Falcine venous plexus within the falx cerebri: anatomical and scanning electron microscopic findings and clinical significance

Tatarlı, Necati; Ceylan, Davut; Canaz, Huseyin; Tokmak, Mehmet; Bay, Hüsniye Hacıoğlu; Şeker, Aşkın; Keleş, Evren; Kılıç, Türker; Çavdar, Safiye

doi:10.1007/s00701-013-1863-1

Cited by 15 publications

(9 citation statements)

References 18 publications

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“…12) Tatarli et al concluded that the falcine venous plexus exhibited different anatomical patterns in the anterior, middle, and posterior portions of the falx cerebri and that falcine sinuses were different patterns according to their location. 13) But an important distinction should be made between the rare persistent fetal falcine sinus and the falcine venous plexus. 14) …”

Section: Discussionmentioning

confidence: 99%

A Case of Dural Arteriovenous Fistula in theFalx Cerebri: Case Report and Review of the Literature

Yamaguchi

Higaki

Yokota

et al. 2016

NMC Case Report Journal

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A 67-year-old man presented with consciousness disturbance and right hemiparesis. Computed tomography (CT) scan showed an intracerebral hematoma with two enhanced vascular lesions. Digital subtraction angiography revealed the dural arteriovenous fistula (dAVF) in the falx cerebri which was supplied by both bilateral middle meningeal arteries and left pericallosal artery and drained into both the superior sagittal sinus and the vein of Galen via the posterior callosal vein accompanied by two venous pouches. The dAVF was obliterated by a combination of the endovascular and the direct surgeries. A dAVF in a falx cerebri is very rare and only five cases were reported. Clinical characteristics of the dAVFs are uncertain. Before deciding the strategy of treatment, it is important to consider the pathological condition including embryology of the falx, the falcine sinus, and the falcine venous plexus.

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Section: Discussionmentioning

confidence: 99%

A Case of Dural Arteriovenous Fistula in theFalx Cerebri: Case Report and Review of the Literature

Yamaguchi

Higaki

Yokota

et al. 2016

NMC Case Report Journal

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“…Even if cerebral angiography shows that the venous sinuses are completely obstructed by the tumor, sufficient collateral circulation is not guaranteed to have developed, and the possibility of impaired venous perfusion or venous infarction associated with venous sinus transection cannot be ignored. [19][20][21] Because preoperative cerebral angiography did not reveal ISS obstruction, preservation of the ISS as well as the SS was regarded as important, and incisions were made in the tentorium and falx cerebri while all the venous sinuses were preserved in all four of our patients.…”

Section: Discussionmentioning

confidence: 94%

Parieto-Occipital Interhemispheric Transfalcine, Trans-Bitentorial Approach for Radical Resection of Falcotentorial Meningiomas

Okada

Miyahara

Tanino

et al. 2020

J Neurol Surg A Cent Eur Neurosurg

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Objective Falcotentorial meningioma occurs close to the falcotentorial edges and the confluence of the vein of Galen. The posterosuperior approach conventionally used to reach this site does not allow direct visualization of the tumor matrix, making detachment difficult. Meningiomas at this location are therefore among those that are not well amenable to radical resection. We devised an alternative anterolateral approach that, when used in addition to the posterosuperior approach, provides an operating field which allows to overview large, bilaterally extending tumors. We report this parieto-occipital interhemispheric transfalcine, trans-bitentorial approach, together with associated procedural modifications. Methods We used the approach in four patients with falcotentorial meningioma between February 2008 and July 2017. We began by extending a parieto-occipital craniotomy slightly beyond the midline, to pass across the most caudal bridging vein on the rostral side. We then created a fan-shaped fenestration as large as possible in the falx, between the superior sagittal sinus and the inferior sagittal and straight sinuses (window 1). We further performed wedge-shaped resections of both tentorial edges to the left and right of window 1 (windows 2 and 3). Tumor debulking was then carried out via these three windows (the triple-window method). Finally, we detached the tumor in the area of the falcotentorial edges and the confluence of the vein of Galen. To obtain a superorostral operating field as wide as possible from laterally, thereby exposing the potential blind spots, the operating surgeon used both hands while retracting the precuneus, and the assistant surgeon used both hands to turn over the falcotentorial edges (twosome four-hand retractorless microsurgery). Results The wide operating field provided by this parieto-occipital interhemispheric transfalcine, trans-bitentorial approach and twosome four-hand retractorless microsurgery provides a direct view of delicate structures at the falcotentorial edges and the confluence of the vein of Galen, a site that is most likely to be a blind spot in conventional approaches. Retraction of the precuneus on the nondominant side enabled radical resection with no neurologic deficit in any of the patients. Conclusions The parieto-occipital interhemispheric transfalcine, trans-bitentorial approach with the triple-window method opens an anterolateral operating field in addition to a posterosuperior operating field in large tumors located in the falcotentorial and pineal region, extending anteroposteriorly and bilaterally. The twosome four-hand retractorless technique via this approach enables visualization of the tumor matrix at sites, which are barely visible with the conventional approach. Thus, the tumor can be removed more radically and safely.

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“…Previous descriptions of the supratentorial innervation have been crude and inconsistent, including the medical illustrations that appear in both textbooks and journal articles (Drake et al 2009;Gilroy et al 2009;Moore et al 2009;Kemp et al 2012;Bauer et al 2005). Accurate knowledge of the anatomy of the venous sinuses in the dura mater is important during neurosurgery involving the arteriovenous fistula or when resecting meningiomas and other types of brain tumours (Tubbs et al 2007;Tatarli et al 2013;Xu et al 2013;Tanaka, 2015;Amato et al 2016;Shibao et al 2016), and so the present study investigated the straight and transverse sinuses adjacent to the tentorium cerebelli in order to elucidate the course of the nervus tentorii.…”

Section: Discussionmentioning

confidence: 99%

Visualization of the tentorial innervation of human dura mater

2017

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Posterior projections of the ophthalmic division of the trigeminal nerve (the ophthalmic nerve) are distributed in the tentorium cerebelli as recurrent meningeal branches. We investigated the morphological tentorial distribution of the ophthalmic nerve. Fifty-two sides of the tentorium cerebelli and adjacent dura mater obtained from 29 human specimens were stained using Sihler's method to examine the nerve fibres in the dural sheets. The innervation patterns of the tentorium cerebelli were classified into the following four types according to their distributions: Type 1, where nerve fibres projected to both the straight and transverse sinuses; Type 2, where nerve fibres projected only to the transverse sinus and lateral convexity; Type 3, where nerve fibres projected medially only to the straight sinus and the posterior part of the falx cerebri; and Type 4, where the nerve fibres terminated within the tentorium cerebelli. Images of the tentorium cerebelli were superimposed to identify areas of dense innervation. The incidence rates of Types 1-4 were 71.2% (n = 37), 21.2% (n = 11), 3.8% (n = 2) and 3.8% (n = 2), respectively. More branches of nerve fibres traversed towards the transverse sinus posterolaterally than towards the straight sinus medially. The space between the anterior half of the straight sinus and the medial tentorial notch can be considered a safe surgical area where innervation is scarce. The posterior part of the falx cerebri was innervated by the ophthalmic nerve that traversed to the straight sinus. The parietal branches of the middle meningeal artery in the lateral convexity that were projected orthogonally by the ophthalmic nerve traversed the transverse sinus, implicating their vulnerability and possible sensitivity under physiological or neurosurgical conditions. This study has revealed the macroscopic tentorial innervation of the dura mater in humans, which could be useful information for both neurosurgeons and neurologists.

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Falcine venous plexus within the falx cerebri: anatomical and scanning electron microscopic findings and clinical significance

Cited by 15 publications

References 18 publications

A Case of Dural Arteriovenous Fistula in theFalx Cerebri: Case Report and Review of the Literature

A Case of Dural Arteriovenous Fistula in theFalx Cerebri: Case Report and Review of the Literature

Parieto-Occipital Interhemispheric Transfalcine, Trans-Bitentorial Approach for Radical Resection of Falcotentorial Meningiomas

Visualization of the tentorial innervation of human dura mater

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