User Tools

Site Tools


dural_venous_sinus

Dural venous sinus

The dural venous sinuses (also called dural sinuses, cerebral sinuses, or cranial sinuses) are venous channels found between layers of dura mater in the brain.

They receive blood from internal and external veins of the brain, receive cerebrospinal fluid (CSF) from the subarachnoid space, and ultimately empty into the internal jugular vein.

Traditionally, the dural venous sinuses have been described only in the cranium. However, antecdotally, during various neurosurgical intradural procedures in the lumbosacral spine, Iwanaga et al., noticed an intradural collection of blood. With no prior studies on this in the extant medical literature, the following anatomical investigation seemed warranted 1).

see lumbosacral venous sinus

Venous sinuses

Structure

The walls of the dural venous sinuses are composed of dura mater lined with endothelium, a specialized layer of flattened cells found in blood vessels. They differ from other blood vessels in that they lack a full set of vessel layers (e.g. tunica media) characteristic of arteries and veins. It also lacks valves as seen in veins.

Clinical relevance

The sinuses can be injured by trauma.

Damage to the dura mater, which may be caused by skull fracture, may result in blood clot formation (thrombosis) within the dural sinuses. While rare, dural sinus thrombosis may lead to hemorrhagic infarction with serious consequences including epilepsy, neurological deficits, or death.

see venous sinus diverticulum The dural venous sinuses (also called dural sinuses, cerebral sinuses, or cranial sinuses) are venous channels found between layers of dura mater in the brain.

They receive blood from internal and external veins of the brain, receive cerebrospinal fluid (CSF) from the subarachnoid space, and ultimately empty into the internal jugular vein.

Many authors have reported the association of pulsatile tinnitus with anomalies of dural venous sinuses and the jugular bulb.


Profuse bleeding originating from an injured cerebral sinus can be a harrowing experience for any surgeon, particularly during an operation on a young child. Common surgical remedies include sinus ligation, primary repair, placement of a hemostatic plug, and patch or venous grafting that may require temporary stenting.

In a paper the Tuite et al., describe the use of a contoured bioresorbable plate to hold a hemostatic plug in place along a tear in the inferomedial portion of a relatively inaccessible part of the posterior segment of the superior sagittal sinus in an 11-kg infant undergoing hemispherotomy for epilepsy. This variation on previously described hemostatic techniques proved to be easy, effective, and ultimately lifesaving. Surgeons may find this technique useful in similar dire circumstances when previously described techniques are ineffective or impractical 2).


see Dural venous sinus thrombosis.

Imaging

The evaluation of the cerebral venous system, especially the dural venous sinuses, is most often performed using MR venography or CT venography.

1)
Iwanaga J, Alonso F, Akobo S, Turgut M, Yurttas C, Loukas M, Reina MA, Oskouian RJ, Tubbs RS. The Lumbosacral Dural Venous Sinus: A New Discovery with Potential Clinical Applications. World Neurosurg. 2017 Feb 8. pii: S1878-8750(17)30142-0. doi: 10.1016/j.wneu.2017.01.116. [Epub ahead of print] PubMed PMID: 28189870.
2)
Tuite GF, Carey CM, Nelson WW, Raffa SJ, Winesett SP. Use of a contoured bioresorbable plate with a hemostatic plug to control life-threatening bleeding from the superior sagittal sinus during hemispherotomy: technical note. J Neurosurg Pediatr. 2016 Oct;18(4):487-492. PubMed PMID: 27391919.
dural_venous_sinus.txt · Last modified: 2017/08/22 09:14 by administrador