Beyin yüzeyel venöz sisteminin dijital subtraksiyon anjiografi görüntüleri üzerinden morfometrik analizi ve tiplendirilmesi
Date
2019
Authors
Yılmaz, Meriç Yıldız
Journal Title
Journal ISSN
Volume Title
Publisher
Bursa Uludağ Üniversitesi
Abstract
Serebral venöz anatomi konusunda literatürde yeterli çalışma yoktur ve venlere arterler kadar dikkat edilmemiştir. Beyin venöz sistemi karmaşık bir anatomiye ve belirgin değişkenliğe sahiptir. Venöz sistemin normal varyasyonları, belirli bölümlerin aplazisi ve / veya hipoplazisi, çoklu bulunma, fenestrasyonlar gibi embriyolojik kalıntıların varlığını içerir. Bu değişikliklerin bilinmesi bazı hastalıkların takibinde ve cerrahi yönetiminde değerlendirmek için gerekli olabilir. Beynin venöz drenajı, serebral venlerden sinus durae matris’lere, oradan da vena jugularis interna’lar ile sistemik dolaşıma bağlanır. Beyin venleri vv. cerebri ve vv. cerebelli olmak üzere temelde iki grupta toplanabilir. Vv. cerebri de anatomik konumlarına göre; yüzeyel venöz sistem (vv. superficiales cerebri) ve derin venöz sistem (vv. profundae cerebri) olarak incelenebilir. Serebral venlere, varyasyonlarının da fazla olması nedeniyle çalışmalarda öncelik verilmemiştir. Ancak venöz yapıların hasara uğraması hemipleji, koma ve ölümü içeren ciddi sonuçlara neden olabilir. Bu yüzden cerrahi işlemlerde venlerin korunmasına özen gösterilmelidir. Bu çalışmada venöz sistemin özellikleri, venlerin birbirleri ile ilişkisi, en sık bulunma yerleri ve varyasyonları üzerinde durulmuştur. Çalışmanın amacı beyin yüzeyel venlerinin sınıflandırılması ve morfolojik özelliklerinin belirlenmesidir. Çalışmada Bursa Uludağ Üniversitesi Radyoloji Anabilim Dalı arşivlerindeki dijital subtraksiyon anjiyografi (DSA) görüntüleri üzerinden 1302 hastada beynin venöz yapıları incelenmiş, 297 olgu çeşitli nedenlerle çalışma dışında bırakılmıştır. Çalışmada incelenen sayısal parametreler şunlardır. Sinus sagittalis superior (SSS), Labbe veni (v. anastomotica inferior), Trolard veni (v. anastomotica superior), sinus transversus, sinus sigmoideus ve v. cerebri media superficialis’in çapları, sinus sigmoideus’un v. jugularis interna’ya döküldüğü yerdeki çapı ve v. cerebri superior sayılarıdır. Açısal ölçüm yapılan parametreler; sinus transversus ile SSS, sinus rectus ile SSS, v. cerebri media superficialis ile Trolard veni, v. cerebri media superficialis ile Labbe veni, sinus transversus iii ile Labbe veni, Trolard veni ile SSS, v. cerebri superior’lar ile SSS, sinus rectus ile sinus transversus arasındaki açılardır. Morfolojik olarak tiplendirme başlığı altında incelenen parametreler ise Labbe ve Trolard venlerinin bulunma durumu ve birbirleri ile ilişkisi, sinus transversus’un taraf baskınlığıdır. Verilerin değerlendirilmesinde, Bursa Uludağ Üniversitesi Tıp Fakültesi Radyoloji A.D’nda iş istasyonlarında yüklü olan Centricity RIS-i Plus® 4.2 ve Centricity PACS® (GE, Fairfield, Connecticut, USA) programlarındaki tetkik görüntüleri ve raporları kullanılmıştır. Elde edilen sonuçlar IBM SPSS 23 (Statistical Package for the Social Sciences) ile analiz edilmiştir. Hastaların yaş ortalaması, 54,5 ± 18,382 olarak bulundu. 528’i (% 52,54) kadın, 477’si (% 47,46) erkekti. 1005 hastanın Labbe ve Trolard venlerinin v. media cerebri superficialis ile ilişkisinin incelenmesi ve beyin yüzeyel venlerinin sınıflandırılmasında 439 hastada her iki anastomotik ven de mevcuttu. Çalışmamızda SSS çapı ortalama 6,65 mm olarak bulunmuştur. Vv. cerebri superiores ortalama sayısı 8 adet ven olarak belirlenmiştir. Bir intrakraniyal ameliyatı planlarken, serebrovasküler sistemin anatomik varyasyonlarının bilgisi ve preoperatif tanınması çok önemlidir. Venöz anatominin varyasyonları, beyinde kronik patolojik durumlara katkıda bulunabilir veya işlemler sırasında komplikasyonlar yaratabilir. Çalışmamızın detaylı bir şekilde beyin yüzeyel venöz anatomisini incelenmesinin literatüre önemli bir katkı sağlayacağını düşünüyoruz.
In the literature, there is not enough study on cerebral venous anatomy, and the veins are not considered significant as arteries. The brain venous system has a complex anatomy and significant variability. Normal variations of the venous system include the presence of embryological residues such as aplasia and hypoplasia of certain regions, multiple presences, fenestrations. Knowing these changes may be necessary to evaluate the follow-up and surgical management of some diseases. Venous drainage of the brain is connected to the systemic circulation from the cerebral veins to the dural sinuses and then to the internal jugular vein. Brain veins mainly can be divided into two groups as cerebral veins and cerebellar veins. Cerebral veins, according to the anatomical position, are divided as superficial cerebral and deep venous system. Cerebral veins were not given priority in the studies due to their frequent high variations. However, damage to venous structures may have serious consequences, including hemiplegia, coma, and death. Therefore, care should be taken to protect the veins in surgical procedures. In this study, the features of the venous system, the relationship of the veins with each other, the most common locations and variations were discussed. The study aimed to classify the superficial veins of the brain and to determine their morphological characteristics. In this study, 1302 patients underwent digital subtraction angiography (DSA) images in the archives of Bursa Uludag University Radiology Department. The numerical parameters examined in the study are as follows. Superior sagittal sinus, Labbe's vein (inferior anastomotic vein), Trolard's vein (superior anastomotic vein), transverse sinus, sigmoid sinus, and medial cerebral vein diameters, v sigmoid sinus, internal jugular vein, and superior cerebral veins are numbers. Angular measurement parameters are between transverse sinus and superior sagittal sinus, straight sinus and superior sagittal sinus, medial cerebral vein and Trolard's vein, medial cerebral veins and Labbe's vein, transverse sinus and Labbe's vein, Trolard's vein and superior sagittal sinus, superior cerebral veins and superior sagittal sinus, straight sinus sinus and transverse sinus. The parameters examined under the title of morphological typing are the presence of the Labbe's and Trolard's veins and their relationship with each other, and the dominant side of the transverse sinus. In the evaluation of the data, the examination images and reports of Centricity RIS-i Plus® 4.2 and Centricity PACS® (GE, Fairfield, Connecticut, USA) programs installed in workstations in Bursa Uludag University Faculty of Medicine Radiology Department were used. The results were analyzed with IBM SPSS 23 (Statistical Package for the Social Sciences). The mean age of the patients was 54.5 ± 18.382. 528 (52.54%) were female, and 477 (47.46%) were male. Both anastomotic veins were present in 439 patients in the examination of the relationship between the medial cerebral vein and the classification of superficial veins of the brain. In our study, the mean diameter of the superior sagittal sinus was 6.65 mm. The average number of superior cerebral veins was determined as eight. When planning an intracranial surgery, knowledge of anatomical variations of the cerebrovascular system and preoperative recognition is critical. Variations of venous anatomy may contribute to chronic pathological conditions in the brain or cause complications during procedures. We think that the study of superficial venous anatomy of the brain in detail will make an essential contribution to the literature.
In the literature, there is not enough study on cerebral venous anatomy, and the veins are not considered significant as arteries. The brain venous system has a complex anatomy and significant variability. Normal variations of the venous system include the presence of embryological residues such as aplasia and hypoplasia of certain regions, multiple presences, fenestrations. Knowing these changes may be necessary to evaluate the follow-up and surgical management of some diseases. Venous drainage of the brain is connected to the systemic circulation from the cerebral veins to the dural sinuses and then to the internal jugular vein. Brain veins mainly can be divided into two groups as cerebral veins and cerebellar veins. Cerebral veins, according to the anatomical position, are divided as superficial cerebral and deep venous system. Cerebral veins were not given priority in the studies due to their frequent high variations. However, damage to venous structures may have serious consequences, including hemiplegia, coma, and death. Therefore, care should be taken to protect the veins in surgical procedures. In this study, the features of the venous system, the relationship of the veins with each other, the most common locations and variations were discussed. The study aimed to classify the superficial veins of the brain and to determine their morphological characteristics. In this study, 1302 patients underwent digital subtraction angiography (DSA) images in the archives of Bursa Uludag University Radiology Department. The numerical parameters examined in the study are as follows. Superior sagittal sinus, Labbe's vein (inferior anastomotic vein), Trolard's vein (superior anastomotic vein), transverse sinus, sigmoid sinus, and medial cerebral vein diameters, v sigmoid sinus, internal jugular vein, and superior cerebral veins are numbers. Angular measurement parameters are between transverse sinus and superior sagittal sinus, straight sinus and superior sagittal sinus, medial cerebral vein and Trolard's vein, medial cerebral veins and Labbe's vein, transverse sinus and Labbe's vein, Trolard's vein and superior sagittal sinus, superior cerebral veins and superior sagittal sinus, straight sinus sinus and transverse sinus. The parameters examined under the title of morphological typing are the presence of the Labbe's and Trolard's veins and their relationship with each other, and the dominant side of the transverse sinus. In the evaluation of the data, the examination images and reports of Centricity RIS-i Plus® 4.2 and Centricity PACS® (GE, Fairfield, Connecticut, USA) programs installed in workstations in Bursa Uludag University Faculty of Medicine Radiology Department were used. The results were analyzed with IBM SPSS 23 (Statistical Package for the Social Sciences). The mean age of the patients was 54.5 ± 18.382. 528 (52.54%) were female, and 477 (47.46%) were male. Both anastomotic veins were present in 439 patients in the examination of the relationship between the medial cerebral vein and the classification of superficial veins of the brain. In our study, the mean diameter of the superior sagittal sinus was 6.65 mm. The average number of superior cerebral veins was determined as eight. When planning an intracranial surgery, knowledge of anatomical variations of the cerebrovascular system and preoperative recognition is critical. Variations of venous anatomy may contribute to chronic pathological conditions in the brain or cause complications during procedures. We think that the study of superficial venous anatomy of the brain in detail will make an essential contribution to the literature.
Description
Keywords
Sinus durae matris, Beyin venleri, Dijital subtraksiyon anjiyografi, Serebral venöz anatomi, Dural venous sinuses, Brain veins, Cerebral venous anatomy, Digital substraction angiography
Citation
Yılmaz, M. Y. (2019). Beyin yüzeyel venöz sisteminin dijital subtraksiyon anjiografi görüntüleri üzerinden morfometrik analizi ve tiplendirilmesi. Yayınlanmamış tıpta uzmanlık tezi. Bursa Uludağ Üniversitesi Tıp Fakültesi.