Abstract：
OBJECTIVE: To measure the size of jugular foramina in infants affected by external hydrocephalus (EH) and in a control group, to support the hypothesis that a jugular foramen (JF) stenosis may determine dural venous sinus alterations and increased venous outflow resistance as main pathophysiological factor.
METHODS: Minimum, maximum, and mean values of JF areas were measured in a series of phase-contrast magnetic resonance venous angiography (angio MRV PCA3D) performed on 81 infants affected by EH. Results were compared with a group of 54 controls.
RESULTS: Smaller JF area was significantly smaller in patients versus controls (43.1 ± 14.6 vs. 52.7 ± 17.8; p < 0.001) resulting in a significantly smaller mean JF areas in patients vs. controls (51.6 ± 15.8 vs. 57.0 ± 18.3; p = 0.043). In patients, smaller JF areas were significantly associated with higher venous obstruction grading score (VOGS) both on the right (p = 0.018) and on the left side (p = 0.005). Positional plagiocephaly (cranial vault asymmetry index > 3.5%) was more frequent among EH patients than controls (38/17) but the difference was not significant (p = 0.07). In the 38 plagiocephalic patients, JF area was smaller on the flattened side than the contralateral in a significant number of cases both in right (21/7) and left (9/1) plagiocephaly (p < 0.0005) as well as the mean area (48.2 + 16.4 mm2 vs. 57.5 + 20.7 mm2, p = 0.002) and VOGS was significantly higher on the plagiocephalic side than on the contralateral side (1.6 ± 1.1 vs. 1.1 ± 0.9, p = 0.019).
CONCLUSIONS: In this series of infants affected by EH, the mean size of the ostium of both JF resulted significantly smaller than controls. JF stenosis was significantly associated with higher degrees of venous obstruction on both sides, suggesting a direct extrinsic effect of JF size on dural sinus lumen and possible consequent effect on venous outflow resistance. Positional plagiocephaly, when present, was associated with a decreased JF area and increased VOGS on the flattened side.
METHODS: Minimum, maximum, and mean values of JF areas were measured in a series of phase-contrast magnetic resonance venous angiography (angio MRV PCA3D) performed on 81 infants affected by EH. Results were compared with a group of 54 controls.
RESULTS: Smaller JF area was significantly smaller in patients versus controls (43.1 ± 14.6 vs. 52.7 ± 17.8; p < 0.001) resulting in a significantly smaller mean JF areas in patients vs. controls (51.6 ± 15.8 vs. 57.0 ± 18.3; p = 0.043). In patients, smaller JF areas were significantly associated with higher venous obstruction grading score (VOGS) both on the right (p = 0.018) and on the left side (p = 0.005). Positional plagiocephaly (cranial vault asymmetry index > 3.5%) was more frequent among EH patients than controls (38/17) but the difference was not significant (p = 0.07). In the 38 plagiocephalic patients, JF area was smaller on the flattened side than the contralateral in a significant number of cases both in right (21/7) and left (9/1) plagiocephaly (p < 0.0005) as well as the mean area (48.2 + 16.4 mm2 vs. 57.5 + 20.7 mm2, p = 0.002) and VOGS was significantly higher on the plagiocephalic side than on the contralateral side (1.6 ± 1.1 vs. 1.1 ± 0.9, p = 0.019).
CONCLUSIONS: In this series of infants affected by EH, the mean size of the ostium of both JF resulted significantly smaller than controls. JF stenosis was significantly associated with higher degrees of venous obstruction on both sides, suggesting a direct extrinsic effect of JF size on dural sinus lumen and possible consequent effect on venous outflow resistance. Positional plagiocephaly, when present, was associated with a decreased JF area and increased VOGS on the flattened side.
摘要：
目的：测量受外部脑积水（EH）影响的婴儿和对照组的颈静脉孔的大小，支持以下假设：颈静脉孔（JF）狭窄可能决定硬脑膜静脉窦改变和静脉流出阻力增加是主要病理生理因素。
方法：最小值，最大值,在对81名受EH影响的婴儿进行的一系列相衬磁共振静脉血管造影（血管MRVPCA3D）中，测量了JF区域的平均值。将结果与54个对照组进行比较。
结果：与对照组相比，患者的JF面积较小（43.1±14.6vs.52.7±17.8；p<0.001），导致患者的平均JF面积明显较小对照（51.6±15.8vs.57.0±18.3；p=0.043）。在患者中，较小的JF区域与右侧(p=0.018)和左侧(p=0.005)较高的静脉阻塞分级评分(VOGS)显著相关.在EH患者中，位置性头颅（颅穹顶不对称指数>3.5％）的发生率高于对照组（38/17），但差异不显着（p=0.07）。在38个头颅患者中，在右侧（21/7）和左侧（9/1）斜头畸形（p<0.0005）以及平均面积（48.216.4mm2vs.57.5+20.7mm2，p=0.002），斜头侧的VOGS明显高于对侧（1.6±1.1vs.1.1±0.9，p=0.019）。
结论：在这一系列受EH影响的婴儿中，两个JF的口的平均大小显着小于对照组。JF狭窄与两侧较高程度的静脉阻塞显著相关，提示JF大小对硬脑膜窦腔的直接外在影响，以及对静脉流出阻力的可能后果。位置性头颅，当存在时,与平坦侧的JF面积减少和VOGS增加有关。
方法：最小值，最大值,在对81名受EH影响的婴儿进行的一系列相衬磁共振静脉血管造影（血管MRVPCA3D）中，测量了JF区域的平均值。将结果与54个对照组进行比较。
结果：与对照组相比，患者的JF面积较小（43.1±14.6vs.52.7±17.8；p<0.001），导致患者的平均JF面积明显较小对照（51.6±15.8vs.57.0±18.3；p=0.043）。在患者中，较小的JF区域与右侧(p=0.018)和左侧(p=0.005)较高的静脉阻塞分级评分(VOGS)显著相关.在EH患者中，位置性头颅（颅穹顶不对称指数>3.5％）的发生率高于对照组（38/17），但差异不显着（p=0.07）。在38个头颅患者中，在右侧（21/7）和左侧（9/1）斜头畸形（p<0.0005）以及平均面积（48.216.4mm2vs.57.5+20.7mm2，p=0.002），斜头侧的VOGS明显高于对侧（1.6±1.1vs.1.1±0.9，p=0.019）。
结论：在这一系列受EH影响的婴儿中，两个JF的口的平均大小显着小于对照组。JF狭窄与两侧较高程度的静脉阻塞显著相关，提示JF大小对硬脑膜窦腔的直接外在影响，以及对静脉流出阻力的可能后果。位置性头颅，当存在时,与平坦侧的JF面积减少和VOGS增加有关。
