Keywords:
Arteriovenous malformations, Diagnostic procedure, Catheter arteriography, Veins / Vena cava, Neuroradiology brain, Anatomy
Authors:
S. Ide, H. Kiyosue, S. Tanoue, Y. Hori, M. Okahara, H. Mori; Oita/JP
DOI:
10.1594/ecr2013/C-1926
Conclusion
Discussion
Padget described the detailed developmental anatomy of the cranial venous system (4).
During the early embryonic stage,
the deep telencephalic vein (DTV) flows into the primitive tentorial sinus,
which is the precursor of the superficial telencephalic vein.
The primitive tentorial sinus runs posteriorly and connects to the transverse sinus.
Later,
the basal cerebral vein is formed by the anastomosis of the terminal branches of the DTV,
the ventral diencephalic vein (VDV),
dorsal diencephalic vein (DDV) and mesencephalic vein (Fig.
9).
The UV is thought to be the remnant of the termination of the DTV.
Along with the growth of temporal lobes,
the primitive tentorial sinus is displaced medially and connects with the CS.
Several types of superficial middle cerebral vein variation can occur depending on the degree of the connection between the primitive tentorial sinus and the CS. The variations in UV termination as well as the SMCV would depend on development of these connections and the development of the BVR.
In our results,
the cerebral venous blood via the UV draining into the CS directly (n=43) or through the SMCV and/or the LCS (n=43) was observed in 86 sides (54%) with normal cerebral hemodynamic status.
This can be related to the UV drainage of the CSDAVFs which was found in 33% of cases in this series.
Cerebral hemorrhage of CSDAVFs is less than that of DAVFs at other locations because the CS connects with multiple emissary veins as well as the sinuses (5).
However,
it was reported that the retrograde cortical venous drainage of CSDAVFs brings a high risk of intracerebral venous hemorrhage especially for cases with only a small cerebral venous drainage (6).
CSDAVFs are generally treated by transvenous embolization.
Careful attention should be paid to small cortical venous drainage such as uncal venous drainage during embolization because serious complications can occur when these retrograde drainage routes remain after transvenous embolization.
It is also important to know the variations in UV termination in cases of DAVFs for transvenous catheterization to the uncal venous drainage.
Transvenous catheterization to the uncal venous drainage for cases where the UV joins to the CS via the LCS would be more difficult than other types of UV termination.
Conclusion
In conclusion,
there are several variations in UV termination,
and this can be related to the uncal venous drainage of the CSDAVFs.
It is important to recognize uncal venous drainage and the variations in UV termination for the treatment of CSDAVFs via a transvenous approach.