Cerebral Venous Sinuses: Anatomical Variants or Thrombosis?

Abstract

Anatomical variations of the posterosuperior dural venous sinuses and, in particular, the absence or hypoplasia of one of them has been described in several studies. However, no recent detailed analysis on the subject exists. Cerebral venous thrombosis is quite often evoked, although rarely confirmed, when the physician is faced with patients having various neurological problems. In fact, for a number of cases the image interpreted as thrombosis is nothing but the total or partial absence of a dural sinus. It was considered of interest to undertake an anatomical study in order to define these variations. The results of anatomoradiological investigations of 70 fresh cadavers were compared to those obtained by angiographic examination of 100 patients not suffering from any kind of venous pathology (patients explored angiographically for glioma, meningioma or aneurysm). Our conclusions and a review of the embryology literature enabled us to demonstrate that a number of radiological findings, quite often considered pathognomonic of venous thrombosis (i.e. ‘delta sign’), are in fact the result of anatomical variations.

Unilateral Transverse Sinus Stenting of Patients with Idiopathic Intracranial Hypertension

“…The right lateral sinus is larger or dominant in up to 73% of cases, and partial or total agenesis of portions of a TS are observed in up to 23% of cases. 33 The cortical vein of L'Abbé drains into the distal third of the TS, in addition to several smaller tributaries from the inferolateral temporal lobe, occipital lobe, and cerebellum. 34 Arachnoid granulations are frequently seen in the lateral TS associated with these venous entry sites, 35 and if large may be a cause of venous outflow obstruction.…”

Diagnosis and Management of Cerebral Venous Thrombosis

“…Anatomic variants of normal venous anatomy may mimic sinus thrombosis, including sinus atresia/hypoplasia, asymmetrical sinus drainage, and normal sinus filling defects related to prominent arachnoid granulations or intrasinus septa. 2,71,72,95,97,106,108,109,125,[142][143][144][145][146][147][148][149][150]158 Angiographic examination of 100 patients with no venous pathology 159 showed a high prevalence of asymmetrical lateral (transverse) sinuses (49%) and partial or complete absence of 1 lateral sinus (20%).…”

Cerebral venous sinus thrombosis: review of the demographics, pathophysiology, current diagnosis, and treatment

“…47,56,57,62 Despite the well-documented high sensitivity and specificity of MR imaging and MR venography in diagnosing CVST, there are a few reports in the literature of misdiagnosis due to MR imaging flow artifacts. 8,70 Moreover, the accurate interpretation of the obtained MR imaging and MR venography studies require meticulous knowledge of the cerebral sinus anatomy and their common variations such as left transverse sinus hypoplasia or atresia, which occurs in 49% of cases 74 and is often associated with hypoplasia of the ipsilateral jugular foramen. 56 Additionally, the presence of prominent arachnoid granulations, 47,56 SSS duplication, and other variations should not be confused with CVST.…”