Spencer Pierce S, Cardona Juan J, Reina Francisco, Carrera Ana, Iwanaga Joe, Dumont Aaron S, Donofrio Carmine Antonio, Badaloni Filippo, Fioravanti Antonio, Tubbs R Shane
Department of Anatomical Sciences, St. George's University, St. George's, Grenada; Department of Medical Education, Geisinger Commonwealth School of Medicine, Scranton, PA, USA.
Department of Neurosurgery, Tulane University School of Medicine, New Orleans, LA, USA.
World Neurosurg. 2023 Apr;172:e581-e584. doi: 10.1016/j.wneu.2023.01.087. Epub 2023 Jan 27.
Neurosurgeons must master microanatomy and its variants that occur at the skull base. To the best of our knowledge, we describe a previously unreported dural venous sinus (DVS) within the anterior petroclinoid fold and discuss its potential surgical relevance.
Fifteen latex-injected human cadaveric heads (30 sides) underwent skull base dissection using a surgical microscope. The anterior petroclinoid fold was opened in search of evidence of an embedded DVS. When identified, this sinus was documented, photographed, and measured with microcalipers.
An anterior petroclinoid sinus (APCS) was identified in 67% of sides. These DVSs had a mean diameter of 0.65 mm and a length ranging from 8 to 15 mm (mean: 12.5 mm). The APCS ran from the anterior aspect of the cavernous sinus, arising just lateral (60%), posterior (20%), or medial (20%) to the anterior clinoid process, to the superior petrosal sinus (65%) or the posterior aspect of the cavernous sinus (35%), at the level of the posterior clinoid process. Along the course of the APCS, the oculomotor nerve was located medially at the oculomotor porus. Although slightly more common and larger on the right side, there was no statistically significant side difference.
An improved knowledge of variant DVSs can lower the risk of intraoperative complications and increase our understanding of the venous outflow from the cavernous sinus. Future neuroimaging techniques might also seek to identify the APCS. This is the first description of a DVS contained within the anterior petroclinoid fold.
神经外科医生必须掌握颅底的显微解剖结构及其变异情况。据我们所知，我们描述了一种位于岩床前皱襞内的此前未报道过的硬脑膜静脉窦（DVS），并讨论其潜在的手术相关性。
对15个注入乳胶的人类尸体头部（30侧）使用手术显微镜进行颅底解剖。打开岩床前皱襞以寻找是否存在嵌入的DVS的证据。一旦发现，记录该静脉窦，拍照并用微量卡尺测量。
在67%的侧别中发现了岩床前静脉窦（APCS）。这些DVS的平均直径为0.65毫米，长度范围为8至15毫米（平均：12.5毫米）。APCS从海绵窦的前部发出，恰好在前床突的外侧（60%）、后方（20%）或内侧（20%）发出，至岩上窦（65%）或在鞍背水平处的海绵窦后部（35%）。在APCS的走行过程中，动眼神经位于动眼神经孔的内侧。虽然右侧略为常见且更大，但两侧差异无统计学意义。
更好地了解变异的DVS可以降低术中并发症的风险，并增进我们对海绵窦静脉流出的理解。未来的神经影像学技术也可能会寻找识别APCS。这是对包含在岩床前皱襞内的DVS的首次描述。
