Tentorial Venous Anatomy: Variation in the Healthy Population

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The authors retrospectively reviewed tentorial venous anatomy of the head using CTA/CTV performed for routine care or research purposes in 238 patients. Tentorial vein development was related to the ring configuration of the tentorial sinuses. There were 3 configurations: Groups 1A and 1B had ring configuration, while group 2 did not. Group 1A had a medialized ring configuration, and group 1B had a lateralized ring configuration. Measurements of skull base development were predictive of these groups. The ring configuration of group 1 was related to the presence of a split confluens, which correlated with a decreased internal auditory canal-petroclival fissure angle. Configuration 1A was related to the degree of petrous apex pneumatization.

Abstract

BACKGROUND AND PURPOSE

Transtentorial veins. A–C, 3D volumetric reconstruction of delayed-phase CTA of the head and neck; parenchyma (0–40 HU) has been segmented out, leaving the intracranial vessels filled with contrast. A, Reconstructed volume of the head is shown from the anteroposterior view with a 30° downward rotation to show the plane of the tentorium. B, The same reconstruction as in A is rotated to show the left side. C, The same reconstruction rotated to show the right side, which is symmetric. D–F, Source axial images for the volumetric reconstruction of this scan are shown; MTV, ITV, and LTV are labeled. ICV indicates the internal cerebral vein; SS, straight sinus; SPS, superior petrosal sinus; VGC, vein of Galen confluens; TS, transverse sinus; MTV, medial tentorial sinus.

A new transtentorial venous system consisting of medial, intermediate, and lateral tentorial veins, connecting infra- and supratentorial compartments, was recently shown in 2 cadaver dissections and 2 patient scans. We sought to characterize the venous patterns within the tentorium and their relation to measures of skull development in a cohort of healthy adults.

MATERIALS AND METHODS

We retrospectively reviewed tentorial venous anatomy of the head using CTA/CTV performed for routine care or research purposes in 238 patients. Included studies had adequate contrast opacification of venous structures and a section thickness of ≤2 mm; we excluded cases with space-occupying lesions and vascular pathologies. Tentorial angle, dural sinus configurations, and measures of skull base development were assessed as predictors of tentorial venous anatomy variation via Cramér V association, the binary encoded Pearson correlation, and nearest-point algorithm with the Euclidean distance metric for clustering.

RESULTS

Tentorial vein development was related to the ringed configuration of the tentorial sinuses (P < .005). There were 3 configurations. Groups 1A and 1B (n = 50/238) had ringed configuration, while group 2 did not (n = 188/238). Group 1A (n = 38/50) had a medialized ringed configuration, and group 1B had a lateralized ringed configuration (n = 12/50). Measurements of skull base development were predictive of these groups. The ringed configuration of group 1 was related to the presence of a split confluens, which correlated with a decreased internal auditory canal–petroclival fissure angle. Configuration 1A was related to the degree of petrous apex pneumatization (P value = .010).

CONCLUSIONS

Variations in the transtentorial venous system directly correlate with cranial development.

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