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Mastoid foramen, mastoid emissary vein and clinical implications in neurosurgery

  • Original Article - Neurosurgical Anatomy
  • Published:
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Abstract

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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Abbreviations

CT:

Computed tomography

MRI:

Magnetic resonance imaging

MRA:

Magnetic resonance angiography

HRCT:

High-resolution computed tomography

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Funding

Charles University provided financial support in the form of participation in the project Progres Q37. The sponsor had no role in the design or conduct of this research.

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Authors and Affiliations

  1. Department of Neurosurgery, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Olomouc, Czech Republic

    Martin Hampl, Matej Halaj, Vlastimil Novak, Premysl Stejskal, Miroslav Vaverka, Lumir Hrabalek & David Krahulik

  2. Department of Anatomy, Second Faculty of Medicine, Charles University, U nemocnice 3, Praha 2, 12800, Prague, Czech Republic

    David Kachlik, Roxane Riemer & Ondrej Nanka

  3. Department of Anatomy, Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, Czech Republic

    Katerina Kikalova

  4. Institute of Anatomy, First Faculty of Medicine, Charles University, Prague, Czech Republic

    Ondrej Nanka

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  1. Martin Hampl
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Corresponding author

Correspondence to David Kachlik.

Ethics declarations

The authors kindly thank the all the body donors (with written consent for experimentation with human subjects) for their gift.

The work has been carried out in accordance with The Code of Ethics of the World Medical Association (Declaration of Helsinki).

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The authors disclose that they have no potential conflicts of interest.

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Hampl, M., Kachlik, D., Kikalova, K. et al. Mastoid foramen, mastoid emissary vein and clinical implications in neurosurgery. Acta Neurochir 160, 1473–1482 (2018). https://doi.org/10.1007/s00701-018-3564-2

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  • DOI: https://doi.org/10.1007/s00701-018-3564-2

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