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Development of Posterior Fossa Dural Sinuses, Emissary Veins, and Jugular Bulb: Morphological and Radiologic Study

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Development of Posterior Fossa Dural Sinuses, Emissary Veins, and Jugular Bulb: Morphological and Radiologic Study Development of Posterior Fossa Dural Sinuses, Emissary Veins, and Jugular Bulb: Morphological and Radiologic Study Toshio Okudera, Yun Peng Huang, Tatsuhiko Ohta, Akira Yokota, Yasuhiro Nakamura, Fumiaki Maehara, Hidetsuna Utsunomiya, Kazuo Uemura, and Hitoshi Fukasawa PURPOSE: To report the anatomic and radiologic development of the transverse, sigmoid, and occipital sinuses, the emissary veins, and the jugular bulb formation from the jugular sinus in humans before and after birth. METHODS: Roentgenograms of 33 injected brains showing the cranial venous system in human fetuses from 3 to 7 months of gestational age and cerebral angiograms of newborns and infants up to 6 years of age (23 clinical cases) were made and analyzed in detail. Special attention was focused on the inner diameters of the transverse and sigmoid sinuses and of the internal jugular veins, particularly at the sigmoid sinus-internal jugular vein junction. RESULTS: Marked increase in venous flow from the rapidly growing cerebral hemispheres leads to ballooning of the transverse sinuses in the absence of an increase in the inner diameters of the sigmoid and jugular sinuses. The ballooning also results in formation of the occipital sinus, marginal sinus around the foramen magnum, and emissary veins. The formation of the jugular bulbs from the jugular sinuses begins after birth when a shift from a fetal to a postnatal type of circulation (or from a lying-down position to an erect posture) takes place. CONCLUSION: The morphological changes of the posterior fossa dural sinuses, emissary veins, and jugular bulb are closely related to the development of the brain, shift to postnatal type of circulation, and postural hemodynamic changes. Index terms: Fetus, growth and development; Dural sinuses; Posterior fossa ; Veins, jugular; Veins, anatomy AJNR Am J Neuroradio/15:1871-1883, Nov 1994 With recent advances in the care of prema­ It is therefore important to understand the ana­ ture infants, it is possible for extremely prema­ tomic development of the dural sinuses in in­ ture infants (600 gm in weight, 6-month-old fants of this age. fetuses) to survive the critical postnatal period. We report gross morphological findings based on: (a) dissection of injected fetal brains of 3 to 7 months of gestational age; (b) multi­ directional stereoroentgenograms of injected Re ceived August 12, 1992; accepted after revision April 18, 1994. specimens; and (c) cerebral angiograms of ne­ This work was supported by a grant (63-A) from the National Center of onates and infants up to 6 years of age. Partic­ Neurology and Psychiatry of the Ministry of Health and Welfare, Japan. From the Departments of Radiology (T.O., K.U.) and Pathology (H.F.), ular attention has been paid to the development Akita Research Institute of Brain and Blood Vessels, Akita, Japan; Depart­ of the posterior fossa dural sinuses (the trans­ ment of Radiology, Mount Sinai Medica l Center, New York, NY (Y .P.H .); verse, sigmoid, and occipital sinuses), the em­ Department of Neurosurgery, Fukuoka University School of Medicine, issary veins, and the (superior) jugular bulb. We Fukuoka, Japan (T .O.) ; Department of Neurosurgery, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan describe the cause of (a) enlargement (or bal­ (A.Y.); Departments of Pathology (Y.N.) and Neuroradiology (H.U.), St looning) of the transverse sinuses, (b) marked Mary's Hospital, Kurume, Japan; and Department of Radiology, Kumamoto but transient enlargement of the occipital and University School of Medicine, Kumamoto, Japan (F.M.). marginal sinuses, (c) development of the emis­ Address reprint requests to Toshio Okudera, MD, Department of Radi ­ ology, Akita Research Institute of Brain and Blood Vessels, 6-10 Senshu­ sary veins, and (d) formation of the (superior) Kubota-Machi, Akita City, Akita 010, Japan. jugular bulb from the jugular sinus. AJNR 15:1871-1883, Nov 1994 0195-6108/ 94/1510-1871 © American Society of Neuroradiology 1871 1872 OKUDERA AJNR: 15, November 1994 Materials and Methods small (Fig 1). It can be said to begin at the lryected Aborted Fetuses junction with the straight sinus and run infero­ laterally before turning inferomedially and pos­ Thirty-three brains of aborted fetuses ranging from 3 to teriorly to become the sigmoid sinus. Its posi­ 7 months of gestational age were obtained. Contrast ma­ tion, represented by the outer tentorial margin, terial was injected into the venous system through a cath­ eter introduced into the superior vena cava or into both continues to descend with growth of the cere­ internal jugular veins. Gestational ages of the aborted in­ bral hemispheres. On each side, the superior jected fetal brains were at latter half of third month (3 sagittal, the transverse, and the sigmoid sinuses brains), at fourth month (8 brains), at fifth month (12 form a single narrow curved course that is con­ brains), at sixth month (7 brains) and at seventh month tinuous inferiorly with the internal jugular vein. (3 brains). The gestational ages of the aborted fetuses The superior sagittal sinus is divided posteriorly were determined using Boving's chart ( 1), measuring the into right and left limbs. The straight sinus, lo­ crown-rump length, body weight, and foot length, and cated rather high at this age, drains mainly into expressed in months from the first day of the last men­ strual period. The contrast materials used were water­ the left limb. suspension of fine-grain barium sulfate containing 1.5% Until the age of 4 V2 fetal months (17th and gelatin or microfil silicone rubber. Injections were per­ 18th weeks), the transverse sinus has a rei a­ formed either gently by hand or by using a 500-ml irri­ tively even caliber. At this age, it begins to en­ gator with an average pressure of 34 mm of water. After large from its lateral border on each side (Figs 2 injection of contrast material, stereoroentgenography and 3). This enlargement (or ballooning) (4, 7) was carried out in multiple directions using soft-tissue rapidly progresses medially and reaches the techniques. After opening of a part of the skull with scis­ sors, we fixed the fetus in a 10% formalin solution for 3 primitive torcular approximately 1 to 1 V2 months. This was followed by multidirectional stereo­ months later (Fig 4). This ballooning may be roentgenography of the dural sinuses and veins, dissec­ most conspicuous at the age of the 5th month tion, and further photography. In some brains serial fron­ (19th and 20th weeks) and may further extend tal, horizontal, or sagittal sections were made. into the posterior portion of the superior sagittal and superior petrosal sinuses. With the increas­ Clinica l Material ing volume of the telencephalon, the area where the straight sinus joins the superior sagittal si­ Cerebral angiograms (taken in stereoscopic pairs) of 23 nus gradually descends. As a result, the inferior children were analyzed: 8 less than 1 year of age; 2 be­ tween age 1 and 2 years; 6 between age 2 and 3 years; 2 inclination of the lateral portion of the trans­ between age 3 and 4 years; 2 between age 4 and 5 years; verse sinuses is less marked with the aging of 2 between age 5 and 6 years; and 1 more than 6 years of the fetus. This period corresponds with the rapid age. The transverse and sigmoid sinuses, emissary veins, development of the veins over the cerebral con­ jugular sinuses (from which the jugular bulbs develop), vexity and cerebellar surface, and hence to the and internal jugular veins were systematically investigated period of increased venous drainage of the on both sides, especially as to course, caliber, and mode of brain. Although the transverse sinus continues drainage. Radiologic measurements of the inner diameters of to enlarge, it gradually regains a relatively even these veins and sinuses were made in the anteroposterior caliber (Figs 5 and 6) in the 6th month. At the projection (Towne view). These include measurements of age of 7 fetal months, enlargement of the sinus the inner diameters of the transverse sinuses, sigmoid practically ceases. Rapid increase and decrease sinuses, jugular sinuses (jugular bulbs over age 2), and in the inner diameter of the transverse sinuses internal jugular veins on both sides. frequently results in irregular inner diameters and irregular margins of the transverse sinus. A Results part of the sinus may be missing completely. In some cases, septum formations may be ob­ Transverse Sinus served (Fig 2C). A pouch or pouches of the The terms transverse sinus and lateral sinus dural sinus may be formed and may extend are confusing and have been used interchange­ from the transverse sinus into the convexity ably in the past. For the sake of clarity, the term dura or the tentorial dura. These pouches may lateral sinus is best used to include both the receive cortical veins from the convexity or transverse and sigmoid sinuses. from the undersurface of the temporooccipital At the fetal age of 3 months (11th and 12th lobe. In some cases, the vein of Labbe may weeks), the transverse sinus (on each side) is drain into this dural pouch. AJNR: 15, November 1994 DEVELOPMENT 187 3 A 8 Fig 1. A 12-week-old fetus (65-mm crown-rump length ). A, Photograph of the brain showing injected veins and dural sinuses. The left cerebral hemisphere has been rem oved except for the left thalamus (Th) so that the transverse sinus ( 7) , the free m argin (row of arrow heads) of the tentorium, the internal cerebral vein ( 1), the great cerebral vein of Galen (2), and the straight sinus (3) can be well demonstrated . The superior sa gittal sinus (4), the ventral diencephalic vein (5) (draining into the tentorial sinus [6]), and the stem of the middle cerebral vein ( 7) are also labeled .
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