Relationship of superior sagittal sinus with sagittal midline: A surgical application

Abstract

Background: Interhemispheric approach is widely used to surgical management of midline tumors and vascular lesion in and around the third ventricle. Complete exposure of the superior sagittal sinus to obtain adequate working space of midline lesion is difficult, because of the risk to inadvertent injury to the sinus and bridging veins, which may cause several neurological deficits. Understanding the SSS neuroanatomy and its relationships with external surgical landmarks avoid such complications. The objective of this study is to accurately describe the position of SSS and its displacement in relation with sagittal midline by magnetic resonance imaging. Methods: A retrospective cross-sectional, observational study was performed. Magnetic resonance image of 76 adult patients with no pathological imaging was analyzed. The position of the halfway between nasion and bregma, bregma, halfway between bregma and lambda, and lambda was performed. The width and the displacement of the superior sagittal sinus accordingly to the sagittal midline were assessed in those landmarks. Results: The mean width of superior sagittal sinus at halfway between nasion and bregma, bregma, halfway between bregma and lambda, and lambda was 5.62 ± 2.5, 6.5 ± 2.8, 7.4 ± 3.2, and 8.5 ± 2.1 mm, respectively, without gender discrepancy. The mean displacement according to the midline at those landmarks showed a statistically significant difference to the right side among sexes. Conclusion: In this study, we demonstrate that sagittal midline may approximate external location of the superior sagittal sinus. Our data showed that in the majority of the cases, the superior sagittal sinus is displaced to the right side of sagittal midline as far as 16.3 mm. The data we obtained provide useful information that suggest that neurosurgeons should use safety margin to perform burr holes and drillings at the sagittal midline.

Morphometry of Superior Sagittal Sinus and Its Clinical Significance

“…In this study again the author has reported that none of the SSS was found in the midline; almost all had deviations that were again in contrast to the findings of this study. 2…”

“…3 Oberman et al after measuring the deviation distance of SSS from midline recommended to place the drill or burr holes at a distance of at least 1.7 cm from the midline. 2…”

“…➢ In case of midline tumors and vascular lesions around third ventricle interhemispheric approach is used. 2 Parafalcine and parasagittal meningiomas are the second most common intracranial meningiomas. 8 Since these tumors are in an intimate relationship with major sinuses and draining veins, their resection requires careful preservation of cortical veins that surround the tumor.…”

“…But there are a lot of studies contesting this fact. 2 The deviation of the SSS from the midline was noticed in various studies. This may be of importance to the neurosurgeons in the placement of burr holes for craniotomies and in the interhemispheric approach to the midline tumors and the vascular lesions.…”

Diploic Bone Channel Drilling Facilitates Dissection of the Midline Dura and Protects the Superior Sagittal Sinus in Hyperostosis Frontalis Interna

“…The SSS is a challenging structure to operate around, given the difficulty in controlling an inadvertent laceration [ 6 ]. Oberman et al recently reported that the SSS may be displaced by as far as 16.3 mm in the majority of individuals [ 7 ]. There exists limited literature on surgical approaches to extra-axial pathology around the SSS, with most reports being concerned with the treatment of epidural hematoma.…”