Mastoid foramen, mastoid emissary vein and clinical implications in neurosurgery

Hampl, Martin; Kachlík, David; Kikalova, Katerina; Riemer, Roxane; Halaj, Matej; Novák, Vlastimil; Stejskal, Přemysl; Vaverka, Miroslav; Hrabálek, Lumir; Krahulík, David; Naňka, Ondřej

doi:10.1007/s00701-018-3564-2

Cited by 18 publications

(31 citation statements)

References 21 publications

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“…In the present study, points A, B and C could be easily identified during craniotomy [3,8,20,24]. However, the most important part of this study was that we utilized a reference point, the TMN, to improve the accuracy of localization.…”

Section: Discussionmentioning

confidence: 93%

“…The anterosuperior and inferomedial points of the transverse-sigmoid sinus junction (ASTS and IMTS) represent the most posterior edge of the middle fossa and the most superolateral limit of the retrosigmoid approach, respectively. Accurately locating these key points on the external surface of the cranium is important in lateral skull base craniectomy [1][2][3][4]. Traditionally the squamosal-parietomastoid suture junction (SP) and asterion have been regarded as the classic landmarks for assisting with identifying the ASTS and IMTS, respectively [5][6][7].…”

Section: Introductionmentioning

confidence: 99%

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Mastoid notch as a landmark for localization of the transverse-sigmoid sinus junction

Lei

et al. 2020

BMC Neurol

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Background: The top of the mastoid notch (TMN) is close to the transverse-sigmoid sinus junction. The spatial position relationship between the TMN and the key points (the anterosuperior and inferomedial points of the transverse-sigmoid sinus junction, ASTS and IMTS) can be used as a novel method to precisely locate the sinus junction during lateral skull base craniotomy.Methods: Forty-three dried adult skull samples (21 from males and 22 from females) were included in the study. A rectangular coordinate system on the lateral surface of the skull was defined to assist the analysis. According to sex and skull side, the data were divided into 4 groups: male&left, male&right, female&left and female&right. The distances from the ASTS and IMTS to the TMN were evaluated on the X-axis and Y-axis, symbolized as ASTS&TMN_ x, ASTS&TMN_y, IMTS&TMN_x and IMTS&TMN_y.Results: Among the four groups, there was no significant difference in ASTS&TMN_x (p = 0.05) and ASTS&TMN_y (p = 0.3059), but there were significant differences in IMTS&TMN_x (p < 0.001) and IMTS&TMN_y (p = 0.01), and multiple comparisons indicated that there were significant differences between male&left and female&left both in IMTS&TMN_x (p = 0.0006) and in IMTS&TMN_y (p = 0.0081). In general, the ASTS was located 1.92 mm anterior to the TMN on the X-axis and 27.01 mm superior to the TMN on the Y-axis. For the male skulls, the IMTS was located 3.60 mm posterior to the TMN on the X-axis and 14.40 mm superior to the TMN on the Y-axis; for the female skulls, the IMTS was located 7.84 mm posterior to the TMN on the X-axis and 19.70 mm superior to the TMN on the Y-axis. Conclusions:The TMN is a useful landmark for accurately locating the ASTS and IMTS.

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Section: Discussionmentioning

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Mastoid notch as a landmark for localization of the transverse-sigmoid sinus junction

Lei

et al. 2020

BMC Neurol

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“…However, the emissary veins may represent a primary outflow route in patients with intracranial hypertension, high flow vascular malformation, obstruction in the internal jugular veins, or hypoplasia/aplasia. 3,12,13 The emissary veins prevent increases in intracranial pressure by providing cerebral venous drainage in patients with pathologies of the neck or base of the skull or with internal jugular vein occlusion. [15][16][17] Calibration of the emissary vein canals can increase under conditions of high vascular pressure or hypoplasia or aplasia of the jugular vein that may accompany states such as craniosynostosis.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have reported that there may be more than one MEC/MEV with differing diameters. 3,12,13,19 However, MEVs or MECs have not been investigated in patients with otitis. Our review of the literature revealed one previous study assessing the petrosquamosal sinus (PSS), a rare emissary vein, using HRCT in patients with otitis.…”

Section: Discussionmentioning

confidence: 99%

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Evaluation of the Mastoid Emissary Canals with Computerized Tomography in Patients with Chronic Otitis Media

Özen

Şahin

2019

J Neurol Surg B

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Background The mastoid emissary veins (MEVs) pass through the mastoid emissary canal-mastoid foramen (MEC-MF) in the mastoid region of the skull. MEVs can give rise to complications during surgical procedures. The purpose of our study was to investigate the morphological and morphometric characteristics of MECs of patients with clinical chronic otitis media (COM) using high-resolution computed tomography (HRCT). Methods Patients diagnosed with COM and undergoing temporal HRCT were identified by retrospectively scanning our hospital's automation system. Patients undergoing temporal HRCT for reasons other than COM, infection or tinnitus were identified for the control group by scanning the PACS archive. Sixty-two mastoid regions were examined in 38 unilateral and 12 bilateral COM patients, and 100 mastoid regions in the 50 patients in the control group. The presence of an accessory MEC-MF and MEC-MF diameters was evaluated in both groups. Results Main MEC diameters on the side of the ear with COM were 1.6 mm, and total accessory and main MEC diameters were 1.8 mm, both values being significantly higher than in the control group. Presence of accessory MEC on the side of the ear with COM was determined at 61.8%, significantly higher than in the control group. Conclusion Preoperative awareness of cranial venous drainage abnormalities is important to reduce surgical complications. Our study shows that MECs may be wider in diameter in patients with COM. MECs in COM patients must be identified before surgery to the mastoid region.

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Cerebral Sinus Hemodynamics in Adults Revealed by 4D Flow MRI

Dai,

Zhao,

Ding

et al. 2024

Magnetic Resonance Imaging

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BackgroundThe hemodynamics of the cerebral sinuses play a vital role in understanding blood flow‐related diseases, yet the hemodynamics of the cerebral sinuses in normal adults remains an unresolved issue.PurposeTo evaluate hemodynamics in the cerebral sinus of adults using 4‐dimensional flow MRI (4D Flow MRI).Study TypeCross‐sectional.PopulationNinety‐nine healthy volunteers (mean age, 42.88 ± 13.16 years old; females/males, 55/44).Field Strength/Sequence3 T/4D Flow MRI.AssessmentThe blood flow velocity, average blood flow rate (Q), and vortexes at the superior sagittal sinus (SSS), straight sinus (STS), transverse sinus, sigmoid sinus, and jugular bulb of each volunteer were evaluated by two independent neuroradiologists. The relationship between the total cerebral Q and sex and age was also assessed. Twelve volunteers underwent two scans within a month.Statistical TestsThe intraclass correlation coefficient (ICC) evaluated the inter‐observer agreement. Blood flow parameters among volunteers were compared by the independent‐sample t‐test or Mann–Whitney U test. The multiple linear regression equation was used to evaluate the relationship between total cerebral Q and age and sex. P < 0.05 indicated statistical significance.ResultsThe test–retest and interobserver reliability of average velocity and Q were moderate to high (ICC: 0.54–0.99). Cerebral sinus velocity varied by segment and cardiac cycle. The SSS's velocity and Q increased downstream and Q near torcular herophili was 3.5 times that through the STS. The total cerebral Q decreased by 0.06 mL/s per year (β = −0.06 ± 0.013) and was sex‐independent within the group. Vortexes were found in 12.12%, 8.9%, and 59.8% of torcular herophili, transverse‐sigmoid junction, and jugular bulb, respectively, and were related to higher upstream flow.Data ConclusionCerebral sinuses could be measured visually and quantitatively in vivo by 4D Flow MRI, providing a basis for future research on pulsating tinnitus, multiple sclerosis, and other related diseases.Evidence Level2Technical EfficacyStage 1

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Mastoid foramen, mastoid emissary vein and clinical implications in neurosurgery

Abstract: Despite excellent knowledge of anatomy, however, good pre-operative examination using imaging methods and mastering of microsurgical techniques create the base for successful treatment of pathological structures in these anatomically complex areas.

Cited by 18 publications

References 21 publications

Mastoid notch as a landmark for localization of the transverse-sigmoid sinus junction

Mastoid notch as a landmark for localization of the transverse-sigmoid sinus junction

Evaluation of the Mastoid Emissary Canals with Computerized Tomography in Patients with Chronic Otitis Media

Cerebral Sinus Hemodynamics in Adults Revealed by 4D Flow MRI

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