Absence of the superior petrosal veins and sinus: Surgical considerations.

Eduardosantamaria Carvalhal Ribas,Koichi Miki,Noritaka Komune,Ken Matsushima,Hiro Kiyosue,Albertl Rhoton

doi:10.4103/2152-7806.152147

Abstract

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.

Highlights

The superior petrosal vein, one of the most constant and largest drainage pathways in the posterior fossa, may result in complications if occluded
The superior petrosal veins, which drain into the Surgical Neurology International 2015, 6:34 superior petrosal sinus, commonly number 1 to 3 bridging veins and are the major bridging vein of the petrosal group
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

Summary

Methods

This study examines one venogram and another anatomic specimen in which the superior petrosal vein and sinus were absent. One formalin‐fixed adult head, in which the left superior petrosal veins and sinus were absent, provided the material for anatomic examination. An angiographic study of another patient without any cerebral lesion, in whom the superior petrosal veins and sinus were absent, was analyzed in detail independently by a neurosurgeon and an interventional neuroradiologist. Biplane angiographic equipment (Infinix Celeve‐i INFX‐8000V; Toshiba Medical Systems, Tokyo, Japan) was used to obtain these digital subtraction carotid and vertebral venographic images. This patient was included in the data of a previous report by Shimada et al.[31]

Results

Discussion

Conclusion