Object. The purpose of this anatomical study is to identify reliable extern
al landmarks that can be used to determine accurately the lower border of t
he proximal segment of the transverse sinus (TS).
Methods. The authors used 15 formalin-fixed cadaveric specimens for this pr
oject. Various anatomical structures were dissected and measurements of the
distance between these structures and the proximal TS were obtained.
The data collected in this study demonstrate that the inion is not always a
reliable external landmark to use when determining the internal location o
f the very proximal TS and its drainage into the area of the torcular herop
hili. In addition, the authors found that the most accurate external landma
rk to use in reliably estimating the internal placement of the proximal TS
is the point of insertion of the musculus semispinalis capitus and not the
superior nuchal line. In the present study, this muscle never covered more
than 5 mm of the inferior edge of the TS and was found to be a reliable ana
tomical structure for avoiding the medial segment of the TS.
Conclusions. These findings could aid the surgeon in localizing the TS with
various midline approaches to the posterior fossa and the craniocervical j
unction.