Variations of the cerebral dural sinuses at the torcular herophili: Importance in radical neck dissection

doi:10.1016/0002-9610(72)90066-9

The American Journal of Surgery

Volume 124, Issue 4, October 1972, Pages 456-461

https://doi.org/10.1016/0002-9610(72)90066-9 Get rights and content

Abstract

The cerebral dural sinuses of 215 specimens of dura obtained at autopsy were studied and diagrammed. Particular attention was accorded the anatomic arrangement of the major sinuses that converge to form the torcular. In 57 per cent of the specimens there was free communication between the superior sagittal, the straight, the occipital, and the transverse sinuses at the torcular. In 43 per cent there was maldevelopment of one or more of these major sinuses at or near the torcular. Consideration is given to the clinical import of these variations subsequent to ablation of a part or all of the jugular venous system in the neck.

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Cited by (31)

The Torcular Herophili (Confluence of Sinuses)
2019, Anatomy, Imaging and Surgery of the Intracranial Dural Venous Sinuses
The torcular Herophili (confluence of sinuses) is a highly variable structure that constitutes a vital part of the network of dural venous sinuses. The torcular Herophili is defined historically as the intersection of the superior sagittal sinus, the straight sinus, the occipital sinus, and the two transverse sinuses. Its size varies and it is located inferior to the occipital lobes and posterosuperiomedially to the cerebellum. This chapter outlines the anatomy and clinical implications of this sinus.
Pseudotumor cerebri and lung cancer-associated jugular vein thrombosis: Role of anatomical variations of torcular herophili
2018, eNeurologicalSci
Citation Excerpt :
In the review, the words, ‘anatomy’, ‘torcular’, ‘Herophili’ were selected as search terms using PubMed on the October 1, 2018. As a result, 63 articles were retrieved and 6 of 63 ones were selected as related and well-written studies to our own patient case [8–13]. Furthermore, other 4 studies were added from the references of the selected articles [14–17].
A 71-year-old male appeared at the facility complaining of disturbance of consciousness and bilateral papilledema. The laboratory test revealed anemia and coagulation abnormality. A physical examination and magnetic resonance imaging (MRI) of the brain with and without gadolinium showed no abnormalities. A lumbar puncture showed a high pressure, but a normal cerebrospinal fluid (CSF) cell count. Cerebral angiography showed no morphological abnormalities, but it revealed an asymmetric right dominant type of confluence of the sinuses with the partially-communicating left transverse sinus in the late phase. Furthermore, there was a delay in the cerebral circulation time (CCT). Subsequently, venography and ultrasonography revealed right internal jugular vein thrombosis associated with lung cancer. The patient recovered from the disturbance of consciousness immediately after an emergency ventriculoperitoneal shunt and anticoagulation therapy. This case was diagnosed as secondary pseudotumor cerebri (PTC). In order to facilitate the early detection of secondary PTC, it is important to take note of symptoms of intracranial hypertension with no remarkable intracranial lesions and to consider the possibility of PTC, especially in the patients with high risk factors for coagulopathy including lung cancer.
Chronic Cerebrospinal Venous Insufficiency and Multiple Sclerosis: History and Background
2012, Techniques in Vascular and Interventional Radiology
Multiple sclerosis (MS) is a chronic inflammatory disorder of the central nervous system (CNS) most commonly characterized by focal areas of myelin destruction, inflammation and axonal transection. The multicentric inflammation and demyelination of the brain and spinal cord are associated with variable neurologic symptoms ranging from mild dysfunction to debilitating. Typically, these symptoms are marked by episodes of clinical worsening followed by improvement. The cause of this disease remains unclear currently, but the underlying etiology is generally considered to be immunologically based. Other factors, including genetic, environmental and infectious influences have been implicated, as well. Now recent studies have proposed that extracranial venous obstruction, termed chronic cerebrospinal venous insufficiency (CCSVI) may have a role in the pathogenesis of MS or many of its associated clinical manifestations. It is postulated that venous narrowing affecting one or more of the jugular veins and/or the azygous vein in the chest may be responsible for abnormal blood flow in the veins draining the brain and spinal cord. The abnormal flow may initiate and/or sustain a local inflammatory response at the blood-brain barrier that promote pathological changes within the CNS. This review presents the history of the relationship between the vascular system and MS and explores the background of basic and clinical investigations that led to the concept of CCSVI.
Anatomical Evaluation of the Dural Sinuses in the Region of the Torcular Herophili Using Three Dimensional CT Venography
2010, Academic Radiology
Citation Excerpt :
In cadaveric studies, the drainage patterns of the RS were variable, with infrequent subjects showing unilateral predominance (7,10–14) (Table 2), with the Rd and Rl types predominating in the studies of Knott (10) and Henrici and Kikuchi (7), respectively. Thus, convergence of the SSS, RS, and bilateral TS at the confluence in adults was variable in our study as well as in the literature, which has reported from four to 13 patterns (2–18). The classic pattern in which the SSS, RS, and bilateral TS join together at just one point (Sc-Rc type) was rather rare, representing only 6.3% to 16.7% of cases (6,13,15,17).
The torcular herophili, or “confluence of the sinuses,” shows various configurations with other venous sinuses, as revealed by angiography. The aims of this study were to evaluate anatomic variations of this confluence and to assess their clinical relevance using three-dimensional (3D) computed tomographic (CT) venography.
The torcular herophili and its relevant venous sinuses were analyzed using 3D CT venography in 120 adults, consisting of 76 patients who were proven to have aneurysms and 44 patients who were proven to have no vascular malformations or aneurysms after the examinations. Three-dimensional CT venography was performed following the arterial phase of 3D CT angiography without any additional injection of contrast material. Three-dimensional volume-rendered venous images were reconstructed on a workstation and reviewed.
The superior sagittal sinus (SSS) drained into the transverse sinus (TS) in four patterns: the SSS reached the centrally located confluence, where it divided into the bilateral TS (20.0%); the SSS was prematurely duplicated into the right and left limbs and drained into the same side TS (26.7%); the SSS drained exclusively into the right TS (44.2%); or the SSS drained exclusively into the left TS (9.2%). The draining pattern of the straight sinus was also classified into four types. The right TS was larger than the left TS. The right TS were higher compared to the left TS. Persistent occipital sinuses were recognized in 57.5% of the subjects. Finally, persistent falcial sinuses were seen in 2.5% of the subjects. A septum in the SSS and complicated venous channels in the confluence were each seen in only one case.
Three-dimensional CT venography is useful as a noninvasive method to evaluate the confluence and its relevant dural sinuses and can provide useful information for surgical intervention.
Meningeal Anatomy
2010, Meningiomas: Expert Consult - Online and Print
Meningeal Anatomy
2010, Meningiomas

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^☆: Presented at the First Joint Meeting of the American Radium Society, James Ewing Society, and the Society of Head and Neck Surgeons on the occasion of the Eighteenth Annual Meeting of the Society of Head and Neck Surgeons, Boca Raton, Florida, May 14–19, 1972.

^∗: Present address: The Department of Medicine, University of Washington, Seattle, Washington.

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Scientific paperVariations of the cerebral dural sinuses at the torcular herophili: Importance in radical neck dissection☆

Abstract

Amer J Surg

Amer J Surg

Ueber die Ursachen der Asymmetrie der Sinus transversi and sigmoidei beim Menschen

Beitr Anat Physiol Path Therapy Ohres

Les anomalies des sinus de la dure-mere: leur signification clinique en otologie

Rev Laryng

Ueber otologisch wichtige Anomalien der Hirnsinus, uber accessorische Sinus and bedeutendere Venenverbindungen

Arch Ohrenh

Variations of the cranial venous sinuses in the region of the torcular herophili

Arch Surg

The cerebral sinuses and their variations

Intracranial pressure studies incident to resection of the internal jugular veins

Cancer

Diversion of venous blood through transverse sinuses in one-sided innominate vein obstruction

Radiology

Bilateral radical dissection of the neck

Arch Surg

Scientific paper
Variations of the cerebral dural sinuses at the torcular herophili: Importance in radical neck dissection☆