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At least 37 records · Page 2Linked to original sources

PubMed2004

Transverse sinus septum: a new aetiology of idiopathic intracranial hypertension?

A venographic cryptic stenosis at the junction of middle and lateral third of the transverse sinus has been observed in patients suffering from idiopathic intracranial hypertension. After reviewing the anatomical and embryological literature of the transverse sinus, 20 transverse sinuses were explored (in a pilot study of 10 human cadavers) in order to determine the anatomical basis of this stenosis. The presence of septa of varying sizes was observed. We conclude that the presence of a large septum is one of the causes of venographic cryptic stenosis observed in these patients and might be one of the aetiological factors involved in idiopathic intracranial hypertension.

Cadaver↗

PubMed2001

Anatomic relationship between arachnoid granulations in the transverse sinus and the termination of the vein of Labbé: an angiographic study.

We studied the anatomic relationship between arachnoid granulations in the transverse sinus and the termination of the vein of Labbé in 57 consecutive angiograms. Patients with pathology in intracranial venous structures or with inadequate image quality of the venous system were excluded. Arachnoid granulations were found in 12 of the 57 patients (21.1%), always at the junction of the vein of Labbé and the transverse sinus; the vein of Labbé was present in 55 patients (96.5%), most often without associated arachnoid granulations; the latter, however, were not observed in the absence of a vein of Labbé. This study confirms the close, constant anatomic relationship between arachnoid granulations in the transverse sinus and the termination of the vein of Labbé. This observation may help to differentiate arachnoid granulations from pathologic conditions involving the transverse sinus such as dural sinus thrombosis. The constant character of this relationship suggests a developmental role of afferent veins in the formation of arachnoid granulations.

Arachnoid↗

PubMed2003

Dural arteriovenous fistula of the transverse sinus with concomitant ipsilateral meningioma.

A 69-year-old female complained of headache and tinnitus. Computed tomography, magnetic resonance imaging, and angiography showed a tumour in the right transverse sinus extending to the transverse-sigmoid sinus junction, a dural arteriovenous fistula (AVF), and right transverse-sigmoid sinus thrombosis with the downstream from the right sigmoid sinus involved by the tumour. Right external carotid angiography showed the tumour to be supplied by many branches of the right occipital artery, the posterior branches of the middle meningeal artery, and the posterior auricular artery, and the dural AVF fed by the occipital artery and the meningeal branches of the right vertebral artery. She underwent surgery via a combined right supra- and infratentorial approach. The tumour had invaded and blocked the right transverse sinus, which was resected. After surgery the patient was free of headache and tinnitus was diminished. Histological examination found that the tumour was a fibrous meningioma and that the orifice of the vein at the transverse sinus was blocked by the tumour. Serial follow-up cerebral angiography 2 months after surgery showed no change in the AVF, but 9 months after surgery confirmed disappearance of the AVF. This AVF was caused by occlusion of the right transverse sinus by the meningioma and was an acquired lesion.

Aged↗

PubMed1994

[Transverse sinus thrombosis in a patient with colon and rectal double cancers: a case report].

We report a case of transverse sinus thrombosis accompanied by colon and rectal double cancers. A 48-year-old male transferred to our department from the division of surgery due to deterioration manifested by headache after colectomy and low anterior resection of the rectum. There was bilateral papilledema and right upper homonymous hemianopsia. On admission all the laboratory data were within normal range. CT showed a left temporal mass lesion of heterogeneous density, which was suspected as being intratumorous hematoma in a metastasis. MRI revealed a left transverse sinus thrombosis. The left transverse and sigmoid sinuses were not opacified, but angiography showed that the occipital and marginal sinuses seemed to be markedly developed. Evacuation of the subcortical hematoma was carried out. Histologically, it was a mixed hematoma in acute and chronic stages without any carcinoma component or vascular malformation. Postoperative course was uneventful, and the patient was returned to the division of surgery in order to follow up the cancer 2 weeks after operation. Angiography 4 months after operation showed almost no recanalization in the left transverse sinus. Further, development of the collateral flow and the double occipital sinus was opacified. Because the coagulation system is often activated by the presence of cancer, it is important to distinguish intracerebral hemorrhage due to sinus thrombosis from intratumorous hemorrhage within a metastatic tumor.

Adenocarcinoma↗

PubMed2003

In situ retrocaval skeletonized right internal thoracic artery anastomosed to the circumflex system via transverse sinus: technical aspects and postoperative outcome.

BACKGROUND: The aim of this study was to investigate whether, by using the in situ right internal thoracic artery via the transverse sinus (eventually retrocaval), both the proximal and distal major branches of the circumflex system could be grafted and to evaluate the early and late outcome in these patients. METHODS: Between January 1997 and March 2002, 452 consecutive patients underwent grafting of the circumflex system with the in situ skeletonized right internal thoracic artery routed via the transverse sinus. The mean age was 62.4 +/- 10.3 years. A mean of 2.2 +/- 0.3 arterial grafts per patient were used, and 271 (60%) patients underwent total arterial myocardial revascularization. At 3 months after surgery, 86 patients (right Y or T graft) underwent echo color Doppler imaging before and after an adenosine provocative test. The mean follow-up was 27 +/- 8 months. RESULTS: The success rate of skeletonized right internal thoracic artery grafting to the circumflex system branch was 100%. There were 15 (3.4%) hospital deaths. In 116 patients who underwent postoperative angiography, the total patency rates of the right and left internal thoracic arteries were 94% and 96.6%, respectively. Strong predictors for nonfunctional internal thoracic artery grafts were a small internal thoracic artery caliber (P <.001), recipient coronary artery diameter less than 1.5 mm (P =.012), stenotic lesions of less than 60% (P =.016), and diffuse stenotic lesions (P =.015) of the recipient coronary artery. In 86 patients who underwent postoperative echo color Doppler imaging, the flow reserves at the main stem of the left and right internal thoracic arteries were 2.24 +/- 0.5 and 2.48 +/- 0.6, respectively. Cumulative actuarial survival at 3 years was 96.3%, and event-free cumulative survival was 93%. The Cox model revealed a left ventricular ejection fraction of less than 35% (P =.016), age greater than 70 years (P =.025), New York Heart Association grade greater than III (P =.0019), nontotal arterial myocardial revascularization (P =.002), and the preoperative presence of more than 1 ischemic area (P <.001) as strong predictors for poor overall cumulative event-free survival. CONCLUSIONS: The skeletonized right internal thoracic artery, placed via the transverse sinus and eventually retrocaval, can reach most branches of the circumflex system and is associated with an excellent patency rate. The predictors for poor overall event-free survival seem to be similar to those of the general population undergoing conventional coronary artery bypass grafting. Use of bilateral internal thoracic arteries and in situ right internal thoracic artery grafting via the transverse sinus offers the possibility of various configuration constructions, making possible total arterial myocardial revascularization with a minimum number of arterial conduits.

Adult↗

PubMed2003

Transverse sinus air after cranial trauma.

Air in vascular compartments has been rarely reported. We report a case in whom air within transverse sinus and sinus confluence through ruptured superior sagittal sinus (SSS) due to fractures of parietal and frontal bones was disclosed by computed tomography (CT). Although air in transverse sinus has been reported rarely this could be the first case with air in transverse sinus through the SSS after cranial trauma.

Adult↗

PubMed2004

Importance of anatomical asymmetries of transverse sinuses: an MR venographic study.

Time-of-flight (TOF) magnetic resonance venography (MRV) is often used to examine the intracranial dural sinuses, particularly in the evaluation of dural sinus thrombosis. The goal of the study was to evaluate the use of TOF MRV in assessing the normal anatomy of dural sinuses and their variations as sources of potential pitfalls in the diagnosis of venous sinus thrombosis. Cerebral TOF MRV obtained in 105 persons with normal MR studies were reviewed to determine the presence, aplasia and hypoplasia of the transverse sinuses. Twenty-one (20%) aplasias of the left sinus, 41 (39%) hypoplasia of the left sinus, 33 (31%) symmetric, 6 (6%) hypoplasia of the right sinus, and 4 (4%) aplasias of the right sinus cases were determined in the asymmetry in sizes of transverse sinuses. These results suggested that transverse sinus flow gaps or aplasias can be observed in approximately 24% of normal population on MR imaging. The rate of these gaps in normal subjects must be kept in mind because it can be a source of misdiagnosis in cases of suspected dural sinus thrombosis.

Adult↗

PubMed1996

Transverse sinus dural fistula: combined surgical and endovascular approach: a case report.

BACKGROUND: The treatment of a large dural sinus fistula can be very difficult and complicated. The very extensive and complex nature of these malformations may require a combination therapy in the form of surgery and multistaged embolization. The transverse sinus fistula in our patient was fed by multiple large high-flow feeders and was draining retrograde into the superior sagittal sinus (SSS) and the cortical veins. The SSS did not fill in the late venous phase of the carotid angiogram, suggesting increased venous pressure. METHODS: A case of transverse sinus dural fistula is described that was managed by a combination of surgery and embolization. The complex nature of this malformation encouraged us to adopt a combination of multistaged embolization and surgery for the management and clinical control. The patient underwent embolization of multiple feeders from the branches of the external carotid artery. After this procedure, the patient underwent endovascular occlusion of the transverse sinus via the SSS. Throughout the endovascular treatment, the patient had concomitant intracranial pressure monitoring and SSS pressure monitoring, along with transcranial cerebral oximetry (TCCO). Despite this aggressive endovascular intervention, the fistula could not be completely closed. The patient then underwent surgical excision of the transverse sinus along with duraplasty and cranioplasty. RESULTS: The patient had a good recovery and posttreatment angiogram revealed normal antegrade flow in the SSS with no evidence of the fistula. The combined surgical and endovascular techniques are described and their use in clinical practice is discussed. CONCLUSIONS: The complexity of certain large dural sinus fistulae should not be underestimated. They may require a prolonged multistaged treatment for their total obliteration. Also, despite the large size and complexity of the disease, complete cure can be achieved.

Adult↗

PubMed2001

Meningiomas invading the sagittal or transverse sinuses, resection with venous reconstruction.

Surgery of meningiomas involving dural sinuses leaves the surgeon confronted with a dilemma: leave the fragment invading the sinus and have a higher risk of recurrence, or attempt a total removal with or without venous reconstruction and expose the patient to a potentially greater operative danger. The authors report a series of 80 meningiomas (72 of the sagittal sinus, 5 of the transverse sinus and 3 of the torcular) in whom gross total removal was achieved in all but 7 cases (i.e., 91%), and venous reconstruction attempted in a majority. In total, 70 patients (87.5%) had a good outcome and resumed their previous activities. There was a permanent neurological deficit in seven (8.7%) due to infarction secondary to injury of central veins (all but one in the sagittal sinus mid-third). Three patients (3.6%) died from brain swelling; all with meningioma totally occluding the sinus and in whom resection was achieved without sinus reconstruction. There were two recurrences (2.5%) in this series which has a mean follow-up of 8.5 years. The conclusion is to favour, whenever possible, total removal with sinus reconstruction, using a patch for meningiomas with partial sinus invasion and a venous bypass for those with total sinus occlusion.

Adolescent↗

PubMed1998

Venous reconstruction in surgery of meningiomas invading the sagittal and transverse sinuses.

SURGERY OF MENINGIOMAS INVOLVING MAJOR DURAL SINUSES LEAVES THE SURGEON CONFRONTED WITH A DIFFICULT DILEMMA: leave the fragment invading the sinus in place and have a higher risk of recurrence, or attempt a total removal with or without venous reconstruction and expose the patient to a potentially greater operative danger. The authors report a series of 47 meningiomas (41 of the sagittal sinus, 4 of the transverse sinus and 2 of the torcular) in whom gross total removal was achieved in all cases, and venous reconstruction (of various types) attempted in a majority. Thirty-nine patients had a good outcome and resumed their previous activities. There was a permanent neurological deficit in five due to infarction secondary to injury of central veins (all in the sagittal sinus midthird). Three patients died from brain swelling; all with meningioma totally occluding the sinus and in whom resection was achieved without sinus reconstruction. There were two recurrences in this series which has a mean follow-up of 7.5 years.The authors' surgical experience led them to favor whenever possible, total removal with sinus reconstruction, using a patch for meningiomas with partial sinus invasion and a venous bypass for those with total sinus occlusion.

Journal Article↗

PubMed1998

Long-term patency rate of right internal thoracic artery bypass via the transverse sinus.

BACKGROUND: Although concern regarding patency and possible compromise of graft blood flow by routing the right internal thoracic artery (RITA) through the transverse sinus has been raised, little is known about long-term patency. METHODS AND RESULTS: To evaluate long-term patency of in situ RITA bypass via the transverse sinus, our first 115 patients (94 men, 21 women; mean age, 62.5 years; range, 13 to 77 years) who were alive in 1998 were enrolled for angiographic study. Only good-caliber grafts with no occlusion, string sign, or significant stenosis were considered patent. Early postoperative angiography had been performed 2 to 3 weeks after surgery in 114 patients. The early patency rates were 97.1% for RITA and 95.4% for left internal thoracic artery (LITA) grafts. Of 109 long-term survivors, 73 (67.0%) consented to have late angiographic restudy at a mean of 59 months (range, 9 to 93 months); 89.9% of RITA and 92.3% of LITA grafts were patent. Cumulative patency rates (actuarial curves) at 6 years were 89.3% (95% CI, 85% to 94%) for RITA and 94.5% (95% CI, 92% to 97%) for LITA, the differences not reaching statistical significance (multivariate Cox analysis). CONCLUSIONS: Our study demonstrated good long-term patency of in situ RITA bypass grafting via the transverse sinus for revascularization of the circumflex and diagonal arteries and supports its continued use.

Adolescent↗

PubMed2001

Sigmoid and transverse sinus thrombosis after closed head injury presenting with unilateral hearing loss.

Sinus thrombosis has rarely been associated with closed head injury; more often, thrombosis of the sigmoid or transverse sinus is caused by otogenic inflammations or tumours, or occurs during pregnancy. Symptoms are frequently vague, while untreated thrombus progression may be fatal due to venous congestion and infarction. We report a 32-year-old man presenting with right hearing loss, tinnitus and headache 2 days after a closed head injury. Neurological examination showed no additional abnormality. The EEG showed focal bifrontal slowing. CT revealed a fracture of the occipital bone. MRI and MRA demonstrated complete thrombosis of the right sigmoid and transverse sinuses. After 2 weeks of intravenous heparin therapy followed by warfarin, the patient's hearing improved and MRI and MRA showed complete recanalisation of the sigmoid and transverse sinuses. Venous sinus thrombosis can be an undetected sequel to head injury. Appropriate imaging studies should be carried out to enable therapy to be started as soon as possible.

Adult↗

PubMed1996

Right internal thoracic artery through the transverse sinus in myocardial revascularization.

BACKGROUND: This study presents the late patency rate of the right internal thoracic artery (ITA) used in situ through the pericardium transverse sinus to the circumflex artery and its branches. METHODS: From April 1983 to December 1994, 2,642 patients were submitted to myocardial revascularization; 201 of them had bilateral ITAs. The right ITA through the transverse sinus was grafted to obtuse marginal artery in 170 patients (84.5%) and the left ITA was grafted to the anterior descending artery in 188 patients (93.5%). Angiographic studies were performed in 80 patients, 44 patients in the immediate postoperative period and 36 patients in the late follow-up (mean, 51.6 months). RESULTS: The right ITA was patent in 75 patients (93.7%) and the left ITA was patent in 77 (96.2%). At the late postoperative period, the right ITA was patent in 33 patients (91.6%) and the left ITA was patent in 34 (94.4%). CONCLUSIONS: The right ITA placed through the pericardium transverse sinus has a good long-term patency rate, similar to that observed with the left ITA and superior to that of saphenous vein grafts for myocardial revascularization.

Actuarial Analysis↗

PubMed2006

Idiopathic intracranial hypertension and transverse sinus stenosis: a modelling study.

Idiopathic intracranial hypertension (IIH) is a syndrome of unknown etiology characterized by elevated intracranial pressure (ICP). Although a stenosis of the transverse sinus has been observed in many IIH patients, the role this feature plays in IIH is in dispute. In this paper, a lumped-parameter model is developed for the purpose of analytically investigating the elevated pressures associated with IIH and a collapsible transverse sinus. This analysis yields practical predictions regarding the degree of elevated ICPs and the effectiveness of various treatment methods. Results suggest that IIH may be caused by a sufficiently collapsible transverse sinus, but it is also possible that a stenosed sinus may persist following resolution of significant intracranial hypertension.

Acetazolamide↗

PubMed1988

MR imaging of the transverse sinus of the pericardium.

On MR images of the chest, a low-signal-intensity band is often seen between the ascending aorta and left atrium in the transverse plane, and between the right pulmonary artery and left atrium in the coronal and sagittal planes. CT and MR of cadavers, with injection of contrast media into the pericardial space, confirmed that this structure was the transverse sinus of the pericardium. Retrospective review of MR studies in 45 patients without evidence of pericardial disease showed the transverse sinus of the pericardium in 80% (32/40) of transverse ECG-gated images, 78% (7/9) of sagittal ECG-gated images, and 67% (14/21) of coronal ECG-gated images. Nongated studies showed the sinus infrequently. Knowledge of the three-dimensional anatomy of the transverse sinus of the pericardium and of its typical MR appearance should allow its recognition and preclude misinterpretation.

Adolescent↗

PubMed1997

Dural arteriovenous shunt involving the superior petrosal sinus: presentation and treatment by transvenous embolisation via the occipital and transverse sinuses.

We report a dural arteriovenous shunt on the superior petrosal sinus at the origin of the petrosal vein, and its treatment. This is the first report of transvenous embolisation of such a shunt through the contralateral occipital and transverse sinuses. It was possible to achieve complete obliteration of the superior petrosal sinus shunt by coils and polyvinyl acetate liquid embolisation, in a combined venous and arterial approach.

Aged↗

PubMed2006

Bilateral transverse sinus stenosis predicts IIH without papilledema in patients with migraine.

BACKGROUND: The headache profile of patients with idiopathic intracranial hypertension without papilledema (IIHWOP) may be indistinguishable from that of migraine. Bilateral transverse sinus stenosis (BTSS) has been found in the majority of patients with IIHWOP. The frequency of BTSS associated with IIHWOP in patients with migraine is unknown. OBJECTIVE: To detect the frequency of BTSS in adult patients with migraine and to investigate whether the presence of BTSS identifies patients with IIHWOP. METHODS: In a prospective study from December 2000 to November 2005, 724 consecutive patients with recurrent headaches who fulfilled International Headache Society diagnostic criteria for migraine underwent cerebral MR venography (MRV). A portion of these patients underwent a lumbar puncture (LP) to measure CSF pressure. MRV and LP were also performed in 70 age-matched control subjects. RESULTS: Six hundred seventy-five of the 724 patients with migraines had normal MRV. Seventy of these 675 patients underwent LP, and all of them had normal CSF pressure. Forty-nine (6.7%) of the 724 patients with migraine had BTSS. Twenty-eight of these 49 patients with BTSS underwent LP, and 19 (67.8%) had IIHWOP. The headache profiles of patients with BTSS and IIHWOP did not differ from those of patients with normal MRVs and CSF pressures within normal limits. CSF pressure was normal in both patients and controls with normal MRV. CONCLUSIONS: Of patients with migraine, 6.7% had bilateral transverse sinus stenosis; 67.8% of these patients had idiopathic intracranial hypertension without papilledema (IIHWOP). These results suggest that patients with migraine who present bilateral transverse sinus stenosis on cerebral MR venography should undergo lumbar puncture to exclude IIHWOP.

Adult↗

PubMed1980

Transverse sinus anomaly simulating a meningioma on CT scanning.

A rare, anomalously dilated right transverse sinus with involvement of the torcular herophili strongly suggested the appearance of a meningioma on CT scanning. Carotid and vertebral arteriography did not reveal the nature of the abnormality, since there was only faint opacification of the anomalous vessel, which was interpreted as a faint tumor stain. Transjugular venography was necessary to establish this diagnosis. When a similar lesion is encountered on CT scanning and the transverse sinus is not clearly seen on arteriography, venography should be carried out to determine if the appearance is due to occlusion by a mass or, as in this case, anomalous dilatation of the sinus.

Adult↗