Sinus Lumen Research Articles

Jugular foramen stenosis in external hydrocephalus in infants.

To measure the size of jugular foramina in infants affected by external hydrocephalus (EH) and in a control group, to support the hypothesis that a jugular foramen (JF) stenosis may determine dural venous sinus alterations and increased venous outflow resistance as main pathophysiological factor. Minimum, maximum, and mean values of JF areas were measured in a series of phase-contrast magnetic resonance venous angiography (angio MRV PCA3D) performed on 81 infants affected by EH. Results were compared with a group of 54 controls. Smaller JF area was significantly smaller in patients versus controls (43.1 ± 14.6 vs. 52.7 ± 17.8; p < 0.001) resulting in a significantly smaller mean JF areas in patients vs. controls (51.6 ± 15.8 vs. 57.0 ± 18.3; p = 0.043). In patients, smaller JF areas were significantly associated with higher venous obstruction grading score (VOGS) both on the right (p = 0.018) and on the left side (p = 0.005). Positional plagiocephaly (cranial vault asymmetry index > 3.5%) was more frequent among EH patients than controls (38/17) but the difference was not significant (p = 0.07). In the 38 plagiocephalic patients, JF area was smaller on the flattened side than the contralateral in a significant number of cases both in right (21/7) and left (9/1) plagiocephaly (p < 0.0005) as well as the mean area (48.2 + 16.4 mm2 vs. 57.5 + 20.7 mm2, p = 0.002) and VOGS was significantly higher on the plagiocephalic side than on the contralateral side (1.6 ± 1.1 vs. 1.1 ± 0.9, p = 0.019). In this series of infants affected by EH, the mean size of the ostium of both JF resulted significantly smaller than controls. JF stenosis was significantly associated with higher degrees of venous obstruction on both sides, suggesting a direct extrinsic effect of JF size on dural sinus lumen and possible consequent effect on venous outflow resistance. Positional plagiocephaly, when present, was associated with a decreased JF area and increased VOGS on the flattened side.

Chordae Willisii of the dural sinuses: an anatomical study using magnetic resonance imaging.

The chordae Willisii (CWs), trabecular projections into the lumen of the dural sinuses, are not well understood. We aimed to explore them using magnetic resonance imaging (MRI). Eighty-five patients underwent volumetric contrast-enhanced MRI, while another 30 underwent a fluid-attenuated inversion recovery (FLAIR) sequence in the coronal section. The CWs were detected as linear filling defects lying in the dural sinuses, adjacent to the surrounding dura mater. They were found in the superior sagittal sinus (SSS) in 68.2% of the patients, most frequently in the middle third, with laminar appearance. In 27.1% of the patients, the CWs divided the SSS lumen into separate channels. The CWs were identified in the transverse sinus, transverse-sigmoid sinus junctional area and sigmoid sinus, and straight sinus in 54.1, 47.1, and 8.2%, respectively. On the FLAIR images, dural septi partially dividing the SSS lumen were identified in all patients. In addition, in 73.3% of the patients, fine linear structures were observed in the lumen with inconstant arrangements. The CWs may be constant structures distributed over the lumen of the intracranial dural sinuses. Contrast-enhanced MRI may be useful for detecting laminar CWs. The FLAIR sequence may be advantageous for delineating the dural septi projecting into the lumen of the dural sinuses.

Technical considerations and long-term results of endovascular venous stenting to control venous hypertension from meningiomas invading intracranial venous sinuses.

Meningiomas invading the intracranial venous sinuses may cause intracranial venous hypertension, papilledema, and visual compromise. Sinus resection and graft reconstructions, however, add significant complexity to tumor surgery, with the potential for increased morbidity. In this study, the authors explored whether venous sinus stenting might provide an alternative means of controlling venous hypertension that would be sustainable over the long term. The authors performed a retrospective review of all 16 patients with intracranial meningiomas who underwent stenting at their institution for venous sinus compromise. At presentation, all had headache and 9 had papilledema. Thirteen patients had 1 meningioma and 3 had 2 or more. Three patients had had previous tumor resection and radiotherapy. One patient had been treated with a lumboperitoneal shunt and radiotherapy. The median length of clinical follow-up was 8 years (range 4 months-18 years). Venous sinus narrowing was often not confined to the site of meningioma, and bilateral transverse sinus narrowing, reminiscent of that seen in idiopathic intracranial hypertension, was present in 7 patients with sagittal sinus meningiomas. Eleven patients had stents placed solely across sinus narrowing caused by meningioma. Five patients had additional stents placed at other sites of venous narrowing at the same time: in one of these patients, a stent was placed across a defect in the sagittal sinus caused by previous surgery, and in the 4 other patients, stents were placed across nontumor narrowings of the transverse sinuses. In 1 patient, the jugular vein was also stented. Nine patients developed symptomatic in-stent restenosis at the meningioma site. Eight had further stenting procedures with variable success in restoring the in-stent lumen. The remaining patient, with a late partial relapse, is being reinvestigated. Papilledema resolved in all patients after stenting. Six patients experienced prolonged and very substantial relief of all symptoms. Five patients had persistent headache despite restoration of the sinus lumen. Five had persistent symptoms associated with resistant in-stent stenosis. There were no significant complications from any of the diagnostic or therapeutic procedures. In patients who are symptomatic with meningiomas obstructing the venous sinuses, successful stenting of the affected segment can give a good outcome, especially in terms of relieving papilledema. However, further procedures are often necessary to maintain stent patency, other areas of venous compromise frequently coexist, and some patients remain symptomatic despite apparently successful treatment of the index lesion. Long-term surveillance is a requirement.

Optimized interdisciplinary approach in the treatment of maxillary sinus upper wall fractures in children

To study the effectiveness and safety of the functional method of treating fractures of the upper wall of the maxillary sinus using endoscopic sinus surgery and a sinus balloon catheter. The study included 106 children aged 5 to 17 years with fractures of the upper wall of the maxillary sinus who underwent surgical treatment at the Morozovskaya Children's City Clinical Hospital from 2018 to 2023. Treatment was administered to children with pronounced bone defects, combined injuries, and ophthalmological symptoms. As a result of the treatment, all 106 children showed no hernial protrusions in the lumen of the maxillary sinus on control tomograms. There were no cases of decreased visual acuity or impaired eye movement function during follow-up by an ophthalmologist. Complete consolidation of bone fragments with restoration of the integrity of the sinus wall was achieved in 91.5% of patients; in the remaining 8.5% of cases, a bone defect in the upper wall of the maxillary sinus up to 1-2 mm in diameter was preserved according to CT data, which clinically did not manifest itself. The proposed technique using a sinus balloon catheter is preferable for children with fractures of the upper wall of the maxillary sinus. Due to the functionality of access, absence of the need for endoprosthetics of the bone walls of the sinus and orbit, minimization of disruptions to the growth zones of the facial skeleton, and achieving good functional and cosmetic results.

Endovascular Treatment With Targeted Embolization of Cavernous Sinus Dural Arteriovenous Fistulas: A Single-Center Study.

To assess the feasibility, efficacy, and safety of targeted embolization for cavernous sinus dural arteriovenous fistulas (CSDAVF). This retrospective study investigated patients with CSDAVF who underwent endovascular treatment at a tertiary hospital between October 1991 and March 2023. Treatment strategies were determined based on clinical symptoms and shunt characteristics. Targeted or non-targeted curative embolization was performed to achieve complete shunt occlusion. Initially, targeted embolization, selective occlusion of the shunted pouch while preserving the normal cavernous sinus lumen, was conducted, should that fail, non-targeted embolization was performed. In contrast, palliative embolization solely reduced shunt flow. Clinical signs, imaging characteristics, and outcomes were evaluated according to the agreed treatment strategy. In total, 198 patients with CSDAVF (mean age 59.0 ± 12.1 years, 23.2% male) participated in this study. Of which, 94 patients (47.5%) were treated with targeted embolization, 75 (37.9%) with non-targeted embolization, and 29 (14.6%) with palliative treatment. For patients undergoing curative embolization, 55.7% (94/169) successfully achieved targeted embolization; this procedure was usually used to treat focal fistulas (restrictive or late-restrictive types), whereas diffuse fistulas (proliferative type) often underwent non-targeted or palliative embolization. For patients that underwent targeted embolization, the rate of complete or near-complete occlusion on immediate post-treatment digital subtraction angiography was 93.6% (88/94), with a complication rate of 2.1% (2/94), symptom improvement rate of 96.8% (91/94), and retreatment rate of 5.3% (5/94). No serious complications were reported during follow-up. When successful, targeted embolization of CSDAVF causes low rates of cranial nerve palsy, retreatment, and good clinical outcomes.

Numerical investigation of calcification effects on aortic valve motions and ambient flow characteristics

The pathogenesis and progression of calcific aortic stenosis pose a significant challenge in medical science due to the intricate nature of blood fluid dynamics. To better understand this crucial phenomenon, this study investigates the physiological behaviors of aortic valves with varying degrees of lesions and ambient flow conditions using an in-house CFD solver, CgLES-Y code. The code is validated by simulating two-dimensional valve opening and closure, followed by the extension to three-dimensional symmetrically simplified valve dynamics. The simulation results exhibit great agreement with other numerical, experimental and clinical data. Patient-specific models of the aortic root and inner valve geometries are developed based on CT images. Analysis of fluid dynamics traits, configuration properties and leaflet stress is performed for both normal and calcified aortic valves during the systolic and diastolic periods. The study further examines the impact of calcium deposition on abnormal flow fields and leaflet motion, which indicates that calcium deposition increases the tensional burden on healthy leaflets, therefore, the microcosmic increase in valve modulus leads to global damage extending from the root to the tip, whereas macroscopic calcification primarily induces damage in the vicinity of the calcium compound. Additionally, the generation of additional vortices on the valve surface and sinus lumen heightens the likelihood of calcium accumulation.

Variations of coronary sinus tributaries among patients undergoing cardiac resynchronisation therapy.

In cardiac resynchronisation therapy (CRT), the coronary venous system is used for left ventricular pacing electrode placement. Despite the well- -known anatomy of the coronary sinus and its tributaries, heart failure patients' remodelled and enlarged left ventricles may impede the successful lead placement because of acquired anatomical obstacles. Fifty-five patients qualified for CRT treatment were divided into ischaemic and non-ischaemic cardiomyopathy. Forty-four control groups without heart failure underwent dual-source computed tomography (CT). Rendered reconstructions of cardiac coronary systems were compared. The presence of main tributaries was comparable in all groups. The left marginal vein, small cardiac vein, and oblique vein of the left atrium were present in 63%, 60%, and 51% of the hearts in all the groups. CRT referred CTs had significantly longer distances between posterior and lateral cardiac veins over the left ventricle (p < 0.05), wider angles of tributaries (p = 0.03), and smaller lumen of coronary sinus (p = 0.03). In the non-ischaemic group, the posterior interventricular and great cardiac veins are more extensive than in the control group. Age-related analysis of vessel size shows a moderate correlation between age and diminishing mean vessel size in all the groups studied. The general structure of the coronary heart system is consistent in patients with and without heart failure. The variance of the general structure, or the presence of adequate veins, is an individual variation. The use of CT and analysis of the coronary veins allow better planning of the CRT-D implantation procedure and may reduce the risk of ineffective left ventricular electrode implantation.

Maxillary Aneurysmal Bone Cyst: About a Case

Introduction: Aneurysmal bone cyst (ABC) is a primary or secondary benign tumor, consisting of an intraosseous cavity, uni or multilocular, with hematic content. It can develop on all bones of the skeleton with, however, a predilection for the long bones and the spine. KOA mainly affects children and young adults, with a slight female predominance. Objective: The aim of this work is to reveal the diagnostic features at the imaging level. Case Report: This is an 11-year-old female patient with no previous pathological history who has presented for 1 year with diffuse maxillofacial pain, with intermittent fluid discharge in the oral cavity. Facial CT scan without and with contrast injection objective a lytic image centered on the lateral wall of the left maxillary sinus bulging into the sinus lumen with a spontaneously hypodense multicompartmental appearance without contrast gain after PDC injection. Conclusion: KAO is a very polymorphic lesion, which presents a diagnostic problem (Aspecific radiological appearance). In spite of the different therapeutic modalities proposed, it is the surgical treatment which exposes less risk of recurrence.

Anatomical Study of Arachnoid Granulation in Superior Sagittal Sinus Correlated to Growth Patterns of Meningiomas.

Meningiomas in the parasagittal region were formed by arachnoidal cells disseminated among arachnoid granulations. The purpose of this study was to characterize the morphology of chordae willisii, and AGs found in the superior sagittal sinus. This study used 20 anatomical specimens. Rigid endoscopes were introduced via torcula herophili into the sinus lumen. The morphological features of arachnoid granulation and chordae willisii were analyzed, and then arachnoid granulations and chordae willisii were assessed by elastic fiber stains, Masson’s stains, and imaging analysis. Three types of arachnoid granulations were present in the examined sinuses. There were 365 counts of arachnoid granulations in examined sinuses by imaging analysis, averaging 1.36 ± 2.58 per sinus. Types I, II, and III made up 20.27, 45.20, and 34.52% of 268 patients, respectively. Microscopy of chordae willisii transverse sections indicated the existence of a single layer and a multiple-layered dura sinus wall. The dural sinus wall was the thickest one in the superior sagittal sinus. The thickness of longitudinal lamellae was significantly greater than trabeculae. This study reveals the anatomical differences between arachnoid granulations in the superior sagittal sinus. The arachnoid granulations classification enables surgeons to predict preoperatively growth patterns, followed by safely achieving the optimal range of parasagittal meningioma resection.

Dural sinus thrombosis after resection of vestibular schwannoma using suboccipital retrosigmoid approach-thrombosis classification and management proposal.

Dural sinus thrombosis is one of the complications after posterior fossa surgery. However, that topic is not described well with regard to vestibular schwannoma surgery using the unique suboccipital retrosigmoid approach. We analyzed retrospectively medical records and radiological investigations of 116 patients. The including criteria were histopathologically confirmed vestibular schwannoma operated on using the retrosigmoid approach, preoperative and postoperative contrast-enhanced MRI, and at least 1-year follow-up. The patient group included 36% males and 64% females. The average age was 47.3 ± 13.9years. Sixty percent of the tumors were classified as T4b according to the Hannover scale and their mean volume was 13.73 ± 10.28 cm3. There were no signs of thrombosis preoperatively. Postoperative changes in the dural sinuses were found in 26 (22%) cases. In 7 (27%) cases, there was an external compression by the hemostatic agent, and in 19 (73%) cases, a thrombus was visualized in the sinus lumen. The size of the sinus, age, and the tumor size were not risk factors for thrombosis, whereas an intraoperative sinus injury was a statistically significant risk factor (p = 0.0012). All of the patients diagnosed with thrombosis were in good clinical condition in long-term follow-up, except one fatal case. Complete recanalization was observed in 58% of cases after 1-year follow-up. Postoperative changes in the dural venous sinuses are a frequent finding after vestibular schwannoma surgery using the suboccipital retrosigmoid approach. Intraoperative dural injury is a risk factor for thrombosis. Thrombosis in that group of patients is usually asymptomatic and does not influence the prognosis.

Combined Exoscopic and Endoscopic Technique for Craniofacial Resection.

We determined the feasibility of the combined exoscopic-endoscopic technique (CEE) as an alternative to the microscope in craniofacial resection (CFR). This retrospective study was conducted at a single institution and included eight consecutive patients with head and neck tumors who underwent CFR between September 2019 and July 2021. During the transcranial approach, microsurgery was performed using an exoscope in the same manner as in traditional microscopic surgery, and an endoscope was used at the blind spot of the exoscope. The exoscope provided images of sufficient quality to perform microsurgery, while the sphenoid sinus lumen was the blind spot of the exoscope during anterior (n = 3) and anterolateral CFR (n = 2), and the medial aspect of the temporal bone was the blind spot of the exoscope during temporal bone resection (n = 2). These blind spots were visualized by the endoscope to facilitate accurate transection of the skull base. The advantages of the exoscope and endoscope include compact size, ergonomics, surgical field accessibility, and equal visual experience for neurosurgeons and head and neck surgeons, which enabled simultaneous transcranial and transfacial surgical procedures. All the surgeries were successful without any relevant complications. CEE is effective in transcranial skull base surgery, especially CFR involving simultaneous surgical procedures.

Coronary sinus reducer therapy for refractory angina: is it ready for prime time?

The contemporary treatment of angina is centred around improving coronary arterial flow and increasing perfusion of ischaemic myocardium. This is variably achieved with medication, percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). The coronary sinus reducer (CSR; Neovasc Inc., Richmond, BC, Canada) is the only therapy which attempts to improve angina by acting on the postcapillary myocardial circulation. Unlike PCI, which has an intuitive, well-described, extensively investigated mechanism, how the CSR affects angina is not well understood. The CSR is an hourglass-shaped, balloon-mounted, wire-mesh device that reduces the coronary sinus lumen, after inflammation and fibrosis have caused ...

Evaluation of splenic accumulation and colocalization of immature reticulocytes and Plasmodium vivax in asymptomatic malaria: A prospective human splenectomy study.

BackgroundA very large biomass of intact asexual-stage malaria parasites accumulates in the spleen of asymptomatic human individuals infected with Plasmodium vivax. The mechanisms underlying this intense tropism are not clear. We hypothesised that immature reticulocytes, in which P. vivax develops, may display high densities in the spleen, thereby providing a niche for parasite survival.Methods and findingsWe examined spleen tissue in 22 mostly untreated individuals naturally exposed to P. vivax and Plasmodium falciparum undergoing splenectomy for any clinical indication in malaria-endemic Papua, Indonesia (2015 to 2017). Infection, parasite and immature reticulocyte density, and splenic distribution were analysed by optical microscopy, flow cytometry, and molecular assays. Nine non-endemic control spleens from individuals undergoing spleno-pancreatectomy in France (2017 to 2020) were also examined for reticulocyte densities. There were no exclusion criteria or sample size considerations in both patient cohorts for this demanding approach.In Indonesia, 95.5% (21/22) of splenectomy patients had asymptomatic splenic Plasmodium infection (7 P. vivax, 13 P. falciparum, and 1 mixed infection). Significant splenic accumulation of immature CD71 intermediate- and high-expressing reticulocytes was seen, with concentrations 11 times greater than in peripheral blood. Accordingly, in France, reticulocyte concentrations in the splenic effluent were higher than in peripheral blood. Greater rigidity of reticulocytes in splenic than in peripheral blood, and their higher densities in splenic cords both suggest a mechanical retention process. Asexual-stage P. vivax-infected erythrocytes of all developmental stages accumulated in the spleen, with non-phagocytosed parasite densities 3,590 times (IQR: 2,600 to 4,130) higher than in circulating blood, and median total splenic parasite loads 81 (IQR: 14 to 205) times greater, accounting for 98.7% (IQR: 95.1% to 98.9%) of the estimated total-body P. vivax biomass. More reticulocytes were in contact with sinus lumen endothelial cells in P. vivax- than in P. falciparum-infected spleens. Histological analyses revealed 96% of P. vivax rings/trophozoites and 46% of schizonts colocalised with 92% of immature reticulocytes in the cords and sinus lumens of the red pulp. Larger splenic cohort studies and similar investigations in untreated symptomatic malaria are warranted.ConclusionsImmature CD71+ reticulocytes and splenic P. vivax-infected erythrocytes of all asexual stages accumulate in the same splenic compartments, suggesting the existence of a cryptic endosplenic lifecycle in chronic P. vivax infection. Findings provide insight into P. vivax-specific adaptions that have evolved to maximise survival and replication in the spleen.

CHANGES IN THE STRUCTURAL ORGANIZATION OF THE SPLEEN UNDER THE INFLUENCE OF MONOSODIUM GLUTAMATE AND AFTER ITS ABOLITION

Актуальність. Глутамат натрію є однією з найпоширеніших харчових добавок в світі. В статті наведено та проаналізовано дані експериментального дослідження, яке проводено на 52 білих щурах самцях та самках репродуктивного віку.&#x0D; Мета дослідження – вивчити морфометричні, гістологічні та електронно-мікроскопічні зміни паренхіми селезінки щурів за умов впливу глутамату натрію та після його відміни.&#x0D; Методи. Мікроанатомію компонентів селезінки білих щурів за умов фізіологічної норми дослідили на 10 інтактних тваринах. Експериментальні тварини поділені на 3 групи. Статистичну обробку цифрових даних проводили за допомогою програмного забезпечення «Excel» та «STATISTICA» 6.0 з використанням параметричного методу.&#x0D; Результати. Через вісім тижнів дії глутамату натрію виявлено достовірне зменшення відносної площі білої пульпи в паренхімі селезінки білих щурів самців та самок, збільшення кількості вторинних лімфоїдних вузликів, зростання кількості моноцитів, макрофагів, плазматичних клітин та клітин мієлоїдного ряду, зростання частки ретикулярної сполучної тканини в складі селезінкових тяжів червоної пульпи. Еритроцити та тромбоцити заповнюють не лише просвіт пазух селезінки, але й накопичуються в пульпарних тяжах, велика кількість лімфоцитів на різних стадіях апоптозу. Венозні пазухи червоної пульпи повнокровні, їхні просвіти розширені та дещо деформовані. Навколо судин та венозних пазух наявні ознаки набряку. Збільшення кількості плазматичних клітин свідчить про пришвидшення проліферації активованих лімфоцитів, яке є ознакою iмуноіндукуючого ефекту. Через чотири тижні після відміни глутамату натрію гістологічна та електронно-мікроскопічна будова органа майже не відрізняється від попередньої групи тварин. Зростає повнокрів’я судин паренхіми селезінки, щільність клітин зменшується. Збільшується кількість апоптично змінених клітин.&#x0D; Підсумок. Через вісім тижнів після відміни глутамату натрію зворотніх змін у структурі паренхіми селезінки не виявлено. Отже, відміна введення глутамату натрію після його тривалого впливу не «покращує» морфометричних показників паренхіми селезінки щурів та не призводить до відновлення структурної організації органа.

Ультраструктурная характеристика синусов твердой мозговой оболочки при судебно-медицинской оценке черепно-мозговой травмы

Aim. Search for features of the ultrastructural structure of the dura mater sinus that can be used to clarify the forensic diagnosis of the immediate cause of death, if it occurred as a result of brain damage in traumatic brain injury, and was accompanied by thrombosis of the dura mater sinuses, including against the background of connective tissue dysplasia. Materials and methods. Retrospective analysis of medical documents, laboratory, instrumental, using atomic force microscopy and sectional study of individuals with clinically diagnosed craniocerebral trauma and sinus thrombosis of the dura mater against the background of connective tissue dysplasia. 144 cases of isolated traumatic brain injury, which were the main cause of death, were investigated, according to the Omsk regional Bureau of forensic medical examination for the period 2017-2020. Сorpses of persons who were treated for the period 2017-2020 in the Omsk city clinical hospital No. 1 and the Omsk city clinical ambulance No. 2. 54 cases in persons with signs of connective tissue dysplasia, 90 cases in persons without signs of connective tissue dysplasia, which made up the control group. Inclusion criterion: Isolated traumatic brain injury. Terms of providing medical care in a hospital setting from a few hours to 64 days. Dura mater sinus thrombosis detected in the section as a result of trauma. Exclusion criteria: pathology of the blood system, pathology of the nervous system, the presence of chronic intoxication of various origins (alcohol, drugs, drugs). Cases of gross neurological dysfunction. Traumatic brain injury that is not compatible with life. The main and control groups were identical in gender and age composition: 103 male and 31 female subjects, aged from 16 to 50 years. Results. In a sectional study of subjects with isolated traumatic brain injury, thrombosis of the dura mater sinuses in various types of traumatic brain injury was observed. More often in people with signs of connective tissue dysplasia. the peculiarity of the dura mater ultrastructure in these individuals was the cause of inadequate sinus lumen when changing the speed and direction of venous blood flow in the sinus. This caused the formation of secondary necrosis and the development of cerebral edema. A feature of the ultrastructural structure of the dura mater in individuals with connective tissue dysplasia was revealed – changes in the type and location of fibrils and collagen fibers in the intrasinus apparatus in subjects with connective tissue dysplasia. This probably leads to a decrease in the extensibility and elasticity of the walls of venous vessels and does not correspond to the parameters of venous outflow when the blood flow rate changes. This feature of the ultrastructure can be a criterion for clarifying the forensic diagnosis in cases of traumatic brain injury, if they were with a favorable prognosis. Conclusion. The peculiarity of the ultrastructural structure of the dura mater in individuals with connective tissue dysplasia was established. it creates an obstacle to maintaining an adequate sinus lumen when the intra-sinus pressure changes in the acute period of traumatic brain injury. This leads to a high incidence of sinus thrombosis of the dura mater, in a greater number of cases, in persons with signs of connective tissue dysplasia.

The Comparison of the Right and Left Sigmoid Sinus Cross-Sectional Areas in Fetal Period and the Factors Affecting the Venous Dominance.

Skull base is an important and a challenging area for surgeons. Success in skull base surgery depends on various factors such as pre-operative evaluation, appropriate surgical technique, anesthesia duration, intraoperative neuromonitorization and wound care. This study was performed in the Anatomy dissection laboratory of M.U. Medical Faculty (Ethical committee approval number 2010-103). Twelve fetuses between 17-33 gestational weeks fixed with formaldehyde were enrolled to the study. This study was planned to investigate the cross sectional areas of the sigmoid sinus in three levels to compare the right-left sides and the probable relationship among the levels in fetuses to further delineate the developmental factors on jugular foramen asymmetry. The cross-sectional measurements of sigmoid sinus lumen were done on 3 levels which are described as A1 level; sinodural angle, A2 level; the midpoint between the sinodural angle and endocranial orifice and A3 level as the entrance (endo-cranial orifice) of the jugular foramen. There is a strong positive correlation between left (L) A1 and L A2 and also the same for L A1 and right (R) A2. These strong and positive correlations are all valid between L A2-L A3, L A2-R A2, L A2-R A3, L A3-R A3, R A1-R A2. Multicenter studies would be beneficial to investigate the topic with greater number of fetuses also on the different regions for genetic differences.

The Management of the Venous Sinuses During Surgery for Posterior Fossa Meningiomas

To define, from a series of surgically treated meningiomas of the posterior fossa with dural attachment above the dural sinuses, the best management of the sinus invasion according to the pattern of venous circulation. Seventy-five patients with posterior fossa meningioma whose dural attachment involved the major venous sinuses were included in the study. We considered tumor location and dural attachment, pattern of venous sinus circulation, degree of sinus involvement and its management, entity of surgical resection, complications, and recurrences. The resection of the involved sinus segment (Simpson I) was performed in 15 patients (20%) (10 with complete occlusion and pattern of circulation of types A and B and 5 with narrowed sinus and type B circulation); 42 cases (56%, all of type 1) were treated by coagulation and/or removal of the outer dural layer (Simpson II). In 14 (19%) the intrasinusal fragment was left (Simpson III), and in 4 (5%) the resection was partial, with residual intradural tumor (Simpson IV). No postoperative complications secondary to venous obstruction occurred. Eleven patients (15%) experienced tumor recurrence and were reoperated on. Only 4 of them with extensive dural invasion had further recurrence. In patients with posterior fossa meningiomas, we suggest to safety resect the involved sinus segment only when completely occluded. If the sinus lumen is not invaded or the tumor lies on the side of the unique or dominant transverse sinus, it should be preserved. This results in no or negligible risk of venous infarction and rather low recurrence rate.

Feasibility of High-Resolution 3-Dimensional Sampling Perfection with Application-Optimized Contrast Using Different Flip Angle Evolution Imaging for the Preoperative Detection of Parasinus Meningioma: A Pilot Study Compared with Contrast-Enhanced Magnetic Resonance Venography

To prospectively evaluate the diagnostic value of 3.0 Tesla magnetic resonance 3-dimensional sampling perfection with application-optimized contrast using different flip angle evolution (3D-SPACE) in the detection of sinus wall invasion and sinus patency in parasinus meningiomas. In this study, 28 patients with suspected meningiomas adjacent to the venous sinus underwent conventional magnetic resonance imaging, contrast-enhanced magnetic resonance venography, and 3D-SPACE scans. We collected patient charts and surgical reports for demographic details, histologic analysis, and neurologic performance preoperatively and postoperatively. Images obtained by each technique were assessed independently by 2 neurosurgeons for characteristics of sinus infiltration, wall invasion, lumen patency, and collateral veins. The blood flow signal inside the lumen and collateral veins were depressed and presented as black, contrasting well with the sinus wall on 3D-SPACE imaging. When the curved-planar reconstruction images were combined, it was intuitive and accurate to detect the extent of sinus wall invasion by meningioma and also to detect lumen patency. An intratumoral "false lumen" was shown to maintain the blood flow inside the sinus at a totally invaded lesion. Moreover, collateral veins enveloped in a meningioma with their confluence points of the venous sinus were easily observed on 3D-SPACE images. With an integrative presentation of parasinus meningioma, wall invasion, lumen patency, and collateral veins, high-resolution 3D-SPACE imaging provides a reliable technique to accurately assess venous sinus invasion preoperatively.

The Condemned Sinus: Natural Disease or Surgical Sequela?

Unilateral, mucopurulent drainage from an isolated paranasal sinus may be encountered in patients with a history of surgery for the treatment of chronic rhinosinusitis (CRS). Static mucus is visualized on nasal endoscopy within the sinus lumen but without significant disease in the adjacent sinuses. The reasons for this phenomenon are unknown although an iatrogenic cause is proposed. A case series was prospectively compiled from consecutive patients presenting for evaluation of CRS at a tertiary rhinology practice during a 16-month period. Computerized tomography and nasal endoscopy were performed, and endoscopically directed aerobic and anaerobic bacterial cultures were obtained. Osteitis scores were recorded for diseased and nondiseased sides. Twenty-three of 113 patients (20.4%) had evidence of chronic unilateral drainage from either a maxillary (21) or sphenoid (2) sinus. Mean osteitis scores were higher for the diseased side (P < 0.01). A nonendoscopic transantral approach was reported in 57.1% of cases with chronic maxillary disease, with 52.2% occurring more than 10 years earlier. The most common bacterial isolate was Pseudomonas aeruginosa (6 cases, 26.1%), followed by methicillin-resistant Staphylococcus aureus (5 cases, 21.7%). Six cases (26.1%) were polymicrobial, and 6 (26.1%) were culture-negative. Tobacco use was reported in 8 (34.8%) cases, and chronic obstructive pulmonary disease was present in 6 (26.1%) cases. The condemned sinus is a distinct entity that may represent a sequela of previous non-mucosal-sparing surgery. An association with hyperostosis is observed. Mucopurulent drainage is characterized by polymicrobial infection comparable to that found in diffuse CRS.

Association between Transverse Sinus Hypoplasia and Cerebral Venous Thrombosis: A Case-Control Study

Hypoplasia of the transverse sinus (TS) is a common anatomical variation. However, the relationship between TS hypoplasia and venous thrombosis has not been studied. We analyzed the hypothesis that TS hypoplasia is a predisposing factor for ipsilateral thrombosis. We retrospectively evaluated 20 confirmed cases with isolated TS thrombosis and 43 age- and sex-matched controls. TS thrombosis and hypoplasia were diagnosed using both computed tomography and magnetic resonance venography. Hypoplasia was defined as a TS diameter less than 50% of the cross-sectional diameter of the lumen of the distal superior sagittal sinus and by a bony groove ratio less than 1.02. Univariate analysis was performed to evaluate the association between TS hypoplasia and thrombosis. There were a total of 45 hypoplastic TS: 31 (49%) left hypoplastic TS (12 (60%) cases vs 19 (44%) controls (P = .24), and 14 (22%) right hypoplastic TS (9 (45%) cases vs 5 (12%) controls (P = .003). TS hypoplasia was more frequently found in cases (n = 18, 90.0%) than in controls (n = 22, 51.2%; relative risk 1.7, confidence interval [CI] 95% 1.3-2.4, P = .003). Hypoplastic TS and ipsilateral TS thrombosis showed a significant association (P = .002 for right and P = .008 for left TS hypoplasia) with relative risk of 3.8 (95% CI 1.3-10) for right and 7.5 (95% CI 1.1-48) for left hypoplasia. No significant association was found between hypoplastic TS and functional outcome at 30- or 90-day follow-up. TS hypoplasia might be a predisposing factor for ipsilateral TS thrombosis, but not for functional outcome.