The diploic venous system: surgical anatomy and neurosurgical implications

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>There are few systematic investigations of the dissected surgical anatomy of the diploic venous system (DVS) in the neuroanatomical literature. The authors describe the DVS relative to different common neurosurgical approaches. Knowledge of this system can help avoid potential sources of unacceptable bleeding and may impact healing of the cranium.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>Using a high-speed drill with a 2-mm bit, the authors removed the outer layer of the compact bone in the skull to expose the DVS in 12 formalin-fixed cadaver heads. Pterional, supraorbital, and modified orbitozygomatic craniotomies were performed to delineate the relationship of the DVS.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>The draining point of the frontal diploic vein (FDV) was located near the supraorbital notch. The draining point of the anterior temporal diploic vein (ATDV) was located in all pterional areas; the draining point of the posterior temporal diploic vein (PTDV) was located in all asterional areas. The PTDV was the dominant diploic vessel in all sides. The FDV and ATDV could be damaged during supraorbital, modified orbitozygomatic, and pterional craniotomies. The anterior DVS connected with the sphenoparietal and superior sagittal sinus (SSS). The posterior DVS connected with the transverse and sigmoid sinuses and was the dominant diploic vessel in all 24 sides. Of all the major diploic vessels, the location and pattern of distribution of the FDV were the most constant. The parietal bone contained the most diploic vessels. No diploic veins were found in the area delimited by the temporal squama.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>The pterional, orbitozygomatic, and supraorbital approaches place the FDV and ATDV at risk. The major anterior diploic system connects the SSS with the sphenoparietal sinus. The posterior diploic system connects the SSS with the transverse and sigmoid sinuses.</jats:p></jats:sec>

The Prevalence of Persistent Petrosquamosal Sinus and Other Temporal Bone Anatomical Variations on High-Resolution Temporal Bone Computed Tomography

“…The anatomical variations of the TB could be the reason for many different serious intraoperative complications during ear surgery and neurosurgery procedures [4–7]. Recent data suggest that patients with venous pulsatile tinnitus may have multiple vascular anomalies or variants on the symptomatic side [8].…”

Cranial Arachnoid Protrusions and Contiguous Diploic Veins in CSF Drainage

“…25 They have been infrequently associated with dural arteriovenous fistulas, [26][27][28] tumorous pa- thologies, 29,30 and sinus pericranii. 31 The distribution of DVs in the whole cranium is difficult to assess by intraoperative local observation or postmortem dissection because DVs lie intraosseously, surrounded by hard cortical bone.…”

Is Unresolved Inflammatory Angiogenesis a Mechanism for the Delayed Development of Skeletal Lesions in Syphilis?

“…It accounts for the generalised swelling of long and tubular bones, and the consequent bone pain, which may start in the secondary stage before the changes become visibly apparent. The wide variation of morphology of the skull diploic veins from individual to individual (García‐González et al ., ) may then account for the great variety of expression of cranial lesions.…”