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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]

Background: Dural arteriovenous fistulas (DAVFs) involving superior petrosal sinus (SPS) and superior petrosal vein (SPV) are extremely rare. The pathogenesis of these fistulas remains unclear. We are illustrating 2 cases of DAVFs involving the superior petrosal sinus and veins associated with venous sinus thrombosis with a literature review. Methods: We reviewed the literature using the PRISMA (preferred reporting items for systematic reviews and meta-analyses) guidelines focusing on DAVFs involving the SPS and/or SPV. Additionally, we searched for additional articles through the reference lists of the included studies. Results: Our review yielded 20 articles from 1997 until 2022 involving 33 patients with 34 fistulas, including our 2 patients. The mean age was 55.1 ± 12.9 years (range 25–85), 54.5% were males (n = 18). The patients presented with hemorrhage in 36.4% (n = 12), and progressive myelopathy in 30.3% (n = 10). Most fistulas often had arterial supply from MMA, MHT, and/or OA. The fistulas had infratentorial drainage in 64.71% (n = 22), supratentorial drainage in 23.53% (n = 8), and both supra and infratentorial drainage in 11.76% (n = 4). In 27.3% (n = 9), cerebral venous thrombosis was mentioned or identified. Endovascular treatment was performed in 47.1% of cases (n = 16), surgery in 29.4% (n = 10), and combination of treatments in 23.5% (n = 8). A total of 30.3% (n = 10) of cases had incomplete recovery or poor result. Conclusion: DAVFs involving the SPS and/or SPV are associated with aggressive natural history, requiring early diagnosis and prompt treatment, leading to good prognosis. These fistulas may be acquired in origin, probably secondary to cerebral venous thrombosis.

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]

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., Competing Interests: Declarations. Ethical approval: All procedures conducted in this study involving human participants adhered to the ethical standards of the Bahcesehir University Clinical Research Ethics Committee, as approved by the ethics committee of the Bahcesehir University Faculty of Medicine (protocol ID: 2022-17/02 and approval date: November 16, 2022), and were in accordance with the 1964 Helsinki Declaration and its subsequent amendments or comparable ethical standards. Consent to participate: Not applicable. Consent to publish: Not applicable. Informed consent: Not applicable. Statement of research involving human participants and animals: The study was approved by the Bahcesehir University Clinical Research Ethics Committeeand certify that the study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. Conflicts of interest: The authors declare that they have no conflicts of interest., (© 2024. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.)

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.)

Introduction: Knowledge regarding projections on cerebral aspect of petrous temporal bone especially in relation to dural venous sinuses or at the site of dural attachments is required for evaluating and differentiating normal from abnormal. Aim: This study was aimed to observe the incidence and localisation of various bony projections relating to sulcus for Dural venous sinus on the postero-superior surface of petrous temporal bone. Material and Methods: The study was conducted on 260 skulls (out of which 20 were obtained from cadavers during dissection and 240 were dry skull) in the Department of Anatomy, ANIIMS from April 2016 to December 2019. The cerebral aspect of petrous temporal bone was observed for presence and localisation of projections. They were classified according to their size (Small- 3 mm), Location, laterality and its relation to sulcus for dural venous sinus. Images were taken and the data was tabulated with percentage incidence of individual observation. Results: Most of the projections seen were bilateral, 168 (64.61%), however most of the projections were seen on right side 146 (56.15%). As per their location the projections were either located along superior border, 31 (11.92%) only in relation to sulcus for superior petrosal sinus or along posterior border, 91 (35.00%) in relation to sulcus for sigmoid sinus or jugular foramen. Majority of specimens (n=138, 53.08%) showed occurrence of projections along both specified sites. Conclusion: Presence of majority of projections bilaterally suggests a symmetrical pattern which might be influenced genetically during development or due to environmental/ external factors. A profound knowledge of various projections on postero-superior surface of petrous temporal bone is required by clinicians and surgeons for management and to avoid their misinterpretation as pathological ones. These findings have a relevance in understanding functional and evolutionary anatomy, and to provide individual variations.

Purpose: To correlate objective measures of audio-vestibular function with superior canal dehiscence (SCD) size and location in ears with SCD and compare results with literature. Methods: We retrospectively evaluated 242 patients exhibiting SCD and/or extremely thinned bone overlying superior canals (SC) on CT scans and selected 73 SCD patients (95 ears with SCD). Data concerning audiometry, impedance audiometry, video-head impulse test (vHIT), cervical vestibular-evoked myogenic potentials (cVEMPs) and ocular VEMPs (oVEMPs) to air- (AC) and bone-conducted (BC) stimuli were collected for each pathologic ear and correlated with dehiscence size and location. Results: AC pure-tone average (PTA) (p = 0.013), low-frequency air–bone gap (ABG) (p < 0.001), AC cVEMPs amplitude (p = 0.002), BC cVEMPs amplitude (p < 0.001) and both AC and BC oVEMPs amplitude (p < 0.001) positively correlated with increasing SCD size. An inverse relationship between dehiscence length and both AC cVEMPs and oVEMPs thresholds (p < 0.001) and SC vestibulo–ocular reflex (VOR) gain (p < 0.001) was observed. Dehiscences at the arcuate eminence (AE) exhibited lower SC VOR gains compared to SCD along the ampullary arm (p = 0.008) and less impaired BC thresholds than dehiscences at the superior petrosal sinus (p = 0.04). Conclusion: We confirmed that SCD size affects AC PTA, ABG and both amplitudes and thresholds of cVEMPs and oVEMPs. We also described a tendency for SC function to impair with increasing SCD size and when dehiscence is located at the AE. The latter data may be explained either by a spontaneous canal plugging exerted by middle fossa dura or by a dissipation through the dehiscence of mechanical energy conveyed to the endolymph during high-frequency impulses. [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., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Sawada, Matsuda, Tanzawa, Sakamoto, Kudo, Nakashima and Ikezono.)

OBJECTIVES: This study aimed to present 3 different clinical stages in patients presenting with superior semicircular canal dehiscence (SSCD) by the superior petrosal sinus (SPS). A specific 3-class classification based on clinical, radiological, and audio-vestibular arguments is proposed. MATERIALS AND METHODS: We retrospectively compared clinical and radiological findings in 3 patients with different degrees of audio-vestibular dysfunction in whom the imagery evocated the diagnosis of SSCD by SPS. Imaging sensitivity was improved by combining inner ear high-resolution computed tomography (HRCT) scan and magnetic resonance imaging in fusion, allowing us to compare and corroborate clinical and audio-vestibular findings in each case with the imagery. RESULTS: HRCT and 3T inner ear fusion imaging highlighted a direct contact and/or compression between SPS and the membranous superior semicircular canal (SSC). We propose a new classification of SSCD by SPS. Class "A" corresponds to an HRCT image with a "cookie bite" and thin bone still covering the SSC. Class "B" corresponds to a "cookie bite" image with confirmed contact between the SPS wall and the membranous SSC in MRI labyrinthine sequences. Class "C" type corresponds to a "cookie bite" image, contact, and obvious compression of the membranous SSC by SPS on MRI sequences. CONCLUSION: Anatomical systematization is needed for daily practice. This classification of SSCD by SPS would contribute to a better understanding of the wide variety and variability in the occurrence and onset of symptoms. [ABSTRACT FROM AUTHOR]

An adult male was found to have a variation of the left basal vein of Rosenthal after presenting with complaints of headache and balance issues. In this case, the vein drained directly into the left superior petrosal sinus (SPS) instead of the great vein of Galen. Anatomical variation of the basal vein is likely due to embryonic development of the deep cerebral venous system as primitive structures either differentiate regress or further with age. These changes may result in the uncommon presentation seen in this case. To our knowledge, this is the first case that shows the basal vein drains into the SPS. The normal and variant anatomy of this vessel are discussed. [ABSTRACT FROM AUTHOR]

Superior petrosal sinus (SPS) dural arteriovenous fistulas (DAVFs) are a common subtype of tentorial DAVFs that often require microsurgical treatment. We have noted a rare condition involving the presence of a coexisting normal superior petrosal vein (SPV) during surgery for SPS DAVFs; this condition has not been reported in the literature. Identification and preservation of coexisting normal veins are crucial to prevent venous complications. We reviewed data of 12 patients with SPS DAVFs who underwent microsurgical treatment. Intraoperative indocyanine green video angiography was used to confirm the location of the fistula and identify the normal SPV. Postoperative radiologic examination was performed, and the clinical outcome was evaluated with the modified Rankin Scale. A coexisting normal functional SPV was found in 6 cases. Analysis of the tributaries of the SPV showed the vein of the cerebellopontine fissure was the most frequent arterialized drainage vein (66.7%), while the pontotrigeminal vein was the most frequent normal drainage vein (45.5%). The DAVFs were easily identified and disrupted using intraoperative indocyanine green video angiography. The normal SPV was also successfully preserved. All 6 patients experienced good clinical and radiologic outcomes. An SPS DAVF can coexist with a normal functional SPV, which should be preserved. Use of indocyanine green video angiography is an efficient way to identify the normal SPV. [ABSTRACT FROM AUTHOR]

The superficial middle cerebral vein (SMCV) drains the venous blood from most of the superolateral surface of the brain and drains typically into the cavernous sinus as mentioned in standard textbooks. But the drainage of the SMCV is variable as indicated by various radiological studies. Although variations in the drainage of the SMCV exist, there is a shortage in the literature providing cadaveric evidence for the same. The present study was designed to identify the variations in the drainage pattern of the SMCV in fetal cadavers. During the dissection of formalin-fixed full-term fetuses, deviation in the drainage of the SMCV was observed in five out of 30 cases. In three out of 30 specimens (10%), SMCV was observed draining into superior petrosal sinus; and in two specimens (6.6%) into the transverse sinus. In the remaining specimens, the SMCV drained directly into the cavernous sinus. Knowledge of the variations noted in the present study is essential, not only for diagnosing several diseases involving the cavernous sinus or paracavernous sinuses but also in surgeries of paracavernous sinus lesions and endovascular treatment of arteriovenous fistulas. The SMCV and superior petrosal sinus can be a venous refluxing route in patients with arteriovenous fistulas. [ABSTRACT FROM AUTHOR]

We describe a patient with Borden type II transverse-sigmoid dural arteriovenous fistula. On the venous phase of the left vertebral artery injection, there was no superior petrosal veins and sinus on the side of lesion. After transvenous balloon-assisted Onyx embolisation, the patient developed extensive venous infarction from venous occlusion. This report calls attention to a highly unusual variant in which the superior petrosal veins and sinus are absent, and the cerebellar veins will be drained by tributaries of the bridging veins in this circumstance. In such circumstances, occlusion of the bridging vein on the tentorial cerebellar surface may lead to complications during transverse-sigmoid dural arteriovenous fistula embolisation. [ABSTRACT FROM AUTHOR]

Patients presenting superior semicircular canal dehiscence (SSCD) can experience symptoms such as conductive hearing loss, pulsatile tinnitus, autophony, and pressure-induced vertigo. Decreased cervical vestibular-evoked myogenic potentials (cVEMPs) thresholds and high-resolution computed tomography (HRCT) of the petrous bone are essential for diagnosis of SSCD syndrome. We report the case of a 43-year-old man suffering from constant right pulsatile tinnitus, intermittent autophony, and unsteadiness induced by physical exercise. An SSCD by the superior petrosal sinus (SPS) was confirmed on the right side by axial HRCT of the temporal bone reformatted in the plane of Pöschl and ipsilateral abnormally low elicited cVEMPs. Treatment options were discussed with the patient since the pulsatile tinnitus progressively became debilitating. Two options were considered: surgery or a new endovascular treatment; the patient chose the latter option. After stenting the right SPS, the intensity of the pulsatile tinnitus dramatically decreased. As there was no complication the patient was discharged at Day 1. The other symptoms improved progressively. By the 60-day follow-up visit the patient only reported a slight tinnitus worsened by physical exercise. Angiographic follow-up at 5 months confirmed the patency of the SPS. Stenting the SPS in patients with SSCD by the SPS appears to be an alternative to the existing surgical treatments.

Patients presenting superior semicircular canal dehiscence (SSCD) can experience symptoms such as conductive hearing loss, pulsatile tinnitus, autophony, and pressure-induced vertigo. Decreased cervical vestibular-evoked myogenic potentials (cVEMPs) thresholds and high-resolution computed tomography (HRCT) of the petrous bone are essential for diagnosis of SSCD syndrome. We report the case of a 43-year-old man suffering from constant right pulsatile tinnitus, intermittent autophony, and unsteadiness induced by physical exercise. An SSCD by the superior petrosal sinus (SPS) was confirmed on the right side by axial HRCT of the temporal bone reformatted in the plane of Pöschl and ipsilateral abnormally low elicited cVEMPs. Treatment options were discussed with the patient since the pulsatile tinnitus progressively became debilitating. Two options were considered: surgery or a new endovascular treatment; the patient chose the latter option. After stenting the right SPS, the intensity of the pulsatile tinnitus dramatically decreased. As there was no complication the patient was discharged at Day 1. The other symptoms improved progressively. By the 60-day follow-up visit the patient only reported a slight tinnitus worsened by physical exercise. Angiographic follow-up at 5 months confirmed the patency of the SPS. Stenting the SPS in patients with SSCD by the SPS appears to be an alternative to the existing surgical treatments. [ABSTRACT FROM AUTHOR]

The superior petrosal sinus is located between the middle and posterior cranial fossae and is important during many neurosurgical approaches to the skull base. Using standard search engines, the anatomical and clinical importance of the superior petrosal sinus was investigated. The superior petrosal sinus is important in many neurosurgical approaches and pathological entities. Therefore, it is important for those who operate at the skull base or interpret imaging here to have a good working knowledge of its anatomy, development, and pathological involvement. [ABSTRACT FROM AUTHOR]

Background: While technological advances have improved the efficacy of endovascular techniques for tentorial dural arteriovenous fistulae (DAVF), superior petrosal sinus (SPS) DAVF with dominant internal carotid artery (ICA) supply frequently require surgical intervention to achieve a definitive cure. Methods: To compare the angiographic and clinical outcomes of endovascular and surgical interventions in patients with SPS DAVF, the records of all patients with tentorial DAVF from August 2010 to November 2015 were reviewed. Results: Within this cohort, eight patients with nine SPS DAVF were eligible for evaluation. Five DAVF were initially treated with endovascular embolization, while four underwent surgical occlusion without embolization. Of the SPS DAVF treated with embolization, two (40%) remained occluded on follow-up, while the remaining three (60%) persisted/recurred and required surgical intervention for definitive closure. Of the four SPS DAVF treated with primary surgical occlusion, all four (100%) remained closed on follow-up. In addition, of the three SPS DAVF that persisted/recurred following embolization and required subsequent surgical closure, all three (100%) remained occluded on follow-up. Two (100%) SPS DAVF that were successfully treated with embolization had major or minor external carotid artery supply, while the three (100%) persistent lesions had major ICA supply via the meningohypophyseal trunk (MHT). Three (75%) of the four SPS DAVF treated with primary surgical occlusion had dominant MHT supply. Conclusion: Complete endovascular closure of SPS DAVF with dominant ICA supply via the MHT may be difficult to achieve, while upfront surgical intervention is associated with a high rate of complete occlusion. [ABSTRACT FROM AUTHOR]

Objective:To determine signs and symptoms for superior canal dehiscence syndrome caused by the superior petrosal sinus.Methods:A review of the English-language literature on PubMed and Embase databases was conducted, in addition to a multi-centre case series report.Results:The most common symptoms of 17 patients with superior petrosal sinus related superior canal dehiscence syndrome were: hearing loss (53 per cent), aural fullness (47 per cent), pulsatile tinnitus (41 per cent) and pressure-induced vertigo (41 per cent). The diagnosis was made by demonstration of the characteristic bony groove of the superior petrosal sinus and the ‘cookie bite’ out of the superior semicircular canal on computed tomography imaging.Conclusion:Pulsatile tinnitus, hearing loss, aural fullness and pressure-induced vertigo are the most common symptoms in superior petrosal sinus related superior canal dehiscence syndrome. Compared to superior canal dehiscence syndrome caused by the more common apical location of the dehiscence, pulsatile tinnitus and exercise-induced vertigo are more frequent, while sound-induced vertigo and autophony are less frequent. There is, however, considerable overlap between the two subtypes. The distinction cannot as yet be made on clinical signs and symptoms alone, and requires careful analysis of computed tomography imaging. [ABSTRACT FROM PUBLISHER]

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.

Infratentorial cerebral hemorrhage due to a direct carotid-cavernous fistula (CCF) is very rare. To our knowledge, only four such cases have been reported. Cerebellar hemorrhage due to a direct CCF has not been reported. We describe a 63-year-old female who presented with reduced consciousness 3 days after undergoing a maxillectomy for maxillary cancer. Computed tomography showed a cerebellar hemorrhage. Magnetic resonance angiography showed a left-sided direct CCF draining into the left petrosal and cerebellar veins through the left superior petrosal sinus (SPS). Her previous surgery had sacrificed the pterygoid plexus and facial vein. Increased blood flow and reduced drainage could have led to increased venous pressure in infratentorial veins, including the petrosal and cerebellar veins. The cavernous sinus has several drainage routes, but the SPS is one of the most important routes for infratentorial venous drainage. Stenosis or absence of the posterior segment of the SPS can also result in increased pressure in the cerebellar and pontine veins. We emphasize that a direct CCF with cortical venous reflux should be precisely evaluated to determine the hemodynamic status and venous drainage from the cavernous sinus. [ABSTRACT FROM AUTHOR]