The oblique occipital sinus: anatomical study using bone subtraction 3D CT venography

Shin, Hwa Seon; Choi, Dae Seob; Baek, Hye Jin; Choi, Ho Cheol; Choi, Hye Young; Park, Mi Jung; Kim, Ji Eun; Han, Jeong Yeol; Park, SungEun

doi:10.1007/s00276-016-1767-x

Cited by 14 publications

(16 citation statements)

References 8 publications

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“…It has been reported that the OV is more prominent in patients with thrombosis [20]. If the TS and SS are hypoplastic, the OV is used as an alternative outflow pathway [9].…”

Section: Discussionmentioning

confidence: 99%

The evaluation of cerebral venous normal anatomy and variations by phase-contrast cranial magnetic resonance venography

Doğan

Apaydin

2022

Folia Morphol

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Background: The aim of our study is to determine the ability of the PC-CMRV technique to detect cranial anatomy, variations, thrombosis, to reveal the deficits of the technique and to discuss the reasons for these deficits on a physics basis. Materials and methods: PC's detection rates of anatomic variations and physiological filling defects (FDs) were evaluated in 136 patients and compared with the time-of-flight (TOF) technique MRI and cadaveric studies. Results: The dominance correlation between the three evaluated sinuses (transverse sinus (TS), sigmoid sinus, jugular vein) which originated from different embryological buds were statistically significant and the right vessel chain was dominant. PC is inadequate to show some vessels like inferior sagittal sinus (anatomically, this vessel is approximately present in 100% of the cases, but it was only visualized in 41.2% of the patients in PC-MRI). Visualization of major veins was sufficient. PC-MRI creates physiological FDs in 27.2% (72,3% middle,10.3% inner,17% outer part) of the patients. The FDs were concentrated in the middle part and not observed in the dominant sinus. Conclusions: The defects of visualization are present due to the PC's technique. It can be misdiagnosed as agenesis or thrombosis. PC creates a high incidence of physiologic FDs in TS. The results are not reliable, especially if FDs are in the middle part or non-dominant side.

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“…It has been reported that the OV is more prominent in patients with thrombosis [20]. If the TS and SS are hypoplastic, the OV is used as an alternative outflow pathway [9].…”

Section: Discussionmentioning

confidence: 99%

The evaluation of cerebral venous normal anatomy and variations by phase-contrast cranial magnetic resonance venography

Doğan

Apaydin

2022

Folia Morphol

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“…Variations in the occipital sinus are important for neurosurgical planning in the posterior cranial fossa and deviation from the expected midline location should be reported. If the occipital sinus deviates from the midline and joins a sigmoid sinus inferolaterally, it is known as an oblique occipital sinus (Fig B–D) . Superiorly, an oblique sagittal sinus communicates with the confluence of sinuses, transverse sinus, straight sinus, or superior sagittal sinus .…”

Section: Dural Venous Sinus Variations and Related Pathologymentioning

confidence: 99%

“…If the occipital sinus deviates from the midline and joins a sigmoid sinus inferolaterally, it is known as an oblique occipital sinus (Fig B–D) . Superiorly, an oblique sagittal sinus communicates with the confluence of sinuses, transverse sinus, straight sinus, or superior sagittal sinus . An oblique sagittal sinus can be uni‐ or bilateral and associated with hypoplastic transverse (Fig C and D) and/or sigmoid sinuses …”

Section: Dural Venous Sinus Variations and Related Pathologymentioning

confidence: 99%

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Variations of the CNS Venous System Mimicking Pathology: Spectrum of Imaging Findings

Freeman

Lazor

Loevner

et al. 2019

Journal of Neuroimaging

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Variations in the venous drainage of the central nervous system can have imaging and clinical findings that mimic pathology, presenting a challenge for neuroimagers and clinicians. Patients with these variants may undergo unnecessary testing, and patients with pathology may receive delayed diagnoses because of overlap with benign findings. Consequently, the accurate identification of venous variations on cross-sectional imaging and angiography and their potential causes are critical for differentiating benign imaging variants from potential pathologic processes requiring further evaluation. For example, in the epidural space, benign dilation of the epidural venous plexus may be mistaken for evidence of a fistula, abscess, or metastasis. Hypoplasia of a dural venous sinus or an arachnoid granulation may mimic venous sinus thrombosis. The superior ophthalmic vein may demonstrate benign dilation in intubated patients, mimicking thrombosis, increased intracranial pressure, orbital varix, inflammatory pseudotumor, or other conditions. Furthermore, certain venous variations, such as the occipital sinus or emissary veins, may complicate surgery or herald pathology and should be reported. In addition, some supposedly benign variations, such as the developmental venous anomaly, can be complicated by pathology. The objective of this review article is to provide a descriptive and pictorial review of common anatomic and physiologic variations in the venous drainage system of the brain, spine, and orbits that can mimic pathology. Neuroimaging findings of related pathologies and differences in clinical presentations will also be discussed to assist in the approach to differential diagnosis.

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“…The patent OS can rarely run off the midline, over the cerebellar convexity dura, and communicate with the SS, and such entity is called an “oblique OS ” [4]. In a CT-angiography study on 1,805 patients, Shin et al [5] found the oblique OS incidence to be 2.3%. A persistent large OS could present a hazardous surgical challenge.…”

Section: Introductionmentioning

confidence: 99%

Management of a Persistent Oblique Occipital Sinus with Staged Ligation in a Case of Medulloblastoma: A Case Report

Tyagi¹,

Singh²,

Beniwal³

et al. 2021

Pediatr Neurosurg

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Introduction: A patent persistent occipital sinus (OS) can be seen in 10% of adults. The presence of such a dominant draining OS can present as a challenge for posterior fossa surgeries. Occlusion or division of the sinus can cause venous hypertension, causing a cerebellar bulge or increased intra-op bleeding. Case report: A 3-and-a-half-year-old female child presented with a vermian medulloblastoma with hydrocephalus. MR venography (MRV) revealed a large patent OS draining from the torcula to the right sigmoid sinus. She underwent a left Frazier’s point VP shunt followed by a midline suboccipital craniotomy for the lesion. The OS was divided during a “Y”-shaped durotomy. Following the sinus ligation, there was a significant cerebellar bulge and excessive bleeding from the lesion. We released cisternal CSF and punctured the tumor cysts to allow the brain bulge to settle. Hemostasis was secured, and surgery was deferred, an augmented duroplasty was done, and bone flap was removed to allow for intracranial pressure decompression. The patient was electively ventilated for 24 h and weaned off gradually. A repeat MRV at 7 days showed the reorganization of the venous outflow at the torcula. Reexploration with tumor resection was done on post-op day 10. The patient recovered well from the surgery and was referred for adjuvant therapy. Conclusion: Surgeons should carefully analyze venous anatomy before posterior fossa surgeries. The persistent dominant OS, when present, should be taken care of while planning the durotomy. A hypoplastic but persistent transverse sinus allowed us to ligate and divide the OS. By doing a staged division of the sinus, reorganization of the venous outflow from the torcula can be allowed to occur, and the lesion can be resected.

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The oblique occipital sinus: anatomical study using bone subtraction 3D CT venography

Abstract: Many anatomical variations in the oblique occipital sinus can be seen on CT venography. Some OOSs function as the main drainage route of the intracranial veins instead of the TS. Thus, careful examination is essential for preoperative evaluation in posterior fossa lesions.

Cited by 14 publications

References 8 publications

The evaluation of cerebral venous normal anatomy and variations by phase-contrast cranial magnetic resonance venography

The evaluation of cerebral venous normal anatomy and variations by phase-contrast cranial magnetic resonance venography

Variations of the CNS Venous System Mimicking Pathology: Spectrum of Imaging Findings

Management of a Persistent Oblique Occipital Sinus with Staged Ligation in a Case of Medulloblastoma: A Case Report

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