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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

Type C uncal venous termination with various SMCV termination. a The SMCV terminating to the laterocavernous sinus. Right internal carotid angiography at venous phase shows the uncal vein (arrows) draining into the laterocavernous sinus and the SMCV (arrowheads) draining into the laterocavernous sinus separately. b The SMCV terminating to the paracavernous sinus. Right internal carotid angiography at venous phase shows the uncal vein (arrows) draining through the laterocavernous sinus to the pterygoid plexus and the SMCV (arrowheads) draining through the paracavernous sinus to the pterygoid plexus. c Aplastic SMCV. Right internal carotid angiography at venous phase shows a large uncal vein (arrows) draining through the laterocavernous sinus to the pterygoid plexus. The SMCV is not identified
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Fig8: Type C uncal venous termination with various SMCV termination. a The SMCV terminating to the laterocavernous sinus. Right internal carotid angiography at venous phase shows the uncal vein (arrows) draining into the laterocavernous sinus and the SMCV (arrowheads) draining into the laterocavernous sinus separately. b The SMCV terminating to the paracavernous sinus. Right internal carotid angiography at venous phase shows the uncal vein (arrows) draining through the laterocavernous sinus to the pterygoid plexus and the SMCV (arrowheads) draining through the paracavernous sinus to the pterygoid plexus. c Aplastic SMCV. Right internal carotid angiography at venous phase shows a large uncal vein (arrows) draining through the laterocavernous sinus to the pterygoid plexus. The SMCV is not identified

Mentions: In type C, the SMCV terminated into the LCS in 10 sides, and the PCS in 3 sides (Figs. 7a, b and 8a, b). The SMCV was absent in two sides (Figs. 7c and 8c). Among the 10 sides in which the SMCV terminated into the LCS, the LCS terminated into the CS alone in 2 sides, both the CS and the pterygoid plexus in 5 sides, and the pterygoid plexus alone in 3 sides.Fig. 7


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)

Type C uncal venous termination with various SMCV termination. a The SMCV terminating to the laterocavernous sinus. Right internal carotid angiography at venous phase shows the uncal vein (arrows) draining into the laterocavernous sinus and the SMCV (arrowheads) draining into the laterocavernous sinus separately. b The SMCV terminating to the paracavernous sinus. Right internal carotid angiography at venous phase shows the uncal vein (arrows) draining through the laterocavernous sinus to the pterygoid plexus and the SMCV (arrowheads) draining through the paracavernous sinus to the pterygoid plexus. c Aplastic SMCV. Right internal carotid angiography at venous phase shows a large uncal vein (arrows) draining through the laterocavernous sinus to the pterygoid plexus. The SMCV is not identified
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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

Fig8: Type C uncal venous termination with various SMCV termination. a The SMCV terminating to the laterocavernous sinus. Right internal carotid angiography at venous phase shows the uncal vein (arrows) draining into the laterocavernous sinus and the SMCV (arrowheads) draining into the laterocavernous sinus separately. b The SMCV terminating to the paracavernous sinus. Right internal carotid angiography at venous phase shows the uncal vein (arrows) draining through the laterocavernous sinus to the pterygoid plexus and the SMCV (arrowheads) draining through the paracavernous sinus to the pterygoid plexus. c Aplastic SMCV. Right internal carotid angiography at venous phase shows a large uncal vein (arrows) draining through the laterocavernous sinus to the pterygoid plexus. The SMCV is not identified
Mentions: In type C, the SMCV terminated into the LCS in 10 sides, and the PCS in 3 sides (Figs. 7a, b and 8a, b). The SMCV was absent in two sides (Figs. 7c and 8c). Among the 10 sides in which the SMCV terminated into the LCS, the LCS terminated into the CS alone in 2 sides, both the CS and the pterygoid plexus in 5 sides, and the pterygoid plexus alone in 3 sides.Fig. 7

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