Illustrated Encyclopedia of Human Anatomic Variation: Opus II: Cardiovascular System: Veins: Upper Limb
Ronald A. Bergman, PhD
Adel K. Afifi, MD, MS
Ryosuke Miyauchi, MD
Peer Review Status: Internally Peer Reviewed
Waltner provided a short outline of the development of sinuses, which may help to explain the genesis of variations. The sinuses develop from three venous plexuses, which in the primary type of circulation are drained by the "head vein" (Streeter, spec. ref. 1). The "head vein" runs along side the brain tube. In early embryonic life the primitive anterior and middle venous plexuses of the brain drain mainly into the vena capitis lateralis, which leaves the endocranium through the spurious jugular foramen and drains into the system of the external jugular vein. The spurious jugular foramen is located above the jaw joint and is usually obliterated in fully developed skulls. The posterior venous plexuses drain into the internal jugular vein, which gives origin to the sigmoid sinus. Later the sigmoid sinus becomes connected with the anterior and middle plexuses by means of a horizontally running channel which represents the lateral sinus. The vena capitis lateralis is obliterated (Labbé, spec. ref. 2).
In most mammals, both before and after birth, the venous blood of the brain is drained almost entirely through the spurious jugular foramen into the external jugular vein; this venous structure seems to be phylogenetically the older one. The internal jugular vein plays only a secondary role in the drainage. In man and in some anthropoid monkeys the main venous channel of the endocranium is the internal jugular vein. An incomplete or missing connection between these two types of venous plexuses or persistence of the primitive venous channels explains most of the (variations). A large number of persistent, patent spurious jugular foramina were reported by different authors: first by Krause, spec. ref. 3, in 1842; and then by Hyrtl, spec. ref. 4; Knott, (in 26 cases), spec. ref. 5; Luschka, spec. ref. 6; Cheatle (in 23 of 2,585 skulls examined), spec. ref 7; and others. This fact confirms the embryologic data and suggests a more frequent occurrence of the primitive, persistent petrosquamous sinus which passes through that foramen than is commonly assumed. Cheatle found 3 spurious jugular foramina located in the glenoid fossa of the temporomandibular joint, 3 in the zygomatic process, 6 at the base of the malar bone, and 11 close to the glaserian fissure. It may be mentioned here that studies of the skulls alone may lead to faulty conclusions about the venous sinuses, because frequently a small sinus is located in a large groove of the skull or a large sinus in a small groove.
I (Waltner) found few or no data about anatomic variations of the venous sinuses in textbooks of anatomy. In the following paragraph many of these variations important to the otologist will be discussed:
1. A contracted jugular foramen with a small internal jugular vein was found by Linser, spec. ref. 8, in 30 of 1,022 skulls examined. The contralateral jugular vein sometimes was four times as large in such cases. A contracted jugular foramen was five times more frequent on the left side. Swift, spec. ref. 9, reported a case in which both jugular foramina of a newborn child were rudimentary; the infant died three days after birth.
2. Absence of the lateral sinus is a rare variation and usually occurs on the left side. A few cases were reported by Lieutaud, spec. ref. 10, Hallett, spec. ref. 11, and Furstenberg, spec. ref. 12. The superior petrosal sinus was present in these cases, and continued directly into the sigmoid sinus. This variation occurs if the the internal jugular vein is not connected or is only insufficiently united with the anterior and middle venous plexuses of the brain. The sigmoid sinus, which develops from the internal jugular vein, is present, while the lateral sinus is either absent or is filiform (fig. B, of illustration).
3. A small transverse sinus leaving the endocranium through the mastoid foramen was observed by by Knott, spec. ref. 5, in 2 cases; the sinus was 1.5 mm in diameter (fig. C, of illustration). In Hoople's case, spec. ref. 13, the lateral sinus measured 3 mm and continued with the mastoid emissary vein just below the superior knee of the sigmoid sinus. A persistent petrosquamous sinus was present (spec. ref. C2).
4. A. normal lateral sinus leaving the skull through an enlarged mastoid foramen was reported by Malacarne, spec. ref. 14, it was a bilateral variation and the emissary foramen measured 15 by 10 mm. In Laff's case, spec. ref. 15, the lateral sinus abruptly curved downward into a large mastoid foramen; the jugular foramen was small, the jugular bulb was absent and the inferior petrosal sinus emptied into a small jugular vein. The whole petrous bone was infantile and underdeveloped, although the patient was 35 years old (fig. D). In Barkow's case, spec. refr. 16, the sigmoid sinus was missing between the large mastoid foramen and the jugular fossa.
5. The sigmoid sinus absent, the lateral sinus threadlike, and the large superior petrosal sinus passing through the mastoid foramen were reported in a case of Williams, spec. ref. 17. There is no information about the jugular bulb and inferior petrosal sinus because the variations just mentioned were discovered at operation. Ten years later Williams and Hallberg, spec. ref. 18, reported a case in which the operation revealed no venous sinuses on the right side.
6. A sigmoid sinus ending in a blind pouch and draining through a large mastoid foramen and a persistent petrosquamous sinus were reported by Furstenberg, spec. ref. 12, (fig. 12).
7. Complete absence of the sigmoid sinus with a large inferior petrosal and a narrow lateral sinus has already been described (fig. G).
8. Duplication of the lateral sinus is a more frequent variation. Hahn, spec. ref. 19 and Streit, spec. ref. 20, collected 12 cases of duplicated lateral sinus. The two channels sometimes are separated by a bony ridge; at other times by a fibrous septum divides the lumen of the sinus for a shorter or a longer distance (figs. H1 and H2). The change in position of the dural veins in the fetus is accomplished by the formation of a collateral vein which persists while the substituted primary one is obliterated. Duplication is due to the persistence of both these veins.
9. Hernia-like bulging of the outer walls of the sinus, especially in the region of the upper part of the knee, occurs with relative frequency (fig. I1). Ruttin, spec. ref. 22, described the following variation: A hugh sigmoid sinus ended in a blind sac in the squamous portion of the temporal bone. In addition, the jugular bulb was missing and a small vein connected the enlarged sigmoid sinus with the internal jugular vein. The superior petrosal sinus and the thin lateral sinus drained into the sigmoid sac at the usual location (fig. I2).
10. A persistent petrosquamous sinus draining the lateral sinus is a more frequent variation. Its course shows great variation. Usually it crosses the ridge of the petrous bone, follows the course of the petrosquamous fissure, and leaves the middle cranial fossa either through the spurious jugular foramen (fig. J) or with the middle meningeal vein through through the foramen spinosum. Knott, spec. ref. 5, found 7 bilateral and 19 unilateral persistent petrosquamous sinuses in 44 heads examined. Zuckerkandl, spec. ref. 23, reported a 5 mm wide petrosquamous sinus. Vernieuwe, spec. ref. 24, found a more or less developed petrosquamous in 12 of 60 fresh heads examined. Laff, spec. ref. 15, reported 3 and Streit, spec. ref. 20, reported 2 such variations, most of them with normal lateral and sigmoid sinuses. However, the petrosquamous sinus may be combined with an variation of the sigmoid sinus, as in figure F. Veins of the middle ear may drain directly into the petrosquamous sinus through the petrosquamous fissure. Cheatle, spec. ref. 7, reported two cases in which the infection spread from the middle ear to the lateral sinus by this short route of the petrosquamous sinus, which lies just above the roof of the middle ear and the atrum. This venous communication may give the explanation of some of the early septic symptoms in acute otitis media, if no pathologic condition is found in the mastoid bone.
11. The sinus may lie directly under the periosteum or the cortical layer may br thinned to a paper-like sheet by an enlarged sigmoid sinus, (Bezold, spec. ref. 25) (fig. K). Dehiscences and perforations of the cortical layer are not uncommon along the course of the sinus. Furstenberg, spec. ref. 12, described a variation in which the lateral sinus was located lateral to the skull in the soft tissue of the scalp.
The wide variation in size and location of the sigmoid sinus in the mastoid process are well known to the otologist. It may be, however, of a certain interest to mention those anatomic variations of the outer venous sinuses with which one frequently deals during operations.
1. Absence of the superior petrosal sinus was reported in a few cases (Knott, spec. ref. 5, 2 cases; Hyrtl, spec. ref. 4; 1 case; in Streit's case, spec. ref. 20 the superior petrosal sinus turned downward into the foramen spinosum of the middle cranial fossa (fig. L).
2. The superior longitudinal sinus continued directly with the jugular bulb in a case by Streit, spec. ref. 20, (fig. F).
3.The inferior petrosal sinus drained into the superior thyroid vein in a case reported by Theile, spec. ref. 26. Major variations of the inferior petrosal sinus are extremely rare.
4. Absence of the mastoid foramen and several foramina have been frequently reported. According to Coudert, spec. ref. 27, the mastoid foramen is relatively better developed in children than it is in adults. Occasionally the mastoid emissary vein crosses the mastoid cells in a long bony canal, and an isolated thrombophlebitis of an emissary vein may occur. In many cases the emissary vein was found lying on the dura of the posterior cranial fossa for variable distances. Both the internal and external openings of the mastoid foramen show the widest variations in location. A direct connection between the emissary vein and the petrosquamous sinus was described by Otto, spec. ref. 28.
5. The ophthalmopetrosal sinus connects the ophthalmic vein with the superior petrosal or the lateral sinus in 8 to 9 % of the cases, according to Knott, spec. ref. 5, and Hyrtl, spec ref. 4.
Comment by Waltner:
"Variations of the lateral and sigmoid sinuses are independent of each other, because they are developed from separate analage; a normal sigmoid sinus or a normal lateral sinus may each be present with the other absent.
The sigmoid sinus shows greater constancy and fewer variations than does the lateral sinus. This could be explained by the fact that the lateral sinus has to adapt itself to the increasing size and changing form of the surrounding structures, for example, the brain and the otic capsule. Therefore, the lateral sinus is more likely to be interfered with in its development than is the sigmoid sinus. The latter is located close to the base of the brain from the very beginning of its development.
A knowledge of the anatomic variations is of importance in cases of thrombophlebitis, not only for determining the surgical management but for understanding unusual symptoms and signs."
(SR) Special References for Waltner.
See also Cerebral Dural Sinuses and Veins
Anson, B.J., Ed. (1966) Morris' Human Anatomy, 12th ed., The Blakiston Division, McGraw-Hill Book Company, New York.
Baló, J. (1950) The dural venous sinuses. Anat. Rec. 106:319-325.
Special Reference (SR) Barkow, J.C.L. (1851) Anatomische Abhandlungen. F. Hirt, Breslau, page 1.
Bergman, R.A., Thompson, S.A., Afifi, A.K. and F.A. Saadeh. (1988) Compendium of Human Anatomic Variation: Catalog, Atlas and World Literature. Urban & Schwarzenberg, Baltimore and Baltimore.
(SR) Bezold, -. (1873) Monatsschr. Ohrenh. 7:130.
Bisaria, K.K. (1985) Anatomic variations of venous sinuses in the region of the torcular Herophili. J. Neurosurg. (Chicago) 62:90-95.
(SR) Brown, J.M. (1921) Trans. Am. Laryngol. Rhinol. Otol. Soc. 27:302.
Browning, H. (1953) The confluence of dural venous sinuses. Am. J. Anat. 92:307-329.
Campbell, E.H. (1933) The cavernous sinus. Anatomical and clinical considerations. Annales of Oto. Rhinol. Laryngol. 42:51-63.
(SR) Cheatle, A. (1899) Trans. Int. Congr. Oto., Sect. 6, page 160.
Coates, A.E. (1933-34) A note on the superior petrosal sinus and its relation to the sensory root of the trigeminal nerve. J. Anat. 68:428.
(SR) Coudert, R. (1900) Anatomie et pathologie de la veine émissaire mastoidienne. Thesis No. 492, Paris.
Delmas, A. et H. Kowsarian. (1951) Lacunes veineuses de la tente du cervelet. Assoc. Anatomistes, Comptes Rendus 38:382-387.
Dora, F. and T. Zileli (1980) Common variatins of the lateral and occipital sinuses at the confluens sinuum. Neuroradiology (Berlin) 20:23-27.
(SR) Furstenberg, A.C. (1937) Trans. Am. Acad. Ophthalmol. 42:424.
(SR) Hahn, R. (1914) Arch. Ital. Otol. 25:203.
(SR) Hallett, -. (1847) Med. Times, Lond. 17:72
Hayner, J.C. (1949) Variations of the torcular Herophili and transverse sinuses. Anat. Rec. 103:542.
(SR)Hoople, G.D. (1936) Ann. Otol. Rhinol. Laryngol. 45:1019.
(SR) Hyrtl, -. (1862) Der Sinus opththalmo-petrosus. Wien. Med. Wochenschr. (No. 19) 12:290-291.
Kalbag, R.M. and A.L. Woolf. (1967) Cerebral Venous Thrombosis. Oxford Press, London and New York.
(SR) Knott, J.F. (1881) On the cerebral sinuses and their variations. J. Anat. Physiol. 16:27-42.
(SR) Krause, C.F.T. (1842) Handbuch der menschlichen Anatomie, 2nd ed., Hahn, Hannover, page 914.
(SR) Labbé, C. (1883) Anomalies des sinus de la dure-mere. Dévelopment de ces canaux veineux dans les cas d'absence de l'un d'eux description de quelques sinus peu connus. Arch. Physiol. Norm. Pathol. S. 3, 1:1-27.
(SR) Laff, H.J. (1930) Unilateral absence of sigmoid sinus. Arch. Otolaryngol. 11:151.
(SR) Lieutaud, J. (1742) Essais anatomiques. P.M. Huart, Paris, page 332
(SR) Linser, -. (1900) Beitr. Klin. Chir. 28:642.
(SR) Luschka, -. (1859) Z. Rat. Med. 7:72.
(SR) Malacarne, M.V. (1780) Encefalotomia nuova universale. G. Briolo, Torino (cited by Labbé).
Mannu, A. (1908) Il confluente dei seni della dura madre, le sue variazione e il suo significato. Internationale Monatsschrift fürAnatomie und Physiologie, Leipzig 24:304-397.
(SR) Otto, -. cited by Streit.
Poynter, C.W.M. (1922) Congenital Anomalies of the arteries and veins of the human body with bibliography. The University Studies of the University of Nebraska 22:1-106.
(SR) Ruttin, E. (1926) Acta Oto-laryngol. 9:217.
Saxena, R.C., Beg, M.A.Q., and A.C. Das. (1973) Double straight sinus. Report of six cases. J. Neurosurg. (Chicago) 39:540-572.
Streeter, G.L. (1915) The development of the venous sinuses of the duramater in the human embryo. Am. J. Anat. (Philadelphia) 18:145-178.
(SR) Streeter, G.L. (1918) Contrib. Embryol. 8:5.
(SR) Streit, H. (1903) Arch. Ohrenh. 58:85, 161.
(SR) Swift, G.W. (1930) Transverse sinus and its relation to choked disk. Arch. Ophthalmol. 3:47.
Theile, -. cited by Streit.
(SR) Vernieuwe, -. (1921) Rev. Laryngol. 53:207.
Williams, Jr., H.L. (1930) Apparent unilateral absence of cranial venous sinuses on the right. Arch. Otolaryngol. 12:339.
Williams, Jr., H.L. and O.E. Hallberg. (1941) Congenital absence of cranial venous sinuses noted at operation. Arch. Otolaryngol. 33:78.
Waltner, J.G. (1944) Anatomic variations of the lateral and sigmoid sinuses. Archives of Otolaryngology 39:307-312.
(SR) Zuckerkandl, -. (1873) Monatsschrift Ohrenh. 7:102.
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