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Purpose: This study aimed to examine the anatomical variations and morphometric characteristics of the sulci in the dural venous sinuses within the intracranial cavity, with a particular focus on sex differences and asymmetry. Methods: Thirty fixed cadaveric heads were used to measure the dimensions (length, width, and depth) and spatial relationships of the dural venous sinus sulci within the intracranial cavity, including the distance to the midline, distance to each other, and lateral margin of the skull. Comparisons were made between sexes and sides of the body. Results: A significant difference was observed in the length of the marginal sinus on the right side between sexes (p = 0.028). Various measurements, including the width of the transverse sinus, origin and insertion sites of the superior petrosal sinus, and distances between the sinuses and midline, showed statistically significant differences between the left and right sides (p < 0.05). Furthermore, the width of the inferior petrosal sinus and depth of the sigmoid sinus were notably higher on the right side (p < 0.05). Conclusion: The results suggest an asymmetric distribution of the sigmoid, superior/inferior petrosal, and transverse sinuses in terms of diameter and distance from the midline. Surgeons should consider these anatomical variations during procedures in this region. [ABSTRACT FROM AUTHOR]

Purpose: Most of Superior Semicircular Canal Dehiscence (SSCD) are located in the apical region of the SSC. However, in a small number of cases, it may be situated in the medial wall, causing the SSC to contact with the superior petrosal sinus (SPS). The aim of this study is to describe four patients with SSCD involving the superior petrosal sinus (SSCD-SPS) and to perform a review of the literature. Methods: Observational retrospective study of patients diagnosed of SSCD-SPS in a tertiary referral center. A systematic review was made, identifying 7 articles in the literature. Clinical presentation, complementary test (pure-tone audiometry, PTA; vestibular evoked myogenic potential, VEMP; computed tomography, CT), therapeutic management and outcomes were reported. Results: Four new cases of SSCD-SPS are reported, in three of them a transmastoid plugging was performed. 54 patients with SSCD-SPS (57 dehiscences) were reported in the literature. The most frequent symptoms were aural pressure (57.41%) and vertigo provoked by pressure/Valsalva (55.55%). Conductive hearing loss was the most common finding in PTA (47.37%). Abnormally low thresholds were observed in 59.46% of reported VEMP. Transmastoid approach was used in ten cases, middle fossa approach in four, round window reinforcement in one, and occlusion of the SPS using coils in two. Conclusions: Within SSCD, we have encountered a rare subtype characterized by its medial wall location in close proximity to the SPS. This subgroup needs special consideration as it has shown its own distinct characteristics. Regarding therapeutic management, we advocate a transmastoid approach. [ABSTRACT FROM AUTHOR]

Several surgical techniques have been documented for approaching and repairing superior semicircular canal dehiscence syndrome (SCDS). These techniques encompass the trans-middle cranial fossa, transmastoid, endoscopic approaches, and round window reinforcement (RWR). RWR entails the placement of connective tissue with or without cartilage and around the round window niche, restricting the round window’s movement to minimize the 3rd window effect and restore the bony labyrinth closer to its normal state. We employed the multilayer RWR technique, resulting in significant postoperative improvement and long-lasting effects for 3.7  years in 2 cases. Here, we present the clinical findings, surgical procedures, and the effectiveness of multilayer RWR. This technique can be the initial choice for surgical treatments of SCDS due to its high effectiveness, longer-lasting effect, and minimal risk of surgical complications. [ABSTRACT FROM AUTHOR]

The audio-vestibular symptoms caused by the partial absence of the bony structure surrounding the superior semicircular canal (SCC) are known as superior canal dehiscence syndrome (SCDS). The dehiscence region can be seen in high-resolution computed tomography (HRCT). Dehiscence is often seen at the arcuate eminence level in the apical region of the SCC. The superior petrosal sinus may rarely course in the vicinity of the medial wall of the SCC and can even cause SCDS. The vascular origin of the dehiscence cannot be exactly determined in routine HRCT without contrast agent administration. In the literature, the use of contrast-enhanced magnetic resonance imaging (MRI) has been reported in a small number of cases to demonstrate this pathology. There may be a relationship between the degree of dehiscence demonstrated by MRI and the patient's symptoms. Here, we present a case that is thought to be superior petrosal sinus dehiscence to SCC using HRCT. Contrast-enhanced arterial and venous phase 3D T1-weighted MRI was performed for the confirmation of the diagnosis, but there was no good correlation between the degree of radiological dehiscence and symptoms in contrast to the previous literature. [ABSTRACT FROM AUTHOR]

The exhaustive information regarding the types of trigeminal pore (TP) or trigeminal impression (TI), internal acoustic opening (IAO), and related surgical approaches is lacking in the literature. Therefore, this study is performed to further elucidate the types of TP or TI, IAO, and the relationships with critical surgical landmarks in the skull base. Trigeminal impression (TI) and internal acoustic opening (IAO) found in 11 dry skulls, 24 right temporal bones, and 25 left temporal bones were examined on both sides to define their relationship to each other and nearby structures. The age and sex of these bones were not identified. Besides these, 77 skulls were examined by radiologic imaging methods. These skulls were identified by gender. According to test results, there was a significant difference between the left and right internal acoustic opening in the case of horizontal dimension (HD). The left HD-IAO is bigger than the right one. In addition, right HD-IAO, vertical dimension (VD) of right internal acoustic opening, left HD-IAO, and left VD-IAO values differed significantly in male and female patients. Investigating the relationship of TI and IAO with relevant structures suggests that surgical approaches involving the TP and IAO indicated that surgical approaches considering the TI and IAO variations may be used in the development of surgical processes and primary surgical interventions. [ABSTRACT FROM AUTHOR]

Background: Dural arteriovenous fistulas (dAVFs) at the superior petrosal sinus are a rare but important subtype that pose a high risk of mortality and morbidity. Treatment for these lesions can be challenging with stand-alone endovascular methods. Methods: We describe our "in-out-in" technique for disconnecting dAVFs at the superior petrosal sinus, which includes definitive sacrifice of the superior petrosal sinus and the transverse sigmoid sinus, if involved. This method achieves complete fistula obliteration and minimizes recurrence risk with new arterial feeders. Conclusions: The in-out-in technique is a safe and effective approach for the treatment of dAVFs involving the superior petrosal sinus. [ABSTRACT FROM AUTHOR]

Background: The presigmoid approach classically includes the ligature and section of the superior petrosal sinus to get a wider visibility window to the antero-lateral brainstem surface. In some cases, the separation of this venous structure should not be performed. Method: We present our experience getting safely to a pontine cavernous malformation through a conventional mastoidectomy presigmoid approach preserving an ingurgitated superior petrosal sinus because the association with an abnormal venous drainage of the brainstem. Conclusions: When sectioning the superior petrosal sinus in classical presigmoid approaches is contraindicated, its preservation could also offer good surgical corridors to get to small-medium anterior and lateral brainstem cavernous malformations. [ABSTRACT FROM AUTHOR]

Background: Dandy's superior petrosal vein (SPV) anatomy is highly relevant for neurosurgeons. The SPV drains into the superior petrosal sinus (SPS), closely related to the trigeminal and internal auditory pores. Method: The archived enhanced MRI files of a male patient were studied. Results: An infratentorial ring-shaped (RS) SPV was found on the petrosal surface of the right cerebellar hemisphere. It was inserted in the SPS above the internal auditory pore, postero-lateral to the trigeminal pore. The anterior arm of that venous ring received a delicate supratrigeminal plexus of veins from the pontine surface and continued as a single venous trunk on the cerebellar surface. Conclusion: Such previously unreported RS-SPV is of utmost importance to be identified before subtemporal transtentorial and retrosigmoid approaches for different neurosurgical reasons. [ABSTRACT FROM AUTHOR]

Background Meningiomas arising from the petroclival area remain a challenge for neurosurgeons. Various approaches have been proposed to achieve maximum resection with minimal morbidity and mortality. Also, some articles correlated preservation of adjacent veins with less neurologic deficits. Objective To describe the experiences in using a new technique to achieve maximal resection of petroclival meningiomas and preserving the superior petrosal veins (SPVs) and the superior petrosal sinus (SPS). Methods A retrospective analysis of 26 patients harboring a true petroclival meningioma with a diameter ≥25 mm and undergoing surgery with the modified transpetrosal–transtentorial approach (MTTA) was performed. Results Fifty-four percent of 22 patients complained of severe headache at presentation. There was also complaint of cranial nerve (CN) deficit, with CN VII deficit being the most common (present in 42% of patients). The average tumor size (measured as maximum diameter) was 45.2 mm, and most of the tumors compressed the brainstem. Total resection was achieved in 12 patients (46.2%), whereas the others were excised subtotally (54.8%). Most of the patients had WHO grade I (96.1%) meningioma; only one had a grade II (3.8%) meningioma. In addition, clinical improvement and persistence of symptoms were observed in 17 (65.4%) and 8 (30.7%) patients, respectively, and postoperative permanent CN injury was observed in 3 (11.5%) patients. Conclusion Using the MTTA, maximal resection with preservation of the CNs and neurovascular SPV-SPS complex can be achieved. Therefore, further studies and improvements of the technique are required to increase the total resection rate without neglecting the complications that may develop postoperatively. [ABSTRACT FROM AUTHOR]

A dural arteriovenous fistula involving the superior petrosal vein (SPV DAVF) is an extremely rare condition. Therefore, its clinical presentation, imaging characteristics, treatment methods, and risk factors remain unclear. In this study, we discuss and analyze the aforementioned features of an SPV DAVF. We retrospectively reviewed 30 patients with SPV DAVFs, with a 1-year follow-up rate of 96.67% (29 of 30). The neurological function of the patients was assessed using the modified Aminoff-Logue scale and the modified Rankin Scale score. The risk factors before and after treatment were established using univariate and multivariate logistic regression analyses. Additionally, treatments involving 3 distinct SPV DAVF drainage patterns were presented. Of the 30 patients, 24 were men (80.0%). Besides, the angiography images were reexamined 12 months after surgery. Univariate analyses indicated that the extent of edema (odds ratio 1.889, 95% confidence interval 1.132–3.154) and the number of draining veins (≤2) (odds ratio 10.833, 95% confidence interval 1.961–59.834) were risk factors for pretreatment modified Rankin Scale score ≥3. However, multivariate analyses revealed no statistically significant differences (P = 0.051, P = 0.055). Following the multivariate analyses, steroid pulse (odds ratio 12.153 95% confidence interval 1.080–136.772) was found to be the only significant risk factor for post-treatment difference between pretreatment and 1-year follow-up modified Rankin Scale score ≥2. A DAVF with SPV drainage is an uncommon type of intracranial vascular malformation. Most lesions involve the brain stem or high cervical spinal cord, thereby posing a higher risk of disability or death. Moreover, neuronal damage from persistent venous hypertension is permanent. Therefore, precise diagnosis and timely treatment are key to a good patient prognosis. [ABSTRACT FROM AUTHOR]

The superficial middle cerebral vein (SMCV) commonly drains in the cavernous sinus. Its different drainage variants include preserved segments of the primitive tentorial sinus. In any of these variants, the terminal venous segment of SMCV passes on the base of the skull. The archived computed tomography angiograms of a 58-year-old female case were documented anatomically. On the left side was found the sinus of the lesser sphenoidal wing converging with the middle meningeal vein to form a venous channel located within the Sylvian fissure at 4 mm laterally to the cavernous sinus and trigeminal cavum. That venous channel was thus termed the 'laterocavernous vein'. It drained posteriorly within the superior petrosal sinus. This aberrant vein could interfere unpleasantly with pterional neurosurgical approaches for the Sylvian fissure, cavernous sinus or trigeminal ganglion. [ABSTRACT FROM AUTHOR]

A profound knowledge of the anatomy and surgical management of the superior petrosal vein (SPV) is vital during neurosurgical procedures in the posterior fossa. The debate on preserving the SPV or whether it can be duly obliterated is still ongoing. This review provides an update on all historical articles pertaining to the risk profile of superior petrosal sacrifice since Walter Dandy. Not only were the heterogenous methods but also the respective authors' conclusions analyzed. In light of the collected evidence, we come to the conclusion that occluding the SPV poses an ineligible risk to patient safety and should be considered obsolete., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Isolated superior petrosal sinus dural arteriovenous fistula (SPSdAVF) is a rare condition for which transvenous embolization is a safe treatment, even if accessing the isolated sinus can be challenging. A 39-year-old female patient with dizziness and right facial palsy underwent magnetic resonance imaging, revealing a venous infarction at the posterior fossa and a dural arteriovenous fistula. Digital subtraction angiography showed an isolated SPSdAVF. The shunt point was posterior to the isolated superior petrosal sinus, and the shunt flowed only through the petrosal vein. Contrast-enhanced magnetic resonance imaging showed thrombosis at the anterior segment of the superior petrosal sinus. Transvenous embolization was successfully performed via the thrombosed anterior segment of the superior petrosal sinus without associated complications. This case shows that transvenous embolization through a thrombosed superior petrosal sinus is an alternative treatment option for isolated SPSdAVF., Competing Interests: The authors declare no conflicts of interest., (© 2024 The Japan Neurosurgical Society.)

Background: Transvenous embolization for cavernous sinus (CS) dural arteriovenous fistulas (CS-DAVFs) with limitations of the major access routes to the CS is challenging., Observations: A 74-year-old woman presented with left-sided conjunctival injection and exophthalmos. Cerebral angiography showed a left CS-DAVF draining into the left uncal vein and superior ophthalmic vein, with the fistulous point located in the posterosuperior compartment of the left CS. The left inferior petrosal sinus and internal jugular vein were occluded, and no drainage route from the left superior ophthalmic vein was seen. The anterior segment of the left superior petrosal sinus (SPS) was occluded, but the posterior segment was not. Microangiography from the posterior segment of the left SPS showed a beak-like orifice in the anterior segment of the left SPS toward the left CS. A micro-guidewire was guided through the beak-like orifice, and the microcatheter was advanced into the left CS. The left CS was packed and the DAVF was occluded., Lessons: Transvenous embolization through an occluded SPS may be an option in the endovascular treatment of CS-DAVFs. Penetration along the beak-like orifice of the occluded SPS visualized by venography at the blind end of the SPS may be useful in reaching the CS via the SPS.

Petroclival meningiomas represent the most complex lesions in skull base surgery, being closely related to critical neurovascular structures. The combined petrosal approach allows a wide exposure of the petroclival region and provides multiple angles of attack, limiting brain retraction. The authors present the case of a 54-year-old man with a large left petroclival meningioma responsible for headaches, dysphagia, and trigeminal neuralgia. The lesion was resected using a combined petrosal approach. A progressive improvement of the preoperative symptoms was observed. Postoperative MRI showed a near-total resection of the tumor, along with reexpansion of the brainstem. The video can be found here: https://stream.cadmore.media/r10.3171/2022.1.FOCVID21226., Competing Interests: Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this publication.The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this publication., (© 2022, The Authors.)