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Morphologic Evaluation of the Caudal End of the Inferior Petrosal Sinus Using 3D Rotational Venography

Y. Mitsuhashia, A. Nishiob, S. Kawaharaa, T. Ichinosea, S. Yamauchia, H. Narusea, Y. Matsuokaa, K. Ohatab and M. Harab

a Department of Neurosurgery, Izumi Municipal Hospital, Osaka, Japan
b Department of Neurosurgery, Osaka City University, Graduate School of Medicine, Osaka, Japan


Figure 1
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  		Fig 1. A 3DRV superimposed on a 3D rotational osteogram shows the relationship of venous structures—IPS (arrow), ACV (arrowhead), LCV (asterisk)—to bony structures (skull and upper cervical spine).


Figure 2
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  		Fig 2. 3DRV (anteromedial view of the right side) and schema (frontal view of the right side) of type A: The IPS (arrow) drains into the JB (arrowhead) and does not anastomose with the VVP.


Figure 3
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  		Fig 3. 3DRV rotation venogram (medial view of the right side) and schema (frontal view of the right side) of type B: The IPS (arrow) drains into the IJV (arrowhead) at the level of the extracranial opening of the hypoglossal canal and anastomoses with the VVP via the ACV (asterisk).


Figure 4
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  		Fig 4. 3DRV (frontal view of the right side) and schema (frontal view of the right side) of type C-1: The IPS (arrow) shows a long extracranial extension and joins the IJV at the level of the atlas. In this case, the IPS has no anastomosis with the VVP. The arrowhead indicates the JB.


Figure 5
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  		Fig 5. 3DRV (anterolateral view of the right side) and schema (frontal view of the right side) of type C-2: The IPS (arrow) shows a long extracranial extension (double arrow). Note another upper junction (arrowhead) to the IJV and the anastomosis with the VVP via the ACV (asterisk) at the level of the extracranial opening of the hypoglossal canal.


Figure 6
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  		Fig 6. 3DRV (medial view of the right side) and schema (frontal view of the right side) of type D: The upper route (arrow) that enters the JB has no anastomosis with the VVP, and the lower route (double arrows) anastomoses with the VVP via the ACV (asterisk) and enters the IJV (arrowhead).


Figure 7
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  		Fig 7. 3DRV (frontal view of the left side) and schema (frontal view of the right side) of type E: The IPS (arrow) has no connection to the IJV (arrowhead) and drains directly into the VVP via the ACV (asterisk).


Figure 8
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  		Fig 8. 3DRV (medial view of the left side) and schema (frontal view of the right side) of type F: The IPS is absent, and the pterygoid plexus (arrow) shows marked development. An arrowhead indicates the JB; an asterisk indicates the cavernous sinus.


Figure 9
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  		Fig 9. Theoretic schematic representation of the development of the caudal portion of the IPS in the embryonic and fetal periods.

A, In the early embryonic phases, the primary head sinus and the anterior cardinal vein (the future IJV) run ventromedially to the vagal, accessory, and hypoglossal nerve and to cervical nerve roots.

B, The primary head sinus and the anterior cardinal vein migrate dorsolaterally to the lower cranial nerves and the ansa cervicalis, forming a venous plexus around nerves.

C, The vagal vein, the hypoglossal vein, and the upper cervical intersegmental veins are stretched and anastomose with each other on the ventromedial side of the IJV. The ventral myeloencephalic vein and the primitive hypoglossal emissary vein are formed through this process.

D, The ventral myeloencephalic vein is connected to the cavernous sinus with its cranial end, and the IPS is formed. The morphologic variation of the caudal portion of the IPS may be determined by the extent of development and degeneration of individual venous channels.


Figure 10
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  		Fig 10. The new classification is evaluated with our theory about the development of the caudal portion of the IPS.

In type A, the caudal portion of the IPS is derived from the vagal vein only and has no anastomosis with the VVP.

In type B, the caudal portion of the IPS is formed by the anastomosis of the vagal vein and the hypoglossal vein, so the anastomosis with the VVP via the ACV is common.

In type C-1, the caudal portion of the IPS is formed by the longitudinal anastomosis of the vagal vein, the hypoglossal vein, and the cervical intersegmental veins and drains into the extracranial lower IJV.

In type C-2, the upper venous route is formed as in type B, and the another lower route develops as in type C-1.

In type D, the development of the upper route drains is the same as that in type A, and the lower route develops as in type B.

In type E, no venous channel connecting the IPS to the IJV develops, and the venous return drains directly into the VVP via the venous route formed by anastomosis between the vagal vein and the hypoglossal vein.

In type F, the IPS is absent.


Figure 11
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  		Fig 11. 3DRVs (A, superomedial view of the left side; B, medial view of the left side) and schemas presenting our theory of the development of the caudal end of the IPS (ventral view of the right side) are shown. In these cases, we can find a duplicated venous channel (double arrow) with the IJV. The arrow indicates the IPS, the arrowhead indicates the JB, and the asterisk indicates the ACV.

A, The duplicated channel may be formed with the longitudinal anastomosis of the hypoglossal vein and the 1st cervical intersegmental vein.

B, The duplicated channel may be formed with the longitudinal anastomosis of the 1st and 2nd cervical intersegmental veins.





Copyright © 2009 by the American Society of Neuroradiology. Print ISSN: 0195-6108 Online ISSN: 1936-959X