Relation between bilateral differences in internal jugular vein caliber and flow patterns of dural venous sinuses

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Abstract

We measured the calibers of the left and right internal jugular veins (IJV) and sizes of the left and right transverse sinuses (TS) in 91 cadavers, compared them between the left and right sides, and also evaluated the drainage patterns of the superior sagittal sinus (SSS) and straight sinus (=rectal sinus, RS) in the torcular Herophili. In addition, the running type of groove for the SSS was investigated. The results were as follows: (1) The right IJV was larger in 81.3 %, while the left IJV was larger in only 11.0 %. (2) The drainage pattern of the SSS was the right type in 73.6 %, intermediate type in 14.3 %, and left type in 12.1 %. (3) The drainage pattern of the RS was the right type in 27.5 %, intermediate type in 25.3 %, and left type in 47.3 %. (4) The running type of groove for the SSS was mostly consistent with the drainage pattern of this sinus. (5) Concerning the relationships among these findings including the size of the TS, the drainage pattern of the SSS was mostly consistent with the side showing a larger TS as well as the side showing a larger IJV. These results suggest that the pattern of drainage of the SSS into the left and right TS affects the size of the TS and the running type of groove for the SSS, and is also closely involved in the caliber of the IJV. A discussion of the embryological, genetic, and clinical implications of these results is presented.

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Prognosis of cerebral vein and dural sinus thrombosis: results of the International Study on Cerebral Vein and Dural Sinus Thrombosis (ISCVT).

José M Ferro, Patrícia Canhão, Jan Stam … (2004)

The natural history and long-term prognosis of cerebral vein and dural sinus thrombosis (CVT) have not been examined previously by adequately powered prospective studies. We performed a multinational (21 countries), multicenter (89 centers), prospective observational study. Patients were followed up at 6 months and yearly thereafter. Primary outcome was death or dependence as assessed by modified Rankin Scale (mRS) score >2 at the end of follow-up. From May 1998 to May 2001, 624 adult patients with CVT were registered. At the end of follow-up (median 16 months), 356 patients (57.1%) had no symptom or signs (mRS=0), 137 (22%) had minor residual symptoms (mRS=1), and 47 (7.5%) had mild impairments (mRS=2). Eighteen (2.9%) were moderately impaired (mRS=3), 14 (2.2%) were severely handicapped (mRS=4 or 5), and 52 (8.3%) had died. Multivariate predictors of death or dependence were age >37 years (hazard ratio [HR]=2.0), male sex (HR=1.6), coma (HR=2.7), mental status disorder (HR=2.0), hemorrhage on admission CT scan (HR=1.9), thrombosis of the deep cerebral venous system (HR=2.9), central nervous system infection (HR=3.3), and cancer (HR=2.9). Fourteen patients (2.2%) had a recurrent sinus thrombosis, 27 (4.3%) had other thrombotic events, and 66 (10.6%) had seizures. The prognosis of CVT is better than reported previously. A subgroup (13%) of clinically identifiable CVT patients is at increased risk of bad outcome. These high-risk patients may benefit from more aggressive therapeutic interventions, to be studied in randomized clinical trials.

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Real-time ultrasound-guided catheterisation of the internal jugular vein: a prospective comparison with the landmark technique in critical care patients

Dimitrios Karakitsos, Nicolaos Labropoulos, Eric de Groot … (2006)

Introduction Central venous cannulation is crucial in the management of the critical care patient. This study was designed to evaluate whether real-time ultrasound-guided cannulation of the internal jugular vein is superior to the standard landmark method. Methods In this randomised study, 450 critical care patients who underwent real-time ultrasound-guided cannulation of the internal jugular vein were prospectively compared with 450 critical care patients in whom the landmark technique was used. Randomisation was performed by means of a computer-generated random-numbers table, and patients were stratified with regard to age, gender, and body mass index. Results There were no significant differences in gender, age, body mass index, or side of cannulation (left or right) or in the presence of risk factors for difficult venous cannulation such as prior catheterisation, limited sites for access attempts, previous difficulties during catheterisation, previous mechanical complication, known vascular abnormality, untreated coagulopathy, skeletal deformity, and cannulation during cardiac arrest between the two groups of patients. Furthermore, the physicians who performed the procedures had comparable experience in the placement of central venous catheters (p = non-significant). Cannulation of the internal jugular vein was achieved in all patients by using ultrasound and in 425 of the patients (94.4%) by using the landmark technique (p < 0.001). Average access time (skin to vein) and number of attempts were significantly reduced in the ultrasound group of patients compared with the landmark group (p < 0.001). In the landmark group, puncture of the carotid artery occurred in 10.6% of patients, haematoma in 8.4%, haemothorax in 1.7%, pneumothorax in 2.4%, and central venous catheter-associated blood stream infection in 16%, which were all significantly increased compared with the ultrasound group (p < 0.001). Conclusion The present data suggest that ultrasound-guided catheterisation of the internal jugular vein in critical care patients is superior to the landmark technique and therefore should be the method of choice in these patients.

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No cerebrocervical venous congestion in patients with multiple sclerosis.

Florian Doepp, Friedemann Paul, José M Valdueza … (2010)

Multiple sclerosis (MS) is characterized by demyelination centered around cerebral veins. Recent studies suggested this topographic pattern may be caused by venous congestion, a condition termed chronic cerebrospinal venous insufficiency (CCSVI). Published sonographic criteria of CCSVI include reflux in the deep cerebral veins and/or the internal jugular and vertebral veins (IJVs and VVs), stenosis of the IJVs, missing flow in IJVs and VVs, and inverse postural response of the cerebral venous drainage. We performed an extended extra- and transcranial color-coded sonography study including analysis of extracranial venous blood volume flow (BVF), cross-sectional areas, IJV flow analysis during Valsalva maneuver (VM), and CCSVI criteria. Fifty-six MS patients and 20 controls were studied. Except for 1 patient, blood flow direction in the IJVs and VVs was normal in all subjects. In none of the subjects was IJV stenosis detected. IJV and VV BVF in both groups was equal in the supine body position. The decrease of total jugular BVF on turning into the upright position was less pronounced in patients (173 +/- 235 vs 362 +/- 150 ml/min, p 1 criterion for CCSVI. Our results challenge the hypothesis that cerebral venous congestion plays a significant role in the pathogenesis of MS. Future studies should elucidate the difference between patients and healthy subjects in BVF regulation.

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Author and article information

Contributors

Kazunobu Saiki: +81-958-197023 , +81-958-497024 , anatomys@nagasaki-u.ac.jp

Journal

Journal ID (nlm-ta): Anat Sci Int

Journal ID (iso-abbrev): Anat Sci Int

Title: Anatomical Science International

Publisher: Springer Japan (Japan )

ISSN (Print): 1447-6959

ISSN (Electronic): 1447-073X

Publication date (Electronic): 10 April 2013

Publication date PMC-release: 10 April 2013

Publication date (Print): June 2013

Volume: 88

Issue: 3

Pages: 141-150

Affiliations

Unit of Translational Medical Science, Department of Macroscopic Morphology, Nagasaki University, Graduate School of Biomedical Science, 1-12-4 Sakamoto, Nagasaki, 852-8523 Japan

Article

Publisher ID: 176

DOI: 10.1007/s12565-013-0176-z

PMC ID: 3654179

PubMed ID: 23572397

SO-VID: 50012732-e6ac-4e32-a62b-08905e353459

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution License which permits any use, distribution, and reproduction in any medium, provided the original author(s) and the source are credited.

History

Date received : 12 December 2012

Date accepted : 25 March 2013

Custom metadata

ScienceOpen disciplines: Anatomy & Physiology

Keywords: internal jugular vein,superior sagittal sinus,transverse sinus,groove for superior sagittal sinus,bilateral differences

Data availability:

ScienceOpen disciplines: Anatomy & Physiology

Keywords: internal jugular vein, superior sagittal sinus, transverse sinus, groove for superior sagittal sinus, bilateral differences

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