Classification of the Superior Petrosal Veins and Sinus Based on Drainage Pattern

Matsushima, Ken; Matsushima, Toshio; Kuga, Yoshihiro; Kodama, Yuji; Inoue, Keiji; Ohnishi, Hideyuki; Rhoton, Albert L.

doi:10.1227/neu.0000000000000323

Cited by 47 publications

(51 citation statements)

References 50 publications

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“…The tributaries of the superior petrosal veins can be subdivided in four subgroups: (i) Petrosal subgroup with tributaries draining the fourth ventricle, lateral medulla, middle cerebellar peduncle, and petrosal cerebellar surface facing the posterior surface of the temporal bone, such as veins of the cerebellopontine fissure and middle cerebellar peduncle; (ii) posterior mesencephalic subgroup with tributaries draining the walls of the cerebellomesencephalic fissure, located between the posterior surface of the midbrain and the opposing surface of the cerebellum, such as the pontotrigeminal and lateral mesencephalic veins; (iii) anterior pontomesencephalic subgroup with tributaries draining the anterior portion of the midbrain and pons, such as the transverse pontine veins; and (iv) tentorial subgroup with tributaries draining the lateral part of the cerebellar surface facing the tentorium and petrosal cerebellar surface facing the posterior surface of the temporal bone, such as the anterior lateral marginal vein. [22]…”

Section: Resultsmentioning

confidence: 99%

“…[2] Complications have followed sacrifice of the superior petrosal veins. [11218192122272930323336394042] Anatomic studies have focused on preventing such complications. [142335] This report calls attention to a unique variant in which the superior petrosal veins and sinus are absent, and the petrosal group of veins is drained by tributaries of the galenic and the tentorial groups.…”

Section: Introductionmentioning

confidence: 99%

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Absence of the superior petrosal veins and sinus: Surgical considerations

Matsushima¹,

Ribas²,

Kiyosue³

et al. 2015

Surg Neurol Int

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Background:The superior petrosal vein, one of the most constant and largest drainage pathways in the posterior fossa, may result in complications if occluded. This study calls attention to a unique variant in which the superior petrosal veins and sinus were absent unilaterally, and the venous drainage was through the galenic and tentorial drainage groups.Methods:This study examines one venogram and another anatomic specimen in which the superior petrosal vein and sinus were absent.Results:The superior petrosal veins, described as 1–3 bridging veins, emptying into the superior petrosal sinus, are the major drainage pathways of the petrosal group of posterior fossa veins. In the cases presented, the superior petrosal vein and sinus were absent and venous drainage was through the galenic and tentorial groups, including the lateral mesencephalic or bridging vein on the tentorial cerebellar surface.Conclusions:In cases in which the superior petrosal sinus and veins are absent, care should be directed to preserving the collateral drainage through the galenic and tentorial tributaries. Although surgical strategies for intraoperative management and preservation of venous structures are still controversial, knowledge of the possible anatomical variations is considered to be essential to improve surgical outcomes.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Absence of the superior petrosal veins and sinus: Surgical considerations

Matsushima¹,

Ribas²,

Kiyosue³

et al. 2015

Surg Neurol Int

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“…The postclival fissure on the tentorial cerebellar surface also merges into the apex of the cerebellopontine fissure to form the suprafloccular cistern. 47 CNs V, VII, and VIII arise between the superior and inferior limbs of the cerebellopontine fissure. The flocculus and rhomboid lip extend laterally with the choroid plexus from the foramen of Luschka ventral to the lower limb of the fissure (Fig.…”

Section: Cerebellopontine and Petrosal Fissuresmentioning

confidence: 99%

“…This route is also useful for upper cerebellopontine angle tumors, such as petrous apex meningiomas, and the apex of the cerebellopontine fissure has been reported as a preferable place to release CSF and identify the vein of the cerebellopontine fissure, the largest tributary of the superior petrosal vein. 47,52 The infrafloccular approach was originally proposed for surgical treatments of hemifacial spasm. 30 The key step to this approach is elevating the flocculus, rhomboid rip, and choroid plexus after opening the inferior part of the inferior limb of the cerebellopontine fissure and superolateral edge of the cerebellomedullary fissure.…”

Section: Cerebellopontine Fissurementioning

confidence: 99%

Anatomy and approaches along the cerebellar-brainstem fissures

Matsushima

Yağmurlu

Kohno

et al. 2016

JNS

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R ecent advances in microsurgical and endoscopic techniques, imaging, and electrophysiological monitoring have facilitated safe resection of brainstem lesions that were previously considered inoperable. [3][4][5]9,11,12,[14][15][16]19,21,[23][24][25][26]37,38,40,44,62,64,65,70,73,75,79,86 The brainstem surface, when near to or accessed by the lesion, is the shortest and most direct path for surgical treatment. 3,5,9,14,21,64,75,79 Several safe entry zones have been proposed and used for lesions inside the brainstem. 3,5,9,12,13,23,24,40,65,86 To maximize the chances of safe and precise removal of these lesions, sufficient exposure of the brainstem surface is critical, as is selection of an appropriate entry corridor into the brainstem.Cerebral fissures, such as the sylvian fissure, are routinely opened in the supratentorial region to access deeply situated pathology without dividing any neural tissue. Fissure dissection has also been used in the infratentorial region. 22,49,53,60,61 Opening the arachnoid membranes and trabeculae along the cerebellar-brainstem fissures, as in the telovelar or transcerebellomedullary fissure approaches, was originally proposed to access the pineal region, cranial nerve (CN) V, and the fourth ventricle. 22,49,60 However, brainstem surgery frequently requires the opening of the 3 cerebellar-brainstem fissures and/or adjacent cerebellar fissures to expose the cerebellar peduncles and brainstem surface hidden by the parts of the cerebellum forming the walls of the 3 cerebellar-brainstem fissures.61,71 Most of the major cerebellar arteries, veins, and vital neural structures, including a majority of the CNs and all 3 cerebellar peduncles, are located inside or close to these fissures. 27,43,45,56,66,68,85 Detailed knowledge of these fissures is abbreviatioNs AICA = anterior inferior cerebellar artery; CN = cranial nerve; PCA = posterior cerebral artery; PICA = posterior inferior cerebellar artery; SCA = superior cerebellar artery. obJective Fissure dissection is routinely used in the supratentorial region to access deeply situated pathology while minimizing division of neural tissue. Use of fissure dissection is also practical in the posterior fossa. In this study, the microsurgical anatomy of the 3 cerebellar-brainstem fissures (cerebellomesencephalic, cerebellopontine, and cerebellomedullary) and the various procedures exposing these fissures in brainstem surgery were examined. methods Seven cadaveric heads were examined with a microsurgical technique and 3 with fiber dissection to clarify the anatomy of the cerebellar-brainstem and adjacent cerebellar fissures, in which the major vessels and neural structures are located. Several approaches directed along the cerebellar surfaces and fissures, including the supracerebellar infratentorial, occipital transtentorial, retrosigmoid, and midline suboccipital approaches, were examined. The 3 heads examined using fiber dissection defined the anatomy of the cerebellar peduncles coursing in the depths of these fissures. results Dissections dir...

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“…Matsushima et al analyzed the petrosal vein and its tributaries using 3-D multi-fusion images combining conventional DSA, CT, and magnetic resonance image (MRI) 17 . They classified the tributaries of the petrosal vein into four groups based on their drainage areas.…”

Section: The Collateral Channels Of the Petrosal Veinmentioning

confidence: 99%