Department of Radiology, New York University Langone Medical Center, New York, New York, USA
Department of Radiology, New York University Langone Medical Center, New York, New York, USA.
J Neurointerv Surg. 2022 Feb;14(2):196-201. doi: 10.1136/neurintsurg-2020-017237. Epub 2021 Mar 16.
The dural vasculature plays a key role in several important conditions, including dural fistulas and subdural collections. While in vivo investigations of intrinsic dural arterial angioarchitecture are rare, no angiographic studies of dural venous drainage exist to our knowledge.
To describe methods by which dural venous drainage might be visualized with current angiographic equipment and technique, and to correlate our results with existing ex vivo literature.
Digital subtraction angiography and 3D angiography (rotational and Dyna CT) of dural neurovasculature were acquired in the context of subdural hematoma embolization and normal dura. Protocols for visualization of dural venous drainage were established, and findings correlated with ex vivo studies.
Meningeal arteries supply both the skull and dura. Normal dural enhancement is accentuated by the presence of hypervascular membranes. Intrinsic meningeal veins/sinuses parallel outer layer arteries with well-known tram-tracking appearance. Dura adjacent to main arterial trunks drains via skull base foramina into the pterygopalatine venous plexus, or via emissary veins into the temporalis venous plexus. Dura near the sinuses drains into venous pouches adjacent to the sinus, before emptying into the sinus proper-possibly the same pouches implicated in the angioarchitecture of dural fistulas. Finally, posterior temporoparietal convexity dura, situated in a watershed-like region between middle and posterior meningeal territories, frequently empties into diploic and emissary veins of the skull. Wide variation in balance is expected between these three routes. Drainage patterns appear to correlate with venous embryologic investigations of Padget and ex vivo studies in adults.
Continued attention to dural venous drainage may prove useful in the diagnosis and management of dural-based vascular diseases.
硬脑膜脉管系统在多种重要情况下发挥着关键作用，包括硬脑膜瘘和硬脑膜下积液。虽然内在硬脑膜动脉血管构筑的活体研究很少，但据我们所知，没有关于硬脑膜静脉引流的血管造影研究。
描述使用当前血管造影设备和技术可视化硬脑膜静脉引流的方法，并将我们的结果与现有的离体文献进行关联。
在硬脑膜下血肿栓塞和正常硬脑膜的背景下，获取硬脑膜神经脉管系统的数字减影血管造影和 3D 血管造影（旋转和 Dyna CT）。建立了可视化硬脑膜静脉引流的方案，并将发现与离体研究进行了关联。
脑膜动脉供应颅骨和硬脑膜。富含血管的膜会增强硬脑膜的增强效果。内在脑膜静脉/窦与外层动脉平行，具有众所周知的 tram-tracking 外观。靠近主要动脉主干的硬脑膜通过颅骨基底孔进入翼腭静脉丛，或通过导静脉进入颞浅静脉丛进行引流。靠近窦的硬脑膜排入邻近窦的静脉囊，然后排入窦本身-可能是与硬脑膜瘘的血管构筑有关的相同囊。最后，位于中脑膜和后脑膜区域之间分水岭样区域的后颞顶凸面硬脑膜，通常排入颅骨的板障和导静脉。这三种途径之间预计会有很大的平衡差异。引流模式似乎与 Padget 的静脉胚胎学研究和成人的离体研究相关。
对硬脑膜静脉引流的持续关注可能有助于硬脑膜血管疾病的诊断和管理。
