Muscle Insertion Line as a Simple Landmark To Identify the Transverse Sinus When Neuronavigation Is Unavailable

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• 作者：Juri Kivelev¹ ; ^{j.v.kivelev@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; Riku Kivisaari² ; Mika Niemelä ; ² ; Juha Hernesniemi²
• 关键词：Posterior craniotomy ; Muscle insertion ; Venous sinuses
• 刊名：World Neurosurgery
• 出版年：2016
• 出版时间：October 2016
• 年：2016
• 卷：94
• 期：Complete
• 页码：394-397
• 全文大小：1167 K

文摘

Skull opening in occipital and suboccipital regions might be associated with risk of damage to the transverse venous sinus and the confluence of sinuses. We analyze the value of magnetic resonance (MR) imaging in localizing the venous sinuses in relation to the superior muscle insertion line (MIL) on the occipital bone.

Methods

We retrospectively analyzed head MR images of 100 consecutive patients imaged for any reason from 1 January 2013. All MR images were interpreted by a radiologist (R.K.). The superior MIL was identified at the midline and on both midpupillar lines, which represent the most frequent sites of skin incision and craniotomy (median and lateral suboccipital craniotomy, respectively).

Results

Patients comprised 56 women (56%) and 44 men (44%). Their mean age was 54 (range 18–84) years. The muscles of the posterior skull were readily visible and clearly identified in both T1 and T2 images of all patients. Identification of the insertion zone and its relation to the venous structures was most readily made in the sagittal plane.

Conclusion

We found that the upper muscle insertion line on occipital bone corresponds to the underlying venous sinus and can be used as a reliable anatomic landmark. We identified it in 100% of preoperative MR images of heads with an intact occiput.