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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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Schematic drawing of development of the UV. a early embryo. During the early embryonic stage, the deep telencephalic vein (T) flows into the primitive tentorial sinus (PTS) which is precursor of the superficial middle cerebral vein. The primitive tentorial sinus is displaced medially and connects with cavernous sinus according to the development of the temporal lobe. Later, the basal vein of Rosenthal is formed by anastomosis of the terminal branches of the deep telencephalic vein, the ventral (D1) and dorsal (D2) diencephalic vein, and the mesencephalic vein (M). b infant. The uncal vein (arrow) consists of the remnant of the proximal part of the deep telencephalic vein
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Fig13: Schematic drawing of development of the UV. a early embryo. During the early embryonic stage, the deep telencephalic vein (T) flows into the primitive tentorial sinus (PTS) which is precursor of the superficial middle cerebral vein. The primitive tentorial sinus is displaced medially and connects with cavernous sinus according to the development of the temporal lobe. Later, the basal vein of Rosenthal is formed by anastomosis of the terminal branches of the deep telencephalic vein, the ventral (D1) and dorsal (D2) diencephalic vein, and the mesencephalic vein (M). b infant. The uncal vein (arrow) consists of the remnant of the proximal part of the deep telencephalic vein

Mentions: According to embryologic development of cerebral veins described by Padget, the UV derives from the deep telencephalic vein flowing into the primitive tentorial sinus which is the precursor of the superficial middle cerebral vein [10]. The primitive tentorial sinus runs posteriorly and connects to the transverse sinus. Later, the basal vein of Rosenthal is formed by the anastomosis of the terminal branches of the deep telencephalic vein, the ventral diencephalic vein, dorsal diencephalic vein, and mesencephalic vein (Fig. 13). Along with the growth of temporal lobes, the primitive tentorial sinus is displaced medially and connects with the CS. Several types in terminations of the superficial middle cerebral vein can occur depending on the degree of the connection between the primitive tentorial sinus and the CS. The several variations in UV termination as well as the SMCV can occur depending on the degree of development of these connections and the development of the basal vein of Rosenthal. However, only few papers have demonstrated the variations in UV termination [7, 8], and the types and frequency of these variations has not been well-known. In our results, the UV can be identified in 118 sides (74 %) of 160 sides on angiography in normal cerebral hemodynamic status. Among the 118 sides, the UV terminated into the CS in 35 %, the SMCV in 49 %, the LCS in 13 %, and the PCS in 3 %. The 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 %). This anatomical variation in termination of the UV can be related to the UV drainage of the CSDAVFs which was found in 50 % of cases in this series. Cerebral hemorrhage of CSDAVFs is less than that of DAVFs at other locations because the CS connects with multiple emissary veins as well as the sinuses [3]. However, it was reported that the retrograde cortical venous drainage of CSDAVFs brings a high risk of intracerebral venous hemorrhage especially for cases with only a small cerebral venous drainage such as uncal vein [4]. In our series, aggressive behavior of CSDAVFs was seen in three cases (11.5 %). All three cases showed Borden type III AVF, and the UV drainage is related to the cerebral hemorrhage in one of the three cases. The aggressive symptoms would be more related to types of drainage such as Borden’s type III rather than presence of uncal venous drainage. However, cortical reflux into the small cerebral vein such as the uncal vein in type III AVF would have higher risk of aggressive symptoms.Fig. 13


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)

Schematic drawing of development of the UV. a early embryo. During the early embryonic stage, the deep telencephalic vein (T) flows into the primitive tentorial sinus (PTS) which is precursor of the superficial middle cerebral vein. The primitive tentorial sinus is displaced medially and connects with cavernous sinus according to the development of the temporal lobe. Later, the basal vein of Rosenthal is formed by anastomosis of the terminal branches of the deep telencephalic vein, the ventral (D1) and dorsal (D2) diencephalic vein, and the mesencephalic vein (M). b infant. The uncal vein (arrow) consists of the remnant of the proximal part of the deep telencephalic vein
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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getmorefigures.php?uid=PMC4125747&req=5

Fig13: Schematic drawing of development of the UV. a early embryo. During the early embryonic stage, the deep telencephalic vein (T) flows into the primitive tentorial sinus (PTS) which is precursor of the superficial middle cerebral vein. The primitive tentorial sinus is displaced medially and connects with cavernous sinus according to the development of the temporal lobe. Later, the basal vein of Rosenthal is formed by anastomosis of the terminal branches of the deep telencephalic vein, the ventral (D1) and dorsal (D2) diencephalic vein, and the mesencephalic vein (M). b infant. The uncal vein (arrow) consists of the remnant of the proximal part of the deep telencephalic vein
Mentions: According to embryologic development of cerebral veins described by Padget, the UV derives from the deep telencephalic vein flowing into the primitive tentorial sinus which is the precursor of the superficial middle cerebral vein [10]. The primitive tentorial sinus runs posteriorly and connects to the transverse sinus. Later, the basal vein of Rosenthal is formed by the anastomosis of the terminal branches of the deep telencephalic vein, the ventral diencephalic vein, dorsal diencephalic vein, and mesencephalic vein (Fig. 13). Along with the growth of temporal lobes, the primitive tentorial sinus is displaced medially and connects with the CS. Several types in terminations of the superficial middle cerebral vein can occur depending on the degree of the connection between the primitive tentorial sinus and the CS. The several variations in UV termination as well as the SMCV can occur depending on the degree of development of these connections and the development of the basal vein of Rosenthal. However, only few papers have demonstrated the variations in UV termination [7, 8], and the types and frequency of these variations has not been well-known. In our results, the UV can be identified in 118 sides (74 %) of 160 sides on angiography in normal cerebral hemodynamic status. Among the 118 sides, the UV terminated into the CS in 35 %, the SMCV in 49 %, the LCS in 13 %, and the PCS in 3 %. The 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 %). This anatomical variation in termination of the UV can be related to the UV drainage of the CSDAVFs which was found in 50 % of cases in this series. Cerebral hemorrhage of CSDAVFs is less than that of DAVFs at other locations because the CS connects with multiple emissary veins as well as the sinuses [3]. However, it was reported that the retrograde cortical venous drainage of CSDAVFs brings a high risk of intracerebral venous hemorrhage especially for cases with only a small cerebral venous drainage such as uncal vein [4]. In our series, aggressive behavior of CSDAVFs was seen in three cases (11.5 %). All three cases showed Borden type III AVF, and the UV drainage is related to the cerebral hemorrhage in one of the three cases. The aggressive symptoms would be more related to types of drainage such as Borden’s type III rather than presence of uncal venous drainage. However, cortical reflux into the small cerebral vein such as the uncal vein in type III AVF would have higher risk of aggressive symptoms.Fig. 13

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