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The Governor Vessel (GV)
Published in Narda G. Robinson, Interactive Medical Acupuncture Anatomy, 2016
Emissary veins: Emissary veins connect the dural venous sinuses to extracranial veins. Emissary veins lack valves, and blood may flow in either direction, though usually its flow is from the brain outward. Emissary veins vary in size and number. Children have a frontal emissary vein that may persist in some adults. The frontal emissary vein connects the superior sagittal sinus with the frontal sinus and nasal cavities. Parietal emissary veins may occur in pairs, passing through the parietal foramina in the calvaria and allowing flow between the superior sagittal sinus and the veins of the scalp. Occipital or posterior auricular veins connect with the sigmoid sinus via the mastoid emissary veins, which course through the mastoid foramina.
Neuroendoscopy
Published in Hemanshu Prabhakar, Charu Mahajan, Indu Kapoor, Manual of Neuroanesthesia, 2017
Other considerations and complicationsHypothermia is common secondary to relatively large surface area of the infant's cranium: active warming during induction, surgical preparation, and also during the procedure is necessary for maintaining normothermia. A carefully planned setup of anesthesia equipment and extended breathing circuit is required for procedures where the operating table is turned 180° after induction.Intraventricular procedures: Cold irrigation used for the endoscope can cause bradycardia, hypothermia, or toxic reactions such as fever, meningitis, headache, and increased cell count.Dilatations of ventricles (a common occurrence during the ventricular endoscopy) may cause a Cushing-type response with hypertension, bradycardia/tachycardia from impaired perfusion, and/or stimulation of preoptic area.Mastery of the technique and anatomy by the surgeon is important to minimize tissue trauma. While navigating the endoscope through the foramen of Monro, potential injury to the fornix can lead to transient memory loss, personality changes, and injury to cranial nerves III and VI.ESC is usually performed on infants less than 3 months of age weighing just over 5 kg. It is associated with a small amount of blood loss, low incidence of blood transfusion, and short hospital stay as compared to the typical open craniosynostosis repair.The risk of venous air embolism is lower in the endoscopic procedure but remains a concern, especially in the sagittal ESC due to higher risk of bleeding from emissary veins.
Utility of right adrenal signature veins in venous sampling for primary aldosteronism
Published in Annals of Medicine, 2023
Zhenglin Shen, Shaoyong Xu, Siyu Guan, Bo Chen, Qingan Li, Ming Yu, Zhao Gao
Previous studies have not given much attention to the course and distribution of adrenal veins, resulting in confusion among clinicians regarding adrenal venography [16,17]. To better understand the characteristics of adrenal vein distribution, it is necessary to reconstruct the 3D anatomical structure of the adrenal gland [18]. Through fusion images of adrenal venography and 3D structure, we made some important discoveries, as follows: (1) When adrenal venography was performed at a right anterior oblique angle of 30 degrees, 93% of venous morphology was of the trunk branch type. (2) The ‘uvula vein’ that we discovered, along with the central vein, was the primary branch of the RAV. The central vein was accompanied by a combination cord, while the ‘uvula vein’ was distributed in the uvula. (3) Adrenal internal signature veins included the central vein, brush vein, and uvula vein. (4) Adrenal external signature veins were the renal capsular veins [19]. A previous study reported that the inferior emissary vein, which belongs to the renal capsular veins, could serve as a reliable landmark in AVS [20].
Hairpulling causing vision loss: a case report
Published in Orbit, 2019
Sidharth Puri, Sarah Madison Duff, Brett Mueller, Mark Prendes, Jeremy Clark
SGH with orbital extension is a very rare and complicated ophthalmologic emergency requiring urgent intervention.4–7 The scalp extends from the forehead to the top of the head and is composed of five layers: skin, dense connective tissue, galea aponeurosis, subaponeurotic space, and pericranium. Adeloye and Odeku report that, in pediatric patients the galeal aponeurosis is loosely attached to the pericranium with a larger quantity of small emissary veins compared to adults.8 Radial (pulling) or tangential (blunt) forces may cause rupture of emissary veins from sheer force while traversing the subgaleal space. The volume of emissary veins and thinner scalp in children make them more susceptible to sheering forces and allow for large quantities of blood to collect. We suspect this to be the case in our patient as the hairpulling event likely occurred in such a way to tear one or several emissary veins causing slow, chronic accumulation of venous blood into the subgaleal space.
A novel retroauricular fixed port for hemodialysis: surgical procedure and preliminary results of the clinical investigation
Published in Acta Oto-Laryngologica, 2019
Marco Caversaccio, Wilhelm Wimmer, Matthias Widmer, Matthias Bachtler, Robert Kalicki, Dominik Uehlinger, Andreas Arnold
The results of the first five patients included in the study are promising. The implantation was technically feasible in all patients Figure 4. The preoperative measurement of the skull thickness is essential and avoids intraoperative complications. It is important to level out the concave bone surface to enable firm base plate fixation. The templates designed to define the cavity for the base plate and the catheter tunnel through the skull bone have proven very helpful. Bleeding from emissary veins of the skull can be controlled by coagulation with a diamond burr without water irrigation. In one case, a small amount of cerebrospinal fluid leaked through a drilled hole. Bone wax was applied to seal the leak. Alternatively, bone dust could have been used in combination with fibrin glue to seal the defect. In the postoperative course, local wound problems in the area of the port are challenging. In one diabetic patient, peri-implant skin necrosis demanded flap reconstruction in the early postoperative stage. Continuous regular wound care is essential, also because hypergranulation tissue can form in the vicinity of the BAP. A satisfying result is that no catheter infection has occurred, as this was our initial intention in developing the BAP, and no catheter thrombosis was observed in the patients during a cumulative duration of nearly 1800 dialysis days.