Endoscopic Anatomy,Histological Characteristics And Clinical Studies About Cerebral Venous Sinus

Background:Due to the lack of the anatomy and histology in the cerebral venous sinus,postoperative complications were easy to present via intravenous approach.Cerebral venous sinus thrombosis(CVST)with hemorrhagewas easily misdiagnosed as spontaneous cerebral hemorrhage.Objective:The aims of this study was to describe topographical features of the intra-sinus structure in cerebral venous sinus with the aid of rigid endoscopy,to clarify the histological characteristics of dural sinus and chordae willisii and to present the comparative early clinical data between CVST with hemorrhage and primary cerebral hemorrhage.Methods:The anatomical and histological characteristics of cerebral venous sinus chordae willisii,arachnoid granulation,and dural sinus wall were analyzed by endoscope and microscope.Endoscopic observation and light microscopy examination were used to assess the impact of the chordae willisii and thrombosis through the mimicking a mechanical thrombectomy procedure performed in the cerebral venous sinus.Theclinical data of patients with CVST with hemorrhage and primary cerebral hemorrhage was analyzed,and the early clinical characteristics and prognosis of the two groups were compared.Results:1.The variations was presented in the junction between the great cerebral vein and the straight sinus.Fold,elevation,small bugle and nodule were detected in the straight sinus.Compared to arachnoid granulation,the nodule presented smooth muscle fibers and higher rate of elastic fibers.The smooth muscle fibers also presented in the branch of the great cerebral vein wall and the junction between the great cerebral vein wall and the sinus wall.2.The inferior petrosal sinus opening had anatomical variation,located at the anterior medial wall of the jugular vein bulb,above the intersection of the saddle-slope extension line and the maxillary-occipital foramen line.3.During the bridge vein flow into the venous sinus,the length of the subarachnoid segment and the sinus wall segment were 15.23 ± 5.40mm and 5.28 ±2.36mm respectively.The distance between the central anterior sulcus vein and the coronary suture were 2.18± 1.90 cm,while the distance between the central sulcus vein and the coronary suture was 5.48 ± 2.19 cm.4.The transverse sinus wall contained a large amount of vascular tissue;The bottom wall of the straight sinus was consisted of various layers,the bottom sinus wall and lamellar type was thicker than others sinus wall,anterior wall of sigmoid sinus was the smallest one.5.In the stent group,the number of cases with Grade 0,Grade 1,Grade 2 were 19(53.1%),16(43.2%)and 2(5.4%),respectively.In the balloon group,there were 34(73.9%)cases showing Grade 0,8(17.4%)Grade 1,and 4(8.7%)Grade 2.The use of stent resulted in no significant increase in damage to chordae willisii during the three replicated procedures in the straight sinus.The incidence of damage to the surface of chordae willisii was higher in the stent group than in the balloon group.6.The number of thrombus particles generated during the first,second and third stent thrombectomy were 11.17± 2.17,9.00 ± 6.07 and 5.00 ± 2.96,respectively.The first stent thrombectomy produced more large thrombus particles;The area of residual thrombus after the first thrombectomy was larger than that of the other times7.Multivariate logistic regression analyses of the clinical variables showed that age,epilepsy symptoms,and edema/hematoma volume ratio were associated with early diagnosis of CVST with hemorrhage.The prognosis of severe CVST with hemorrhage was better than that of the severe primary hemorrhage group.Conclusion:1.The distribution of cerebral venous sinus chordae willisii was vary,and the sinus wall in different parts was vary widely in relation to the histological composition.Familiar with the relevant anatomy of cerebral venous sinus will help surgeon to reduce the surgical difficulty,improve the quality of surgery,thus improve the clinical efficacy in patients with cerebral venous system diseases.2.Stent or balloon navigation through the straight sinus can cause minor damage to the chordae willisii.Frequent uses of retrograde navigation through the straight sinus do not appear to increase the rates of damage to chordae willisii.Clinically,postoperative application of anticoagulant drugs reduce the chance of thrombosis.3.The clinical presentation of CVST with hemorrhage and primary Intracerebral hemorrhage was non-specific.The good prognosis of severe CVST with hemorrhage indicated to avoid misdiagnosis and standardized treatment early.