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Imaging of the Cerebral Venous Sinuses
Poster No.:
C-1365
Congress:
ECR 2016
Type:
Educational Exhibit
Authors:
A. Berrich, A. Ben Abdallah, A. Cherif, N. Arifa, S. Ghannouchi, H.
Jemni, K. Tlili; Sousse/TN
Keywords:
Ischemia / Infarction, Technical aspects, Normal variants, MRAngiography, CT-Angiography, Vascular, Neuroradiology brain,
Anatomy
DOI:
10.1594/ecr2016/C-1365
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Page 1 of 33
Learning objectives
To present a pictorial review of the imaging features of dural venous sinuses.
Fig. 1 on page 2
Images for this section:
Fig. 1
© CHU sahloul - Sousse/TN
Page 2 of 33
Background
A thorough knowledge of cerebral venous blood supply is essential to understanding
the pathophysiology of various vascular pathologies including venous thrombophlebitis
and cerebral vascular malformations. Especially when surgery is planned, it is necessary
to know the veins and the most important cerebral sinus and direction of blood flow.
Indeed, a brain surgery that leads to sacrifice a significant cortical vein or a deep vein
may be complicated by cerebral infarction venous whose territories may be more or less
extensive and can even lead to patient death.
Many studies interested in veins of the brain that are increasingly known by the studies
on the corpse and surgical descriptions. However nowadays with the expansion of new
vascular neuroradiology CT angiography techniques like angiography and magnetic
resonance required to reconsider the learning of cerebral venous anatomy based on
these techniques in order to achieve a better interpretation of radiological exams venous
and attract the attention of the neurosurgeon on certain anatomical variants necessary
to mention the radiological reports.
Indeed, after a long period angiography taught us a lot, new techniques enrich our
knowledge and allow better management of risks related to the achievement of these
examinations, the relatively non-invasive and continuous improvement quality vascular
mapping provided.
The normal and variant anatomy of the cerebral veins and dural venous sinuses is poorly
understood by many radiologists. Beginning with a discussion of cerebral
venous anatomy, this review illustrates clinically pertinent anatomy of the cerebral
sinovenous system. Various methods of imaging cerebral veins and dural venous sinuses
are described. Techniques and pitfalls of MR venography are emphasized. Fig. 2 on page
3
Images for this section:
Page 3 of 33
Fig. 2
© CHU sahloul - Sousse/TN
Page 4 of 33
Findings and procedure details
Venous sinus (1, 2, 3, 4):
The cranial venous sinuses intra venous channels are devoid of valves, of which the walls
consist of a doubling of the dura mater.
They receive cortical and deep cerebral veins, meningeal veins and communicate with
the extra-cranial veins through emissary veins running through the skull.
The whole sine is number twenty-one. Five are odd and median. The others are peers
and side.
Rouviere identify two groups:
•
•
posterior superior group.
antero inferior group.
1-The posterior superior Group:
The sinuses in this group have the common characteristic of opening in front of the
internal occipital protuberance, in the same confluence called "posterior confluence" or
"Herophilus press" or "torcular".
They are seven in number.
Three are odd and occupy the three edges of the falx. these are: the superior sagittal
sinus (SSS), the inferior sagittal sinus (ISS) and the straight sinus (SD).
The four others, peers, are the lateral sinuses (SL) and sinus posterior occipital (SOP).
It should be noted that there are localized thickenings of the walls of the sinus due to
the existence of comparable spongy tissue cavernous tissue. This can be the source of
artifacts and CT angiographic especially at the terminal portion of the superior sagittal
sinus and the straight sinus.
Moreover the light of the sinuses can present septa or adhesions that should not be
confused with thrombus hence the importance of a comprehensive and careful analysis
of CT scans and magnetic resonance imaging.
a- The superior sagittal sinus (superior sagittal sinus) (SSS) (4, 5, 6, 7, 8): Fig. 3 on page
15
Page 5 of 33
The superior sagittal sinus, odd and median, extends from the front region to the torcular.
Its walls are made of a split false brain at its insertion in the vertex. It begins immediately
above the internal frontal crest and responds to its full extent to the gutter dug back and
forth on the cranial vault.
It is triangular in section and its caliber increases from front to back as and when he
receives the cortical veins.
It also receives osteomeningeal veins and communicates forward with nasal veins by
emissary vein at the foramen cecum and forth with the veins of the scalp by the parietal
emissary veins.
It emits lateral diverticula called lateral gaps or blood lakes, particularly in its parietal
part.
Finally, it extends at the torcular by the lateral sinus.
It is visible on CT angiography and MR angiography: what is the impact of profile it
appears the most clear.
In front of the coronal suture, it is inconstant, sometimes replaced by one or two large
front veins path paramedian.
It then extends from the coronal suture to the inner occiput along a median path which
he sometimes deviates somewhat before reaching the torcular back.
But it is not always sinus median. Some authors noted a deviation of more than 1 cm
with respect to the center line in 20% of autopsied subjects.
Sometimes there are two parallel separate channels due to dural median partition.
The termination of the SSS is subject to large variations. These have been studied by
several authors that describe at least four types.
In effect its termination is rarely at the torcular and occurs most often in the lateral sinus
dominant.
You have to know the possibility of a split end portion causing false positive imaging
"false delta". Fig. 4 on page 16 Fig. 5 on page 17
The four main SSS termination types depending Fukusumi (8): Fig. 6 on page 18
•
•
•
Type A: SSS ends at the torcular and is continued by the lateral sinus.
Type B: SSS forks before reaching the posterior confluence and continue by
the lateral sinus.
Type C: SSS is drained primarily by the transverse sinus right with deflection
of the distal part to the right.
Page 6 of 33
•
Type D: SSS is drained mainly by the left transverse sinus with deflecting
distally to the left.
The superior sagittal sinus receives: Fig. 7 on page 19
•
•
•
•
•
•
•
the veins of the blind hole and the front end of the falx
superior cerebral veins
the great anastomotic vein Trolard
anastomotic vein of Labbé
middle meningeal veins.
bone veins or diploic
the parietal emissary vein anastomosis hole circulations intra and extra
cranial.
b - The inferior sagittal sinus (lower longitudinal sinus) (ISS): Fig. 8 on page 20
It has a small caliber. It extends at the posterior two-thirds of the free edge of the brain
false then flows into the anterior end of the right sinus.
He travels back and forth along the dorsal surface of the corpus callosum.
It is not shown for impact face.
It appears effect profile, it has an arcuate appearance concavity.
His path is roughly parallel to that of the superior sagittal sinus, but given its small size,
its visualization is inconstant.
It can be clearly visible in case of venous stasis in particular in case of thrombophlebitis.
It receives small veins of the corpus callosum, the internal face of the cerebral
hemispheres and false; it is sometimes connected to the sagittal sinus higher by veins
crossing the wrong.
It flows into the vein of Galen.
c- The right sinus (9): Fig. 9 on page 21
It begins at the junction of the base of the falx and the tentorium by the meeting of the
vein of Galen and lower sagittal sinus. It receives forward the deep veins at the of Galen
and superior cerebellar vein, then heads down and back and later joined the confluence
(or torcular, Herophilus press).
In CT angiography and MR angiography, its path is visible profile and its termination
appears better on a side or oblique impact.
Page 7 of 33
Sagittal reconstructions in MIP mode MR angiography (A) and VR mode of CT
angiography (B) showing the right sinus.
There are anatomical variations termination of the right sinus: Fig. 10 on page 21
•
•
•
•
Type A: the right sinus joins the central position of torcular and drains
equally to both transverse sinuses levels (the most common).
Type B: the right sinus bifurcates before joining the torcular to join the right
and left transverse sinus.
Type C: the right sinus goes directly to the right transverse sinus.
Type D: the right sinus goes directly to the left transverse sinus.
d- The confluence of sinuses (or confluence or post torcular or press Herophilus): (10)
Fig. 11 on page 22
It is located at the internal occipital protuberance, to the union of the falx, the fake and the
tentorium. It consists of the junction of the superior sagittal sinus, straight sinus, lateral
sinus and the occipital sinus.
In fact, this confluence is often incomplete as shown by angioscanners as the largest
lateral sinus, often right, is a direct response to the superior sagittal sinus, while the other
receives the right sinus.
e- The posterior occipital sinus : (11) Fig. 12 on page 23
These are very narrow sinus. Their origin is in torn holes post (jugular foramen) where
they communicate with the terminal end of lateral sinus or sigmoid sinus. They carry away
back and inside, bypassing the foramen magnum (foramen magnum), then enter the
scythe of the cerebellum and flow into the posterior confluence, sometimes separately,
sometimes by a median trunk.
During their paths, the occipital sinus enter into relationship with the emissary veins
bordering the posterior rim of the foramen magnum (marginal sinus). They drain bone
veins, cerebellar veins and widely communicate with the internal vertebral venous plexus.
The occipital sinus can sometimes be very large (remains embryonic device). Fig. 13 on
page 24
f- The lateral sinus (transverse sinus and sigmoid sinus): (12, 13, 14, 15)
Two in number, they extend on either side of the internal occiput to jugular foramen.
They arise from the division of the superior sagittal sinus at the torcular. They have two
segments: Fig. 14
Page 8 of 33
•
•
the first or transverse sinus, horizontal, travels in a bone trough of the
shell of the occipital bone which corresponds to the insertion of the tent of
the cerebellum. Then their journey to bend inwards and ends at the posterior
superior angle of the rock;
the second segment or sigmoid sinus, runs obliquely downwards and
inwards into the junction between the scale of the occiput and intracranial
posterior surface of rock that is to say along the petro-mastoid gutter and
ends in the Gulf continuous with the jugular.
The transverse sinus veins cerebellar receives directly or through the tentorial sinus
medial and inferior temporal and occipital cerebral veins through the lateral tentorial
sinus. It also receives the upper petrous sinus and communicates with the veins of the
scalp by the mastoid and condylar emissary veins.
Coronal images of the MRA face clearly show the transverse sinus and allow to
differentiate them. While on sagittal images, the paths of the lateral sinus overlap, a
slight obliquity to differentiate them. This effect allows especially to see afferent venous
sinus transverse and sigmoid sinus path that starts under the rock and describes a curve
forward and downward to join the Gulf jugular. Fig. 14 on page 24
Asymmetry of the lateral sinus is common, the right preferentially draining the superior
sagittal sinus in 43% of cases according Durgan (9).
A transverse sinuses may be hypoplastic or missing (2.6% of cases by Durgan), and it is
most often the left. In this case, her bone gutter is also absent, which allows to distinguish
this suppression of an acquired thrombosis of the sinuses. Fig. 15 on page 24
On a study of 13 venous angiography Irm, Yanzen (13) showed a right transverse
sinus dominant in 59% of cases, a left transverse sinus dominant in 25% of cases and
codominance in 16% of cases.
The dominance of the right transverse sinus is explained embryological manner by the
relative correctness of the path of the sigmoid sinus and the right jugular bulb to the right
atrium
Finally, the distal portion of the sigmoid sinus is unusually absent and replaced by large
mastoid emissary veins.
•
lateral sinus fenestration : Fig. 16 on page 25
It is usually discovered incidentally without pathological lesions. They usually sit next to
a lateral tentorial sinuses.
The main differential diagnosis is that of a thrombus where the importance of a careful
analysis of different sequences.
Page 9 of 33
•
Granulation Pacchioni:
It corresponds to a herniation of the arachnoid through the dura. She sits mostly in the
sagittal sinus and sup lateral sinus.
It poses the problem of differential diagnosis with cerebral thrombophlebitis.
The major diagnostic criteria are made on a 3D volume after contrast injection and are:
o granulation is pressed against the wall of the sinus
o its contours are regular
o no extension to adjacent sinuses
o it is crossed by a vein
g- falcine sinus (16, 17, 18, 19, 20) Fig. 17 on page 26
The sinus is a sinus falcoriel that exists in embryo and is normally closed after birth. It is
located in the scythe of the brain and connects the vein of Galen in the superior sagittal
sinus. He was found in children associated with birth defects such as malformations of
the vein of Galen, the corpus callosum agenesis, especially Chiari malformations type
II Meningocele ...
Ruy (16) defined two groups falcoriel sinus according to pathogenesis:
•
•
Group 1: falcine persistent sinus after birth accompanying or not cephalic
disorder or hypoplasia of the right sinus.
Group 2: reversal of a secondary sinus falcoriel to cerebral venous
pathology or other thrombophlebitis.
This sinus is visible on MRI angiography in the midline, especially on the sagittal
sequences.
It must be differentiated from the venous plexus of the fake of the brain that is formed
by small meningeal veins (not visible in the Angio-Irm) draining into the inferior sagittal
sinus and can communicate with the superior sagittal sinus;
2- The anterior-inferior group : (21, 22)
Page 10 of 33
The cavernous sinus is a confluence wherein prior venous flow, with the ophthalmic and
central veins of the retina, the sphenopalatine parietal sinus (of Breschet), coronary (para
cavernous) and transverse occipital.
Cavernous sinus go back clearance channels that drain the venous blood towards the
confluence of the anterior lateral sinuses and are the petrosal sinus, the petro-occipital
sinus and carotid sinus.
We describe successively: the cavernous sinus, their branches afferent and efferent their
branches.
a- The cavernous sinus:
a-1- General configuration (22, 21):
The cavernous sinus is the only intracranial venous sinus extra-dural location. Large,
elongated front to back as an anteroposterior quadrangular pyramid and truncated apex,
cavernous sinus extend from each side of the sella, the inner part, large, the superior
orbital fissure ( superior orbital fissure) forward at the front end of the rock behind.
They are interconnected by the intercaverneux coronary sinus or sinuses content in the
posterior part of sellaire diaphragm (tent of the pituitary). They are based, first, into the
recessed groove on the side face of the body of the sphenoid and respond back to the
upper orifice of the carotid canal. They limit each side of the pituitary fossa which contains
the pituitary.
It measures an average width of 5-7 mm, 5-8 mm high and 10-15 mm deep.
The neurovascular structures through the cavernous sinus are within fatty tissue and
connective tissue support. Fig. 18 on page 26
a-2- The venous plexus intracavernous:
The cavernous sinuses are composed of many venous elements (10 to 14), thin-walled,
small-caliber, separated by interconnected fibrous septa. They surround incomplete
internal carotid artery. They are perfectly identifiable in CT angiography and were
classified into five groups:
• Lateral venous group: they are the veins of the side wall of the CI recovered steadily
(a total of 3 to 6);
• The lower venous group: they are veins under IC, next to the V1 and V2.
Page 11 of 33
• The medial venous group or the gutter carotid veins: located between the IC and
the gutter that form the artery of the sphenoid. (the number of front and rear 2).
• The posterior venous group: it is later compared to the ascending portion of the IC,
the number of 2: higher (above the petro-clinoid ligament) and lower (below the petroclinoid ligament).
• The upper venous group: on the horizontal portion of the CI (anterior and posterior).
•
The inter-cavernous communications:
The venous plexus of the two cavernous sinus anastomose together by:
1.
2.
• The inter-cavernous sinus or coronary: these are trans-sellar anastomoses
in number 3: anterior, posterior and inferior. Indeed the dura lining the sella
and forms the pituitary tent contains a well developed venous network. The
part of the network located in the pituitary tent drawn around the pedicle
pituitary a ring on which one recognizes an anterior segment or previous
coronary sinus, a posterior or posterior coronary sinus segment and a lower
segment or lower coronary sinus.
• The basilar sinus: located behind the sellae dorsum.
b- Branches related cavernous sinus: Fig. 19 on page 27
The cavernous sinus receives: the ophthalmic veins, the central retinal vein, the emissary
veins, the sphénopariétal sinus Breschet, superficial sylvian veins and the transverse
occipital sinus.
b-1 Orbital veins:
•
The ophthalmic veins:
These veins lead to cavernous sinus venous blood from the orbital cavity. Two in number
for each orbit, are distinguished by superior ophthalmic vein and inferior ophthalmic vein.
•
The superior ophthalmic vein:
It begins at the inner corner of the eye by several veins of which is continuous with the
angular vein. From its origin it is doing very flexuous, back and outside, passes below the
upper right and above the optic nerve. It thus comes to the inner part, large, the superior
orbital fissure, it passes through and flows into the anterior end of the two planes, external
or internal or superficial and deep, cavernous sinus.
•
The inferior ophthalmic vein:
Page 12 of 33
She was born in the anteromedial portion of the orbital floor by a few veinlets from lacrimal
system and eyelids. She goes back and off. The vein passes above the lower right and
below the eyeball and optic nerve. She throws herself at the top of the orbit in the upper
ophthalmic vein, or through the superior orbital fissure and ends at the anterior end of
the cavernous sinus.
The lower ophthalmic vein still communicates with one or two anastomoses with the
superior ophthalmic.
NB: ophthalmic veins are united veins of the face and pterygomaxillary area by numerous
anastomosing branches.
•
The central vein of the retina:
Very small satellite of the central artery of the retina, it flows in either one of the ophthalmic
veins or directly into the cavernous sinus.
b-2 The spheno- parietal sinus Breschet SSP (49, 50, 51): Fig. 20 on page 27
In the early nineteenth century (1829) and Gilbert Breschet (49) depicts the existence
of a sphénopariétal sinus became sine Breschet but unfinished in his book there is not
a complete description of the sinuses.
This is Cruveilhier (49) which describes the "sinus located on the edge of the anterior
portion and the middle portion of the base of the skull, sinus occupying a channel
transversely directed inwards and is brought together in the cavernous sinus. This sinus
receives several veins cranial bone, the dura mater, and the temporal vein diploïque ".
This sinus begins Breschet according to the superior sagittal sinus, descends in a groove
on the bone anterolateral part of the skull, then runs along the posterior edge of the small
wing of the sphenoid up to the front end of the cavernous sinus where end.
For some authors, the name "sine of the small wing of the sphenoid" is admissible.
Tanoue (35) describe three varieties of anatomical spheno- parietal sinus:
* Type A: the sphénopariétal sinus runs along the small wing of the sphenoid and ends
at the cavernous sinus.
* Type B: the spheno- parietal sinus runs along the small wing of the sphenoid and ends
at the pterygoid plexus (plexus of the foramen ovale).
* Type C: the spheno- parietal sinus is hypoplastic and ends at the cavernous sinus.
c- The efferent branches of the cavernous sinus:
Page 13 of 33
Venous blood of the cavernous sinus is conducted in the lateral sinus and into the internal
jugular vein through the superior petrosal sinus, petrosal lower, petro-occipital and the
peri-venous plexus carotid. All these sinuses are even and symmetrical.
The basilar plexus and the transverse occipital sinuses are median and perform a wide
anastomosis between the two cavernous sinus.
c-1 The basilar plexus: (52)
This is a venous plexus dug in the dura that covers the basilar groove of the occipital
bone and the sphenoid blade quadrilateral. It carries a wide anastomosis between the
two rear ends of the cavernous sinus; it has two portions:
** the superior, cross, forms the horizontal bar of an H vertical bars together with the
current medial cavernous sinus in inferior petrosal sinus.
** the other lower, quite plexulaire, communicates the lower petrosal sinus and venous
plexus of the foramen magnum, via venous blade which slides on the slope of the
quadrilateral plate.
It is also called "venous Gulf petro-clival" by Laconnetta (140) and the "petro-clivale
venous confluence" by DESTRIEUX (141).
This basilar plexus extends rearwardly to form the marginal sinus.
C-2-The transverse occipital sinus (53)
It is a median sinus, and horizontal single located on the posterior surface of sellae
dorsum. He goes vertically downward to exit the skull through the foramen magnum and
join the basilar plexus. He is described as a sinus except that by some authors.
c-3 The marginal sinus (54)
This is an even sinuses located in a hard-Mérien downturn around the foramen magnum.
It drains the venous blood of the basilar plexus and subsequently communicates with the
occipital sinus (if any). It is normally drained within the sigmoid sinus or the jugular bulb.
Its visualization is difficult on CT angiography and MR angiography given its small size.
c-4 The superior petrosal sinus:
Page 14 of 33
The superior petrosal sinus, born of the posterior superior wall of the cavernous sinus,
sphenoid along the petro-ligament that joins the tip of the petrous part of the temporal
bone of the dorsum sella. It then runs along the upper edge of the petrous part of the
temporal. It is between the two dural layers of the large circumference of the tentorium,
and flows into the first curve of the sigmoid sinus or the transverse sinus.
It receives cerebellar veins, lateral mesencephalic vein, petrosal vein, para-cavernous
sinus and basal vein.
c-5-The inferior petrosal sinus: (55)
The inferior petrosal sinus is from the cavernous sinus and the transverse occipital sinus,
runs along the floor of the cerebellar fossa in the petro-occipital suture, and then exits
through the tapered part of the jugular foramen, to throw out of the skull in the Gulf the
internal jugular.
Is shorter but larger (7-10 mm) than the upper petrosal sinus. It receives labyrinthine
veins, cochlear, and cerebellar pontine.
Shiu et al. (56) described in 1939, 4 types of termination inferior petrosal sinus in the
internal jugular vein;
•
•
•
•
Type I: directly into the internal jugular vein.
Type II: the inferior petrosal sinus runs into a connecting vein that unites the
bulb of the internal jugular vein to the deep cervical venous plexus.
Type III: the inferior petrosal sinus drains into the internal jugular vein
through a venous plexus.
Type IV: the inferior petrosal sinus drains directly into the cervical plexus.
c-6 The petro-occipital sinus (52)
The petro-occipital sinus is a small sinus, first described by liver Trolard in 1890. It
originates at the posterior end of the cavernous sinus, runs parallel to the lower petrosal
sinus ripped through the foramen (foramen lacerum) in extracranial descends along the
underside of the petro-occipital suture and flows either in the inferior petrosal sinus or in
the internal jugular vein. Given its small size, it is difficult to visualize in angiography and
is often superimposed with the inferior petrosal sinus.
Images for this section:
Page 15 of 33
Fig. 3: Sagittal reconstructions (A) coronal (B) and oblique (C) of an MR angiography
showing the superior sagittal sinus.
© CHU sahloul - Sousse/TN
Page 16 of 33
Fig. 4: VR mode coronal reconstruction of a CT angiography showing a duplicated aspect
of SSS (blue arrow).
© CHU sahloul - Sousse/TN
Page 17 of 33
Fig. 5: Axial reconstructions MIP mode of an MRA (A) and VR Mode CT angiography
(B) showing the appearance of "false delta" (blue arrow) secondary to a bifurcation of
the SSS.
© CHU sahloul - Sousse/TN
Page 18 of 33
Fig. 6: Coronal reconstructions of CT angiography in VR mode showing the different
types of termination of the SSS.
© CHU sahloul - Sousse/TN
Page 19 of 33
Fig. 7: Coronal reconstructions in MIP mode MR angiography (2D TOF sequences)
showing the different types of termination of the SSS.
© CHU sahloul - Sousse/TN
Page 20 of 33
Fig. 8: Sagittal reconstructions in MIP mode MR angiography (A: 3D after gadolinium
injection and B: 2D TOF) showing the SSI. A: Note the straight sinus thrombosis.
© CHU sahloul - Sousse/TN
Fig. 9: Sagittal reconstructions in MIP mode MR angiography (A) and VR mode of CT
angiography (B) showing the right sinus.
© CHU sahloul - Sousse/TN
Page 21 of 33
Fig. 10: Axial CT angiography reconstructions of VR mode showing the different types
of terminations of the right sinus.
© CHU sahloul - Sousse/TN
Page 22 of 33
Fig. 11: Oblique reconstruction of MR angiography (2D TOF sequences) showing the
most common form of the incomplete torcular.
© CHU sahloul - Sousse/TN
Fig. 12: Occipital sinus
Page 23 of 33
© CHU sahloul - Sousse/TN
Fig. 13: Coronal reconstruction of a 2D TOF MRA sequences (A); sagittal (B) and oblique
(C) VR mode of a 3D MR angiography sequences SPGR showing a case of a large
occipital sinuses right hand sigmoid sinus to throw at the torcular.
© CHU sahloul - Sousse/TN
Fig. 14: Coronal reconstructions (A) and sagittal (B) and oblique (C) MR angiography
with visualization of the lateral sinus and cortical veins different that reach.
© CHU sahloul - Sousse/TN
Page 24 of 33
Fig. 15: Sagittal reconstructions of MR angiography in a healthy subject showing
asymmetry of the gutter lateral sinus which is smaller left with a skull next (arrow) and
hypertrophic left protruding.
© CHU sahloul - Sousse/TN
Page 25 of 33
Fig. 16: VR mode oblique reconstruction of MR angiography (A) and a CT angiography
(B) showing a fenestration of the lateral sinus next to the lateral tentorial sinus (red arrow).
© CHU sahloul - Sousse/TN
Fig. 17: falcine sinus
© CHU sahloul - Sousse/TN
Page 26 of 33
Fig. 18: Side schematic representation showing the cavernous sinus venous groups:
upper (1), lateral (2), less (3), rear (4).
© CHU sahloul - Sousse/TN
Fig. 19: Schematic representation of the cavernous sinus and its tributaries.
© CHU sahloul - Sousse/TN
Page 27 of 33
Fig. 20: Schematic representation of three types of terminating SSP.
© CHU sahloul - Sousse/TN
Page 28 of 33
Conclusion
Cerebral venous drainage dominance is of great importance and should be considered
before operations on patients for radical neck dissection, removal of tumors.
Personal information
Amira BERRICH AMARA
Department Of Radiology Sahloul Sousse/Tunisia
Adress correspondance: [email protected]
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