Anatomic variations of internal jugular vein, inferior petrosal sinus and its confluence pattern: Implications in inferior petrosal sinus catheterization

Abstract

<jats:sec><jats:title>Objective</jats:title><jats:p> The purpose of this study is to describe anatomic variations of the internal jugular vein (IJV), inferior petrosal sinus (IPS) and their confluence pattern and implications in IPS catheterization. The anatomic route of IPS after going out of the cranium and its confluence patterns with IJV and will supply knowledge about typing of IPS-IJV junction. </jats:p></jats:sec><jats:sec><jats:title>Method</jats:title><jats:p> A review of the literature was performed. </jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p> There might be different routes for entering the intracranial segment of the IPS and multislice spiral computed tomography (MSCT) is effective in identifying the confluences of the IPS with the IJV and their courses. It is important to find the confluence of IPS with IJV for diagnosis and treatment of intracranial lesions via venous route. Meanwhile, IPS diameter at the confluence can significantly affect success of catheterization. </jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p> The classification and the theory of the development of the caudal end of the IPS may be useful in establishing treatment strategies that involve endovascular manipulation via the IPS. </jats:p></jats:sec>

Morphology of the groove of the inferior petrosal sinus: application to better understanding variations and surgery of the skull base

“…Petrosal sinus sampling is a mainstay for diagnosing Cushing syndrome, and for distinguishing this condition from ectopic ACTH levels in the brain with almost 100% sensitivity [ 7 - 12 ]. Prior to the study by Doppman et al [ 9 ], false-negative rates for this diagnostic method were as low as 5%.…”

“…Transvenous embolization for CSDAVFs is reportedly preferred because it gives better outcomes and it is the gold standard for this condition [ 6 , 12 - 15 ]. The many other venous routes to the CS include the superior petrosal, facial, and superior ophthalmic veins, but the IPS remains the mainstay for transvenous embolization regardless of whether the condition in the CS is ipsilateral or contralateral, and even when the IPS is occluded [ 6 ].…”

“…The conventional carotid vertebral angiogram/venogram has been an important tool for visualizing the IPS [ 5 ], which is important in other ways apart from venous blood drainage. In medical application it is used in bilateral sampling, which is valuable in combination with corticotropin-releasing hormone stimulation both for diagnosing Cushing’s disease and also for distinguishing it from ectopic adrenocorticotropic hormone (ACTH) levels [ 7 - 12 ]. Additionally, owing to its position and ease of access, the IPS is routinely used for transvenous embolization of cavernous sinus dural arteriovenous fistulas (CSDAVFs), even in cases when the IPS is radiologically occluded [ 6 , 12 - 15 ].…”

Central Venous Catheterization (CVC) Site Choice Based on Anatomical Landmark Technique: A Systematic Review and Meta-analysis Short title:CVC Site Choice Strategy

“…The overall success rate has been mostly adopted as an outcome in the comparison of ultrasound assisted CVC and landmark CVC 7,11,29 , it's valuable in our comparison of different CVC approaching sites as well. The lower overall success rate of IJVC in adults may be explained by its anatomy variations 30,31 , including the bifurcations that occur at different sites of the internal jugular vein, the bicuspid on the right side of the internal and the tricuspid on the left side. Another explanation could be that IJVC assisted by ultrasound is most recommended and easier to grasp 9 , while for SCVC, the failures and the instant complications weren't be reduced by ultrasound technique 12,32 , the operators would be more inclined to resort to ultrasound guidance when confronted by di cult cannulations during IJVC.…”

The Angle of the Microguidwire on the Lateral Projection: a Prediction of Cannulation of the Occluded Inferior Petrosal Sinuses for the Transvenous Embolization of Cavernous Sinus Dural Arteriovenous Fistulas

“…2,3 The inferior petrosal sinus (IPS) is the most commonly used transvenous approach to obliterate the CSDAVF and provides a relatively direct and shortest route from the internal jugular vein (IJV) to the CS. 4,5 However, IPSs are sometimes thrombosed in CSDAVF patients and angiographically invisible. In such cases, the challenge to transvenous embolization(TVE) is detecting the ori ce to the IPS, and this is di cult due to angiographic invisibility and anatomical variations.…”