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2 results

  • Superior sagittal sinus thrombosis complicating neck dissection

  • D J Howe, M J Henderson, I Ahmad
  • Journal:
    The Journal of Laryngology & Otology / Volume 124 / Issue 10 / October 2010
    Published online by Cambridge University Press:
    19 March 2010, pp. 1126-1128
    Print publication:
    October 2010
  • Objective:

    To report a superior sagittal sinus thrombosis occurring as a rare complication of neck dissection, and to present a review of published literature.

    Case report:

    A 42-year-old man underwent an elective neck dissection for a tumour stage 2, node stage 2b, tonsillar squamous cell carcinoma, prior to chemoradiotherapy. During surgery, the right internal jugular vein was sacrificed as part of the resection, as tumour was adherent to it. Two weeks after surgery, the patient was readmitted with seizures. Subsequent computed tomography and magnetic resonance venography confirmed a superior sagittal sinus thrombosis. The patient was subsequently anticoagulated and underwent radiotherapy without further complication. A review of pre-operative imaging indicated a dominant internal jugular vein, ligation of which may have been a factor in the subsequent sagittal sinus thrombosis.

    Conclusion:

    Superior sagittal sinus thrombosis following neck dissection is a rare occurrence, with little reported in the literature. Dominant internal jugular vein anatomy may be evident on pre-operative imaging. An awareness of this complication may be helpful to surgeons contemplating sacrifice of the internal jugular vein.

  • Fos expression in the midbrain periaqueductal grey after trigeminovascular stimulation

  • KAREN L. HOSKIN, DAVID C. E. BULMER, MICHELE LASALANDRA, ANJA JONKMAN, PETER J. GOADSBY
  • Journal:
    The Journal of Anatomy / Volume 198 / Issue 1 / January 2001
    Published online by Cambridge University Press:
    20 March 2001, pp. 29-35
    Print publication:
    January 2001

  • There is an accumulating body of evidence suggesting that the periaqueductal grey (PAG) is involved in the pathophysiology of migraine. Positron emission tomography (PET) studies in humans have shown that the caudal ventrolateral midbrain, encompassing the ventrolateral PAG, has activations during migraine attacks. The PAG may well be involved not only through the descending modulation of nociceptive afferent information, but also by its ascending projections to the pain processing centres of the thalamus. In this study the intranuclear oncogene protein Fos was used to mark cell activation in the PAG following stimulation of the trigeminally-innervated superior sagittal sinus (SSS) in both cats and in nonhuman primates (Macaca nemestrina). Fos expression in the PAG increased following stimulation to a median of 242 cells (interquartile range 236–272) in the cat and 155 cells (range 104–203) in the monkey, compared with control levels of 35 cells (21–50) and 26 cells (18–33), respectively. Activation was predominantly in the ventrolateral area of the caudal PAG suggesting that the PAG is involved following trigeminally-evoked craniovascular pain.