Sigmoid sinus diverticulum is a rare vascular anomaly often associated with pulsatile tinnitus. It can occur in cases of chronic otitis media squamous type (unsafe type) due to dehiscence of the sigmoid sinus plate caused by cholesteatoma. The presentation of which is that of pulsatile tinnitus. However, we present an unusual case of sigmoid sinus diverticulum occurring concurrently with chronic otitis media mucosal type (safe type) but in the absence of pulsatile tinnitus. This case report highlights the diagnostic challenges and management of this rare clinical scenario.

OBJECTIVE: The aim of this study was to investigate whether the relative narrowing of the dural venous sinuses by arachnoid granulations (AGs) is more pronounced in patients with idiopathic intracranial hypertension (IIH) compared to healthy controls.
BACKGROUND: IIH is characterized by increased intracranial pressure, which is associated with symptoms such as headache and visual disturbances. The role of cerebral venous drainage obstruction in IIH is the subject of ongoing research.
METHODS: In this retrospective case-control study, 3D contrast-enhanced magnetic resonance images of a cohort of 43 patients with IIH were evaluated for (1) the number of AGs per venous sinus and (2) the diameters of the dural venous sinuses at the site of an AG and at standardized measurement points. In addition, the minimum width of the transverse/sigmoid sinus was measured. All data were compared to the same data from a cohort of 43 control participants.
RESULTS: Patients with IIH showed less relative sinus narrowing by AG compared to controls (median: 7%, interquartile range [IQR] 10% vs. 11%, IQR 9% in controls; p = 0.009). In patients with IIH, sinus diameter was larger at the site of an AG (70 ± 25 mm2) compared to its diameter at the standardized measurement point (48 ± 23 mm2; p = 0.010). In the superior sagittal sinus (SSS), patients with IIH had smaller AGs (median: 3 mm2, IQR 2 mm2 vs. 5 mm2, IQR 3 mm2 in controls; p = 0.023) while the respective sinus segment was larger (median: 69 mm2; IQR 21 mm2 vs. 52 mm2, IQR 26 mm2 in controls; p = 0.002). The right transverse sinus was narrower in patients with IIH (41 ± 21 mm vs. 57 ± 20 mm in controls; p < 0.001).
CONCLUSIONS: In contrast to our hypothesis, patients with IIH showed less pronounced relative sinus narrowing by AG compared to controls, especially within the SSS, where AGs were smaller and the corresponding sinus segment wider. Smaller AGs could result in lower cerebrospinal fluid resorption, favoring the development of IIH. Conversely, the smaller AGs could also be a consequence of IIH due to backpressure in the SSS because of the narrower transverse/sigmoid sinus, which widens the SSS and compresses the AG.

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OBJECTIVE: To assess clinical and radiological characteristics of simultaneous acute supra- and infratentorial epidural hematomas.
METHODS: We retrospectively reviewed the clinical and radiological data of 18 patients with a concomitant acute supra- and infratentorial epidural hematoma, who were treated and followed up at our hospital.
RESULTS: The Glasgow Coma Score was 3-8 in four patients, was 9-12 in seven, and was 13-15 in seven patients. While the concomitant supra- and infratentorial hematoma did not cross the midline in 15 of the patients, it did in three of them. The dural venous sinus rupture was repaired in five of the patients. Functional healing was observed in 14 of the 18 patients. Two of the patients died during the postoperative period.
CONCLUSIONS: A simultaneous supra- and infratentorial epidural hematoma rarely occurs in neurosurgical practice. Mortality and morbidity rates are high if these are not addressed in time. The radiological images of patients should be evaluated carefully preoperatively. In patients with a concomitant infra- and supratentorial hematoma, transverse sinus damage, which is a surgical challenge, should be considered. Herein, we describe a surgical technique (supra- and infratentorial craniotomy leaving the bone bridge over the transverse sinus) for draining a concomitant supra- and infratentorial epidural hematoma; this technique is an effective surgical choice in select patients.

BACKGROUND: Sigmoid sinus wall dehiscence can lead to pulsatile tinnitus with a significant decrease in quality of life, occasionally leading to psychiatric disorders. Several surgical and endovascular procedures have been described for resolving dehiscence. Within endovascular procedures, the sagittal sinus approach could be a technical alternative for tracking and accurate stent positioning within the sigmoid sinus when the jugular bulb anatomy is unfavorable.
METHODS: A retrospective case series of three patients with pulsatile tinnitus due to sigmoid sinus wall dehiscence without intracranial hypertension was reviewed from January 2018 to January 2022. From the participants enrolled, the median age was 50.3 years (range 43-63), with 67% self-identifying as female and 33% as male. They self-identified as Hispanic. Sigmoid sinus dehiscence was diagnosed using angiotomography, and contralateral transverse sinus stenosis was observed in all patients. Patients underwent surgery via a navigated endovascular sagittal sinus approach for sigmoid sinus stenting. No neurological complications were associated with the procedure. Pulsatile tinnitus improved after the procedure in all patients.
CONCLUSIONS: Superior sagittal sinus resection for sigmoid sinus wall stenting is a safe and effective technique. Pulsatile tinnitus due to sigmoid sinus wall dehiscence could be treated using the endovascular resurfacing stenting technique. However, further research is needed to evaluate the potential benefit of contralateral stenting for removing sinus dehiscence when venous stenosis is detected. However, resurfacing sigmoid sinus wall dehiscence results in symptomatic improvement.

Veins at the craniocervical junction are complex network structures. They empty into two main brain venous drainages, the internal jugular vein and internal vertebral venous plexus, and reroute venous blood according to postural changes. They are also involved in the etiology of dural arteriovenous shunts in this region. Hence, regional venous anatomy is crucial for interventional neuroradiologists to understand the pathophysiology and formulate therapeutic strategies. This article aims to provide a summary on venous anatomy, radiological findings, and related pathological conditions, especially for young and inexperienced interventional neuroradiologists.

The superior petrosal sinus and petrosal vein are important drainage routes for the posterior cranial fossa, with some variations and collateral vessels. An anterolateral-type tentorial dural arteriovenous fistula, which occurs around the petrosal vein, often develops aggressive symptoms due to venous reflux to the brainstem and cerebellum. Neuroendovascular treatment of this fistula is usually challenging because transarterial embolization has a high risk and indications for transvenous embolization are limited. In the cavernous sinus and transverse sinus/sigmoid sinus dural arteriovenous fistulas, venous reflux to the petrosal vein is dangerous, and a treatment strategy with the occlusion of the petrosal vein is indispensable. Furthermore, attention should be paid to venous approaches through the superior petrosal sinus.

The transverse sinus(TS)and sigmoid sinus(SS)are common sites for dural arteriovenous fistulas, and an understanding of vascular anatomy is important when developing treatment strategies. In recent years, transarterial embolization, with a liquid embolization material, has become the treatment of choice, preserving the sinus without extensive coil filling of the affected sinus. With this expansion of therapeutic options, we feel that an understanding of the microanatomy has become more important. For example, the exact site where the vein of Labbé joins the TS should be determined. This article focuses on the development and anatomy of the TS and SS and makes points that should be considered when treating dural arteriovenous fistulas.

The superior sagittal sinus(SSS)is contained within the dura, which consists of the dura propria and osteal dura at the junction of the falx cerebri, in addition to the attachment of the falx to the cranial vault. The SSS extends anteriorly from the foramen cecum and posteriorly to the torcular Herophili. The superior cerebral veins flow into the SSS, coursing under the lateral venous lacunae via bridging veins. Most of the bridging veins reach the dura and empty directly into the SSS. However, some are attached to the dural or existed in it for some distance before their sinus entrance. The venous structures of the junctional zone between the bridging vein and the SSS existed in the dura are referred to as dural venous channels. The SSS communicates with the lateral venous lacunae connecting the meningeal and diploic veins, as well as the emissary veins. These anatomical variations of the SSS are defined by the embryological processes of fusion and withdrawal of the sagittal plexus and marginal sinus.

The basal vein of Rosenthal, the vein of Galen, and the straight sinus are important venous communication routes connecting the deep, superficial, and dural sinuses. The basal vein is divided into three parts since it originates secondarily from three different areas and its venous areas are diverse. However, care should be taken because disconnection between these segments causes variations that change the venous flow path. Endovascular treatment warrants a proper understanding of this anatomical area and requires consideration of vascular occlusion and venous drainage changes.