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Inferior petrosal sinus 360°

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Inferior petrosal sinus 360°

  1. 1. IPS 360° 24-4-2016 1.47am
  2. 2. Great teachers – All this is their work . I am just the reader of their books . Prof. Paolo castelnuovo Prof. Aldo Stamm Prof. Mario Sanna Prof. Magnan
  3. 3. For Other powerpoint presentatioins of “ Skull base 360° ” I will update continuosly with date tag at the end as I am getting more & more information click www.skullbase360.in - you have to login to slideshare.net with Facebook account for downloading.
  4. 4. IPS & HVP hypoglossal venous plexus Cadaveric dissection image showing the hypoglossal nerve exiting the hypoglossal foramen with its corresponding vein that communicates the internal jugular vein with the basilar plexus
  5. 5. JT = jugular tubercle separates the hypoglossal canal from Jugular foramen
  6. 6. The petrous portion of the temporal bone or pyramid is pyramidal
  7. 7. the anterior petrosectomy with preoperative embolization of the inferior petrosal sinus is a time-conserving approach giving one of the best routes to reach the ventral brainstem while working in front of the cranial nerves and preserving hearing. http://www.worldneurosurgery.org/article/S0090-3019(00)00271-8/fulltext
  8. 8. The Petro-occipital Fissure- contains IPS
  9. 9. The Petro-occipital Fissure- contains IPS
  10. 10. Exocranial & Endocranial views of Jugular Foramen : Within the JF area 2 venous compartement can be identified: a large postero- lateral_SIGMOID_venous channel and a small antero-medial_PETROSAL_venous channel which can receive the drainage of the inferior petrosal sinus (IPS). An intermediary neural compartment is located between the venous ones and houses lower cranial nerves (IX, X, XI). CC carotid canal, CR carotid ridge, ESF endolymphatic sac fossa, FS foramen spinosum, IAM internal acoustic meatus, JT jugular tubercle, OC occipital condyle, PCF petroclival fi ssure, SAF subarcuate fossa, SP styloid process, SSG sigmoid sinus groove, TB tympanic bone, VPTB vaginal process of the tympanic bone, white arrow intrajugular process of the temporal bone, red arrow external ori fi ce of the hypoglossal canal, violet arrow petroclival fi ssure, blue-sky arrow tubal isthmus, black arrow endocranial orifice of the hypoglossal canal, orange arrow trigeminal impression, green arrow pyramidal fossa, black asterisks intrajugular ridge, black circle intrajugularprocess of the occipital bone
  11. 11. Usually inferior petrosal sinus opens into jugular bulb Sometimes along with jugular bulb opening , it opens into internal jugular vein also [ lower single arrow in below photo ]
  12. 12. Inferior petrosal sinus
  13. 13. a. IPS inferior to nerve IX and superior to nerves X and XII. b. IPS inferior and medial to all four nerves. c. IPS superior and lateral to all four nerves d. A second IPS joining the internal jugular vein passing medial to IX and lateral to X, XI, and XII
  14. 14. An anatomical classification according to the level of the inferior petrosal sinus–internal jugular vein junction has been developed 1. Junction at the level of the jugular bulb 2. Junction at the level of the anterior condylar vein junction (extracranial opening of the hypoglossal canal)
  15. 15. 3. Junction at the level of the lower extracranial jugular vein • CoC - level of the condylar canal • IJV- internal jugular vein • JF- level of the jugular foramen • SS- sigmoid sinus • VVP- vertebral venous plexus
  16. 16. 4. Multiple junctions: upper junction at the level of the jugular bulb and lower junction at the level of the anterior condylar vein a )Multiple upper junctions at the level of the jugular bulb (JB). b )Multiple junctions: upper junctions at the level of the jugular bulb and lower junction at the level of the anterior condylar vein. c) No connection between the internal petrosal sinus and the internal jugular vein. The sinus drains in the vertebral venous plexus.
  17. 17. In Transcochlear approach
  18. 18. In infratemporal fossa [=intact cochlear approach – Dr.Morwani ] type B approach See IPS in Kawase approach
  19. 19. Inferior petrosal sinus is superior to jugular tubercle & hypoglossal canal is inferior to jugular tubercle Infratemporal fossa [=intact cochlear approach – Dr.Morwani ] type B approach
  20. 20. See IPS & SPS in below photo A dissection from the superior aspect of the temporal bone. The horizontal portion of the internal carotid artery (ICA) is identified and its anterior medial part is covered by the gasserian ganglion (GsG). The greater superficial petrosal (gspn) nerve runs on the superolateral aspect of the artery.
  21. 21. Right sided anterior petrosectomy on a cadaver dissection: intradural exposure and operative field. PCA Petrous carotid artery; DPA drilled petrous apex; IPS inferior petrosal sinus; BA basilar artery; VI 6th cranial nerve; AICA anterior inferior cerebellar artery; P pons; V 5th cranial nerve
  22. 22. NOTE Inferior petrosal sinus at CLIVUS ICAc cavernous portion of the internal carotid artery, IPS inferior petrosal sinus, PAp petrous apex, SPCG sphenopetroclival gulf, cVIcn cisternal segment of the abducens nerve, gVIcn gulfar segment of the abducens nerve, pVIcn petrosal segment of the abducens nerve, white asterisks dura of the posterior cranial fossa
  23. 23. In infrapetrous approach there are chances of injury to 6th nerve [ in dorello’s canal medial to paraclival carotid ] & 12th nerve
  24. 24. In middle cranial fossa approach
  25. 25. In middle cranial fossa approach
  26. 26. ITFA with Transcondylar Transtubercular approach Here Transcondylar is through Occipital Condyle ; Transtubercular is through Jugular tubercle
  27. 27. * occipital condyle , IJV internal jugular vein , IPS inferior petrosal sinus , JB jugular vein , PCV posterior condylar vein , SS sigmoid sinus
  28. 28. Note the relationship among the sigmoid sinus, jugular bulb, posterior condylar vein, vertebral artery, and lower cranial nerves. C1 atlas , C2N C2 nerve , JB jugular bulb , PCV posterior condylar vein SS sigmoid sinus , TP transverse process of C1 , VA vertebral artery , X vagus nerve , XI spinal accessory nerve
  29. 29. The posterior condylar vein crossing the occipital condyle is noted. ICA internal carotid artery , JB jugular bulb , PCV posterior condylar vein IX glossopharyngeal nerve , XI spinal accessory nerve
  30. 30. After removal of the posterior condylar vein and further removal of the occipital condyle (OC), the hypoglossal nerve (XII) is noted. , ICA internal carotid artery , JB jugular bulb JT jugular tubercle , OC occipital condyle , VA vertebral artery , XI spinal accessory nerve , XII hypoglossal nerve
  31. 31. The lower cranial nerves have an intimate relationship with the jugular tubercle (three black arrows). When the occipital bone and jugular tubercle are being drilled, careful attention should be paid to avoiding damage to the lower cranial nerves. , Cbl cerebellum , ICA internal carotid artery , OC occipital condyle , TP transverse process of the C1 vertebra , VA vertebral artery , VIII cochleovestibular nerve , IX glossopharyngeal nerve , XI spinal accessory nerve
  32. 32. For Other powerpoint presentatioins of “ Skull base 360° ” I will update continuosly with date tag at the end as I am getting more & more information click www.skullbase360.in - you have to login to slideshare.net with Facebook account for downloading.

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