Acta Neurochirurgica

, Volume 160, Issue 7, pp 1473–1482 | Cite as

Mastoid foramen, mastoid emissary vein and clinical implications in neurosurgery

  • Martin Hampl
  • David Kachlik
  • Katerina Kikalova
  • Roxane Riemer
  • Matej Halaj
  • Vlastimil Novak
  • Premysl Stejskal
  • Miroslav Vaverka
  • Lumir Hrabalek
  • David Krahulik
  • Ondrej Nanka
Original Article - Neurosurgical Anatomy



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.


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.


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.


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.


Mastoid emissary Mastoid foramen Mastoid emissary vein Vena emissaria mastoidea Foramen mastoideum 



Computed tomography


Magnetic resonance imaging


Magnetic resonance angiography


High-resolution computed tomography



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.

Compliance with ethical standards

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).

Conflict of interest

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


  1. 1.
    Anderson PJ, Harkness WJ, Taylor W, Jones BM, Hayward RD (1997) Anomalous venous drainage in a case of non-syndromic craniosynostosis. Childs Nerv Syst 13:97–100CrossRefPubMedGoogle Scholar
  2. 2.
    Berry AC, Berry RJ (1967) Epigenetic variation in the human cranium. J Anat 101:361–379PubMedPubMedCentralGoogle Scholar
  3. 3.
    Boyd GI (1930) The emissary foramina of the cranium in man and the anthropoids. J Anat 65:108–121PubMedPubMedCentralGoogle Scholar
  4. 4.
    Braun JP, Tournade A (1977) Venous drainage in the craniocervical region. Neuroradiology 13:155–158CrossRefPubMedGoogle Scholar
  5. 5.
    Cheatle A (1925) The mastoid emissary vein and its surgical importance. Proc R Soc Med 18:29–34PubMedPubMedCentralGoogle Scholar
  6. 6.
    Cushing H (1917) Tumours of the nervous acoustic and the syndrome of the cerebellopontine angle. Saunders, PhiladelphiaGoogle Scholar
  7. 7.
    Demirpolat G, Bulbul E, Yanik B (2016) The prevalence and morphometric features of mastoid emissary vein on multidetector computed tomography. Folia Morphol (Warsz) 75:448–453CrossRefGoogle Scholar
  8. 8.
    Ebner FH, Kleiter M, Danz S, Ernemann U, Hirt B, Löwenheim H, Roser F, Tatagiba M (2014) Topographic changes in petrous bone anatomy in the presence of a vestibular schwannoma and implications for the retrosigmoid transmeatal approach. Neurosurgery 10:481–486CrossRefPubMedGoogle Scholar
  9. 9.
    El Kettani C, Badaoui R, Fikri M, Jeanjean P, Montpellier D, Tchaoussoff J (2002) Pulmonary edema after venous air embolism during craniotomy. Eur J Anaesthesiol 19:846–848CrossRefPubMedGoogle Scholar
  10. 10.
    Falk D (1986) Evolution of cranial blood drainage in hominids: enlarged occipital/marginal sinuses and emissary foramina. Am J Phys Anthropol 70:311–324CrossRefPubMedGoogle Scholar
  11. 11.
    Gudim-Levkovich VV (1972) Roentgenologic image of the canal of the cranial mastoid emissary vein. Zh Ushn Nos Grol Bolezn 33:61–64Google Scholar
  12. 12.
    Hadeishi H, Yasui N, Suzuki A (1995) Mastoid canal and migrated bone wax in the sigmoid sinus: technical report. Neurosurgery 36:1220–1223CrossRefPubMedGoogle Scholar
  13. 13.
    Hoshi M, Yoshida K, Ogawa K, Kawase T (2000) Hypoglossal neurinoma. Two case reports. Neurol Med Chir 40:489–493CrossRefGoogle Scholar
  14. 14.
    Inumaru H (1925) Über das Foramen mastoideum. Folia Anat Jpn 3:229–238Google Scholar
  15. 15.
    Irmak MK, Korkmaz A, Erogul O (2004) Selective brain cooling seems to be a mechanism leading to human craniofacial diversity observed in different geographical regions. Med Hypotheses 63:974–979CrossRefPubMedGoogle Scholar
  16. 16.
    Keskil S, Gözil R, Çalgüner E (2003) Common surgical pitfalls in the skull. Surg Neurol 59:228–231CrossRefPubMedGoogle Scholar
  17. 17.
    Kim LK, Ahn CS, Fernandes AE (2014) Mastoid emissary vein: anatomy and clinical relevance in plastic & reconstructive surgery. J Plast Reconstr Aesthet Surg 67:775–780CrossRefPubMedGoogle Scholar
  18. 18.
    Koesling S, Kunkel P, Schul T (2005) Vascular anomalies, sutures and small canals of the temporal bone on axial CT. Eur J Radiol 54:335–343CrossRefPubMedGoogle Scholar
  19. 19.
    Lang J Jr, Samii A (1991) Retrosigmoidal approach to the posterior cranial fossa. An anatomical study. Acta Neurochir 111(3–4):147–153CrossRefPubMedGoogle Scholar
  20. 20.
    Lee SH, Kim SS, Sung KY, Nam EC (2013) Pulsatile tinnitus caused by a dilated mastoid emissary vein. J Korean Med Sci 28:628–630CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Louis RG Jr, Loukas M, Wartmann CT, Tubbs RS, Apaydin N, Gupta AA, Spentzouris G, Ysique JR (2009) Clinical anatomy of the mastoid and occipital emissary veins in a large series. Surg Radiol Anat 31:139–144CrossRefPubMedGoogle Scholar
  22. 22.
    Malis LI (1975) Microsurgical treatment of acoustic neurinomas. In: Handa H (ed) Microsurgery. Igaku Shoin, TokyoGoogle Scholar
  23. 23.
    Marsot-Dupuch K, Gayet-Delacroix M, Elmaleh-Bergès M, Bonneville F, Lasjaunias P (2001) The petrosquamosal sinus: CT and MR findings of a rare emissary vein. Am J Neuroradiol 22:1186–1193PubMedGoogle Scholar
  24. 24.
    McKenzie D (1913) Thrombo-phlebitis of the mastoid emissary vein. Proc R Soc Med 6:95PubMedPubMedCentralGoogle Scholar
  25. 25.
    Murlimanju BV, Prabhu LV, Pai MM, Jaffar M, Saralaya VV, Tonse M, Prameela MD (2011) Occipital emissary foramina in human skulls: an anatomical investigation with reference to surgical anatomy of emissary veins. Turk Neurosurg 21:36–38PubMedGoogle Scholar
  26. 26.
    Murlimanju BV, Chettiar GK, Prameela MD, Tonse M, Kumar N, Saralaya VV, Prabhu LV (2014) Mastoid emissary foramina: an anatomical morphological study with discussion on their evolutionary and clinical implications. Anat Cell Biol 47:202–206CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Okudera T, Huang YP, Ohta T, Yokota A, Nakamura Y, Maehar F, Utsunomiya H, Uemura K, Fukasawa H (1994) Development of posterior fossa dural sinuses, emissary veins and jugular bulb: morphological and radiologic study. Am J Neuroradiol 15:1871–1883PubMedGoogle Scholar
  28. 28.
    Pekçevik Y, Pekçevik R (2014) Why should we report posterior fossa emissary veins? Diagn Interv Radiol 20:78–81PubMedGoogle Scholar
  29. 29.
    Portet JM, Pidgeon C, Cunningham AJ (1999) The sitting position in neurosurgery: a critical appraisal. Br J Anesth 82:117–128CrossRefGoogle Scholar
  30. 30.
    Rand RW, Kurze T (1965) Microneurosurgical resection of acoustic tumours by a transmeatal posterior fossa approach. Bull Los Angel Neurol Soc 30:17–20Google Scholar
  31. 31.
    Reis CV, Deshmukh V, Zabramski JM, Crusius M, Desmukh P, Spetzler RF, Preul MC (2007) Anatomy of the mastoid emissary vein and venous system of the posterior neck region: neurosurgical implications. Neurosurgery 61(Suppl 2):193–201PubMedGoogle Scholar
  32. 32.
    Roser F, Ebner FH, Ernemann U, Tatagiba M, Ramina K (2011) Improved CT imaging for mastoid emissary vein visualization prior to posterior fossa approaches. Surg Radiol Anat 33:827–831CrossRefGoogle Scholar
  33. 33.
    Samii M (1979) Neurochirurgische Gesichtspunkte der Behandlung der Akustikusneurinome mit besonderer berücksichtigung des Nervus facialis. Laryngol Rhinol Otol (Stuttg) 58:97–106Google Scholar
  34. 34.
    Souders JR (2000) Pulmonary air embolism. J Clin Monit Comput 16:375–383CrossRefPubMedGoogle Scholar
  35. 35.
    Standefer M, Bay JW, Truso R (1984) The sitting position in neurosurgery a retrospective analysis of 488 cases. Neurosurgery 14:649–658CrossRefPubMedGoogle Scholar
  36. 36.
    Treves F (1885) Surgical applied anatomy. Lead Brothers, Philadelphia, pp 10–12Google Scholar
  37. 37.
    Tsutsumi S, Ono H, Yasumoto Y (2017) The mastoid emissary vein: an anatomic study with magnetic resonance imaging. Surg Radiol Anat 39:351–356CrossRefPubMedGoogle Scholar
  38. 38.
    Tubbs RS, Shoja MM, Loukas M (eds) (2016) Bergman’s comprehensive encyclopedia of human anatomic variation. Wiley, Hoboken, pp 817–818Google Scholar
  39. 39.
    Yasargil MG (1978) Mikrochirurgie der Kleinhirnbruckenwinkeltumoren. In: Plester D, Wende S, Nakayama N (eds) Kleinhirnbruckenwinkeltumoren. Springer, Berlin, pp 215–257Google Scholar

Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2018

Authors and Affiliations

  • Martin Hampl
    • 1
  • David Kachlik
    • 2
  • Katerina Kikalova
    • 3
  • Roxane Riemer
    • 2
  • Matej Halaj
    • 1
  • Vlastimil Novak
    • 1
  • Premysl Stejskal
    • 1
  • Miroslav Vaverka
    • 1
  • Lumir Hrabalek
    • 1
  • David Krahulik
    • 1
  • Ondrej Nanka
    • 2
    • 4
  1. 1.Department of Neurosurgery, Faculty of Medicine and DentistryPalacky University Olomouc and University Hospital OlomoucOlomoucCzech Republic
  2. 2.Department of Anatomy, Second Faculty of MedicineCharles UniversityPragueCzech Republic
  3. 3.Department of Anatomy, Faculty of Medicine and DentistryPalacky University OlomoucOlomoucCzech Republic
  4. 4.Institute of Anatomy, First Faculty of MedicineCharles UniversityPragueCzech Republic

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