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Mastoid foramen, mastoid emissary vein and clinical implications in neurosurgery
Martin Hampl1, David Kachlik2, Katerina Kikalova3
1Department of Neurosurgery, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Olomouc, Czech Republic.
Insights
The mastoid emissary vein, crucial for neurosurgery, varies in number and location. Understanding its anatomy and using high-resolution computed tomography aids surgical planning and reduces bleeding risks.
Area of Science:
- Neurosurgery
- Anatomy
- Radiology
Background:
- The mastoid emissary vein is anatomically significant for neurosurgical approaches.
- Its variable location near the occipitomastoid suture can cause bleeding during mastoid process surgeries, particularly retrosigmoid craniotomy.
- High-resolution computed tomography is ideal for pre-operative imaging of these structures.
Purpose of the Study:
- To provide detailed anatomical information on the mastoid emissary vein.
- To analyze quantitative and qualitative parameters of the mastoid foramen.
- To assess variations based on side and gender.
Main Methods:
- Studied 295 skulls from anatomical collections and a museum.
- Evaluated quantitative and qualitative parameters of the mastoid foramen.
- Measured distances from surface landmarks and related anatomical structures, statistically processing the data.
Main Results:
- Type II (Louis) was the most frequent mastoid foramen type (41.2%).
- No statistically significant differences were found between right and left sides.
- Gender-based differences observed in the number of openings, predominant types, and distances from landmarks.
Conclusions:
- Thorough pre-operative imaging, particularly high-resolution computed tomography, is essential.
- Mastery of microsurgical techniques is vital for successful treatment in complex anatomical areas.
- Detailed anatomical knowledge of the mastoid emissary vein improves surgical outcomes.
Background:
Mastoid emissary vein is especially important from the neurosurgical point of view, because it is located in variable number in the area of the occipitomastoid suture and it can become a source of significant bleeding in surgical approaches through the mastoid process, especially in retrosigmoid craniotomy, which is used for approaches to pathologies localized in the cerebellopontine angle. Ideal imaging method for diagnosis of these neglected structures when planning a surgical approach is high-resolution computed tomography. The aim of this work was to provide detailed information about this issue.
Methods:
We studied a group of 295 skulls obtained from collections of five anatomy departments and the National Museum. Both quantitative and qualitative parameters of the mastoid foramen were evaluated depending on side of appearance and gender. Individual distances of the mastoid foramen from clearly defined surface landmarks (asterion, apex of mastoid process, foramen magnum) and other anatomical structures closely related to this issue (width of groove for sigmoid sinus, diameters of internal and external openings of mastoid foramen) were statistically processed.
Results:
The most frequently represented type of the mastoid foramen is type II by Louis (41.2%). The differences between right and left sides were not statistically significant. In men there was a higher number of openings on the right side and in qualitative parameters the type III and IV predominated, whereas in women the types I and II were more frequent. In men, greater distances from the mastoid foramen were observed when evaluating qualitative parameters for defined surface landmarks. Mean size of the external opening diameter was 1.3 mm; however, several openings measured up to 7 mm.
Conclusions:
Despite excellent knowledge of anatomy, however, good pre-operative examination using imaging methods and mastering of microsurgical techniques create the base for successful treatment of pathological structures in these anatomically complex areas.
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