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Neuroradiologie Scan 2016; 06(02): 157-174
DOI: 10.1055/s-0042-105532
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© Georg Thieme Verlag KG Stuttgart · New York

Reformatierte kontrastverstärkte MRT-Aufnahmen zur präoperativen Beurteilung der Brückenvenen an der Schädelbasis[1]

Contrast-enhanced reformatted MR images for preoperative assessment of the bridging veins of the skull base
Pattana Wangaryattawanich
,
Lakshmi S. Chavali
,
Komal B. Shah
,
Bhanu Gogia
,
Raul F. Valenzuela
,
Franco DeMonte
,
Ashok J. Kumar
,
Anne L. Hayman
Further Information

Publication History

Publication Date:
21 April 2016 (online)

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Zusammenfassung

MR- und CT-Phlebografie sind geeignete Verfahren zur Darstellung der Venen, die an der konvexen Seite des Gehirns verlaufen und das Blut aus den oberflächlichen Bereichen der medialen und lateralen Regionen der Hirnhemisphären ableiten. Für die Brückenvenen der Schädelbasis trifft dies jedoch nicht zu. Technische Faktoren verhindern, dass der gekrümmte Verlauf dieser klinisch wichtigen venösen Strukturen in kontrastmittelverstärkten MR- oder CT-Bildern, die in den axialen, koronaren und sagittalen Standardebenen aufgenommen wurden, vollständig zu sehen ist. Diese Einschränkung lässt sich durch die Anwendung eines Rekonstruktionsverfahrens überwinden, das die Abbildung der genannten venösen Strukturen und ihrer Vernetzungen ermöglicht. Die multiplanare Rekonstruktion und die Rekonstruktion in gekrümmten Ebenen mit Herausarbeitung der wichtigen Merkmale der Venen erfordern oft eine komplizierte Manipulation der ursprünglichen Bilder durch einen Spezialisten, der die notwendigen Kenntnisse besitzt und mit den zahlreichen Varianten des Venennetzes und den daraus resultierenden chirurgischen Implikationen vertraut ist. Die Autoren beschreiben die normale Anatomie der venösen Netze – eine Anatomie, die der Radiologe sicher beherrschen muss, damit er dem Chirurgen die wichtigen anatomischen Verhältnisse demonstrieren kann, die auf den Standardaufnahmen häufig nicht erkennbar sind. Diese Informationen erlauben eine bessere Kommunikation zwischen Radiologen und Chirurgen. Aus praktischen Gründen unterteilen die Autoren die Venen der Schädelbasis willkürlich in solche, die beim pterionalen Zugang, und solche, die beim subtemporalen Zugang besonders gefährdet sind. In Erweiterung dieses Vorgehens können auch die Verbindungen zwischen dem oberflächlichen Venensystem und den klappenlosen anderen venösen Netzen aufgezeigt werden, die das Blut aus den tiefen Anteilen der Hirnhemisphären, der Kopfhaut, dem Gesicht, der Halsmuskulatur, der Diploë der Schädelkalotte und den Hirnhäuten ableiten. Mit zunehmender Erfahrung sollten die Bildinterpretationen der Radiologen weiter ausreifen und über die einfache Analyse der primären hämodynamischen Veränderungen hinausgehen, die als Folge einer intraoperativen Opferung oder Verletzung von Venen auftreten können.

Abstract

Magnetic resonance (MR) venography and computed tomographic (CT) venography are suited for displaying the convexity veins that drain the medial and lateral surfaces of the brain hemispheres. However, such is not the case for the bridging veins of the skull base. Technical factors prevent contrast material-enhanced MR or CT images obtained in standard axial, coronal, and sagittal planes from fully displaying the curved pathways of these clinically important venous structures. This limitation can be overcome by using a reconstruction technique that depicts these venous structures and their interconnections. Curved and multiplanar reformatted images that distill the important venous features often require knowledgeable manipulation of source images by an operator who is familiar with numerous venous variants and their surgical implications. The normal anatomy of the draining veins is detailed anatomy that radiologists must master before they can show the surgeon the important venous anatomy that is often missing at standard imaging; this information will foster better communication between radiologists and their surgical colleagues. As a practical matter, the skull base veins are arbitrarily subdivided into those that are at greatest risk with the pterional approach and the subtemporal approach, respectively. These approaches can be expanded to define connections between the superficial venous system and the other valveless venous networks that drain the deep portions of the cerebral hemisphere, the scalp, face, muscles of the neck, diploë of the skull, and meninges. As radiologists gain experience, their image interpretations should mature beyond simple analysis of the primary hemodynamic changes induced by intraoperative sacrifice or injury.

1 © 2016 The Radiological Society of North America. All rights reserved. Originally puplished in English in RadioGraphics 2016; 36: 244 – 257. Online published in 10.1148 /rg.2016150084. Translated and reprinted with permission of RSNA. RSNA is not responsible for any inaccuracy or error arising from the translation from English to German.


 

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