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DOI: 10.1055/s-0030-1252007
© Georg Thieme Verlag KG Stuttgart · New York
Vein of Labbé Mimicking an Occipital Epidural Hematoma
Publikationsverlauf
Publikationsdatum:
17. Mai 2010 (online)
Introduction
The vein of Labbé (VL) or inferior anastomotic vein is defined as a cortical cerebral vein that connects the middle superficial vein, which is located in the sylvian fissure, and the transverse sinus [18] [22]. This vessel is of prime importance since it participates in draining the posterior part of both the temporal and parietal lobes [2] [16]. The VL is not commonly seen on computed tomography (CT) studies [25] [26] due to its similar density to brain tissue, its close anatomical relation to the temporal bone, and its relatively small caliber. Furthermore, VL is rarely implicated in post-traumatic complications. Thus, VL is not usually kept in mind by either neurosurgeons or radiologists when analyzing CT scan images, even after head trauma.
We report the case of a mild head trauma patient, whose urgent CT scan showed an image compatible with an occipital epidural hematoma. After thorough radiological and clinical analysis the initial diagnosis of extradural hematoma was ruled out, while a prominent and looped VL was disclosed as being responsible for the false image on CT.
References
- 1 Asanin B. Traumatic epidural hematomas in posterior cranial fossa. Acta Clin Croat. 2009; 48 27-30
- 2 Bigelow DC, Hoffer ME, Schlakman B. et al . Angiographic assessment of the transverse sinus and vein of Labbé to avoid complications in skull base surgery. Skull Base Surg. 1993; 3 217-222
- 3 Bor-Seng-Shu E, Aguiar PH, de Almeida Leme RJ. et al . Epidural hematomas of the posterior cranial fossa. Neurosurg Focus. 2004; 16 ECP1
- 4 Bozbuğa M, Izgi N, Polat G. et al . Posterior fossa epidural hematomas: observations on a series of 73 cases. Neurosurg Rev. 1999; 22 34-40
- 5 Cawley CM, Barrow DL, Dion JE. Treatment of lateral-sigmoid and sagittal sinus dural arteriovenous malformations.. In: Youmans JR, Neurological Surgery. 5th ed. Vol. 2. Philadelphia: WB Saunders; 2004: 2283-2291
- 6 Dirim BV, Orük C, Erdoğan N. et al . Traumatic posterior fossa hematomas. Diagn Interv Radiol. 2005; 11 14-18
- 7 Hayashi T, Kameyama M, Imaizumi S. et al . Acute epidural hematoma of the posterior fossa – cases of acute clinical deterioration. Am J Emerg Med. 2007; 25 989-995
- 8 Karasu A, Sabanci PA, Izgi N. et al . Traumatic epidural hematomas of the posterior cranial fossa. Surg Neurol. 2008; 69 247-252
- 9 Khwaja HA, Hormbrey PJ. Posterior cranial fossa venous extradural haematoma: an uncommon form of intracranial injury. Emerg Med J. 2001; 18 496-497
- 10 Koperna T, Tschabitscher M, Knosp E. The termination of the vein of “Labbé” and its microsurgical significance. Acta Neurochir (Wien). 1992; 118 172-175
- 11 Kraus M, Shelef I, Niv A. et al . The vein of Labbè masquerading as an epidural abscess. J Laryngol Otol. 2007; 121 e12
- 12 Krisht AF, Barrow DL, Al-Mefty O. et al .Venous anatomy of the vein of Labbé complex, in Hakuba A (ed): Surgery of the Intracranial Venous System. Tokyo: Springer-Verlag; 1996: 36-42
- 13 Labbé C. Note sur la circulation veineuse du cerveau et sur le mode de developpement des corpusules de Pacchioni. Arch Physiol Norm Pathol. 1879; 11 135-154
- 14 Li TC, Chen Y, Lin SM. et al . Acute posterior fossa isodense epidural hematoma: diagnostic pitfalls on computed tomography. J Trauma. 2007; 63 417-419
- 15 Lui TN, Lee ST, Chang CN. et al . Epidural hematomas in the posterior cranial fossa. J Trauma. 1993; 34 211-215
- 16 Lustig LR, Jackler RK. The vulnerability of the vein of Labbé during combined craniotomies of the middle and posterior fossae. Skull Base Surg. 1998; 8 1-9
- 17 Malik NK, Makhdoomi R, Indira B. et al . Posterior fossa extradural hematoma: our experience and review of the literature. Surg Neurol. 2007; 68 155-158
- 18 Morita A, Sekhar LN. Reconstruction of the vein of Labbé by using a short saphenous vein bypass graft. Technical note. J Neurosurg. 1998; 89 671-675
- 19 Ng WH, Yeo TT, Seow WT. Non-traumatic spontaneous acute epidural haematoma – report of two cases and review of the literature. J Clin Neurosci. 2004; 11 791-793
- 20 Otsuka S, Nakatsu S, Matsumoto S. et al . Study on cases with posterior fossa epidural hematoma – clinical features and indications for operation. Neurol Med Chir. 1990; 30 24-28
- 21 Prat R, Galeano I. [Posterior fossa venous epidural hematoma. Based on 2 cases]. Neurologia. 2003; 18 38-41 [Spanish]
- 22 Rhoton Jr AL. The cerebral veins. Neurosurgery. 2002; 51 (4 Suppl) S159-S205
- 23 Saigal G, Villalobos E. A variant of the superficial middle cerebral vein mimicking an extraaxial hematoma. AJNR Am J Neuroradiol. 2003; 24 968-970
- 24 Sanchís JF, Orozco M, Cabanes J. Spontaneous extradural haematomas. J Neurol Neurosurg Psychiatry. 1975; 38 577-580
- 25 Sener RN. The occipitotemporal vein: a cadaver, MRI and CT study. Neuroradiology. 1994; 36 117-120
- 26 Sener RN. The lateral temporal vein: a cadaver, CT and MRI study. Neuroradiology. 1996; 38 (S 01) S57-S59
Correspondence
Dr. J. Ros de San Pedro
Hospital Universitario Virgen de la Arrixaca
Neurosurgery Crta Madrid-Cartagena sn
30120 El Palmar
Spain
Telefon: 0034 968 369489
Telefon: 0034 699 946277
Fax: 0034 968 369678
eMail: javierrosdesanpedro@yahoo.es