Skip to main content

Advertisement

Log in

Possible cerebrospinal fluid pathways in the middle fossa floor and pterional diploe: a magnetic resonance imaging study

  • Original Article
  • Published:
Surgical and Radiologic Anatomy Aims and scope Submit manuscript

Abstract

Purpose

There has not been a study documenting the distribution of cerebrospinal fluid (CSF) pathways in the anterolateral base of the middle fossa (ALB) and diploe of the pterional region (Pt). The present study aimed to delineate these pathways using magnetic resonance imaging.

Methods

Thin-sliced, axial, and coronal T2-weighted sequences were performed for a total of 358 outpatients, including 20 pediatric patients.

Results

Adult population: CSF-filled channels were identified on axial images in the ALB in 57% and in the diploe of the Pt in 65% of 338 patients. These pathways showed variable morphology and number bilaterally. CSF-filled channels were identified on coronal images in the ALB in 14% and in the diploe of the Pt in 100% of 59 patients. These were delineated as linear structures of variable number and thickness. Eleven percent of the pathways identified in the ALB was connected with extracranial channels. Pediatric population: CSF-filled channels were identified on axial images in the ALB in 75% and in the diploe of the Pt in 80% of 20 patients.

Conclusions

The ALB and diploe of the Pt may function as CSF pathways in children and adults. The pathways in the ALB can be a CSF-drainage route connecting to the extracranial sites.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

Similar content being viewed by others

References

  1. Aksu F, Akyer SP, Kale A, Geylan S, Gayretli O (2014) The localization and morphology of pterion in adult West Anatolian skulls. J Craniofac Surg 25:1488–1491

    Article  PubMed  Google Scholar 

  2. Apostolopoulos K, Ferekidis E (2003) Extensive primary Ewings’ sarcoma in the greater wing of the sphenoid bone. ORL J Otorhinolaryngol Relat Spec 65:235–237

    Article  PubMed  Google Scholar 

  3. Aspelund A, Antila S, Proulx ST, Karlsen TV, Karaman S, Detmar M, Wiig H, Alitalo K (2015) A dural lymphatic vascular system that drains brain interstitial fluid and macromolecules. J Exp Med 212:991–999

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Aydin ME, Kopuz C, Demir MT, Corumlu U, Kaya AH (2010) Localization of pterion in neonatal cadavers: a morphometric study. Surg Radiol Anat 32:545–550

    Article  PubMed  Google Scholar 

  5. Battal B, Hamcan S, Akgun V, Sari S, Oz O, Tasar M, Castillo M (2016) Brain herniations into the dural venous sinus or calvarium: MRI findings, possible causes and clinical significance. Eur Radiol 26:1723–1731

    Article  PubMed  Google Scholar 

  6. Boulton M, Flessner M, Armstrong D, Hay J, Johnston M (1998) Determination of volumetric cerebrospinal fluid absorption into extracranial lymphatics in sheep. Am J Physiol 274:R88–R96

    Article  CAS  PubMed  Google Scholar 

  7. Boulton M, Armstrong D, Flessner M, Hay J, Szalai JP, Johnston M (1998) Raised intracranial pressure increases CSF drainage through arachnoid villi and extracranial lymphatics. Am J Physiol 275:R889–R896

    CAS  PubMed  Google Scholar 

  8. Cohen JE, Gomori JM, Grigoriadis S, Spektor S, Rajz G (2008) Dural arteriovenous fistula of the greater sphenoid wing region in neurofibromatosis type 1. Pediatr Neurosurg 44:172–175

    Article  PubMed  Google Scholar 

  9. Crisi G, Calo M, Mauri C (1986) Case report 358: desmoid tumor of the greater wing of the right sphenoid bone. Skeletal Radiol 15:247–250

    Article  CAS  PubMed  Google Scholar 

  10. De Foer B, Hermans R, Morlion J, Baert AL (1993) Solitary plasmacytoma of the greater wing with secondary submandibular soft tissue metastasis. J Belge Radiol 76:169–170

    PubMed  Google Scholar 

  11. Eide PK, Vatnehol SAS, Emblem KE, Ringstad G (2018) Magnetic resonance imaging provides evidence of glymphatic drainage from human brain to cervical lymph nodes. Sci Rep 8:7194

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Gupta PK, Mital M, Dwivedi A, Gupta K (2011) Metastasis of greater wing of sphenoid bone in bronchogenic carcinoma: a unusual case report. J Cancer Res Ther 7:195–197

    Article  CAS  PubMed  Google Scholar 

  13. Johnston M (2003) The importance of lymphatics in cerebrospinal fluid transport. Lymphat Res Biol 1:41–44

    Article  PubMed  Google Scholar 

  14. Kandemirli SG, Candan S, Bilgin C (2019) Post-traumatic occipital intradiploic encephalocele. World Neurosurg. https://doi.org/10.1016/j.wneu.2019.05.174

    Article  PubMed  Google Scholar 

  15. Ma S, Baillie LJ, Stringer MD (2012) Reappraising the surface anatomy of the pterion and its relationship to the middle meningeal artery. Clin Anat 25:330–339

    Article  PubMed  Google Scholar 

  16. Meel R, Thulkar S, Sharma MC, Jagadesan P, Mohanti BK, Sharma SC, Bakhshi S (2012) Childhood osteosarcoma of greater wing of sphenoid: case report and review of literature. J Pediatr Hematol Oncol 34:e59–e62

    Article  PubMed  Google Scholar 

  17. Nevrekar D, Abdu E, Selden NR (2009) Craniectomy for a bilobed dermoid cyst in the temporal fossa and greater wing of the sphenoid bone. Pediatr Neurosurg 45:46–48

    Article  PubMed  Google Scholar 

  18. Oguz O, Sanli SG, Bozkir MG, Soames RW (2004) The pterion in Turkish male skulls. Surg Radiol Anat 26:220–224

    Article  CAS  PubMed  Google Scholar 

  19. Pelaz AC, Llorente Pendás JL, Rodrigo Tapia JP, Suárez Nieto C (2008) Giant cell tumor of the greater wing of the sphenoid: an unusual presentation. J Craniofac Surg 19:822–826

    Article  PubMed  Google Scholar 

  20. Pinna A, Demontis S, Maltese G, Dore S, Carta F (2005) Absence of the greater sphenoid wing in neurofibromatosis 1. Arch Ophthalmol 123:1454

    Article  PubMed  Google Scholar 

  21. Pun A, King JA, Phal PM, Iseli TA (2018) Giant pseudomeningocele of the greater wing of sphenoid. ANZ J Surg 88:E89–E90

    Article  PubMed  Google Scholar 

  22. Reymond J, Charuta A, Wysocki J (2005) The morphology and morphometry of the foramina of the greater wing of the human sphenoid bone. Folia Morphol (Warsz) 64:188–193

    Google Scholar 

  23. Rhoton AL Jr (2002) The anterior and middle cranial base. Neurosurgery 51:S273–S302

    PubMed  Google Scholar 

  24. Sharma RR, Netalkar A, Lad SD (2000) Primary Ewing’s sarcoma of the greater wing of the sphenoid bone. Br J Neurosurg 14:53–56

    Article  CAS  PubMed  Google Scholar 

  25. Urbach H, Jamneala G, Mader I, Egger K, Yang S, Altenmüller D (2018) Temporal lobe epilepsy due to meningoencephaloceles into the greater sphenoid wing: a consequence of idiopathic intracranial hypertension? Neuroradiology 60:51–60

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

This work was not supported by grant funding.

Author information

Authors and Affiliations

Authors

Contributions

All the authors contributed equally to the study. ST conceived the study design. HI and YY collected the imaging data. HO and HI analyzed the imaging data. ST wrote the manuscript.

Corresponding author

Correspondence to Satoshi Tsutsumi.

Ethics declarations

Conflict of interest

The authors have no conflicts of interest concerning the materials or methods used in this study, or the findings presented in this paper.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tsutsumi, S., Ono, H., Yasumoto, Y. et al. Possible cerebrospinal fluid pathways in the middle fossa floor and pterional diploe: a magnetic resonance imaging study. Surg Radiol Anat 41, 1045–1051 (2019). https://doi.org/10.1007/s00276-019-02290-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00276-019-02290-z

Keywords

Navigation