelic finite element model to study the biomechanics of head impact, ultimately leading to the improved design of protective devices by setting up tolerance criteria. This paper presents a comprehensive review of the state-of-the-art knowledge on bridging veins. Tolerance criteria to prevent head injury through impact have been set by a number of research groups, either directly through impact experiments or by means of finite element (FE) simulations. Current state-of-the-art FE head models still lack a biofidelic representation of the bridging veins. To achieve this, a thorough insight into their nature and behaviour is re- quired. Therefore, an overview of the general morphology and histology is provided here, showing the clearly heterogeneous nature of the bridging vein complex, with its three different layers and distinct morphological and histo- logical changes at the region of outflow into the superior sagittal sinus.
    [Show full text]
  • The Development of Mammalian Dural Venous Sinuses with Especial Reference to the Post-Glenoid Vein
    J. Anat. (1967), 102, 1, pp. 33-56 33 With 12 figures Printed in Great Britian The development of mammalian dural venous sinuses with especial reference to the post-glenoid vein H. BUTLER Department ofAnatomy, University of Saskatchewan, Saskatoon, Canada The intracranial venous outflow of mammals drains into both the internal and external jugular veins and the relative role of these two veins varies between different adult mammals as well as at different phases of embryonic and foetal life. In general, the primary head vein (consisting of venae capitis medialis and lateralis and their tributaries) gives rise to the dural venous sinuses which drain into the anterior cardinal vein (the future internal jugular vein). The external jugular veins appear as the face and jaws develop but, at all times, the two venous systems freely com- municate with each other. Morphologically, as shown by Sutton (1888), both the dural venous sinuses and the external jugular venous system are extracranial in so far as they are situated outside the dura mater. The chondrocranium and the dermocranium, however, develop in between the dural venous sinuses and the external jugular vein system (Butler, 1957). Thus, in the adult mammal, the bony skull wall separates the two venous systems, and therefore the dural venous sinuses are topographically intracranial whereas the external jugular venous system is extracranial. Furthermore the development of the skull localizes the connexions between the dural venous sinuses and the external jugular venous system to the various fontanelles and neuro-vascular foramina to form the emissary veins. The post-glenoid vein is one of the more important and controversial emissary veins since its presence or absence has been used in attempts to establish mammalian phylogenetic relationships (van Gelderen, 1925; Boyd, 1930).
    [Show full text]
  • The Occipital Emissary Vein: a Possible Marker for Pseudotumor Cerebri
    Published May 9, 2019 as 10.3174/ajnr.A6061 ORIGINAL RESEARCH ADULT BRAIN The Occipital Emissary Vein: A Possible Marker for Pseudotumor Cerebri X A. Hedjoudje, X A. Piveteau, X C. Gonzalez-Campo, X A. Moghekar, X P. Gailloud, and X D. San Milla´n ABSTRACT BACKGROUND AND PURPOSE: Transverse sinus stenosis can lead to pseudotumor cerebri syndrome by elevating the cerebral venous pressure. The occipital emissary vein is an inconstant emissary vein that connects the torcular herophili with the suboccipital veins of the external vertebral plexus. This retrospective study compares the prevalence and size of the occipital emissary vein in patients with pseudotumor cerebri syndrome with those in healthy control subjects to determine whether the occipital emissary vein could represent a marker of pseudotumor cerebri syndrome. MATERIALS AND METHODS: The cranial venous system of 46 adult patients with pseudotumor cerebri syndrome (group 1) was studied on CT venography images and compared with a group of 92 consecutive adult patients without pseudotumor cerebri syndrome who underwent venous assessment with gadolinium-enhanced 3D-T1 MPRAGE sequences (group 2). The presence of an occipital emissary vein was assessed, and its proximal (intraosseous) and distal (extracranial) maximum diameters were measured and compared between the 2 groups. Seventeen patients who underwent transverse sinus stent placement had their occipital emissary vein diameters measured before and after stent placement. RESULTS: Thirty of 46 (65%) patients in group 1 versus 29/92 (31.5%) patients in group 2 had an occipital emissary vein (P Ͻ .001). The average proximal and distal occipital emissary vein maximum diameters were significantly larger in group 1 (2.3 versus 1.6 mm, P Ͻ.005 and 3.3 versus 2.3 mm, P Ͻ .001).
    [Show full text]
  • Qt7z55j01t.Pdf
    UC Irvine Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health Title Challenging the Pathophysiologic Connection between Subdural Hematoma, Retinal Hemorrhage and Shaken Baby Syndrome Permalink https://escholarship.org/uc/item/7z55j01t Journal Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health, 12(2) ISSN 1936-900X Author Gabaeff, Steven C Publication Date 2011 Supplemental Material https://escholarship.org/uc/item/7z55j01t#supplemental License https://creativecommons.org/licenses/by-nc/4.0/ 4.0 Peer reviewed eScholarship.org Powered by the California Digital Library University of California SPECIAL CONTRIBUTION Challenging the Pathophysiologic Connection Between Subdural Hematoma, Retinal Hemorrhage and Shaken Baby Syndrome Steven C. Gabaeff, MD Emergency Medicine and Clinical Forensic Medicine, Sacramento, CA Supervising Section Editor: Paul Walsh, MD, MSc Submission history: Submitted September 1, 2010; Revision received September 26, 2010; Accepted October 25, 2010 Reprints available through open access at http://escholarship.org/uc/uciem_westjem Child abuse experts use diagnostic findings of subdural hematoma and retinal hemorrhages as near-pathognomonic findings to diagnose shaken baby syndrome. This article reviews the origin of this link and casts serious doubt on the specificity of the pathophysiologic connection.The forces required to cause brain injury were derived from an experiment of high velocity impacts on monkeys, that generated forces far above those which might occur with a shaking mechanism. These forces, if present, would invariably cause neck trauma, which is conspicuously absent in most babies allegedly injured by shaking. Subdural hematoma may also be the result of common birth trauma, complicated by prenatal vitamin D deficiency, which also contributes to the appearance of long bone fractures commonly associated with child abuse.
    [Show full text]