Bonnal J
Neurochirurgie. 1982;28(3):147-72.
Neurosurgeons are confronted with the superior longitudinal sinus (SLS) in three circumstances: following injuries; compression or invasion of the sinus by tumors, particularly parasagittal meningiomas; and other less common occasions such as measuring pressure in the SLS or in the presence of a ventriculosinusal shunt or phlebitis of the SLS. Anatomical and physiological features of the sinus can be summarized as follows. The emissary veins open directory into the sinus at different angles according to whether they are anteriorly, medially, or posteriorly located. Their orifices are protected by willis cords, provoking laminar flow in the sinus. Pacchionian bodies are found mainly in the parasinusal blood lakes. To ensure an effective cerebral blood flow, pressure in the sinus must be less than that of the cerebrospinal fluid which itself must be at a lower pressure than that in the cortical veins. The anatomical structure of the sinuses in the rigid dural folds explains why they are compressed little or not at all by increased intracranial pressure. Surgery on the sinus should therefore include conservation or re-establishment of its two fold structure; internal venous, perfectly visible under the operating microscope, and external dura mater structure. Based on these anatomophysiological considerations, experimental sinus surgery was performed in the dog: either replacement of one or two sinus walls by a venous autograft doubled with dura mater. These techniques have been employed in humans mainly for parasagittal meningiomas, but they can be used for sinus injuries. A provisional shunt is necessary only when there is cerebral edema with venous turgescence, particularly posterior to the rolandic veins. Suturing of wounds, or their repair by means of a vein graft is employed whether they are associated or not with hematomas. Sinus invasion of meningiomas is diagnosed from the venous time of bilateral carotid angiography employing the subtraction process.
神经外科医生在三种情况下会遇到上矢状窦（SLS）：受伤后；肿瘤（尤其是矢状窦旁脑膜瘤）对窦的压迫或侵犯；以及其他不太常见的情况，如测量上矢状窦内压力、存在脑室窦分流或上矢状窦静脉炎时。窦的解剖和生理特征可总结如下。导静脉根据其位于前方、内侧还是后方，以不同角度直接开口于窦内。它们的开口由威利斯索保护，促使窦内形成层流。蛛网膜粒主要见于窦旁血池。为确保有效的脑血流量，窦内压力必须低于脑脊液压力，而脑脊液压力本身又必须低于皮质静脉压力。硬脑膜皱襞中窦的解剖结构解释了为什么它们在颅内压升高时很少或根本不会受到压迫。因此，对窦的手术应包括保留或重建其双重结构：在手术显微镜下清晰可见的内部静脉结构和外部硬脑膜结构。基于这些解剖生理考虑，在狗身上进行了实验性窦手术：用带硬脑膜的自体静脉移植替换一个或两个窦壁。这些技术主要用于人类矢状窦旁脑膜瘤，但也可用于窦损伤。仅当存在脑水肿伴静脉充血，尤其是罗兰多静脉后方出现这种情况时，才需要临时分流。无论伤口是否伴有血肿，都可采用缝合伤口或通过静脉移植进行修复。通过减法处理的双侧颈动脉血管造影的静脉期来诊断脑膜瘤对窦的侵犯。
