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LETTER TO EDITOR
Year : 2012  |  Volume : 60  |  Issue : 5  |  Page : 546-547

Squamosal type superficial middle cerebral vein: A rare venous drainage pattern


1 Department of Neurosurgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
2 Department of Neurology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
3 Department of Neuroradiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India

Date of Web Publication3-Nov-2012

Correspondence Address:
P S Chandra
Department of Neurosurgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.103220

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How to cite this article:
Kumar A, Chandra P S, Mankotia DS, Tripathi M, Garg A, Mahapatra AK. Squamosal type superficial middle cerebral vein: A rare venous drainage pattern. Neurol India 2012;60:546-7

How to cite this URL:
Kumar A, Chandra P S, Mankotia DS, Tripathi M, Garg A, Mahapatra AK. Squamosal type superficial middle cerebral vein: A rare venous drainage pattern. Neurol India [serial online] 2012 [cited 2019 Sep 18];60:546-7. Available from: http://www.neurologyindia.com/text.asp?2012/60/5/546/103220


Sir,

Anatomical variations in the superficial middle cerebral vein (SMCV) drainage are frequent. Several different types of venous drainage patterns have been described for SMCV.[1],[2],[3] SMCV most frequently drains into cavernous sinus, either directly or indirectly via sphenoparietal sinus that runs along the lesser wing of sphenoid bone to drain into cavernous sinus.[3],[4] However, squamosal type of venous drainage is a very rare drainage pattern of SMCV in which SMCV turns backward on reaching the pterion, rather than turning medially and runs along the inner side of temporal squama and joins the transverse sinus.[3] The importance of knowing this venous pattern lies in the fact that it limits the mobility of temporal lobe in subtemporal approaches as the vein is tightly adherent to the middle cranial fossa. We describe a case with such a rare venous drainage.

A 25-year-old female patient with intractable epilepsy underwent right temporal lobectomy for right mesial temporal sclerosis. After raising the bone flap and opening the dura, a large vein could be seen near the temporal base along the inner surface of temporal squama, beginning near the sylvian fissure and receiving tributaries from superficial middle cerebral vein and coursing posteriorly to drain into transverse sinus [Figure 1]. This vein along with the venous connections with superficial middle cerebral vein was preserved. Postoperative course of the patient was uneventful. Magnetic resonance venography was done in the postoperative period, which showed the squamosal type of SMCV draining into transverse sinus [arrow and arrow head in [Figure 2]a-c.

Two embryologic sinuses, namely, tentorial sinus and pro-otic sinus take part in the formation of SMCV.[5],[6] During prenatal period, SMCV drains into transverse sinus through the tentorial sinus rather than into the cavernous sinus. The pro-otic sinus, developing from otic capsule, contributes to the cavernous sinus, sphenoparietal sinus and meningeal sinus.[1],[5] With the growth of cerebral hemisphere, the tentorial sinus elongates posteriorly, and anteriorly, it shifts medially. The relative development of venous pathway from SMCV to transverse sinus via the tentorial sinus and the pathway from cavernous sinus to pterygoid plexus, leads to the development of adult type SMCV drainage. The most common type of SMCV, the sphenoparietal type, develops due to medial displacement of tentorial sinus and regression of its caudal part, whereas an anastomosis develops between its cranial part (that forms the sphenoparietal sinus) and the cavernous sinus.[2],[5] When the tentorial sinus is located laterally, an anastomosis with cavernous sinus is less likely to form,[5] and when this happens, the drainage of SMCV is into the transverse sinus rather than the cavernous sinus. In squamosal type of SMCV, which is one of the rarest types of drainage patterns, tentorial sinus is displaced laterally close to temporal squama, by the developing hemispheres.[3] Therefore, anastomosis with cavernous sinus does not develop and venous drainage continues into transverse sinus via the persistent tentorial sinus.
Figure 1: Intraoperative photographs showing superficial middle cerebral vein (arrow) traversing posteriorly along the inner surface of temporal squama (arrow head) to drain into transverse sinus

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Figure 2: Magnetic resonance venography images (a)-axial, (b)-3D reconstruction) showing superficial middle cerebral vein (arrow) passing posteriorly along the temporal squama (arrow head), (c) shows diagrammatic representation of the rare venous configuration

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In our case, we observed a similar pattern of SMCV drainage. The variant venous drainage was preserved and the patient made uneventful recovery. In patients undergoing subtemporal procedures, knowledge of this rare variation in the anatomy of SMCV drainage is important, otherwise catastrophic venous complications can result from inadvertent injury to these veins while retracting the temporal lobe. A detailed study of venous anatomy, therefore, should be undertaken preoperatively in such patients to identify such an anatomical variation and formulate an alternate surgical strategy.

 
  References Top

1.Wolf BS, Huang YP, Newman CM. The superficial sylvian venous drainage system. Am J Roentgenol Radium Ther Nucl Med 1963;89:398-410.  Back to cited text no. 1
    
2.San Millán Ruiz D, Gailloud P, de Miquel Miquel MA, Muster M, Dolenc VV, Rufenacht DA, et al. Laterocavernous sinus. Anat Rec 1999;254:7-12.  Back to cited text no. 2
    
3.Suzuki Y, Matsumoto K. Variations of the superficial middle cerebral vein: Classification using three-dimensional CT angiography. AJNR Am J Neuroradiol 2000;21:932-38.  Back to cited text no. 3
    
4.Chung JI, Weon YC. Anatomic variations of the deep cerebral veins, tributaries of Basal vein of rosenthal: Embryologic aspects of the regressed embryonic tentorial sinus. Interv Neuroradiol 2005;11:123-30.  Back to cited text no. 4
    
5.Padget DH. The cranial venous system in man in reference to development, adult configuration, and relation to the arteries. Am J Anat 1956;98:307-55.  Back to cited text no. 5
    
6.Padget DH. Development of cranial venous system in man, from view point of comparative anatomy (Carnegie Institution of Washington publication 611). Contrib Embryol 1957;36:79-140.  Back to cited text no. 6
    


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