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Anatomical variations in termination of the uncal vein and its clinical implications in cavernous sinus dural arteriovenous fistulas.

Ide S, Kiyosue H, Tanoue S, Okahara M, Sagara Y, Hori Y, Mori H - Neuroradiology (2014)

Bottom Line: The CSDAVFs drained directly into the UV in two patients, drained via LCS into the UV in two patients, and drained through the SMCV into the UV in the remaining nine patients.All cases were successfully treated by transvenous embolization with special attention given to uncal venous drainage.There are several variations in UV termination according to the embryological development of the primitive tentorial sinus and the deep telencephalic vein.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Oita University Hospital, 1-1 Idaigaoka, Hasama, Yufu City, Oita, 879-5593, Japan.

ABSTRACT

Introduction: The aim of the study was to investigate the variations in the uncal vein (UV) termination and its clinical implication in cavernous sinus dural arteriovenous fistulas (CSDAVFs).

Methods: Biplane cerebral angiography in 80 patients (160 sides) with normal cerebral venous return (normal group) was reviewed with special interest in the termination of the UV. Frequency and types of uncal venous drainage from CSDAVFs in consecutive 26 patients were also analyzed.

Results: In the normal group, the UV was identified in 118 sides (74 %). The UV terminated into cavernous sinus (CS) in 41 sides (34 %), the superficial middle cerebral vein (SMCV) in 58 sides (48 %), the laterocavernous sinus (LCS) in 15 sides (13 %), and the paracavernous sinus (PCS) in 4 sides (3 %). Cerebral venous blood via the UV draining into the CS directly (n=41) or through the SMCV and/or the LCS (n=45) was observed in 86 sides (54 %). Uncal venous drainage from CSDAVFs was found in 13 patients (50 %). The CSDAVFs drained directly into the UV in two patients, drained via LCS into the UV in two patients, and drained through the SMCV into the UV in the remaining nine patients. All cases were successfully treated by transvenous embolization with special attention given to uncal venous drainage.

Conclusion: There are several variations in UV termination according to the embryological development of the primitive tentorial sinus and the deep telencephalic vein. Careful attention should be paid to uncal venous drainage for the treatment of CSDAVFs.

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Related in: MedlinePlus

Cavernous sinus dural arteriovenous fistula with uncal venous drainage directly from the cavernous sinus. a CT shows right putaminal hemorrhage with perifocal edema. b Left internal carotid angiography shows the dural arteriovenous fistulas involving the right cavernous sinus. The AVFs drain into the superficial middle cerebral vein (arrow heads) and the uncal vein (arrows) directly from the right cavernous sinus
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Fig11: Cavernous sinus dural arteriovenous fistula with uncal venous drainage directly from the cavernous sinus. a CT shows right putaminal hemorrhage with perifocal edema. b Left internal carotid angiography shows the dural arteriovenous fistulas involving the right cavernous sinus. The AVFs drain into the superficial middle cerebral vein (arrow heads) and the uncal vein (arrows) directly from the right cavernous sinus

Mentions: In the 26 cases of CSDAVFs, uncal venous drainage from CSDAVFs was found in 13 patients (50 %) (Table 1). CSDAVFs drained directly into the UV in two patients (Fig. 11), through the LCS into the UV in two patients (Fig. 12), through the SMCV into the UV in four patients, through the LCS and the SMCV to the UV in four patients, and through the paraCS and SMCV into the UV in one patient. All three patients presented with the aggressive symptoms showed Borden III type of the CSDAVFs. Among the three patients, the CSDAVFs drained retrogradely into the SMCV alone (cerebral hemorrhage), the SMCV and UV (cerebral hemorrhage) (Fig. 11), or the prepontine bridging vein (brain stem edema).Fig. 11


Anatomical variations in termination of the uncal vein and its clinical implications in cavernous sinus dural arteriovenous fistulas.

Ide S, Kiyosue H, Tanoue S, Okahara M, Sagara Y, Hori Y, Mori H - Neuroradiology (2014)

Cavernous sinus dural arteriovenous fistula with uncal venous drainage directly from the cavernous sinus. a CT shows right putaminal hemorrhage with perifocal edema. b Left internal carotid angiography shows the dural arteriovenous fistulas involving the right cavernous sinus. The AVFs drain into the superficial middle cerebral vein (arrow heads) and the uncal vein (arrows) directly from the right cavernous sinus
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4125747&req=5

Fig11: Cavernous sinus dural arteriovenous fistula with uncal venous drainage directly from the cavernous sinus. a CT shows right putaminal hemorrhage with perifocal edema. b Left internal carotid angiography shows the dural arteriovenous fistulas involving the right cavernous sinus. The AVFs drain into the superficial middle cerebral vein (arrow heads) and the uncal vein (arrows) directly from the right cavernous sinus
Mentions: In the 26 cases of CSDAVFs, uncal venous drainage from CSDAVFs was found in 13 patients (50 %) (Table 1). CSDAVFs drained directly into the UV in two patients (Fig. 11), through the LCS into the UV in two patients (Fig. 12), through the SMCV into the UV in four patients, through the LCS and the SMCV to the UV in four patients, and through the paraCS and SMCV into the UV in one patient. All three patients presented with the aggressive symptoms showed Borden III type of the CSDAVFs. Among the three patients, the CSDAVFs drained retrogradely into the SMCV alone (cerebral hemorrhage), the SMCV and UV (cerebral hemorrhage) (Fig. 11), or the prepontine bridging vein (brain stem edema).Fig. 11

Bottom Line: The CSDAVFs drained directly into the UV in two patients, drained via LCS into the UV in two patients, and drained through the SMCV into the UV in the remaining nine patients.All cases were successfully treated by transvenous embolization with special attention given to uncal venous drainage.There are several variations in UV termination according to the embryological development of the primitive tentorial sinus and the deep telencephalic vein.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Oita University Hospital, 1-1 Idaigaoka, Hasama, Yufu City, Oita, 879-5593, Japan.

ABSTRACT

Introduction: The aim of the study was to investigate the variations in the uncal vein (UV) termination and its clinical implication in cavernous sinus dural arteriovenous fistulas (CSDAVFs).

Methods: Biplane cerebral angiography in 80 patients (160 sides) with normal cerebral venous return (normal group) was reviewed with special interest in the termination of the UV. Frequency and types of uncal venous drainage from CSDAVFs in consecutive 26 patients were also analyzed.

Results: In the normal group, the UV was identified in 118 sides (74 %). The UV terminated into cavernous sinus (CS) in 41 sides (34 %), the superficial middle cerebral vein (SMCV) in 58 sides (48 %), the laterocavernous sinus (LCS) in 15 sides (13 %), and the paracavernous sinus (PCS) in 4 sides (3 %). Cerebral venous blood via the UV draining into the CS directly (n=41) or through the SMCV and/or the LCS (n=45) was observed in 86 sides (54 %). Uncal venous drainage from CSDAVFs was found in 13 patients (50 %). The CSDAVFs drained directly into the UV in two patients, drained via LCS into the UV in two patients, and drained through the SMCV into the UV in the remaining nine patients. All cases were successfully treated by transvenous embolization with special attention given to uncal venous drainage.

Conclusion: There are several variations in UV termination according to the embryological development of the primitive tentorial sinus and the deep telencephalic vein. Careful attention should be paid to uncal venous drainage for the treatment of CSDAVFs.

Show MeSH
Related in: MedlinePlus