Department of Radiology, Takanohara Central Hospital, Nara 631-0805, Japan.
Acad Radiol. 2010 Sep;17(9):1103-11. doi: 10.1016/j.acra.2010.04.020.
The torcular herophili, or "confluence of the sinuses," shows various configurations with other venous sinuses, as revealed by angiography. The aims of this study were to evaluate anatomic variations of this confluence and to assess their clinical relevance using three-dimensional (3D) computed tomographic (CT) venography.
The torcular herophili and its relevant venous sinuses were analyzed using 3D CT venography in 120 adults, consisting of 76 patients who were proven to have aneurysms and 44 patients who were proven to have no vascular malformations or aneurysms after the examinations. Three-dimensional CT venography was performed following the arterial phase of 3D CT angiography without any additional injection of contrast material. Three-dimensional volume-rendered venous images were reconstructed on a workstation and reviewed.
The superior sagittal sinus (SSS) drained into the transverse sinus (TS) in four patterns: the SSS reached the centrally located confluence, where it divided into the bilateral TS (20.0%); the SSS was prematurely duplicated into the right and left limbs and drained into the same side TS (26.7%); the SSS drained exclusively into the right TS (44.2%); or the SSS drained exclusively into the left TS (9.2%). The draining pattern of the straight sinus was also classified into four types. The right TS was larger than the left TS. The right TS were higher compared to the left TS. Persistent occipital sinuses were recognized in 57.5% of the subjects. Finally, persistent falcial sinuses were seen in 2.5% of the subjects. A septum in the SSS and complicated venous channels in the confluence were each seen in only one case.
Three-dimensional CT venography is useful as a noninvasive method to evaluate the confluence and its relevant dural sinuses and can provide useful information for surgical intervention.
通过血管造影显示，在硬脑膜窦汇（又称“静脉窦汇”）与其他静脉窦交汇处存在各种不同的形态。本研究旨在通过三维（3D）计算机断层扫描（CT）静脉造影评估该交汇点的解剖变异，并评估其临床相关性。
使用 3D CT 静脉造影对 120 例成年人的硬脑膜窦汇及其相关静脉窦进行分析，其中 76 例患者经检查证实存在动脉瘤，44 例患者经检查证实无血管畸形或动脉瘤。3D CT 血管造影的动脉期后，无需额外注射造影剂即可进行 3D CT 静脉造影。在工作站上重建 3D 容积再现静脉图像并进行评估。
上矢状窦（SSS）以四种模式流入横窦（TS）：SSS 到达中央交汇点，在此处分为双侧 TS（20.0%）；SSS 过早分为右和左分支，并排入同侧 TS（26.7%）；SSS 仅排入右侧 TS（44.2%）；或 SSS 仅排入左侧 TS（9.2%）。直窦的引流模式也分为四种类型。右侧 TS 大于左侧 TS。与左侧 TS 相比，右侧 TS 更高。57.5%的受试者存在永存枕窦。最后，2.5%的受试者存在永存岩上窦。仅在 1 例中观察到 SSS 中的隔和汇流处复杂的静脉通道。
3D CT 静脉造影是一种非侵入性方法，可用于评估汇流及其相关硬脑膜窦，并可为手术干预提供有用信息。
