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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 variation in termination of SMCV in type A uncal venous termination. a The uncal vein terminated directly to the cavernous sinus, and the SMCV terminated to the cavernous sinus. b The SMCV terminated to the laterocavernous sinus. c The SMCV terminated to the paracavernous sinus. d The SMCV is aplastic. Arrows indicate the uncal vein, and arrowheads indicate the superficial middle cerebral vein
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Fig4: Schematic drawing of variation in termination of SMCV in type A uncal venous termination. a The uncal vein terminated directly to the cavernous sinus, and the SMCV terminated to the cavernous sinus. b The SMCV terminated to the laterocavernous sinus. c The SMCV terminated to the paracavernous sinus. d The SMCV is aplastic. Arrows indicate the uncal vein, and arrowheads indicate the superficial middle cerebral vein

Mentions: In type A, the SMCV terminated into the CS in 25 sides, the LCS in 4 sides, and the PCS in 7 sides (Figs. 4a–c and 5a–c). In five sides, the SMCV was not identified (aplastic) (Fig. 4d). Among the 25 sides in which the SMCV terminated into the CS, the SMCV terminated into the CS alone in the 22 sides. In the remaining three sides, the SMCV terminated into the CS with another termination into the PCS (n = 2) or the pharyngeal plexus (n = 1).Fig. 4


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 variation in termination of SMCV in type A uncal venous termination. a The uncal vein terminated directly to the cavernous sinus, and the SMCV terminated to the cavernous sinus. b The SMCV terminated to the laterocavernous sinus. c The SMCV terminated to the paracavernous sinus. d The SMCV is aplastic. Arrows indicate the uncal vein, and arrowheads indicate the superficial middle cerebral vein
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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

Fig4: Schematic drawing of variation in termination of SMCV in type A uncal venous termination. a The uncal vein terminated directly to the cavernous sinus, and the SMCV terminated to the cavernous sinus. b The SMCV terminated to the laterocavernous sinus. c The SMCV terminated to the paracavernous sinus. d The SMCV is aplastic. Arrows indicate the uncal vein, and arrowheads indicate the superficial middle cerebral vein
Mentions: In type A, the SMCV terminated into the CS in 25 sides, the LCS in 4 sides, and the PCS in 7 sides (Figs. 4a–c and 5a–c). In five sides, the SMCV was not identified (aplastic) (Fig. 4d). Among the 25 sides in which the SMCV terminated into the CS, the SMCV terminated into the CS alone in the 22 sides. In the remaining three sides, the SMCV terminated into the CS with another termination into the PCS (n = 2) or the pharyngeal plexus (n = 1).Fig. 4

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