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Anatomical study of the mastoid foramina and mastoid emissary veins: classification and application to localizing the sigmoid sinus

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Abstract

The mastoid foramen (MF) is located on the mastoid process of the temporal bone, adjacent to the occipitomastoid suture or the parietomastoid suture, and contains the mastoid emissary vein (MEV). In retrosigmoid craniotomy, the MEV has been used to localize the position of the sigmoid sinus and, thus, the placement of the initial burr hole. Therefore, this study aimed to examine the exact location and variants of the MF and MEV to determine if their use in localizing the sigmoid sinus is reasonable. The sample in this study comprised 22 adult dried skulls (44 sides). MF were identified and classified into five types based on location, prevalence, whether they communicated with the sigmoid sinus and exact entrance into the groove of the sigmoid sinus. The diameters and relative locations of the MF in the skull were measured and recorded. Finally, the skulls were drilled to investigate the course of the MEV. Additionally, ten latex-injected sides from human cadavers were also dissected to follow the MEV, especially in cases with more than one vein. We found that type I MFs (single foramen) were the most prevalent (50%). These MFs were mainly located on the occipitomastoid suture; only one case on the right side was adjacent to the parietomastoid suture. Type II (paired foramina) was the second most prevalent (22.73%), followed by type III (13.64%), type 0 (9.09%), and type IV (4.55%). The diameter of the external opening in a connecting MF (2.43 ± 0.79) was twice that of a non-connecting MF (1.14 ± 0.56). Interestingly, on one side, two MFs on the external surface shared a single internal opening; the MEV bifurcated. MFs followed three different courses: ascending, almost horizontal, and descending. Regardless of how many external openings there were for the MF, these all ended at a single opening in the groove for the sigmoid sinus. For cadaveric specimens with multiple MEVs, all terminated in the sigmoid sinus as a single vein, with the more medial veins terminating more medially into the sinus. Based on our study, the MF/MEV can guide the surgeon and help localize the deeper-lying sigmoid sinus. Knowledge of this anatomical relationship could be an adjunct to neuronavigational technologies.

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Acknowledgments

The authors sincerely thank those who donated their bodies to science so that anatomical research could be performed. Results from such research can potentially increase mankind’s overall knowledge that can then improve patient care. Therefore, these donors and their families deserve our highest gratitude [18].

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Authors and Affiliations

  1. Department of Anatomy, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand

    Arada Chaiyamoon

  2. Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, 131 S. Robertson St., Suite 1300, New Orleans, LA, 70112, USA

    Arada Chaiyamoon, Joe Iwanaga & R. Shane Tubbs

  3. Tulane University School of Medicine, New Orleans, LA, USA

    Kevin Schneider & R. Shane Tubbs

  4. Department of Neurology, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, USA

    Joe Iwanaga & R. Shane Tubbs

  5. Department of Oral and Maxillofacial Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan

    Joe Iwanaga

  6. Department of Structural & Cellular Biology, Tulane University School of Medicine, New Orleans, LA, USA

    Joe Iwanaga & R. Shane Tubbs

  7. Neurosurgery Department, ASST Cremona, Viale Concordia 1, 26100, Cremona, Italy

    Carmine Antonio Donofrio & Antonio Fioravanti

  8. Division of Biology and Genetics, Department of Molecular and Translational Medicine, Faculty of Medicine, University of Brescia, Viale Europa 11, 25123, Brescia, Italy

    Carmine Antonio Donofrio

  9. Department of Neurosurgery, IRCCS Istituto Delle Scienze Neurologiche di Bologna, Bologna, Italy

    Filippo Badaloni

  10. Department of Anatomical Sciences, St. George’s University, St. George’s, Grenada

    R. Shane Tubbs

  11. Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA

    R. Shane Tubbs

  12. Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, LA, USA

    R. Shane Tubbs

Authors
  1. Arada Chaiyamoon
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  2. Kevin Schneider
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  3. Joe Iwanaga
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  4. Carmine Antonio Donofrio
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  5. Filippo Badaloni
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  6. Antonio Fioravanti
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  7. R. Shane Tubbs
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Contributions

JI and RST conceived the concept and designed the study; AC, JI, and RST contributed to the concept; AC and KS acquired the data; AC, KS, and JI wrote the manuscript; CAD, FB, AF, and RST edited the manuscript and all authors approved the manuscript.

Corresponding author

Correspondence to Joe Iwanaga.

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Chaiyamoon, A., Schneider, K., Iwanaga, J. et al. Anatomical study of the mastoid foramina and mastoid emissary veins: classification and application to localizing the sigmoid sinus. Neurosurg Rev 47, 16 (2024). https://doi.org/10.1007/s10143-023-02229-4

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  • DOI: https://doi.org/10.1007/s10143-023-02229-4

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