Giant Mastoid Emissary Vein: Source of Profuse Bleeding During Mastoid Surgery

Ahmad, Rauf; Ali, Ihsan; Naikoo, Ghulam M.; Choo, Naseer A.; Jan, Fozia

doi:10.1007/s12070-011-0215-9

Cited by 11 publications

(10 citation statements)

References 2 publications

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“… 6 Preoperative knowledge of these veins could assist surgeons in preventing potential complications such as profuse bleeding, tinnitus, thrombosis, and infections. 13 14 15 Any potential surgery in the mastoid region requires a thorough evaluation of the relevant skeletal structures. A review of the English-language literature revealed a dearth of studies on this anatomical variant.…”

Section: Discussionmentioning

confidence: 99%

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Incidental occurrence of an unusually large mastoid foramen on cone-beam computed tomography and review of the literature

et al. 2016

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The incidental finding of an enlarged mastoid foramen on the right posterior mastoid region of temporal bone is reported, together with a discussion of its clinical significance. A 67-year-old female underwent the pre-implant assessment of a maxillary left edentulous region. A cone-beam computed tomographic (CBCT) image was acquired and referred for consultation. Axial CBCT slices revealed a unilateral, well-defined, noncorticated, low-attenuation, transosseous defect posterior to the mastoid air cells in the right temporal bone. The borders of the osseous defect were smooth and continuous. No other radiographic signs suggestive of erosion or sclerosis were noted in the vicinity. The density within the defect was homogenous and consistent with a foramen and/or soft tissue. The patient's history and physical examination revealed no significant medical issues, and she was referred to a neuroradiologist for a second opinion. The diagnosis of an enlarged mastoid foramen was made and the patient was reassured.

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Section: Discussionmentioning

confidence: 99%

“…Emissary veins can measure anywhere between 1 mm and 4 mm. 13 14 If they are more than 3.5 mm in diameter, then they are considered prominent or enlarged mastoid emissary veins. 8 13 In our case, the maximum diameter of the vein was over 5 mm.…”

Section: Discussionmentioning

confidence: 99%

Incidental occurrence of an unusually large mastoid foramen on cone-beam computed tomography and review of the literature

et al. 2016

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“…Generally, bleeding is trivial and can be easily controlled by plugging any openings with gauze or bone wax; however, in the cases of large EVs, it may be troublesome. 15 Moreover, late bleeding from EVs may also result in postoperative epidural hematoma formation. 4,16 Although the most appropriate material, including fibrin glue, should be inserted into a bleeding emissary foramen, care should be taken when using these materials; for example, bone wax applied to a bleeding emissary foramina has been known to enter the deeply placed venous sinuses and result in extensive thrombosis.…”

Section: Discussionmentioning

confidence: 99%

Improved CT Imaging for Mastoid Emissary Vein Visualization Prior to Posterior Fossa Approaches

Röser

Ebner

Ernemann

et al. 2016

J Neurol Surg A Cent Eur Neurosurg

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The clinical relevance of emissary veins (EVs) is often neglected. However, for posterior fossa approaches, especially in semisitting positions, these transosseous connections become potentially life threatening. Therefore, knowledge of the presence and configuration of EVs is essential in preoperative planning. We report on the use of preoperative computed tomography (CT) imaging techniques to visualize EVs reliably. A total of 100 consecutive patients were evaluated by helical CT in bone window mode reconstructed using the standard technique (4.5-mm slices) and the high-resolution technique (1 mm) for the posterior fossa. The presence and size of the EVs, their entry point in the sigmoid sinus, their predilection site, and their visibility using either CT technique were evaluated. Statistical analyses included a comparison of the data from both sides of the head. We noted impressive anatomical variations (high standard deviations) in the number, size, and intraosseous length of the EVs among the study population and between the sides (right and left) of an individual patient; however, no statistical significance was observed for any of these parameters. The detection rate of EVs in thin-slice CT scans versus standard CT scans is significantly different ( = 0.0001 on both sides). Thin-slice CT is essential in the preoperative planning of posterior fossa approaches to identify the presence and the course of EVs, reducing preventable approach-related morbidity during surgery.

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“…7 It is important for these veins to be assessed using preoperative imaging techniques, because they may represent a source of bleeding and air embolism during surgery. [8][9][10] However, many surgeons fail to pay these veins sufficient attention. 11 The number of radiological studies of the emissary veins is limited.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of the Mastoid Emissary Canals with Computerized Tomography in Patients with Chronic Otitis Media

Özen

Şahin

2019

J Neurol Surg B

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Background The mastoid emissary veins (MEVs) pass through the mastoid emissary canal-mastoid foramen (MEC-MF) in the mastoid region of the skull. MEVs can give rise to complications during surgical procedures. The purpose of our study was to investigate the morphological and morphometric characteristics of MECs of patients with clinical chronic otitis media (COM) using high-resolution computed tomography (HRCT). Methods Patients diagnosed with COM and undergoing temporal HRCT were identified by retrospectively scanning our hospital's automation system. Patients undergoing temporal HRCT for reasons other than COM, infection or tinnitus were identified for the control group by scanning the PACS archive. Sixty-two mastoid regions were examined in 38 unilateral and 12 bilateral COM patients, and 100 mastoid regions in the 50 patients in the control group. The presence of an accessory MEC-MF and MEC-MF diameters was evaluated in both groups. Results Main MEC diameters on the side of the ear with COM were 1.6 mm, and total accessory and main MEC diameters were 1.8 mm, both values being significantly higher than in the control group. Presence of accessory MEC on the side of the ear with COM was determined at 61.8%, significantly higher than in the control group. Conclusion Preoperative awareness of cranial venous drainage abnormalities is important to reduce surgical complications. Our study shows that MECs may be wider in diameter in patients with COM. MECs in COM patients must be identified before surgery to the mastoid region.

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Giant Mastoid Emissary Vein: Source of Profuse Bleeding During Mastoid Surgery

Cited by 11 publications

References 2 publications

Incidental occurrence of an unusually large mastoid foramen on cone-beam computed tomography and review of the literature

Incidental occurrence of an unusually large mastoid foramen on cone-beam computed tomography and review of the literature

Improved CT Imaging for Mastoid Emissary Vein Visualization Prior to Posterior Fossa Approaches

Evaluation of the Mastoid Emissary Canals with Computerized Tomography in Patients with Chronic Otitis Media

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