title: Contrast-enhanced Reformatted MR Images for Preoperative Assessment of the Bridging Veins of the Skull Base.
abstract: Magnetic resonance (MR) venography and computed tomographic (CT) venography are suited for displaying the convexity veins that drain the medial and lateral surfaces of the brain hemispheres. However, such is not the case for the bridging veins of the skull base. Technical factors prevent contrast material-enhanced MR or CT images obtained in standard axial, coronal, and sagittal planes from fully displaying the curved pathways of these clinically important venous structures. This limitation can be overcome by using a reconstruction technique that depicts these venous structures and their interconnections. Curved and multiplanar reformatted images that distill the important venous features often require knowledgeable manipulation of source images by an operator who is familiar with numerous venous variants and their surgical implications. The normal anatomy of the draining veins is detailed-anatomy that radiologists must master before they can show the surgeon the important venous anatomy that is often missing at standard imaging; this information will foster better communication between radiologists and their surgical colleagues. As a practical matter, the skull base veins are arbitrarily subdivided into those that are at greatest risk with the pterional approach and the subtemporal approach, respectively. These approaches can be expanded to define connections between the superficial venous system and the other valveless venous networks that drain the deep portions of the cerebral hemisphere, the scalp, face, muscles of the neck, diploë of the skull, and meninges. As radiologists gain experience, their image interpretations should mature beyond simple analysis of the primary hemodynamic changes induced by intraoperative sacrifice or injury.
authors.affiliation: From the Department of Radiology, University of Pittsburgh Medical Center, 200 Lothrop St, 2nd Floor, Suite 200, East Wing, Pittsburgh, PA 15213 (P.W.); Departments of Diagnostic Radiology (L.S.C., K.B.S., B.G., A.J.K.) and Neurosurgery (F.D.), University of Texas MD Anderson Cancer Center, Houston, Tex; Estigia Teleradiology Services, Santiago, Chile (R.F.V.); and Anatom-e Information Systems, Houston, Tex (L.A.H.).
authors.forename: Pattana
authors.initials: P
authors.lastname: Wangaryattawanich
authors.affiliation: From the Department of Radiology, University of Pittsburgh Medical Center, 200 Lothrop St, 2nd Floor, Suite 200, East Wing, Pittsburgh, PA 15213 (P.W.); Departments of Diagnostic Radiology (L.S.C., K.B.S., B.G., A.J.K.) and Neurosurgery (F.D.), University of Texas MD Anderson Cancer Center, Houston, Tex; Estigia Teleradiology Services, Santiago, Chile (R.F.V.); and Anatom-e Information Systems, Houston, Tex (L.A.H.).
authors.forename: Lakshmi S
authors.initials: LS
authors.lastname: Chavali
authors.affiliation: From the Department of Radiology, University of Pittsburgh Medical Center, 200 Lothrop St, 2nd Floor, Suite 200, East Wing, Pittsburgh, PA 15213 (P.W.); Departments of Diagnostic Radiology (L.S.C., K.B.S., B.G., A.J.K.) and Neurosurgery (F.D.), University of Texas MD Anderson Cancer Center, Houston, Tex; Estigia Teleradiology Services, Santiago, Chile (R.F.V.); and Anatom-e Information Systems, Houston, Tex (L.A.H.).
authors.forename: Komal B
authors.initials: KB
authors.lastname: Shah
authors.affiliation: From the Department of Radiology, University of Pittsburgh Medical Center, 200 Lothrop St, 2nd Floor, Suite 200, East Wing, Pittsburgh, PA 15213 (P.W.); Departments of Diagnostic Radiology (L.S.C., K.B.S., B.G., A.J.K.) and Neurosurgery (F.D.), University of Texas MD Anderson Cancer Center, Houston, Tex; Estigia Teleradiology Services, Santiago, Chile (R.F.V.); and Anatom-e Information Systems, Houston, Tex (L.A.H.).
authors.forename: Bhanu
authors.initials: B
authors.lastname: Gogia
authors.affiliation: From the Department of Radiology, University of Pittsburgh Medical Center, 200 Lothrop St, 2nd Floor, Suite 200, East Wing, Pittsburgh, PA 15213 (P.W.); Departments of Diagnostic Radiology (L.S.C., K.B.S., B.G., A.J.K.) and Neurosurgery (F.D.), University of Texas MD Anderson Cancer Center, Houston, Tex; Estigia Teleradiology Services, Santiago, Chile (R.F.V.); and Anatom-e Information Systems, Houston, Tex (L.A.H.).
authors.forename: Raul F
authors.initials: RF
authors.lastname: Valenzuela
authors.affiliation: From the Department of Radiology, University of Pittsburgh Medical Center, 200 Lothrop St, 2nd Floor, Suite 200, East Wing, Pittsburgh, PA 15213 (P.W.); Departments of Diagnostic Radiology (L.S.C., K.B.S., B.G., A.J.K.) and Neurosurgery (F.D.), University of Texas MD Anderson Cancer Center, Houston, Tex; Estigia Teleradiology Services, Santiago, Chile (R.F.V.); and Anatom-e Information Systems, Houston, Tex (L.A.H.).
authors.forename: Franco
authors.initials: F
authors.lastname: DeMonte
authors.affiliation: From the Department of Radiology, University of Pittsburgh Medical Center, 200 Lothrop St, 2nd Floor, Suite 200, East Wing, Pittsburgh, PA 15213 (P.W.); Departments of Diagnostic Radiology (L.S.C., K.B.S., B.G., A.J.K.) and Neurosurgery (F.D.), University of Texas MD Anderson Cancer Center, Houston, Tex; Estigia Teleradiology Services, Santiago, Chile (R.F.V.); and Anatom-e Information Systems, Houston, Tex (L.A.H.).
authors.forename: Ashok J
authors.initials: AJ
authors.lastname: Kumar
authors.affiliation: From the Department of Radiology, University of Pittsburgh Medical Center, 200 Lothrop St, 2nd Floor, Suite 200, East Wing, Pittsburgh, PA 15213 (P.W.); Departments of Diagnostic Radiology (L.S.C., K.B.S., B.G., A.J.K.) and Neurosurgery (F.D.), University of Texas MD Anderson Cancer Center, Houston, Tex; Estigia Teleradiology Services, Santiago, Chile (R.F.V.); and Anatom-e Information Systems, Houston, Tex (L.A.H.).
authors.forename: L Anne
authors.initials: LA
authors.lastname: Hayman
mesh_terms: D002550:Cerebral Veins / Q000473:pathology* / Q000601:surgery*; D003287:Contrast Media; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D018810:Magnetic Resonance Angiography / Q000379:methods*; D056888:Patient Positioning / Q000379:methods; D011300:Preoperative Care / Q000379:methods*; D011379:Prognosis; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D019291:Skull Base / Q000098:blood supply* / Q000601:surgery*; D014680:Veins
chemical_list: D003287:Contrast Media