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Angiographic evaluation of the distance from the top of the jugular bulb to the inferior petrosal sinus–internal jugular vein junction: simple classification and identification method for the orifice of the non-visualized inferior petrosal sinus during neuroendovascular surgery

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Abstract

Background

The inferior petrosal sinus (IPS) is the transvenous access route for neurointerventional surgery that is occasionally undetectable on digital subtraction angiography (DSA) because of blockage by a clot or collapse. This study was aimed at analyzing the distance from the jugular bulb (JB) to the IPS–internal jugular vein (IJV) junction and proposing a new anatomical classification system for the IPS–IJV junction to identify the non-visualized IPS orifice.

Methods

DSA of 708 IPSs of 375 consecutive patients were retrospectively investigated to calculate the distance from the top of the JB to the IPS–IJV junction, and a simple classification system based on this distance was proposed.

Results

The median distance from the top of the JB to the IPS–IJV junction was 20.8 ± 14.7 mm. Based on the lower (10.9 mm) and upper (31.1 mm) quartiles, IPS–IJV junction variants were: type I, 0–10 mm (22.3%); type II, 11–30 mm (45.8%); type III, > 31 mm (23.9%); and type IV, no connection to the IJV (8.0%). Bilateral distances showed a positive interrelationship, with a correlation coefficient of 0.86. The bilateral symmetry type (visualized IPSs bilaterally) according to our classification occurred in 267 of 300 (89.0%) patients.

Conclusions

In this study, the IPS–IJV junction was located far from the JB (types II and III), with a higher probability (69.6%). This distance and the four-type classification demonstrated high degrees of homology with the contralateral side. These results would be useful for identifying the non-visualized IPS orifice.

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Data availability

The authors confirm that the data supporting the findings of this study are available within the article.

Abbreviations

ACCDAVF:

Anterior condylar confluence dural arteriovenous fistula

CSDAVF:

Cavernous sinus dural arteriovenous fistula

CTV:

Computed tomography venography

DSA:

Digital subtraction angiography

IJV:

Internal jugular vein

IPS:

Inferior petrosal sinus

IQR:

Interquartile range

JB:

Jugular bulb

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Authors and Affiliations

  1. Department of Neurosurgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-Ku, Sagamihara, Kanagawa, 252-0374, Japan

    Daisuke Yamamoto, Ichiyo Shibahara, Hiroyuki Koizumi, Jun Niki, Takuichiro Hide & Toshihiro Kumabe

  2. Department of Neurology, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan

    Daisuke Ishima, Ryo Usui & Ayato Kimura

  3. Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan

    Jun Oikawa

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  1. Daisuke Yamamoto
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Contributions

Daisuke Yamamoto, Ichiyo Shibahara, Hiroyuki Koizumi, and Toshihiro Kumabe contributed to the study conception and design. Material preparation and data collection were performed by Jun Niki, Daisuke Ishima, Ryo Usui, Ayato Kimura, and Takuichiro Hide. Jun Oikawa helped in statistical analysis. The first draft of the manuscript was written by Daisuke Yamamoto, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Daisuke Yamamoto.

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Declarations

This manuscript is original and has not been submitted elsewhere in part or in whole.

Ethics approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the Ethics Committee of the Kitasato University Hospital (B20-334, May 18, 2021).

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The requirement of informed consent was waived owing to the retrospective study design.

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Yamamoto, D., Shibahara, I., Koizumi, H. et al. Angiographic evaluation of the distance from the top of the jugular bulb to the inferior petrosal sinus–internal jugular vein junction: simple classification and identification method for the orifice of the non-visualized inferior petrosal sinus during neuroendovascular surgery. Acta Neurochir 165, 4095–4103 (2023). https://doi.org/10.1007/s00701-023-05887-x

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