The neglected emissary vein in mastoidectomy; persistent petrosquamosal sinus in the laterally located sigmoid sinus

Choi, Jeong Hwan; Woo, Hoon Young

doi:10.1016/j.amjoto.2012.11.014

Cited by 9 publications

(4 citation statements)

References 3 publications

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“…We found no cases of such PSS-related intraoperative complications in the literature. However, Choi and Woo described one case of this anomaly correctly diagnosed by preoperative imaging in a patient with COM in whom PSS coexisted with a laterally placed sigmoid sinus [10], and An et al described two cases of PSS as a perioperative finding in patients with COM [11]. The PSS incidence in our sample was 6.9%, and it was significantly higher in TBs with RCOM (14.6%).…”

Section: Discussionmentioning

confidence: 56%

The Prevalence of Persistent Petrosquamosal Sinus and Other Temporal Bone Anatomical Variations on High-Resolution Temporal Bone Computed Tomography

et al. 2016

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BackgroundThe aim of the study was to determine the prevalence of petrosquamosal sinus (PSS) and other temporal bone (TB) anatomical variations in various patients using high-resolution computed tomography (CT).Material/MethodsWe reviewed clinical and consecutively obtained CT data for 276 TBs of 138 patients. The incidence of TB anatomical variations was compared among patients with radiological markers of chronic otitis media (RCOM) and non-RCOM.ResultsThe PSS incidence in our sample was 6.9%, and it was significantly higher in TBs with RCOM (14.6%). Selected anatomical variations of RCOM TBs were observed: lateral sigmoid sinus (14.5%), prominent sigmoid sinus (23.6%), PSS (14.6%), and high jugular bulb (17.3%). Lateral sigmoid sinus and prominent sigmoid sinus (p<0.01), high jugular bulb (p<0.05), and PSS (p<0.01) were observed more often in RCOM than in non-RCOM TBs.ConclusionsThe TB vascular and anatomical variations, including PSS, a high jugular bulb, and a laterally and prominent placed sigmoid sinus, were more often observed in TBs with RCOM. Presurgical imaging and CT-based navigation techniques for TB surgery can offer remarkable value for understanding the altered anatomy of this complex structure and can localize rare anatomical variations.

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Section: Discussionmentioning

confidence: 56%

The Prevalence of Persistent Petrosquamosal Sinus and Other Temporal Bone Anatomical Variations on High-Resolution Temporal Bone Computed Tomography

et al. 2016

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“…Detection of this anomalous embryonic vessel prior to surgery is possible using high-resolution CT, CT venography, or magnetic resonance venography. 1 However, due to its small caliber, PSS is amenable for identification by imaging techniques only when it persists as a large channel or is contained in a bony canal within the petrosquamosal suture, 4 explaining the discrepancy in its size and prevalence among studies. 1 Development in imaging techniques has made radiologists more aware of this vascular anomaly, accounting for the increase in its prevalence in recent studies.…”

Section: Discussionmentioning

confidence: 99%

“…1 As a rule, bleeding is trivial, but in some cases, it can be troublesome. 4 Hemostasis can be achieved by drilling with a diamond burr, packing with hemostatic material, bipolar coagulation, vessel ligation, or bone wax application. 2 Nevertheless, some complications associated with bleeding control have been reported, including extensive thrombosis due to migration of bone wax into the sigmoid sinus.…”

Section: Discussionmentioning

confidence: 99%

The Petrosquamosal Sinus: A Rare Vascular Variant Encountered During Cochlear Implantation Surgery

Lakhdar,

Youbi,

Oulghoul

et al. 2024

The Laryngoscope

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The petrosquamosal sinus is a rare and almost unknown emissary vein of the temporal bone. It traverses the middle cranial fossa along the petrosquamosal fissure and connects dural sinuses with extracranial venous networks. It is known to undergo normal involution during fetal and early postnatal life, and therefore is rarely found in humans. When encountered during surgery, it can be a significant source of bleeding hindering proper visualization of important surgical landmarks. Here we report the case of a PSS, encountered in a child during cochlear implantation surgery. We discuss its clinical significance and impact on the surgical approach. Laryngoscope, 2024

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“…Third, the upper petrosquamosal EV originates at the junction of the transverse and sigmoid sinuses. 4,[7][8][9][10] The MEV may originate from the sigmoid or transverse sinus at the outer edge of the lateral sinus groove just below the bend and follow a course in the substance of the bone in an upward and backward direction to communicate with extracranial veins. 8 It opens at the surface just behind the upper posterior edge of the mastoid process at the level of the bony auditory meatus to enter the occipital or posterior auricular vein.…”

Section: Discussionmentioning

confidence: 99%

Improved CT Imaging for Mastoid Emissary Vein Visualization Prior to Posterior Fossa Approaches

Röser

Ebner

Ernemann

et al. 2016

J Neurol Surg A Cent Eur Neurosurg

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The clinical relevance of emissary veins (EVs) is often neglected. However, for posterior fossa approaches, especially in semisitting positions, these transosseous connections become potentially life threatening. Therefore, knowledge of the presence and configuration of EVs is essential in preoperative planning. We report on the use of preoperative computed tomography (CT) imaging techniques to visualize EVs reliably. A total of 100 consecutive patients were evaluated by helical CT in bone window mode reconstructed using the standard technique (4.5-mm slices) and the high-resolution technique (1 mm) for the posterior fossa. The presence and size of the EVs, their entry point in the sigmoid sinus, their predilection site, and their visibility using either CT technique were evaluated. Statistical analyses included a comparison of the data from both sides of the head. We noted impressive anatomical variations (high standard deviations) in the number, size, and intraosseous length of the EVs among the study population and between the sides (right and left) of an individual patient; however, no statistical significance was observed for any of these parameters. The detection rate of EVs in thin-slice CT scans versus standard CT scans is significantly different ( = 0.0001 on both sides). Thin-slice CT is essential in the preoperative planning of posterior fossa approaches to identify the presence and the course of EVs, reducing preventable approach-related morbidity during surgery.

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The neglected emissary vein in mastoidectomy; persistent petrosquamosal sinus in the laterally located sigmoid sinus

Cited by 9 publications

References 3 publications

The Prevalence of Persistent Petrosquamosal Sinus and Other Temporal Bone Anatomical Variations on High-Resolution Temporal Bone Computed Tomography

The Prevalence of Persistent Petrosquamosal Sinus and Other Temporal Bone Anatomical Variations on High-Resolution Temporal Bone Computed Tomography

The Petrosquamosal Sinus: A Rare Vascular Variant Encountered During Cochlear Implantation Surgery

Improved CT Imaging for Mastoid Emissary Vein Visualization Prior to Posterior Fossa Approaches

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