Artikel
Is the sagittal suture a reliable anatomical landmark to localize the superior sagittal sinus?
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Autoren
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Firas Thaher
- Neurochirurgische Klinik, Katharinenhospital, Klinikum Stuttgart, Stuttgart
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Nikolai J. Hopf
- Neurochirurgische Klinik, Katharinenhospital, Klinikum Stuttgart, Stuttgart
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Anne-K. Hickmann
- Neurochirurgische Klinik, Katharinenhospital, Klinikum Stuttgart, Stuttgart
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Boris Krischek
- Universitätsklinik für Neurochirurgie, Universitätsklinikum Tübingen, Tübingen
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Sören Danz
- Abteilung für Neuroradiologie, Universitätsklinikum Tübingen, Tübingen
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Marcos Tatagiba
- Universitätsklinik für Neurochirurgie, Universitätsklinikum Tübingen, Tübingen
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Guenther C. Feigl
- Neurochirurgische Klinik, Katharinenhospital, Klinikum Stuttgart, Stuttgart
| Veröffentlicht: | 21. Mai 2013 |
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Gliederung
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Objective: The sagittal suture has traditionally been viewed as an external anatomical landmark indicating the location of the superior sagittal sinus (SSS) for surgical approaches. However, cadaver studies have shown variability in the relationship between the position of the sagittal suture and the underlying SSS. To further evaluate these findings, we have used a non-invasive method to examine the precise anatomical relationship between the sagittal suture and the SSS in patients.
Method: An image guidance system (IGS) with volumetric 3D image rendering (CBYONTM - Med-Surgical Services Inc., Sunnyvale California, USA) was used to visualize the position of the sagittal suture in relation to the SSS. Computed tomography images from 30 patients, who received CT scans with contrast enhancement during diagnostic imaging, were used for this study. 3D volumetric image rendering of the cranial bone and dural vasculature were performed. The position of the sagittal suture in relationship to the SSS was assessed by modulation of the opacity of the skull bone in the 3D images using the IGS. Measurements were performed on three predefined points along the course of the sagittal sinus at the bregma, the lamda and in the middle between these two landmarks.
Results: The SSS was found to deviate to the right side of the sagittal suture in 50%, deviation to the left side at the bregma was noted in 10 % of cases. In 46.7% the SSS was located right of the sagittal suture at the midpoint and lambda and in 10% -13% on the left side. In 40 % - 43 % the sinus was found to lie below the sagittal suture on all three predefined points.
Conclusions: Anatomical studies can be performed also with non invasive methods using a state of the art neuronavigation system. Neurosurgeons should be aware of the fact that the sagittal suture is not a reliable bony skull landmark to locate the SSS. A thorough study of preoperative images or an IGS can help to localize the SSS intraoperatively and prevent an injury of the SSS when placing boreholes or drilling near the sagittal suture.
