The superior petrosal sinus: a review of anatomy, embryology, pathology, and neurosurgical relevance

Abstract

The superior petrosal sinus is located between the middle and posterior cranial fossae and is important during many neurosurgical approaches to the skull base. Using standard search engines, the anatomical and clinical importance of the superior petrosal sinus was investigated. The superior petrosal sinus is important in many neurosurgical approaches and pathological entities. Therefore, it is important for those who operate at the skull base or interpret imaging here to have a good working knowledge of its anatomy, development, and pathological involvement.

Cadaveric findings of a duplicated superior petrosal sinus

“…2) emerges at Carnegie stage 2 of development and thus, the variant identified in the present case would occur during this time. The formation of a large suprotic anastomosis appears at Carnegie stage 3, connecting the prootic and posterior rhombencephalic veins [15]. This newly formed channel and the terminal segment of the posterior rhombencephalic veins join to form the sigmoid sinus [16].…”

“…To summarize the developmental process: the trochlear nerve, oculomotor nerve, and superior petrosal sinus travel near the otic capsule and anterior dural fold during early development (Carnegie stage 2), with the trigeminal ganglion separating both [16]. As the temporal lobe enlarges, it pushes the anterior tentorial layer backwards, pushing the oculomotor, trigeminal ganglion, superior petrosal sinus and trochlear nerves toward the otic capsule [15]. The superior petrosal sinus and cranial nerves expand along the border of the otic capsule in order to attain their adult positions [13].…”

“…Later in development, the superior petrosal sinus travels over the trigeminal ganglion and beneath the trochlear and oculomotor nerves, the now-enlarged cavernous sinus projecting anterosuperiorly into the trigeminal ganglion and draining the superior petrosal sinus. The relationship between the superior petrosal sinus and the cavernous sinus occurs later in development and does not always form [15].…”

“…The clinical relevance of the superior petrosal sinus to abnormal connections such as carotid-cavernous fistulas and DAVFs have been noted [13]. DAVFs have been classified into three categories depending on their drainage pattern [13,15]. Type I drains the dural venous sinuses or meningeal veins in an anterograde fashion.…”

“…DAVFs can be treated through either endovascular therapy or surgery; the therapy of choice for all arteriovenous fistula malformation (AVFM) types is transarterial embolization, a type of nonsurgical endovascular therapy. It is rarely a cure, but can make surgery less challenging by decreasing flow through the fistula [15]. Gamma knife radiosurgery is another type of surgery for superior petrosal sinus AVFM, though three years are needed for closure of the fistula and the treatment is not always viable for high-grade AVFMs [13,28].…”