颅内静脉系统窦汇解剖形态学分析及其对静脉系统相关疾病的临床意义

Anatomic morphology analysis of the torcular herophili of the intracranial venous system and its clinical significance to related venous system diseases

目的探讨颅内静脉系统窦汇解剖形态学分布特点及其对临床常见静脉相关疾病的治疗评估意义。方法回顾性连续纳入2016年1月至2018年7月解放军总医院第一医学中心因脑血管疾病相关症状收住院患者2668例,其中男1572例,女1096例;年龄11~82岁,平均(54±14)岁。行头部DSA,根据窦汇区(枕内隆凸处)的直窦、双侧或单侧横窦、上矢状窦等各血管的解剖形态学及引流途径,将窦汇的解剖学形态分为Ⅰ型(完全窦汇型)、Ⅱ型(不全窦汇型,包括Ⅱ1A、Ⅱ1B、Ⅱ2、Ⅱ3、Ⅱ4、Ⅱ5亚型)、Ⅲ型(无窦汇型)。Ⅰ型指上矢状窦、直窦、双侧横窦4条静脉汇合于枕内隆凸处;Ⅱ型指上矢状窦、直窦、双侧横窦中任3条静脉汇合于枕内隆凸处;Ⅲ型指直窦自行汇入一侧横窦-乙状窦,且并未汇入对侧静脉引流,左右横窦间无相通。结果(1)因脑血管疾病相关症状收入院并完成DSA检查的2668例患者中,不同窦汇解剖形态学分型所占比例由高至低依次为Ⅱ型[56.4%(1504例)]、Ⅰ型[39.0%(1040例)]、Ⅲ型[3.7%(100例)]。(2)Ⅱ型中5种亚型,Ⅱ1A型占20.4%(544/2668),Ⅱ1B型占5.7%(152/2668),Ⅱ2型占19.8%(528/2668),Ⅱ3型占2.8%(76/2668),Ⅱ4型占4.3%(116/2668),Ⅱ5型占3.3%(88/2668)。(3)右侧优势引流比例最大,占50.5%(1348/2668),其次为双侧均势引流,占36.4%(972/2668),左侧优势引流比例最小,占12.1%(324/2668)。结论颅内静脉系统窦汇形态学变异很大,了解窦汇处解剖学特征,评估静脉窦汇处的分流特点,可对静脉系统疾病的诊治提供参考。

Objective To investigate anatomic and morphological distribution characteristics of the torcular herophili of the intracranial venous system and to provide reference for the treatment and evaluation of common diseases related to the venous system.Method From January 2016 to July 2018,2668 inpatients with cerebrovascular disease related symptoms admitted in Department of Neurology and the other departments,the First Medical Center of the PLA General Hospital were retrospectively recruited.These patients included 1572 men and 1096 women.The ages ranged from 11 to 82 years,with an average of(54±14)years old.According to the anatomic morphology and drainage channel of the straight sinus,bilateral or unilateral transverse sinuses,superior sagittal sinus and other blood vessels in the sinus confluence area(occipital protuberance),the anatomic morphology of the torcular herophili from DSA results can be divided into typeⅠ(complete torcular herophili type),typeⅡ(incomplete torcular herophili type,includingⅡ1A,Ⅱ1B,Ⅱ2,Ⅱ3,Ⅱ4 andⅡ5 five subtypes),typeⅢ(no torcular herophili).TypeⅠrefers to venous confluence of the superior sagittal sinus,straight sinus and bilateral transverse sinuses in the occipital protuberance;TypeⅡrefers venous confluence of any three of the superior sagittal sinus,straight sinus and bilateral transverse sinuses in the occipital protuberance,and it must contain the superior sagittal sinus and the straight sinus not directly connected with bilateral transverse sinuses;TypeⅢrefers to confluence of the straight sinus alone into the one side of the transverse sinus-sigmoid sinus,but without drainage from the contralateral veins and no communication between bilateral transverse sinuses.Results(1)Among the 2668 patients admitted to the hospital due to cerebrovascular disease related symptoms and completed DSA examination,the proportion of different anatomic types torcular herophili from high to low was typeⅡ56.4%(1504 cases),typeⅠ39.0%(1040 cases)and typeⅢ3.7%(100 cases).(2)Among five subtypes of typeⅡ,the proportion ofⅡ1A was 20.4%(544/2668),Ⅱ1B 5.7%(152/2668),Ⅱ219.8%(528/2668),Ⅱ32.8%(76/2668),Ⅱ44.3%(116/2668)andⅡ53.3%(88/2668).(3)The proportion of right dominant drainage was the highest,accounting for 50.5%(1348/2668),followed by bilateral balanced drainage,accounting for 36.4%(972/2668).The left dominant drainage was the lowest,accounting for 12.1%(324/2668).Conclusions There are great morphological variations in the sinus confluence of the intracranial venous system.Understanding of the anatomical features of the sinuses and assessment of the drainage characteristics of the venous sinuses could provide references for diagnosis and treatment of venous system diseases.