The Anatomical Relationship Between the Transverse-Sigmoid Complex and Skull Landmarks in a 3D CTV Imaging Study

Siriwut Pokanan; Arnupap Puchaisang; Chonnawee Chaisawasthomrong; Woottinun Phondet; Atthaporn Boongird

ผู้แต่ง

Siriwut Pokanan Division of Neurosurgery, Department of Surgery, Ramathibodi Hospital, Mahidol University
Arnupap Puchaisang Division of Neurosurgery, Department of Surgery, Ramathibodi Hospital, Mahidol University
Chonnawee Chaisawasthomrong Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Praboromarajchanok Institute, Ratchaburi Medical Education Center
Woottinun Phondet Division of Neurosurgery, Department of Surgery, Ramathibodi Hospital, Mahidol University
Atthaporn Boongird Division of Neurosurgery, Department of Surgery, Ramathibodi Hospital, Mahidol University

คำสำคัญ:

Transverse-sigmoid complex, Asterion, Digastric point, Volume-rendering 3D imaging, Retrosigmoid craniotomy, Skull bony landmarks

บทคัดย่อ

Background: The retrosigmoid craniotomy is one of the most common approaches in neurosurgery. The bony landmarks related to the transverse-sigmoid sinus are important for performing surgery safely and effectively. This study investigated the relationship between the transverse-sigmoid sinus complex and external skull landmarks, focusing on the asterion–digastric point line as a reference for the vertical sigmoid sinus and related anatomy. Method: Radiographic study was conducted using 51 three-dimensional computed tomography venography scans obtained from patients older than 15 years at Ramathibodi Hospital between 2021 and 2023. Volume-rendering techniques were applied to identify the asterion, the digastric point, the transverse-sigmoid sinus junction, and the vertical segment of the sigmoid sinus. Measurements were taken at the proximal, mid, and distal portions relative to the asterion-digastric point line, with the angles in the x (coronal), y (sagittal), and z (rotational) axes set at 12°, 15°, and 120°, respectively. Results: The line connecting the asterion and the digastric point serves as the most reliable landmark (100%) for locating the vertical segment of the sigmoid sinus on both sides. The mean distances from this line to the medial border of the vertical part of the sigmoid sinus were 4.16±2.45 mm, 7.90±2.33 mm, and 3.24±1.64 mm from proximal to distal, respectively. The mastoid emissary foramen is more commonly found on the right side than on the left and is mostly located medial to this line. The occipitomastoid suture was found to be medial to the asterion- digastric point line in all cases. The mean distance from the digastric point to the occipitomastoid suture is 9.36 ± 1.30 mm on the right side and 9.48 ± 1.22 mm on the left side. Additionally, the right sigmoid sinus was significantly larger (7.50 ± 1.22 mm, P < 0.001) than the left in most cases. Conclusion: Recognizing the asterion-digastric point line and the occipitomastoid suture as the most reliable landmark for the vertical part of sigmoid sinus helps surgeons avoid inadvertent injury to the transversesigmoid venous sinus during routine craniotomy in this area.

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