Thrombosis of the Transverse Sinus: About a Clinical Observation and Review of the Literature

Cerebral venous thrombosis has an unfavorable prognosis. It is a rather rare pathology concerning 3 to 5 cases per million inhabitants. The clinical symptomatology also varies according to the topography of the venous thrombosis and, in some cases, the CVT can have an unusual presentation. Progress and accessibility of non-invasive imaging currently allow early diagnosis of CVT. Brain MRI is the reference method for the diagnosis of CVT. We report a case of transverse sinus thrombosis in a 32-year-old male patient who consulted for headaches through which we want to study the etiological, clinical, paraclinical, therapeutic aspects as well as the evolutionary profile. The clinical history dates back to 2 weeks ago with frontal headaches radiating to the occipital region, throbbing of severe intensity, progressive onset and permanent evolution associated with right unilateral anterior purulent rhinorrhea. He had no nasal obstruction, epistaxis, hearing loss or other otological symptoms;no neurological deficit or notion of head trauma. Cerebral and maxillofacial computed tomography showed right maxillary sinusitis and right transverse sinus thrombosis. We carried out medical treatment based on antibiotics and analgesics without the use of anticoagulants. The evolution was favorable after four weeks of treatment. Conclusion: Transverse sinus thrombosis has a non-specific and heterogeneous clinical presentation. Headaches are the first sign. MRI and CT can help establish the diagnosis. The treatment is both etiological and symptomatic.

Bone remodeling in sigmoid sinus diverticulum after stenting for transverse sinus stenosis in pulsatile tinnitus: A case report

BACKGROUND Pulsatile tinnitus(PT)is a potentially disabling symptom that has received increasing attention.Multiple causes of PT have been confirmed by targeted treatment.However,dynamic changes of related structures in PT patients with multiple causes after stenting for ipsilateral transverse sinus stenosis(TSS)have not been previously reported.We report such a case and present postoperative computed tomography venography(CTV)follow-up findings to demonstrate the decreased sigmoid sinus diverticulum and bone remodeling.CASE SUMMARY A 45-year-old man suffered from left-sided PT for 15 years that was occasionally accompanied by headache and dizziness.Pre-operative CTV revealed left-sided sigmoid sinus wall anomalies(SSWAs),TSS,outflow dominance,large posterior condylar emissary vein,and an empty sella turcica.A cerebrospinal fluid pressure of 270 mmH2O was further detected.The sound disappeared immediately after stenting for ipsilateral TSS,with no recurrence during 2 years of follow-up.After the procedure,the patient underwent four consecutive CTV examinations.The diverticulum decreased 6 mo after the procedure with new bone remodeling.The density of the remodeled bone was further increased 1 year later,and a hardened edge was formed 2 years later.CONCLUSION PT associated with SSWAs,TSS,and idiopathic intracranial hypertension can be cured by stenting for TSS alone.And bone remodeling around SSWAs is a more significant finding.

Microsurgical Treatment of Meningiomas Invading the Sagittal or Transverse Sinuses

OBJECTIVE To analyze our management strategy and results of treating patients affected by meningiomas invading the sagittal or transverse sinuses.METHOOS Review of data from 35 patients with pathologically confirmed meningiomas（29 of the sagittal sinus and 6 of the transverse sinus） surgically treated between from July 1999 and June 2003, including clinical manifestations, mode of diagnosis and curative effect of microsurgery etc. For our surgical decision-making, meningiomas were classified into six types based on the degree of sinus involvement.RESULTS A Simpson＇s Grade Ⅰ resection was achieved in 27 cases （77.1%）, Grade Ⅱ in 6 （17.1%） and Grade Ⅲ in 2 （5.7%）. No patients died after the operations. The recurrence rate in the study overall was 2.9%, with a follow-up period from 3 to 6 years.CONCLUSION Application of microsurgical techniques, protection of the sinus, avoidance of damages to the cerebral cortex, veins of the central sulcus, as well as other veins from the tumor, are the major factors for increasing the rate of total resection, reducing complications and improving the quality of life for the patients with meningiomas invading the sagittal or transverse sinuses.

Localization of Anterosuperior Point of Transverse-sigmoid Sinus Junction Using a Reference Coordinate System on Lateral Skull Surface

Background： During craniotomies using the transpetrosal-presigmoid approach, exposure of the sigmoid sinus remains an essential but hazardous step. In such procedures, accurate localization of the anterosuperior point of the transverse-sigmoid sinus junction （ASTS） is very important lbr reducing surgical morbidity. This study aimed to create an accurate and practical method for identifying the ASTS. Methods： On the lateral surfaces of 40 adult skulls （ 19 male skulls and 21 female skulls）, a rectangular coordinate system was defined to measure the x and y coordinates of two points： the ASTS and the squamosal-parietomastoid suture junction （SP）. With the coordinate system, the distribution characteristics of the ASTS were statistically analyzed and the differences between the ASTS and SP were investigated. Results： For ASTS-x, significant differences were found in different sides （P =0.020）; the ASTS-x in male skulls was significantly higher on the right side （P =0.017）; there was no significant difference between the sides in female skulls. There were no significant differences in gender or interaction of gender and side for ASTS-x, and for ASTS-y, there were no significant differences in side, gender, or interaction of gender and side. For both sides combined, the mean ASTS-x was significantly higher than the mean SP-x （P = 0.003） and the mean ASTS-y was significantly higher than the mean SP-y （P = 0.011 ）. Conclusions： This reference coordinate system may be an accurate and practical method for identifying the ASTS during presigmoid craniotomy. The SP might be difficult to find during presigmoid craniotomy and, therefore, it is not always a reliable landmark for defining the ASTS.

Modified surgical method of supra-and infratentorial epidural hematoma and the related anatomical study of the squamous part of the occipital bone

BACKGROUND Supra-and infratentorial acute epidural hematoma(SIEDH)is a common posterior cranial fossa epidural hematoma located at the inner surface of the squamous part of the occipital bone(SOB).Traditionally,surgical treatment of the SIEDH requires a combined supra-infratentorial craniotomy.AIM To analyze the morphological characteristics of the SOB and introduce a single supratentorial craniotomy for SIEDH.METHODS Skull computed tomography(CT)scan data from 32 adult patients were collected from January 1,2019 to January 31,2020.On the median sagittal plane of the CT scan,the angle of the SOB(ASOB)was defined by two lines:Line A was defined from the lambdoid suture(LambS)to the external occipital protuberance(EOP),while line B was defined from the EOP to the posterior edge of the foramen magnum(poFM).The operative angle for the SIEDH(OAS)from the supra-to infratentorial epidural space was determined by two lines:The first line passes from the midpoint between the EOP and the LambS to the poFM,while the second line passes from the EOP to the poFM.The ASOB and OAS were measured and analyzed.RESULTS Based on the anatomical study,a single supratentorial craniotomy was performed in 8 patients with SIEDH.The procedure and the results of the modified surgical method were demonstrated in detail.For males,the ASOB was 118.4±4.7 and the OAS was 15.1±1.8;for females,the ASOB was 130.4±5.1 and the OAS was 12.8±2.0.There were significant differences between males and females both in ASOB and OAS.The smaller the ASOB was,the larger the OAS was.The bone flaps in 8 patients were designed above the transverse sinus intraoperatively,and the SIEDH was completely removed without suboccipital craniotomy.The SOB does not present as a single straight plane but bends at an angle around the EOP and the superior nuchal lines.The OAS was negatively correlated with the ASOB.CONCLUSION The single supratentorial craniotomy for SIEDH is reliable and effective.

Retrosigmoid approach assisted by high-resolution computed tomography: a cost-effective technique to identify the transverse and sigmoid sinus transition

Background:When utilizing the retrosigmoid approach(RA),accurately identifying the transverse and sigmoid sinus transition(TSST)is a key procedure for neurosurgeons,especially in developing countries restricted by the lack of expensive devices,such as the neural navigation system and the three-dimensional volumetric image-rendered system.Before operations,a computed tomography scan is a common and cost-effective method of checking patients who suffer lesions located at the cerebellopontine angle.Therefore,we present a technique using only high-resolution computed tomography to identify the transverse and sigmoid sinus transition.Methods:This retrospective study included 35 patients who underwent retrosigmoid approach operations to resect an acoustic neurinoma with the assistance of our technique.In brief,our technique contains 4 steps:(1)All patients’1-mm,consecutive,high-resolution computed tomographic images that clearly displayed landmarks,such as the inion,lambdoid suture,occipitomastoid suture,and the mastoid emissary foramen,were investigated initially.(2)We selected two particular slices(A and B)among all of these high-resolution computed tomographic images in which scanning planes were parallel with the line drawn from the root of the zygoma to the inion(LZI).Slice A contained both the root of the zygoma and the inion simultaneously,and slice B displayed the mastoid emissary foramen.(3)Four points(α,β,γ,δ)were arranged on slices A and B,and pointαwas located at the inner surface of the skull,which represents the posterior part of the sulci of the sigmoid sinus.Pointβwas located at the outer surface of the skull,and the line connecting them was perpendicular to the bone.Similarly,on slice B,we labeled pointγas the point that represents the posterior part of the sulci of the sigmoid sinus at the inner surface and pointδas the point located at the outer surface of the skull,and the line connecting them was also perpendicular to the bone.The distances between pointβand the lambdoid suture/occipitomastoid suture and between pointδand the mastoid emissary foramen were calculated for slices A and B,respectively.(4)During the operation,a line indicating the LZI was drawn on the bone with ink when the superficial soft tissue was pushed away,and this line would cross the lambdoid suture/occipitomastoid suture.With both the crosspoint and the distance obtained from the high-resolution CT images,we could locate pointβ.We also used the same method to locate pointδafter revealing the mastoid emissary foramen.The line connecting pointβand pointδindicated the posterior border of the sigmoid sinus,and the intersection between the line and LZI indicated the inferior knee of the transverse and sigmoid sinus transition(TSST).Results:All 35 patients underwent the RA craniectomies that were safely assisted by our technique,and neither the sigmoid sinus nor the transverse sinus was lacerated during the operations.Conclusion:Our cost-effective technique is reliable and convenient for identifying the transverse and sigmoid sinus transition(TSST)which could be widely performed to guarantee the safety of RA craniectomy.