BACKGROUNDDuring craniotomies using the transpetrosal-presigmoid approach, exposure of the sigmoid sinus remains an essential but hazardous step. In such procedures, accurate localization of the anterosuperior point of the transverse-sigmoid sinus junction (ASTS) is very important for reducing surgical morbidity. This study aimed to create an accurate and practical method for identifying the ASTS.

METHODSOn the lateral surfaces of 40 adult skulls (19 male skulls and 21 female skulls), a rectangular coordinate system was defined to measure the x and y coordinates of two points: the ASTS and the squamosal-parietomastoid suture junction (SP). With the coordinate system, the distribution characteristics of the ASTS were statistically analyzed and the differences between the ASTS and SP were investigated.

RESULTSFor ASTS-x, significant differences were found in different sides (P = 0.020); the ASTS-x in male skulls was significantly higher on the right side (P = 0.017); there was no significant difference between the sides in female skulls. There were no significant differences in gender or interaction of gender and side for ASTS-x, and for ASTS-y, there were no significant differences in side, gender, or interaction of gender and side. For both sides combined, the mean ASTS-x was significantly higher than the mean SP-x (P = 0.003) and the mean ASTS-y was significantly higher than the mean SP-y (P = 0.011).

CONCLUSIONSThis reference coordinate system may be an accurate and practical method for identifying the ASTS during presigmoid craniotomy. The SP might be difficult to find during presigmoid craniotomy and, therefore, it is not always a reliable landmark for defining the ASTS.

Adult ; Cranial Sinuses ; anatomy & histology ; Craniotomy ; Female ; Humans ; Male ; Middle Aged ; Skull ; anatomy & histology ; Transverse Sinuses ; anatomy & histology

It is extremely dangerous to treat the posterior third of the superior sagittal sinus (PTSSS) surgically, since it is usually not completely ligated. In this report, the authors described the case of a 27-year-old man with a ruptured and defective PTSSS caused by an open depressed skull fracture, which was treated by ligation of the PTSSS and the patient achieved a positive recovery. The patient's occiput was hit by a height-limiting rod and was in a mild coma. A CT scan showed an open depressed skull fracture overlying the PTSSS and a diffuse brain swelling. He underwent emergency surgery. When the skull fragments were removed, a 4 cm segment of the superior sagittal sinus (SSS) and the adjacent dura mater were removed together with bone fragments. Haemorrhage occurred and blood pressure dropped. We completed the operation by ligating the severed ends of the fractured sagittal sinus. One month after the operation, apart from visual field defects, he recovered well. In our opinion, in primary hospitals, when patients with severely injured PTSSS cannot sustain a long-time and complicated operation, e.g., the bypass using venous graft, and face life-threatening conditions, ligation of the PTSSS is another option, which may unexpectedly achieve good results.
Adult ; Cranial Sinuses ; Humans ; Male ; Skull Fracture, Depressed/surgery* ; Superior Sagittal Sinus/surgery* ; Tomography, X-Ray Computed

Cerebral venous thrombosis (CVT) is a disease sometimes associated with a wide variety of clinical signs and symp-toms. Single or multiple cranial nerve palsies without evidence of any other signs and symptoms have not, so far, been considered as a relevant syndrome of CVT. A 49-year-old woman was admitted to our hospital because of diplopia, vertigo with tinnitus and ataxia which had begun approximately three weeks before. Neurological examination revealed a right 6th nerve palsy by a red glass test and an impaired tandem walking test. Laboratory tests including CSF exami-nation and brain MRI were normal but MR venography and following 4-vessel angiography showed thrombosis in the left transverse and sigmoid sinuses and suspicious thrombosis in the right lateral sinus. She was treated with heparin and proceeded to get well.
Abducens Nerve Diseases ; Angiography ; Ataxia ; Brain ; Colon, Sigmoid ; Cranial Nerve Diseases ; Cranial Nerves* ; Diplopia ; Female ; Glass ; Heparin ; Humans ; Lateral Sinus Thrombosis* ; Magnetic Resonance Imaging ; Middle Aged ; Neurologic Examination ; Phlebography ; Thrombosis ; Tinnitus ; Transverse Sinuses* ; Venous Thrombosis ; Vertigo ; Walking

PURPOSE: The purpose of this study was to describe the MR imaging and CT findings of intracranial inflammatory pseudotumors. MATERIALS AND METHODS: We reviewed the MR imaging (n=8) and CT (n=4) studies of eight patients (M:F = 4:4, mean age: 41 years) with pathologically proven intracranial inflammatory pseudotumor. The findings were then evaluated with regard to location, shape, MR signal intensity, CT density and degree of contrast enhancement of the lesion, surrounding parenchymal edema, adjacent bone change and the location of accompanying extracranial lesion. RESULTS: In two patients, the parietal convexity was involved unilaterally, with no extracranial mass, and in the other six, the middle cranial fossa was involved unilaterally and extracranial mass was present. The lesion also involved the tentorium in four cases, the cavernous sinus in four, the anterior cranial fossa in one, and the posterior cranial fossa in one. The location of extracranial mass was the mastoid and middle ear cavity in two cases, the infratemporal fossa in two, both the infratemporal fossa and paranasal sinuses in one, and the orbit in one. MR images showed diffuse dural thickening in all eight cases, leptomeningeal thickening in four, and focal meningeal-based mass in two. As seen on T1-weighted images, the lesions were isointense to gray matter in eight cases, and on T2-weighted images were hypointense in seven cases and isointense in one. Marked homogeneous contrast enhancement was seen in all eight cases. The lesions seen on brain CT, performed in two cases, were isodense. Adjacent brain parenchymal edema and the destruction of adjacent bones were each seen in five cases. CONCLUSION: The characteristic MR findings of intracranial inflammatory pseudotumors are(1) diffuse dural thickening;(2) a focal meningeal-based mass which on T2-weighted images is seen as hypointense; and marked (3) contrast enhancement : these findings are, however, nonspecific. In order to differentiate these tumors, an awareness of these findings is, however, useful.
Brain ; Cavernous Sinus ; Cranial Fossa, Anterior ; Cranial Fossa, Middle ; Cranial Fossa, Posterior ; Ear, Middle ; Edema ; Granuloma, Plasma Cell* ; Humans ; Magnetic Resonance Imaging* ; Mastoid ; Orbit ; Paranasal Sinuses ; Rabeprazole

Humans ; Cranial Sinuses/surgery* ; Intracranial Hypertension/etiology*

Congenital arteriovenous(AV) communications of retinal circulation are rare developmental anomalies, exsisting alone or in association with ipsilateral vascular anomalies of the mid brain, cranial sinuses and skin. These are usually unilateral. We report a case of bilateral congenital arteriovenous communication. The right eye showed group III arteriovenous communication of retina with vitreous hemorrhage. The left eye showed group II arteriovenous communication combined with group I.
Brain ; Cranial Sinuses ; Retina ; Retinaldehyde ; Skin ; Vitreous Hemorrhage

Cranial Fossa, Posterior ; Cranial Sinuses ; anatomy & histology ; Humans ; Skull ; anatomy & histology ; Transillumination

The anatomical pattern of the dural venous sinuses in the vicinity of their confluence was examinaed in 54 cases of human fetus. The classification introduced here by author was based upon the presence or absence of bifurcation of the superior sagittal and straight sinuses without regard to their sizes or to those of the transverse sinuses. Four types of pattern occurred;common pool type, double bifurcation type, straight sinus bifurcation type and superior sagittal sinus bifurcation type. In a total of 54 anatomical dissections, 28 cases(51.8%) were of the first type(common pool), 5 cases(9.3%) of the second(double bifurcation), 6 cases(11.1%) of the third(straight sinus bifurcation) and 15 cases(27.8%) of the fourth(superior sagittal sinus bifurcation) .
Classification ; Fetus ; Humans ; Superior Sagittal Sinus ; Transverse Sinuses

PURPOSE: To identify the relationship between hemoglobin (Hgb) or hematocrit (Hct) level and dural sinus density using unenhanced computed tomography (UECT). MATERIALS AND METHODS: Patients who were performed UECT and had records of a complete blood count within 24 hours from UECT were included (n=122). We measured the Hounsfield unit (HU) of the dural sinus at the right sigmoid sinus, left sigmoid sinus and 2 points of the superior sagittal sinus. Quantitative measurement of dural sinus density using the circle regions of interest (ROI) method was calculated as average ROI values at 3 or 4 points. Simple regression analysis was used to evaluate the correlation between mean HU and Hgb or mean HU and Hct. RESULTS: The mean densities of the dural sinuses ranged from 24.67 to 53.67 HU (mean, 43.28 HU). There was a strong correlation between mean density and Hgb level (r=0.832) and between mean density and Hct level (r=0.840). CONCLUSION: Dural sinus density on UECT is closely related to Hgb and Hct levels. Therefore, the Hgb or Hct levels can be used to determine whether the dural sinus density is within the normal range or pathological conditions such as venous thrombosis.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Cranial Sinuses/pathology/*radiography ; Female ; *Hematocrit ; Hemoglobins/*analysis ; Hepatolenticular Degeneration/complications ; Humans ; Male ; Middle Aged ; Pregnancy ; Pregnancy Complications ; Radiographic Image Interpretation, Computer-Assisted ; Reference Values ; Regression Analysis ; Superior Sagittal Sinus/pathology/*radiography ; Tomography, X-Ray Computed/*methods ; Young Adult

A schwannoma, also known as neurilemmoma, is a relatively rare benign tumor originating from the schwann cells of the nerve sheath. It occurs along any somatic, sympathetic and cranial nerves except the olfactory and optic nerves. It occurred most frequently in the head and neck but rarely in the nasal cavity and paranasal sinuses. Occurrence was especially rare in the nasal vestibule. Recently we experienced an unusual case of the schwannoma involving the left nasal vestibule. The mass was completely removed via a sublabial approach and histopathological examination and immunohistochemical staining study confirmed the schwannoma. We report this case with review of literatures.
Cranial Nerves ; Head ; Nasal Cavity ; Neck ; Neurilemmoma ; Optic Nerve ; Paranasal Sinuses ; Schwann Cells