Abstract
Introduction
Detailed descriptions of the mastoid emissary veins (MEVs) and the foramina through which they travel are lacking in the literature. Therefore, the aim of our study was to explore and delineate the morphology, topography and morphometry of the MEV, mastoid foramen (MF) and occipital foramen (OF). One hundred cadaver heads and 100 dried human skulls were grossly examined
Results
The MF and OF varied from being absent to having as many as four small openings, each transmitting an emissary vein. The overall prevalence of MEV was 98% on the right and 72% on the left. The overall prevalence of OF was 7% on the right and 4% on the left. The mean length of the MEV from its point of origin to its point of termination was found to be 7.2 cm with a range of 3.8–11.8 cm. The mean diameter of the MEV at the mastoid emissary foramen was 3.5 mm with a range of 1.1–5.6 mm. In the majority of the cadavers (85%) it was observed that mastoid and occipital emissary veins formed a confluent venous system, while in the remaining 15%, they remained as single vessels.
Conclusions
The MEV may be a significant source of bleeding during surgery of the skull base or middle ear, particularly during retrosigmoid and far-lateral approaches and detailed anatomical knowledge may help to prevent these complications. Endovascular treatment of dural arteriovenous fistulas is often extremely difficult due to limited access, however, the use of the MEV represents a unique and potentially valuable technique for accessing an isolated or inaccessible transverse or sigmoid sinus system.
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References
Anderson PJ, Harkness WJ, Taylor W, Jones BM, Hayward RD (1997) Anomalous venous drainage in a case of non-syndromic craniosynostosis. Childs Nerv Syst 13:97–100
Bithal P, Dash HH, Vishnoi N, Chaturvedi A (2003) Venous air embolism:does the site of embolism influence hemodynamic changes? Neurol India 51:370–372
Boyd GI (1930) The emissary foramina of the cranium in man and the anthropoid. J Anat 65:108–121
Braun JP, Tournade A (1977) Venous drainage in the craniocervical region. Neuroradiology 13:155–158
Chahlavi A, Steinmetz MP, Masaryk TJ, Rasmussen PA (2004) Transcranial approach for direct mechanical thrombectomy of dural sinus thrombosis. Report of two cases. J Neurosurg 101:347–351
Clemente CD (ed) (1985) Gray’s anatomy, 30th edn. Lea & Febiger, Philadelphia, pp 815–816
El Kettani C, Badaoui R, Fikri M, Jeanjean P, Montpellier D, Tchaoussoff J (2002) Pulmonary edema after venous air embolism during craniotomy. Eur J Anaesthesiol 19:846–848
Falk D (1986) Evolution of cranial blood drainage in hominids: enlarged occipital/marginal sinuses and emissary foramina. Am J Phys Anthropol 70:311–324
Hadeishi H, Yasui N, Suzuki A (1995) Mastoid canal and migrated bone wax in the sigmoid sinus: technical report. Neurosurgery 36:1220–1223
Hoffmann O, Klingebiel R, Braun JS, Katchanov J, Valdueza JM (2002) Diagnostic pitfall: atypical cerebral venous drainage via the vertebral venous system. Am J Neuroradiol 23:408–411
Houdart E, Saint Maurice JP, Chapot R, Ditchfield A, Blanquet A, Lot G, Merland JJ (2002) Transcranial approach for venous embolization of dural arteriovenous fistulas. J Neurosurg 97:280–286
Hoshi M, Yoshida K, Ogawa K, Kawase T (2000) Hypoglossal neurinoma. Two case reports. Neurol Med Chir 40:489–493
Irmak MK, Korkmaz A, Erogul O (2004) Selective brain cooling seems to be a mechanism leading to human craniofacial diversity observed in different geographical regions. Med Hypotheses 63:974–979
Koesling S, Kunkel P, Schul T (2005) Vascular anomalies, sutures and small canals of the temporal bone on axial CT. Eur J Radiol 54:335–343
Loukas M, Louis RG Jr, Hullett J, Loiacano M, Skidd P, Wagner T (2005) An anatomical classification of the variations of the inferior phrenic vein. Surg Radiol Anat 27:566–574
Marsot-Dupuch K, Gayet-Delacroix M, Elmaleh-Bergès M, Bonneville F, Lasjaunias P (2001) The petrosquamosal sinus: CT and MR findings of a rare emissary vein. Am J Neuroradiol 22:1186–1193
Martinez F, Laxague A, Vida L, Prinzo H, Sgarbi N, Soria VR, Bianchi C (2005) Topographic anatomy of the asterion. Neurocirugia 16:441–446
Moore KL, Dalley AF II (eds) (2006) Clinically oriented anatomy, 5th edn. Lippincott Williams & Wilkins, Baltimore, pp 915–916
Okudera T, Huang YP, Ohta T, Yokota A, Nakamura Y, Maehara F, Utsunomiya H, Uemura K, Fukasawa H (1994) Development of posterior fossa dural sinuses, emissary veins and jugular bulb: morphological and radiologic study. Am J Neuroradiol 15:1871–1883
Osammor JY, Baruah AK (1989) Unexplained neurological problems after mastoid surgery. J Laryngol Otol 103:269–271
Reis C, Deshmukh V, Zabramski JM, Crusius M, Desmuskh P, Spetzler RE, Preul MC (2007) Anatomy of the mastoid emissary vein and venous system of the posterior neck region: neurosurgical implications. Neurosurgery 61:ONS193–ONS201
Rivet DJ, Goddard JK, Rich KM, Derdeyn CP (2006) Percutaneous transvenous embolization of a dural arteriovenous fistula through a mastoid emissary vein. Technical note. J Neurosurg 105:636–639
Robson CD, Mulliken JB, Robertson RL, Proctor MR, Steinberger D, Barnes PD, McFarren A, Muller U, Zurakowski D (2000) Prominent basal emissary foramina in syndromic craniosynostosis: correlation with phenotypic and molecular diagnoses. Am J Neuroradiol 21:1707–1717
San Millan Ruiz D, Gailloud P, Rufenacht DA, Delavelle J, Henry F, Fasel JH (2002) The craniocervical venous system in relation to cerebral venous drainage. Am J Neuroradiol 23:1500–1508
Schelling F (1978) The emissaries of the human skull. Anat Anz 143:340–382
Standefer M, Bay JW, Truso R (1984) The sitting position in neurosurgery. a retrospective analysis of 488 cases. Neurosurgery 14:649–658
Standring S (ed) (2005) Gray’s anatomy, 39th edn. Elsevier Churchill Livingstone, Edinburgh, pp 281
Taylor WJ, Hayward RD, Lasjaunias P, Britto JA, Thompson DN, Jones BM, Evans RD (2001) Enigma of raised intracranial pressure in patients with complex craniosynostosis: the role of abnormal intracranial venous drainage. J Neurosurg 94:377–385
Tedechi H, Rhoton AL Jr (1994) Lateral approaches to the petroclival region. Surg Neurol 41:180–216
Venezio FR, Naidich TP, Shulman ST (1982) Complications of mastoiditis with special emphasis on venous sinus thrombosis. J Pediatr 101:509–513
Williams PL, Warwick R, Dyson M, Bannister LH (eds) (1989) Gray’s anatomy, 37th edn. Churchill Livingstone, Edinburgh, pp 225–226
Zouaoui A, Hidden G (1987) The cervical vertebral venous plexus and anastomoses with the cranial venous sinuses. Bull Assoc Anat 71:7–13
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Louis, R.G., Loukas, M., Wartmann, C.T. et al. Clinical anatomy of the mastoid and occipital emissary veins in a large series. Surg Radiol Anat 31, 139–144 (2009). https://doi.org/10.1007/s00276-008-0423-5
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DOI: https://doi.org/10.1007/s00276-008-0423-5