Abstract
IntroductionThe aim of the study was to investigate the variations in the uncal vein (UV) termination and its clinical implication in cavernous sinus dural arteriovenous fistulas (CSDAVFs).MethodsBiplane cerebral angiography in 80 patients (160 sides) with normal cerebral venous return (normal group) was reviewed with special interest in the termination of the UV. Frequency and types of uncal venous drainage from CSDAVFs in consecutive 26 patients were also analyzed.ResultsIn the normal group, the UV was identified in 118 sides (74 %). The UV terminated into cavernous sinus (CS) in 41 sides (34 %), the superficial middle cerebral vein (SMCV) in 58 sides (48 %), the laterocavernous sinus (LCS) in 15 sides (13 %), and the paracavernous sinus (PCS) in 4 sides (3 %). Cerebral venous blood via the UV draining into the CS directly (n = 41) or through the SMCV and/or the LCS (n = 45) was observed in 86 sides (54 %). Uncal venous drainage from CSDAVFs was found in 13 patients (50 %). The CSDAVFs drained directly into the UV in two patients, drained via LCS into the UV in two patients, and drained through the SMCV into the UV in the remaining nine patients. All cases were successfully treated by transvenous embolization with special attention given to uncal venous drainage.ConclusionThere are several variations in UV termination according to the embryological development of the primitive tentorial sinus and the deep telencephalic vein. Careful attention should be paid to uncal venous drainage for the treatment of CSDAVFs.
Highlights
The aim of the study was to investigate the variations in the uncal vein (UV) termination and its clinical implication in cavernous sinus dural arteriovenous fistulas (CSDAVFs)
We investigate the variations in UV termination and its clinical significance in CSDAVFs
The UV terminated into the CS in 41 sides, the superficial middle cerebral vein (SMCV) in 58 sides, the laterocavernous sinus (LCS) in 15 sides, and the paracavernous sinus (PCS) in 4 sides (Table 1; Figs. 1 and 2)
Summary
The aim of the study was to investigate the variations in the uncal vein (UV) termination and its clinical implication in cavernous sinus dural arteriovenous fistulas (CSDAVFs). There are many types of drainage route for cavernous sinus dural arteriovenous fistulas (CSDAVFs), namely: anterior drainage through the ophthalmic veins, inferior drainage through the inferior petrosal sinus and the pterygoid plexus, posterior drainage through the superior petrosal sinus, medial drainage through the intercavernous sinus, lateral drainage through the superficial middle cerebral vein, and deep drainage through the prepontine bridging vein, and uncal venous drainage [1–3]. Recognition of deep venous drainage routes from CSDAVFs is important because CSDAVFs with deep venous drainage carry a risk of deep cerebral bleeding [4] Serious complications such as brain edema or hemorrhage can occur when the dural arteriovenous fistulas (DAVFs) remain with a small cerebral venous drainage after transvenous embolization [5]. We investigate the variations in UV termination and its clinical significance in CSDAVFs
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