Sphenoparietal Sinus Research Articles

Parasagittal Meningioma with Unusual Venous Drainage Manifesting through Peritumoral Hemorrhage

A 63-year-old female was admitted with a 5-day history of left hemiparesis. Computed tomography showed an enhanced mass with perifocal edema in the right frontal parasagittal region and an irregular-shaped, high-density mass anterior to the tumor. Right carotid angiography disclosed the prominent middle meningeal artery (MMA) to be the main feeding vessel of the tumor. In the venous phase, the superior sagittal sinus (SSS) was obstructed and a dilated middle meningeal vein (MMV) drained downward to the sphenoparietal sinus. Left carotid angiography demonstrated similar findings. There was a filling defect in the lumen of the MMV due to the MMA running within the vein. At surgery, careful manipulation was required, as the venous blood in the left MMV drained not only from the tumor but also from the anterior half of the SSS. The left MMA was found to run through the cavity of the dilated MMV. The SSS was invaded by tumor. There was an old hematoma cavity containing xanthochromic fluid in the brain parenchyma adjacent to the tumor. Histological examination showed meningothelial meningioma. The postoperative course was uneventful, although the right MMV was opacified on carotid angiography. It was suspected that obstruction of the SSS by tumor invasion had caused dilatation of the bilateral MMV and peritumoral hemorrhage due to disturbance of the venous drainage.

Microsurgical anatomy of the superficial veins of the cerebrum.

The microsurgical anatomy of the superficial cortical veins was examined in 20 cerebral hemispheres. The superficial cortical veins are divided into three groups based on whether they drain the lateral, medial, or inferior surface of the hemisphere. The veins on the three surfaces are further subdivided on the basis of the lobe and cortical area that they drain. The superficial cerebral veins collect into four groups of bridging veins: a superior sagittal group, which drains into the superior sagittal sinus; a sphenoidal group, which drains into the sphenoparietal and cavernous sinuses on the inner surface of the sphenoid bone; a tentorial group, which converges on the sinuses in the tentorium; and a falcine group, which empties into the inferior sagittal or straight sinus or their tributaries. The superior sagittal group drains the superior part of the medial and lateral surfaces of the frontal, parietal, and occipital lobes and the anterior part of the basal surface of the frontal lobe. The sphenoidal group drains the parts of the frontal, temporal, and parietal lobes adjoining the sylvian fissure. The tentorial group drains the lateral surface of the temporal lobe and the basal surface of the temporal and occipital lobes. The falcine group drains an area that includes the cingulate and parahippocampal gyri and approximates the cortical parts of the limbic lobe of the brain. The relationship of these veins to the venous lacunae was also examined.

The superficial sylvian vein in humans: with special reference to its termination.

A study of the termination of the superficial middle cerebral vein in 140 human specimens revealed that in 80 cranial cavities (51.1%) the vein drained into both the sphenoparietal sinuses, in nine cranial cavities (6.4%) into the sphenoparietal and cavernous sinuses, and in 19 cranial cavities (13.6%) into the sphenoparietal sinuses and middle meningeal veins. In 20 cranial cavities (14.3%) the vein drained into the cavernous sinuses alone and in eight cranial cavities (5.7%) it drained into the cavernous sinuses and middle meningeal veins. In one cranial cavity (0.71%) it drained into the vein in the foramen lacerum and the sphenoparietal sinus, in one cranial cavity (0.71%) into the sphenoparietal sinus and the superior petrosal sinus, in one cranial cavity (0.71%) into the middle meningeal veins on either side, and in another cranial cavity (0.71%) into the superior sagittal sinus, a finding which has not been reported in the past. The presence of an uncal vein draining the medial surface of the temporal lobe was observed occasionally (5.7%) in this study. A part of the superficial middle cerebral vein and sphenoparietal sinus in the form of a vein running a short course between the two layers of the lateral wall of the cavernous sinus is an observation previously not reported. This should be of value to neurosurgeons in the approach to the internal carotid artery through Parkinson's triangle.

Electrothrombosis of carotid-cavernous fistula.

The author describes a technique for directly closing a carotid cavernous fistula with electrothrombosis while preserving the intracranial arterial circulation. Copper wires are introduced through the superior ophthalmic vein or a frontotemporal craniotomy, and thus directly into the portion of the sinus into which the fistula drains; if posterior, into the posterior segment of Parkinson's triangle, if inferior, into the pterygoid plexus, and if anterior, through the sphenoparietal sinus and/or middle cerebral vein to the anterior-inferior portion of the sinus. A direct current is applied until a thrombus is confirmed angiographically and the wires are left in place. Four patients treated by this method are presented.

Aneurysm of the vein of Galen.

History: This 272 year old female child was admitted to Montefiore Hospital on November 13, 1956. Her birth at full term following a normal pregnancy had been unremarkable but was followed by a brief period of neonatal anoxia. At the age of 5 months the infant had an upper respiratory tract infection lasting 4 weeks. At this time the head was first noted to be enlarging more rapidly than normal. The illness was associated with moderate somnolence and lethargy because of which she was admitted to another hospital where her general condition soon improved. A ventriculogram revealed extensive hydrocephalus, and the probability of a deep thalamic neoplasm was suggested. No treatment was instituted and the child did well at home despite progressive enlargement of the head. At the age of 1 year she was readmitted to the other hospital because of severe epistaxis. The hemorrhage stopped spontaneously and did not recur. The hydrocephalus had increased and a proptosis was noted. During the next 16 months the child was alert and continued to respond to auditory and visual stimuli. The weight of the enlarging head prevented sitting or turning. The mother had noted mild, irregular elevations of the patient's temperature. Examination: On admission to this hospital the fontanelles were found to be large and bulging. The right eye was protuberant with dilated venous channels around it and over the anterior portion of the cranial vault. The head was massively enlarged. Radiographs showed severe osteoporosis of the skull, moderate suture separation, and slight enlargement of the sella turcica. Ventricular fluid was clear, colorless and without cells. Its total protein content was 16 mgm. per 100 cc. Course: The child was persistently febrile throughout her course although no infection could be demonstrated. The temperature was 100-102° F. until the terminal episode. Indigo carmine dye injected into the left lateral ventricle promptly appeared on the opposite side but none was apparent in the lumbar spinal fluid within 20 minutes. A 300 cc. ventriculogram revealed massive hydrocephalus without visualization of the aqueduct of Sylvius or 4th ventricle. The patient responded well after the procedure, but on the following day her temperature rose to 105.6° F. Despite alcohol sponges and antibiotics she expired on November 29,1956, two days after ventriCUlography. Post Mortem Findings: Permission for post mortem examination limited the investigation to the head. The body was well developed without external abnormalities. The calvarium was very thin with widened sutures. The cerebral hemispheres were greatly enlarged with flattening of the gyri and diminution of the depth of the sulci. The floor of the third ventricle was thin and bulged downward. The cranial nerves were intact. A 1.5 x 0.8 cm., thin-walled, venous channel connected the sphenoparietal sinus with the right deep middle cerebral veins which were dilated and tortuous (fig. 2). The superior and inferior longi-

RUPTURED CEREBRAL VARICES

When Pfannenstiel1described the first case of ruptured cerebral varix in 1887 he expressed the belief that the rupture was due to the intracranial congestion which occurred during eclamptic convulsions. In a second case studied by Kaufmann2the rupture occurred during eclampsia, lending support to the theory that toxemia of pregnancy in some way predisposes to the formation of cerebral varices. Amsler3described two instances of cerebral varix, each occurring in the inconstant ophthalmomeningeal vein of Hyrtl. He expressed the belief that the anatomic position of this vein subjects it to possible trauma as it passes through the orbital fissure and that stasis in the vein itself or in the underlying sphenoparietal sinus might result in pressure of the vein against the sharp upper bony margin of the orbital fissure and in injury of the wall. Continued stasis might result in dilatation of the injured vein. However,