Juskys Raimondas, Rocka Saulius, Suchomlinov Andrej
Faculty of Medicine, Vilnius University, Vilnius, LTU.
Department of Anatomy, Histology, and Anthropology, Faculty of Medicine, Vilnius University, Vilnius, LTU.
Cureus. 2022 Feb 7;14(2):e21979. doi: 10.7759/cureus.21979. eCollection 2022 Feb.
Background and objective Injuries to the parasagittal cerebrovenous structures may lead to devastating complications. Being aware of the inherent anatomical heterogeneity in the region might lower the rate of undesirable outcomes. In this study, our goal was to characterize the superior sagittal sinus (SSS) positioning in relation to the midline and depict tributary bridging veins (BVs) distribution over the lateral surface of the cerebral hemispheres. Methods We performed anatomical dissections of the brain in 10 cadaveric specimens (five females and five males; median age: 52 years, range: 44-74 years). Measurements (in mm) of the SSS width and deviation of its lateral margin from the midline were obtained along the entire length of the structure at six craniometric points [at mid-distance between Nasion and Bregma (½ N-B); at Bregma (B); in the middle of the Bregma-Lambda segment (½ B-L); at Lambda (L); halfway between Lambda and Inion (½ L-I); and at Inion (I)]. The count, diameter, and lateral insertion points of the draining BVs were also documented in three segments [Nasion-Bregma (N-B), Bregma-Lambda (B-L), and Lambda-Inion (L-I)]. Results The width of the SSS increased progressively along the direction of the blood flow (p<0.01). There was an SSS lateral deviation bias to the right, but the comparison failed to reach the significance level (p=0.12). The maximal lateralization of the SSS in the pre-Lambdal interval was 13.1 mm on the right side and 11.7 mm on the left side. These values increased up to 19.8 mm and 15.1 mm in the torcular area on the right and left sides, respectively. A total of 191 BVs were identified (a mean of 19.1 ± 2.5 per individual). The L-I segment showed a lower number of BVs as compared to its N-B and B-L counterparts (mean: 0.9 ± 0.6 vs. 8 ± 1.8 and 10.2 ± 2, respectively, p<0.01). Along the entire span of the SSS, the average diameter of the BVs was larger on the right side (mean: 1.4 ± 0.9 mm vs. 1.1 ± 0.8 mm on the left, p<0.01). The average lateralization of BVs dural entry points was lower on the left side in the B-L segment (mean: 5.6 ± 6.4 mm vs. 8.8 ± 6.7 mm on the right, p<0.01). There was a statistically significant trend of decreasing BVs lateralization with each consecutive SSS segment (mean: 10.9 ± 7.4 mm in the N-B segment, 7.3 ± 6.7 mm in B-L, and 1.6 ± 1.2 mm in L-I, p<0.01). The maximal lateral deviation of BVs insertion points was 33.6 mm in N-B, 30 mm in B-L, and 4.1 mm in L-I portions of the SSS. Conclusions In most cases, the SSS deviated laterally from the midline, up to 13 mm in the pre-Lambdal segment and up to 20 mm in the torcular area. Right-sided BVs were of larger average diameters. The lateral insertion points of BVs decreased along the rostrocaudal span of the SSS.
背景与目的 矢状窦旁脑静脉结构损伤可能导致严重并发症。了解该区域固有的解剖异质性可能会降低不良后果的发生率。在本研究中，我们的目标是描述上矢状窦（SSS）相对于中线的位置，并描绘大脑半球外侧面的引流桥静脉（BVs）分布。方法 我们对10具尸体标本（5名女性和5名男性；中位年龄：52岁，范围：44 - 74岁）进行了脑部解剖。在六个颅骨测量点[鼻根与前囟中点（½ N - B）；前囟（B）；前囟 - 枕外隆凸段中点（½ B - L）；枕外隆凸（L）；枕外隆凸与枕骨大孔中点（½ L - I）；以及枕骨大孔（I）]沿着SSS的全长获取SSS宽度（以毫米为单位）及其外侧缘与中线偏差的测量值。还记录了引流BVs在三个节段[鼻根 - 前囟（N - B）、前囟 - 枕外隆凸（B - L）和枕外隆凸 - 枕骨大孔（L - I）]的数量、直径和外侧插入点。结果 SSS的宽度沿血流方向逐渐增加（p<0.01）。SSS存在向右侧的外侧偏移倾向，但比较未达到显著水平（p = 0.12）。SSS在枕外隆凸前区间的最大外侧化在右侧为13.1毫米，在左侧为11.7毫米。在左右侧的窦汇区，这些值分别增加到19.8毫米和15.1毫米。共识别出191条BVs（平均每人19.1±2.5条）。与N - B和B - L节段相比，L - I节段的BVs数量较少（平均值分别为0.9±0.6条与8±1.8条和10.2±2条，p<0.01）。在SSS的整个跨度上，BVs的平均直径右侧较大（平均值：1.4±0.9毫米 vs 左侧1.1±0.8毫米，p<0.01）。在B - L节段，BVs硬脑膜入口点的平均外侧化左侧较低（平均值：5.6±6.4毫米 vs 右侧8.8±6.7毫米，p<0.01）。随着SSS的每个连续节段，BVs外侧化存在统计学上显著的下降趋势（平均值：N - B节段为10.9±7.4毫米，B - L节段为7.3±6.7毫米，L - I节段为1.6±1.2毫米，p<0.01）。BVs插入点的最大外侧偏差在SSS的N - B节段为33.6毫米，B - L节段为30毫米，L - I节段为4.1毫米。结论 在大多数情况下，SSS从中线向外侧偏移，在枕外隆凸前段可达13毫米，在窦汇区可达20毫米。右侧BVs的平均直径较大。BVs的外侧插入点沿SSS的前后跨度减少。
