Venous Drainage Patterns of the Cavernous Sinus: A Retrospective Angiographic Analysis

Background: Cavernous sinus venous drainage patterns affect the accuracy of inferior petrosal sinus sampling and may be responsible for variability in vascular events after skull-base surgery. Descriptions of the normal venographic patterns of the cavernous sinus venous outflow are scarce in the literature.

Objective: To study the cavernous sinus drainage patterns using the venous phases of cerebral angiograms.

Methods: A retrospective review of elective cerebral angiograms was performed. Patients were included if they had no cerebrovascular abnormalities that could influence the cerebral venous flow. Patients with prior intracranial surgery, ruptured aneurysms, arteriovenous malformations, thrombectomy, idiopathic intracranial hypertension, and carotid-cavernous fistulas were excluded. Measurements of the venous sinuses were performed in the lateral views at the largest vessel diameter.

Results: A total of 61 cerebral angiograms were reviewed. Patients underwent elective angiograms for workup on unruptured aneurysms (63.9%), abnormal imaging findings (16.4%), unspecified epilepsy (16.4%), and pituitary-dependent Cushing's (3.3%). The right and left superior petrosal sinus had mean diameters of 1.08 mm (SD ± 0.44) and 1.03 mm (SD ± 0.37). The right and left inferior petrosal sinus had mean diameters of 1.4 mm (SD ± 0.51) and 1.57 mm (SD ± 0.56). The right pterygoid plexus could be visualized in 47 cases (77%) and the left in 44 (72.1%). The right and left cavernous sinuses had dominant drainage on the pterygoid plexus in 29 patients (47.5%) and 36 patients (59%), on the inferior petrosal sinus in 17 (27.9%) and 11 (18%), on the superior petrosal sinus in 8 (13.1%) and 11 (18%), intercavernous in 2 (3.3%) and 0 (0%), and could not be visualized in 5 (8.2%) and 3 (4.9%), respectively. The venous drainage of the transverse and sigmoid sinuses (i.e., lateral sinuses) was right-dominant in 35 cases (57.4%), left-dominant in 14 (22.9%), and co-dominant in 12 (19.7%). No significant associations were found between lateral sinus dominance and visualization of the right (p = 0.85) nor of the left (p = 0.23) pterygoid plexuses.[1] [2]

Conclusion: The pterygoid plexus is an important route of cavernous sinus venous drainage; yet it seems not correlated to lateral sinus dominance. Future studies should investigate the clinical correlates of pterygoid plexus dominant drainage in skull-base pathologies and post-surgical complications.

Publikationsverlauf

Artikel online veröffentlicht:
01. Februar 2023

• References

• 1 Osborn AG. Craniofacial venous plexuses: angiographic study. AJR Am J Roentgenol 1981;136(1):139–143
• 2 Matur AV, Body AM, Johnson MD, et al. An algorithm to improve lateralization accuracy of inferior petrosal sinus sampling: procedural nuances for complex patterns of venous drainage. Patient series. J Neurosurg Case Lessons 2021;2(13):CASE21374