Superior and inferior ophthalmic veins, (SOV, IOV) drain into CS which in turn drain into the superior and inferior petrosal
sinuses [Figure 1].
1) It is formed by the union of the sigmoid and inferior petrosal
dural venous sinuses within the jugular foramen.
The sigmoid sinus, inferior petrosal
sinus, meningeal branches of occipital and ascending pharyngeal arteries, glossopharyngeal nerve, vagus nerve and accessory nerve with their ganglia traverse the foramen.
Subsequent bilateral inferior petrosal
sinus sample (BIPSS) was performed for the localization diagnosis [Figure 1]d, which demonstrated adrenocorticotrophic hormone (ACTH) level of inferior petrosal
sinus and femoral vein at 0 min were 691.
The gold standard CRH test is performed using bilateral inferior petrosal
sinus sampling (9).
A critical analysis of the value of simultaneous inferior petrosal
sinus sampling in Cushing's disease and the occult ectopic adrenocorticotropin syndrome.
The efferent are basilar plexus end inferior petrosal
The patient was referred for inferior petrosal
sinus vein sampling, which surprisingly did not show a central to peripheral ACTH gradient.
During the procedure, cerebral angiography demonstrated an 80% stenosis of the left ICA and an ipsilateral direct CCF draining into the contralateral cavernous sinus via the intercavernous sinuses, posteriorly into the internal jugular veins through the inferior petrosal
No adenoma was revealed, but inferior petrosal
sinus sampling showed a central origin.
If this failed, venous access was made and the cavernous sinus was cannulated with microcatheter from either the inferior petrosal
sinus route or through angular / ophthalmic vein and embolization was done by using pushable platinum coils (Figure-2) and/or cyanoacrylate glue.
The reason for this difference likely lies in the lack of availability in their center of the inferior petrosal
sampling (IPSS) test.