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PubMed1993

Angiographic assessment of the transverse sinus and vein of labbé to avoid complications in skull base surgery.

Advances in the field of skull base surgery have dramatically reduced the mortality and morbidity of operations on the skull base. Nevertheless, cerebral ischemic events from compromised blood supply to areas of the brain still occur. Although arterial compromise is responsible for a majority of these events, the venous side of the circulation can also play a role in producing cerebral infarctions. A key area of cerebral venous drainage is at the junction of the transverse sinus, sigmoid sinus, and vein of Labbé. Absence of the transverse sinus with the outflow of the vein of Labbé limited to the sigmoid sinus puts these patients at an increased risk for venous infarcts when this area is manipulated during skull base surgery. We have studied 100 consecutive carotid angiograms performed on 50 individuals for carotid artery disease or to rule out aneurysms. We have found that 16.7% of individuals have one atretic transverse sinus. We discuss our results and the implications that they have in skull base surgery. It is our hope that a better understanding of the cerebral venous drainage patterns will help skull base surgeons avoid complications in the future.

Journal Article↗
PubMed2005

Transverse sinus stenoses persist after normalization of the CSF pressure in IIH.

BACKGROUND: Bilateral transverse sinus (TS) stenosis has been found in more than 90% of patients with idiopathic intracranial hypertension (IIH). OBJECTIVE: To evaluate whether TS stenosis changed after normalization of CSF pressure in patients with IIH during medical treatment. METHODS: Fourteen consecutive patients with IIH with bilateral TS stenosis on cerebral MR venography (MRV) during the medical treatment were studied. Patients were followed for over a 6-year period. During the follow-up, patients underwent repeated lumbar punctures (LPs) and cerebral MRV. MRV was always performed before each LP. RESULTS: TS stenosis persisted in all the patients during the follow-up. In 9 of 14 (64%) patients with IIH, CSF pressure normalized during medical treatment. CONCLUSIONS: Transverse sinus (TS) stenoses, as revealed by MR venography, persist in patients with idiopathic intracranial hypertension after normalization of CSF pressure, suggesting the lack of a direct relationship between the caliber of TS and CSF pressure.

Acetazolamide↗
PubMed2003

Passing the right internal thoracic artery through the transverse sinus.

We describe a simple reliable method to pass the right internal thoracic artery safely through the transverse sinus. At first, a 4-mm-wide vascular tape is passed through the transverse sinus. The cut end of the right internal thoracic artery is then attached to the right end of the tape with a hemoclip. Pulling the left end of the tape leftwards can ensure the passage of the right internal thoracic artery without any risk of twisting.

Humans↗
PubMed2001

Feasibility of the utilisation of the right internal thoracic artery in the transverse sinus in off pump coronary revascularisation: early angiographic results.

OBJECTIVE: The objective of this study was to analyze the feasibility of beating heart coronary surgery and to angiographically assess complete revascularisations with routine use of the two internal thoracic arteries (ITA), with the right ITA pedicled and placed through the transverse sinus. The authors report the results of their initial experience of coronary surgery without CPB, which began in December 1998. METHODS: From December 1998 to October 1999, 50 patients underwent non-urgent beating heart coronary revascularisation via a median sternotomy with the 2 ITA. Stabilization of the anastomotic site was ensured by the Octopus stabilizer 1 then 2. A troponin Ic assay was systematically performed in the initial postoperative period. With the patient's consent, postoperative angiography was performed before discharge. RESULTS: The mean number of anastomoses was 2.5+/-0.6 per patient (range: 2-4). Distal anastomoses by arterial grafts were performed in 87% of cases. In one case, the right ITA could not be kept pedicled and tunnelled in the transverse sinus and a Y graft onto the left ITA had to be performed. Left anterior descending-diagonal sequential bypass with the left ITA was performed in seven patients (14%). There was no operative mortality. One patient developed postoperative myocardial infarction. Follow-up angiography was performed in 42 cases (84%), with 104 anastomoses reviewed (85%). The patency rate for all anastomoses was 98.1%, with 90.4% of excellent results. The patency rate of the right ITA was 100%, with 90.5% of excellent results. CONCLUSIONS: Beating heart coronary surgery allows revascularisation of all coronary territories. This technique is not an obstacle to the use of the pedicled right ITA tunnelled in the transverse sinus. It is not associated with an increased postoperative morbidity and mortality, and the early follow-up angiographic results are excellent.

Aged↗
PubMed2000

Three-dimensional transcranial colour-coded duplex sonography of the transverse sinus.

The case of a patient with partial superior sagittal sinus and partial right sided transverse sinus thrombosis, and posterior fossa venous collaterals is presented. We report on the use of venous transcranial colour-coded duplex sonography (TCCS), combined with a new three-dimensional transcranial duplex data acquisition system, which allows free hand scanning of the region of interest. TCCS with three-dimensional image reconstruction allowed a more precise spatial localization of venous flow signals in the posterior fossa and facilitated the understanding of the haemodynamics of the venous collateral network.

Adult↗
PubMed2003

Arachnoid granulations in the transverse sinuses of a patient with ocular melanoma.

Arachnoid granulations show typical imaging features that allow their distinction from dural sinus thrombosis and intrasinus tumor. These features include a mid-lateral transverse sinus location, focality, common adjacent entering superficial veins, origin of attachment, low density on computed tomography (CT), isointensity-hypointensity on T1-weighted magnetic resonance imaging (MRI) and hyperintensity on T2-weighted MRI. We report the CT and MRI findings of incidentally detected bilateral arachnoid granulations in the transverse sinuses of a patient with ocular melanoma.

Aged↗
PubMed1992

Dural arteriovenous malformation of the transverse sinus with sinus occlusion: report of a case.

We report a case of dural arteriovenous malformation (AVM) of the transverse sinus with sinus occlusion. This 49-year-old man developed right parietal lobe dysfunction with acute onset. Computed tomography and magnetic resonance imaging (MRI) showed a non-hemorrhagic venous infarct in the subcortical white matter of the right parietal lobe, and diffusely dilated subcortical veins. Thrombosis of the right internal jugular bulb was also revealed on MRI. Cerebral angiography showed a dural AVM in the posterior fossa with occlusion of the right transverse sinus and retrograde venous drainage into the superior sagittal sinus, causing diffuse engorgement of the superficial cortical and the deep intramedullary veins. The focal neurologic deficits in this case were due to a non-hemorrhagic venous infarct in the subcortical white matter of the right parietal lobe secondary to retrograde cortical venous drainage.

Dura Mater↗
PubMed1980

Bilateral thrombosis of the transverse sinuses: microsurgical revascularization with venous bypass.

The present paper reports a case of intracranial hypertension secondary to thrombophlebitis of the two transverse sinuses and internal jugular veins in which microsurgical revascularization was attempted. This was carried out by means of a bypass graft inserted between the right transverse sinus and the superficial jugular vein. As early as the first post-operative week, intracranial pressure improved and visual disorders regressed. This type of venous revascularization using microsurgical techniques should contribute to more successful and lasting results in cases of sinus occlusions of thrombophlebitic, traumatic or tumorous origins.

Adolescent↗
PubMed2003

Cerebral MR venography of transverse sinuses in subjects with normal CSF pressure.

Flow artifacts or anatomic variants of venous sinuses often make MR venography (MRV) interpretation difficult. The authors investigated cerebral MRV in 111 subjects with normal CSF pressure to identify the most common flow abnormalities of transverse sinuses (TS). Disturbance of venous outflow in one transverse sinus was commonly observed in 30% of subjects whereas flow abnormalities of both TS occurred in 2 of 111 individuals. Subjects with flow gaps in both TS should undergo lumbar puncture to exclude increased CSF pressure.

Adolescent↗
PubMed1996

In situ right internal thoracic artery graft via transverse sinus for revascularization of posterolateral wall: early results in 116 cases.

The in situ right internal thoracic artery graft brought through the transverse sinus was used to revascularize the posterolateral wall in 116 patients. Its advantages were assessed retrospectively. The graft was anastomosed to the circumflex marginal branch in 70 patients (60%) or to the posterolateral branch in 41 patients (35%). One patient died (mortality rate 0.9%). Perioperative myocardial infarction occurred outside the territory of the right internal thoracic artery graft in 10 patients, four of whom required mechanical support for hemodynamic deterioration. Postoperative early angiography in 114 patients found the graft to be patent in 97.4%. The ratio of the diameter of the right internal thoracic artery to that of the recipient marginal branch was 0.94 +/- 0.18 (n = 69), and that to the posterolateral branch was 0.88 +/- 0.18 (n = 37) (not significantly different). Results of a postoperative stress test were abnormal in one patient (1/96 tested patients). This retrospective study suggests that the right internal thoracic artery brought through the transverse sinus to revascularize the posterolateral wall provided excellent early patency and good clinical results, even to the most distally located branches. This continues to be our procedure of choice for patients with multivessel coronary disease.

Adolescent↗
PubMed2000

Analysis by early angiography of right internal thoracic artery grafting via the transverse sinus : predictors of graft failure.

BACKGROUND: There has been debate regarding whether technically demanding right internal thoracic artery (RITA) grafting via the transverse sinus can be extensively applied to patients in high-risk groups, such as patients with a small body size, elderly patients, and woman with relatively smaller coronary artery and internal thoracic artery (ITA) diameters. METHODS AND RESULTS: Of the 1456 patients who underwent isolated coronary artery bypass grafting between January 1989 and December 1998 at Kumamoto Central Hospital, 393 patients (mean age, 62.4+/-9.0 years) with the RITA anastomosed to the major branches of the circumflex artery were studied. Left ITA grafting was performed in 384 patients, and in 369, the in situ left ITA was anastomosed to the left anterior descending coronary artery using standard methods. Early postoperative angiography was performed in 381 patients. The RITA was occluded in 4 patients, and string-like artery and significant stenosis were present in 11 and 7 patients, respectively; RITA graft patency was thus 94.1%. Of the preoperative variables and angiographic data, simple and multiple logistic regression analyses identified decreased severity of native stenosis, diffuse sclerosis of native vessels, and residual side branches of the ITA as independent predictors of nonfunctional grafts. The method of ITA grafting did not influence the patency of the graft. CONCLUSIONS: The excellent patency rate demonstrated by this study, the largest angiographic study to date of RITA grafting via the transverse sinus, indicates that this technique can provide reliable revascularization of the left ventricle and that it has the potential to be applied to a wide variety of patients with diseased circumflex arteries.

Adolescent↗
PubMed2004

Guidelines for the ligation of the sigmoid or transverse sinus during large petroclival meningioma surgery.

The authors present guidelines for the ligation of the transverse or sigmoid sinus during the surgical removal of petroclival meningiomas. The medical records and venograms of 14 patients with a petroclival meningioma requiring transverse or sigmoid sinus ligation treated in the Department of Neurosurgery, Seoul National University Hospital between 1986 and 1999 were reviewed. All patients successfully received a sinus trial clamping during the operation. The drainage pattern of the confluens of Herophili was classified into four types: Type A, confluens and equal on both transverse sinuses; Type B, confluens and nondominant transverse sinus on the tumor side; Type C, confluens and dominant transverse sinus on the tumor side; and Type D, unilateral transverse sinus only. Of the 14 cases, four were Type A, five were Type B, and two were Type C. There was no brain swelling after intraoperative test clamping of the sinus for more than 30 minutes. None of the cases developed postoperative complications related to the sinus ligation. Patients with Type A, B, or C drainage patterns were ideal candidates for sinus ligation, especially transverse sinus ligation, if the test clamping proved to be safe. The sinus was cut proximal to the superior petrosal sinus, distal to the vein of Labbé.

Journal Article↗
PubMed2005

[Hemangiopericytoma at the transverse sinus presenting with intracerebral hemorrhage: case report].

The authors report on a patient with hemangiopericytoma(HPC). This 43-year-old female presented severe headache, vomiting and right homonymous hemianopsia. Magnetic resonance imaging and an angiogram showed a tumor above the left transverse sinus. The patient underwent a total resection of the tumor and reconstruction of the transverse sinus without additional neurological deficits. Based on the findings shown in this case report, hemangiopericytoma should be included in the differential diagnosis from benign meningioma. Because this tumor often undergoes recurrences and metastases, we recommend a combination of radical surgical extirpation of followed by postoperative radiotherapy.

Adult↗
PubMed2004

Sigmoid and transverse sinus thrombosis caused by mastoid implant -- case report.

INTRODUCTION: Extraoral craniofacial implants are often used for retention of auricular prostheses. In this case report, the rare complication of sigmoid and transverse sinus thrombosis after implant placement in the mastoid is described. CASE REPORT: A 36-year-old man with congenital hypoplasia of the right ear was treated with an implant-based auricular prosthesis. One of the three implants in the mastoid area had to be removed because of an infection, whereas the other two implants were removed at the patient's request. Twenty-four days after implant removal, he was seen with sigmoid and transverse sinus thrombosis and successfully treated with fibrinolytic and consecutive anticoagulation therapy. CONCLUSIONS: Implants in the mastoid area are a very important aid for retention of auricular prostheses, but may have life-threatening intracranial consequences.

Adult↗
PubMed1995

[Hemodynamics of the transverse sinus using cine angiography].

Numerous anatomical observations of the transverse sinus (TS) have been reported and features of this sinus, as assessed by cerebral angiography, are referred to in many monographs. However, there are no studies on the hemodynamics in the TS. We recently investigated the TS, using cerebral angiography with cinematographic films. The subjects were 35 patients who underwent angiography of 3 or 4 vessels at our institute, using Seldinger's method. The contrast material was infused manually. Cinematography permitted observation of the size of the bilateral TS and the direction of blood flow. Depending on the features of the bilateral TS, the patients could be divided into three groups. Type I (cases where the right TS was dominant) accounted for the highest percentage (54.3%, 19/35). In 11 of these 19 cases, the left TS also showed antegrade blood flow. In 6 of the Type I group, the blood flow through the left TS was in two directions (towards the Torcular Herophili and towards the left sigmoid sinus). In the other two cases rated as Type I, the blood flow through the left TS was in the direction from the Torcular Herophili to the right TS. Fourteen cases (40.0%) were rated as Type II (in which both sinuses were similar in size). In 13 of these 14 cases, blood flow through the bilateral TS was almost symmetrical (Type II-A). In one of the 14 cases, the blood flow through the left TS was in two directions (towards the Torcular Herophili and towards the left sigmoid sinus).

Aneurysm, Ruptured↗
PubMed2005

[Endovascular treatment of benign intracranial hypertension by stent placement in the transverse sinus. Therapeutic and pathophysiological considerations illustrated by a case report].

We report a case of benign intracranial hypertension in a 31-year-old man treated by endovascular stent placement in the right transverse sinus. The patient presented with a typical benign intracranial hypertension syndrome. Ophthalmologic findings showed bilateral papilledema with a 7/10 loss visual acuity loss in the right eye and 2/10 in the left eye. At lumbar puncture, cerebrospinal fluid (CSF) pressure was 40 mmHg. Magnetic resonance imaging (MRI) showed slit ventricles and dilatation of optic nerve sheaths. optiques. After failure of medical treatment, the patient was referred to our neurosurgical department for therapeutic decision. Direct retrograde cerebral venography showed predominant cerebral venous drainage via the right transverse sinus which exhibited stenosis in its proximal third. Mamometry revealed a 25 mmHg pressure gradient across the point of stenosis. Due to possible venogenic benign intracranial hypertension, endovascular stent placement was proposed and accepted by the patient. At 3 months follow-up, the patient was symptoms free, papilledema had disappeared and visual acuity was 10/10 on both eyes. CSF pressure on lumbar puncture was 11 mmHg. The pathophysiological aspects and therapeutic management of this pathology illustrated by this are discussed along with a careful and exhaustive review of the literature.

Adult↗
PubMed2005

Sudden re-opening of collapsed transverse sinuses and longstanding clinical remission after a single lumbar puncture in a case of idiopathic intracranial hypertension. Pathogenetic implications.

The aetiopathogenetic role of sinus venous obstructions carried by most idiopathic intracranial hypertension (IIH) patients is controversial. We report the case of a young woman diagnosed with IIH with papilloedema and narrowing of transverse sinuses, in which lowering of intracranial pressure by a single 20 ml cerebrospinal fluid (CSF) resulted in a strong dimensional increase of the transverse sinuses. Changes were followed by clinical remission and normalisation of optical nerve calibre, maintained after a 2-month follow-up. Our findings indicate that, although secondary to CSF hypertension, venous sinuses compression may have an important role in hypertensive status maintenance. Pathogenetic implications of venous sinus compression by hypertensive CSF in IIH are discussed.

Adult↗