Kivelev Juri, Kivisaari Riku, Niemelä Mika, Hernesniemi Juha
Department of Neurosurgery, Turku University Central Hospital, Turku, Finland.
Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland.
World Neurosurg. 2016 Oct;94:394-397. doi: 10.1016/j.wneu.2016.07.031. Epub 2016 Jul 17.
Skull opening in occipital and suboccipital regions might be associated with risk of damage to the transverse venous sinus and the confluence of sinuses. We analyze the value of magnetic resonance (MR) imaging in localizing the venous sinuses in relation to the superior muscle insertion line (MIL) on the occipital bone.
We retrospectively analyzed head MR images of 100 consecutive patients imaged for any reason from 1 January 2013. All MR images were interpreted by a radiologist (R.K.). The superior MIL was identified at the midline and on both midpupillar lines, which represent the most frequent sites of skin incision and craniotomy (median and lateral suboccipital craniotomy, respectively).
Patients comprised 56 women (56%) and 44 men (44%). Their mean age was 54 (range 18-84) years. The muscles of the posterior skull were readily visible and clearly identified in both T1 and T2 images of all patients. Identification of the insertion zone and its relation to the venous structures was most readily made in the sagittal plane.
We found that the upper muscle insertion line on occipital bone corresponds to the underlying venous sinus and can be used as a reliable anatomic landmark. We identified it in 100% of preoperative MR images of heads with an intact occiput.
枕部和枕下区域的颅骨切开可能与横窦及窦汇损伤风险相关。我们分析磁共振（MR）成像在确定枕骨上静脉窦相对于上肌肉附着线（MIL）位置方面的价值。
我们回顾性分析了自2013年1月1日起因任何原因接受成像的100例连续患者的头部MR图像。所有MR图像均由一名放射科医生（R.K.）解读。在上中线以及两条瞳孔中线处确定上MIL，这两条线分别代表最常见的皮肤切口和开颅部位（分别为枕下正中开颅和外侧开颅）。
患者包括56名女性（56%）和44名男性（44%）。他们的平均年龄为54岁（范围18 - 84岁）。所有患者的T1和T2图像中，后颅骨的肌肉均清晰可见且易于识别。在矢状面最容易确定附着区域及其与静脉结构的关系。
我们发现枕骨上的肌肉附着线上方对应下方的静脉窦，可作为可靠的解剖标志。在枕骨完整的头部术前MR图像中，我们在100%的图像上识别出了该标志。
