Skip to main content
SpringerLink
Log in

Localization of transverse-sigmoid sinus junction using preoperative 3D computed tomography: application in retrosigmoid craniotomy

  • Original Article
  • Published:
Neurosurgical Review Aims and scope Submit manuscript

Abstract

In retrosigmoid craniotomy, neurosurgeons usually depend on surface landmarks and their experience to evaluate the position of transverse-sigmoid sinus junction (TSSJ) and place an appropriate initial burr-hole, which is not accurate each time because of variability in different craniums. The authors introduce a simple procedure based on 3D computed tomography (CT) to localize the TSSJ in retrosigmoid craniotomy. Eighteen patients who underwent retrosigmoid craniotomy were analyzed. On the internal view of skull in 3D CT image, a simulative burr-hole was placed on the margin of transverse-sigmoid sinus groove junction. Then, on the external view of skull in 3D CT image, the center of the simulative burr-hole was marked and a coordinate system was established based on a line connected the digastric point and the asterion. Then the coordinate of the burr-hole’s center was measured in this coordinate system. In operation, the burr-hole was placed according to the coordinate measured previously and craniotomy was performed. The margin of TSSJ was exposed in each case. No damage of venous sinus was encountered. Post-operative skull base CT demonstrated a good match between the actual and predicted burr-hole and bone defects only existed along the cut line. This simple method could help in localizing the TSSJ and avoiding the risk of sinus injury and reducing the bone defect. It is sufficiently precise for practical application at surgical planning.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8

Similar content being viewed by others

References

  1. Avci E, Kocaogullar Y, Fossett D, Caputy A (2003) Lateral posterior fossa venous sinus relationships to surface landmarks. Surg Neurol 59:392–397

    Article  PubMed  Google Scholar 

  2. Bozbuga M, Boran BO, Sahinoglu K (2006) Surface anatomy of the posterolateral cranium regarding the localization of the initial burr-hole for a retrosigmoid approach. Neurosurg Rev 29:61–63

    Article  PubMed  Google Scholar 

  3. da Silva E, Leal AG, Milano JB, da Silva L, Clemente RS, Ramina R (2010) Image-guided surgical planning using anatomical landmarks in the retrosigmoid approach. Acta Neurochir (Wien) 152:905–910

    Article  Google Scholar 

  4. Day JD, Kellogg JX, Tschabitscher M, Fukushima T (1996) Surface and superficial surgical anatomy of the posterolateral cranial base: significance for surgical planning and approach. Neurosurgery 38:1079–1083

    PubMed  CAS  Google Scholar 

  5. Day JD, Tschabitscher M (1998) Anatomic position of the asterion. Neurosurgery 42:198–199

    Article  PubMed  CAS  Google Scholar 

  6. Gharabaghi A, Rosahl SK, Feigl GC, Liebig T, Mirzayan JM, Heckl S, Shahidi R, Tatagiba M, Samii M (2008) Image-guided lateral suboccipital approach: part 1-individualized landmarks for surgical planning. Neurosurgery 62:18–22

    Article  PubMed  Google Scholar 

  7. Gharabaghi A, Rosahl SK, Feigl GC, Safavi-Abbasi S, Mirzayan JM, Heckl S, Shahidi R, Tatagiba M, Samii M (2008) Image-guided lateral suboccipital approach: part 2-impact on complication rates and operation times. Neurosurgery 62:24–29

    Article  PubMed  Google Scholar 

  8. Hamasaki T, Morioka M, Nakamura H, Yano S, Hirai T, Kuratsu J (2009) A 3-dimensional computed tomographic procedure for planning retrosigmoid craniotomy. Neurosurgery 64:241–245

    Article  PubMed  Google Scholar 

  9. Jia G, Wu Z, Zhang J, Zhang L, Xiao X, Tang J, Meng G, Geng S, Wan W (2010) Two-bone flap craniotomy for the transpetrosal-presigmoid approach to avoid a bony defect in the periauricular area after surgery on petroclival lesions: technical note. Neurosurg Rev 33:121–126

    Article  PubMed  Google Scholar 

  10. Lang JJ, Samii A (1991) Retrosigmoidal approach to the posterior cranial fossa. An anatomical study. Acta Neurochir (Wien) 111:147–153

    Article  Google Scholar 

  11. Ojemann RG (2001) Retrosigmoid approach to acoustic neuroma (vestibular schwannoma). Neurosurgery 48:553–558

    Article  PubMed  CAS  Google Scholar 

  12. Raso JL, Gusmao SN (2011) A new landmark for finding the sigmoid sinus in suboccipital craniotomies. Neurosurgery 68:1–6

    Article  PubMed  Google Scholar 

  13. Ribas GC, Rhoton AL, Cruz OR, Peace D (2005) Suboccipital burr holes and craniectomies. Neurosurg Focus 19:E1

    Article  PubMed  Google Scholar 

  14. Tubbs RS, Loukas M, Shoja MM, Bellew MP, Cohen-Gadol AA (2009) Surface landmarks for the junction between the transverse and sigmoid sinuses: application of the “strategic” burr hole for suboccipital craniotomy. Neurosurgery 65:37–41

    PubMed  Google Scholar 

  15. Ucerler H, Govsa F (2006) Asterion as a surgical landmark for lateral cranial base approaches. J Craniomaxillofac Surg 34:415–420

    Article  PubMed  Google Scholar 

  16. Yasargil MG (1996) Microneurosurgery. Thieme, New York

    Google Scholar 

Download references

Financial support

Clinical specific projects from Beijing Municipal Science & Technology Commission (Z111107058811015)

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Beijing Sanbo Brain Hospital, Capital Medical University, No. 50, Yi-Ke-Song Road, Haidian District, 100093, Beijing, China

    Lei Xia, Mingshan Zhang, Yanming Qu, Ming Ren, Haoran Wang, Hongwei Zhang & Chunjiang Yu

  2. Department of Radiology, Beijing Sanbo Brain Hospital, Capital Medical University, Beijing, China

    Mingwang Zhu

  3. Department of Neurosurgery, the First Hospital of Handan, Handan, Hebei, China

    Jianhua Li

Authors
  1. Lei Xia
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mingshan Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yanming Qu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ming Ren
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Haoran Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hongwei Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Chunjiang Yu
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Mingwang Zhu
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Jianhua Li
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding authors

Correspondence to Hongwei Zhang or Chunjiang Yu.

Additional information

Comments

Mario Giordano, Hannover, Germany

In this well-illustrated technical note the authors report a method for preoperative and intraoperative localization of the transverse-sigmoid sinus junction using 3D computed tomography reconstruction and anatomical landmarks on the external surface of the skull. They use this procedure successfully in 18 retrosigmoid craniotomies for correct placement of the initial burr-hole.

The transverse and sigmoid sinuses are fundamental landmarks for retrosigmoid approach providing orientation for both craniotomy and dural opening. The overexposure is anyway unnecessary and their damage can lead to disastrous consequences for the patient. Therefore the idea of a coordinate-based system to localize the transverse-sigmoid sinus junction is interesting because of the well-known interpersonal variation of its anatomy.

This straightforward paper helps a better understanding of the correlation between superficial and intracranial structures, thus more publications of this type are needed to facilitate young neurosurgeons in their everyday practice.

Guilherme Carvalhal Ribas, São Paulo, Brazil

The current neuroimaging 3D reconstructions allow the neurosurgeon to plan ahead and even to simulate his procedures, taking already in consideration the patients’ individual important anatomical landmarks as their extracranial-intracranial bony relationships, their sulcal and gyral own pattern, the individual anatomy of their cisterns and ventricles, the actual position of arteries, veins and cranial nerves, and the relationships of all these structures with the lesion to be operated on. Further use of CT and MRI images’ fusion will definitely enhance this type of pre-operative information, putting together bone and intracranial structures.

In this direction Xia et al. propose in this article a straightforward and practical technical note about the important feature of localizing the transverse – sigmoid sinuses’ junction, which constitutes the main natural limit of the suboccipital exposures. Their method is simple considering the usually available CT facilities and is already based in a fair number of patients (18 cases).

Personally I believe that their findings are not significantly different of the previous related anatomical studies if we consider the statistical variations pertinent to the data obtained from cadaveric specimens. In a previous study we did we found that a 1 cm burr hole centered 1 cm anteriorly to the Asterion and with its superior base on the parietomastoid suture exposed the inferior aspect of the transverse-sigmoid sinuses’ junction in 84 % of the studied specimens (1, 2, 3), very much compatible with Xia et al. findings and illustrations.

Nevertheless this type of study definitely constitutes one step ahead of the usual anatomical studies since it is based in the patient’ own anatomy as provided by his own imaging data, and should be encouraged in order to generate more practical anatomical data able to take also into account unexpected anatomical variations.

References

1. Ribas GC. Study of the anatomic relationships of the lambdoid, occipitomastoid and parietomastoid sutures with the transverse and sigmoid sinuses, and of regional burr holes sites. São Paulo: Doctorship Thesis, Faculdade de Medicina da Universidade de São Paulo, 1991.

2. Ribas GC, Rhoton AL Jr, Cruz OR, Peace D. Temporo-parieto-occipital burr hole sites study and systematized approaches proposal. In: Samii M, editor. Skull base surgery, anatomy, diagnosis and treatment. Basel: Karger; 1994. p. 723–30.

3. Ribas GC, Rhoton AL Jr, Cruz OR, Peace D. Suboccipital burr holes and craniectomies. Neurosurg Focus 19(2):E1, 2005.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Xia, L., Zhang, M., Qu, Y. et al. Localization of transverse-sigmoid sinus junction using preoperative 3D computed tomography: application in retrosigmoid craniotomy. Neurosurg Rev 35, 593–599 (2012). https://doi.org/10.1007/s10143-012-0395-0

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10143-012-0395-0

Keywords

Search

Navigation