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SBA Answers and Explanations
Published in Vivian A. Elwell, Jonathan M. Fishman, Rajat Chowdhury, SBAs for the MRCS Part A, 2018
Vivian A. Elwell, Jonathan M. Fishman, Rajat Chowdhury
Between the parietal and visceral layers there are two pericardial sinuses. The transverse sinus lies in between the pulmonary artery and aorta in front and the pulmonary veins and superior vena cava behind. The oblique sinus is a space behind the heart between the left atrium in front and the fibrous pericardium behind, posterior to which lies the oesophagus. The transverse sinus is especially important in cardiac surgery. A digit and ligature can be passed through the transverse sinus and, by tightening the ligature, the surgeon can stop the blood flow through the aorta or pulmonary trunk while cardiac surgery is performed.
Jugular Foramen Lesions and their Management
Published in John C Watkinson, Raymond W Clarke, Christopher P Aldren, Doris-Eva Bamiou, Raymond W Clarke, Richard M Irving, Haytham Kubba, Shakeel R Saeed, Paediatrics, The Ear, Skull Base, 2018
The transverse sinus is an important structure in the venous drainage system of the brain, which opens into the sigmoid sinus. Venous flow proceeds via the jugular foramen through the skull base towards the IJV in the neck. Several venous pathways drain into the sigmoid–jugular complex: the superior and inferior petrosal sinuses, the occipital sinus and the mastoid and condylar emissary veins. The most important is the inferior petrosal sinus that contains the effluence of the cavernous sinus and the basilar plexus. The dome of the jugular bulb is in close contact with the floor of the hypotympanum, the vestibule, the posterior semicircular canal, the vestibular aqueduct and the internal auditory canal. The lateral side of the jugular bulb is close to the mastoid (vertical) segment of the facial nerve. The jugular foramen lies in close proximity to the internal carotid artery: only a small osseous spine separates the vertical part of the carotid canal from the jugular foramen (Figures 107.2 and 107.3).
Developmental Anatomy of the Pituitary Fossa
Published in John C Watkinson, Raymond W Clarke, Louise Jayne Clark, Adam J Donne, R James A England, Hisham M Mehanna, Gerald William McGarry, Sean Carrie, Basic Sciences Endocrine Surgery Rhinology, 2018
The sinus receives tributaries from the superficial middle cerebral vein, inferior cerebral vein, sphenoparietal sinus, inferior ophthalmic vein and sometimes the central retinal vein and frontal tributaries of the middle meningeal vein. The sinus then drains into the internal jugular vein via the inferior petrosal sinus, to the transverse sinus via the superior petrosal sinus, and small emissary veins drain through the foreman lacerum and foramen ovale to the pterygoid plexus.
Neuro-Behcet Disease and Ocular Inflammation: A Case Report and Literature Review
Published in Ocular Immunology and Inflammation, 2022
Shaivi A. Patel, Chinwenwa Okeagu, Krystyna Jones, Ammar Chaudhry, Meghan K. Berkenstock
She represented one month later with unsteady gait and increasingly blurred vision in OD. Repeat MRA/MRV of the brain showed acute and subacute venous infarcts in the central pons, left frontal lobe, and the corpus callosum. New pachymeningeal enhancement was also noted (Figure 1). These findings were felt to originate from venous infarcts from bilateral transverse venous thromboses in the setting of a new right transverse sinus thrombosis and the extension of the left venous sinus thrombosis despite therapeutic levels of warfarin (Figure 2). Given an elevated opening pressure on repeat LP, the increased intracranial pressure was felt to cause the increased blurred vision, and optic nerve edema was again noted OU on the dilated exam. Without an identifiable cause for the new thromboses, she was discharged on enoxaparin and was deemed to have failed warfarin therapy.
Cerebral venous sinus stenosis should not be neglected when cerebral artery stenosis is confirmed: a case report
Published in International Journal of Neuroscience, 2021
Zhongao Wang, Jiayue Ding, Jian Chen, Yuchuan Ding, Xunming Ji, Ran Meng
The patient underwent subcutaneous injection of low molecular weight heparin for 3 days after stent placement, followed by antiplatelet agents (aspirin in combination with clopidogrel), neuron nutrition medicines and the drugs for her hypertension and diabetes control. Her feelings of the tinnitus and head noise relieved remarkably 1-day after stenting. At 1-month follow-up after stenting, all her symptoms disappeared except for a mild tinnitus. The follow-up ultrasonography indicated that the right transverse sinus outflow was robust without restenosis or thrombosis. The 3-month and 1-year follow-up MRV showed that the right transverse sinus outflow disturbance was significantly corrected (Figure 4). At 6-month and 1-year follow-up, no symptom reoccurred and the tinnitus disappeared completely.
Microsurgical techniques for achieving gross total resection of ependymomas of the fourth ventricle
Published in Acta Chirurgica Belgica, 2020
The telovelar [40–42,44,49,52] and transvermian [49] approaches readily gain resplendent neurosurgical access to the fourth ventricular cavity. The patient may alternatively be placed in the prone, sitting, or Concorde positions. Ventroflexion of the head facilitates operative exposure and working angles. Midline skin incision of the occiput and cervical region from the level of the inion to the level of the C2 spinous process exposes deeper tissues, allowing midline splitting of the fascia and dissection of the posterior cervical musculature down to the suboccipital bone and posterior surfaces of the upper cervical vertebrae [51]. The transverse sinuses and the posterior margin of the foramen magnum represent the rostral and caudal borders of the suboccipital trephination, respectively. Inclusion of a C1 laminectomy improves the bony exposure and may safely be performed up to the sulcus arteriosus in order to protect the vertebral artery. C1 laminectomy signifcantly enhances operative access and working angles to the rostral reaches and cerebral aqueduct of the fourth ventricle. C1 laminectomy renders rostral ventricular access gained by the transtelovelar approach equivalent to that gained by the vermian splitting transvermian approach [49]. This proves especially useful when utilizing the transtelovelar trajectory, though gains little other than surgeon comfort when achieving access to the fourth ventricular cavity via a vermian splitting approach.