Identification of venous variants in the pineal region with 3D preoperative computed tomography and magnetic resonance imaging navigation

A statistical study of venous anatomy in living patients

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Object

The purpose of this study was to determine the ability of software-assisted 3D reconstruction performed using a neuronavigation system to delineate the anatomy and variation patterns of the pineal region venous complex, and then to compare these data with previous anatomical findings.

Methods

The authors retrospectively reviewed the neuroimages obtained in 100 patients with intracranial lesions (50 computed tomography [CT] scans obtained with contrast agents and 50 magnetic resonance [MR] images obtained with gadolinium) by using a neuronavigation workstation for 3D reconstruction. Particular attention was given to the internal cerebral vein, basal vein (BV), and the vein of Galen. The various connection patterns between the major vessels were classified and statistically analyzed.

Conclusions

The venous system of the pineal region shows a wide range of sex-related variations. In the female patient the absence of a BV (Type 0) is significantly more frequent than in the male. In this study the authors illustrate the ability to depict the venous drainage patterns in the pineal region for all cases studied by using 3D neuronavigation software without the need for additional examinations. This simple tool provides important information for surgical planning and may be of significant help intraoperatively.

Abbreviations used in this paper:

BV = basal vein; CT = computed tomography; ICV = internal cerebral vein; MR = magnetic resonance; PMV = posterior mesencephalic vein.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

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  • 1

    Ammirati M, , Bernardo A, , Musumeci A, & Bricolo A: Comparison of different infratentorial–supracerebellar approaches to the posterior and middle incisural space: a cadaveric study. J Neurosurg 97:922928, 2002

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 2

    Brunner C: Zur Pathologie und Operabilität der Tumoren der Zirbeldrüse. Beitr Klin Chir 83:451574, 1913

  • 3

    Caron JP, , Debrun G, , Sichez JP, , Comoy J, & Lacour P: [Ligation of the internal cerebral veins and survival. Apropos of 2 pinealomectomies.]. Neurochirurgie 20:8190, 1974. (Fr)

    • Search Google Scholar
    • Export Citation
  • 4

    Chaynes P: Microsurgical anatomy of the great cerebral vein of Galen and its tributaries. J Neurosurg 99:10281038, 2003

  • 5

    Dandy WE: An operation for the removal of pineal tumors. Surg Gynecol Obstet 33:113119, 1921

  • 6

    Dandy WE: Operative experience in cases of pineal tumor. Arch Surg 33:1946, 1936

  • 7

    Dandy WE, & Blackfan KD: Internal hydrocephalus. An experimental, clinical and pathological study. Am J Dis Child 8:392486, 1914

  • 8

    Giuseffi V, , Wall M, , Siegel PZ, & Rojas PB: Symptoms and disease associations in idiopathic intracranial hypertension (pseudotumor cerebri): a case-control study. Neurology 41:239244, 1991

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 9

    Hammock MK, , Milhorat TH, , Earle K, & Di Chiro G: Vein of Galen ligation in the primate. Angiographic, gross, and light microscopic evaluation. J Neurosurg 34:7783, 1971

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 10

    Huang YP, & Wolf BS, The basal cerebral vein and its tributaries. Newton TH, & Potts DG: Radiology of the Skull and Brain Vol 2:St. Louis, CV Mosby, 1971. 21112154

    • Search Google Scholar
    • Export Citation
  • 11

    Johnston I, , Hawke S, , Halmagyi M, & Teo C: The pseudotumor syndrome. Disorders of cerebrospinal fluid circulation causing intracranial hypertension without ventriculomegaly. Arch Neurol 48:740747, 1991

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 12

    Kaminogo M, , Hayashi H, , Ishimaru H, , Morikawa M, , Kitagawa N, & Matsuo Y, et al.: Depicting cerebral veins by three-dimensional CT angiography before surgical clipping of aneurysms. AJNR Am J Neuroradiol 23:8591, 2002

    • Search Google Scholar
    • Export Citation
  • 13

    Karahalios DG, , Rekate HL, , Khayata MH, & Apostolides PJ: Elevated intracranial venous pressure as a universal mechanism in pseudotumor cerebri of varying etiologies. Neurology 46:198202, 1996

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 14

    Kawashima M, , Rhoton AL Jr, & Matsushima T: Comparison of posterior approaches to the posterior incisural space: microsurgical anatomy and proposal of a new method, the occipital bitranstentorial/falcine approach. Neurosurgery 51:12081221, 2002

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 15

    Kilic T, , Ozduman K, , Cavdar S, , Ozek MM, & Pamir MN: The galenic venous system: surgical anatomy and its angiographic and magnetic resonance venographic correlations. Eur J Radiol 56:212219, 2005

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 16

    Liauw L, , van Buchem MA, , Spilt A, , de Bruine FT, , van den Berg R, & Hermans J, et al.: MR angiography of the intracranial venous system. Radiology 214:678682, 2000

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 17

    Nazzaro JM, , Shults WT, & Neuwelt EA: Neuroophthalmological function of patients with pineal region tumors approached transtentorially in the semisitting position. J Neurosurg 76:746751, 1992

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 18

    Oppenheim H, & Krause F: Operative Erfolge bei Geschwülsten der Sehhügelund Vierhügelgegend. Berl Klin Wochenschr 50:23162322, 1913

  • 19

    Page LK: The infratentorialsupracerebellar exposure of tumors in the pineal area. Neurosurgery 1:3640, 1977

  • 20

    Poppen JL: The right occipital approach to a pinealoma. J Neurosurg 25:706710, 1966

  • 21

    Radhakrishnan K, , Ahlskog JE, , Cross SA, , Kurland LT, & O'Fallon WM: Idiopathic intracranial hypertension (pseudotumor cerebri). Descriptive epidemiology in Rochester, Minn, 1976 to 1990. Arch Neurol 50:7880, 1993

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 22

    Rajpal S, , Niemann DB, & Turk AS: Transverse venous sinus stent placement as treatment for benign intracranial hypertension in a young male: case report and review of the literature. J Neurosurg 102:3 Suppl 342346, 2005

    • Search Google Scholar
    • Export Citation
  • 23

    Rhoton AL Jr: The cerebral veins. Neurosurgery 51:4 Suppl S159S205, 2002

  • 24

    Rhoton AL Jr: The posterior fossa veins. Neurosurgery 47:3 Suppl 6992, 2000

  • 25

    Roessler K, , Ungersboeck K, , Dietrich W, , Aichholzer M, , Hittmeir K, & Matula C, et al.: Frameless stereotactic guided neurosurgery: clinical experience with an infrared based pointer device navigation system. Acta Neurochir (Wien) 139:551559, 1997

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 26

    Samii M, , Carvalho GA, , Tatagiba M, , Matthies C, & Vorkapic P: Meningiomas of the tentorial notch: surgical anatomy and management. J Neurosurg 84:375381, 1996

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 27

    Sekhar LN, & Goel A: Combined supratentorial and infratentorial approach to large pineal-region meningioma. Surg Neurol 37:197201, 1992

  • 28

    Shin HJ, , Cho BK, , Jung HW, & Wang KC: Pediatric pineal tumors: need for a direct surgical approach and complications of the occipital transtentorial approach. Childs Nerv Syst 14:174178, 1998

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 29

    Stein BM: The infratentorial supracerebellar approach to pineal lesions. J Neurosurg 35:197202, 1971

  • 30

    Suzuki Y, , Ikeda H, , Shimadu M, , Ikeda Y, & Matsumoto K: Variations of the basal vein: identification using three-dimensional CT angiography. AJNR Am J Neuroradiol 22:670676, 2001

    • Search Google Scholar
    • Export Citation
  • 31

    Suzuki Y, , Nakajima M, , Ikeda H, & Abe T: Three-dimensional computed tomography angiography of the galenic system for the occipital transtentorial approach. Neurol Med Chir (Tokyo) 45:387394, 2005

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 32

    Tirakotai W, , Riegel T, , Sure U, , Bozinov O, , Hellwig D, & Bertalanffy H: Clinical application of neuronavigation in a series of single burr-hole procedures. Zentralbl Neurochir 65:5764, 2004

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 33

    Voigt K, & Yasşargil MG: Cerebral cavernous haemangiomas or cavernomas. Incidence, pathology, localization, diagnosis, clinical features and treatment Review of the literature and report of an unusual case. Neurochirurgia (Stuttg) 19:5968, 1976

    • Search Google Scholar
    • Export Citation
  • 34

    Wagner W, , Gaab MR, , Schroeder HW, , Piek J, & Niendorf WR: [Neuronavigation in the central area: impact on different surgical steps related to the location and various pathological processes.]. Zentralbl Neurochir 61:188193, 2000. (Ger)

    • Search Google Scholar
    • Export Citation
  • 35

    Wall M, & George D: Idiopathic intracranial hypertension. A prospective study of 50 patients. Brain 114:155180, 1991

  • 36

    Wetzel SG, , Kirsch E, , Stock KW, , Kolbe M, , Kaim A, & Radue EW: Cerebral veins: comparative study of CT venography with intraarterial digital subtraction angiography. AJNR Am J Neuroradiol 20:249255, 1999

    • Search Google Scholar
    • Export Citation
  • 37

    Wolfsberger S, , Rossler K, , Regatschnig R, & Ungersbock K: Anatomical landmarks for image registration in frameless stereotactic neuronavigation. Neurosurg Rev 25:6872, 2002

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 38

    Yamamoto I: Pineal region tumor: surgical anatomy and approach. J Neurooncol 54:263275, 2001

  • 39

    Ziyal IM, , Sekhar LN, , Salas E, & Olan WJ: Combined supra/infratentorial-transsinus approach to large pineal region tumors. J Neurosurg 88:10501057, 1998

    • Crossref
    • Search Google Scholar
    • Export Citation

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