Increased intracranial pressure as a complication of unilateral radical neck dissection in a patient with congenital absence of the transverse sinus

Internal jugular vein reconstruction: An algorithm for reconstructive surgeons

OBJECTIVES

The internal jugular vein (IJV) provides critical drainage from the brain, skull, and deep regions of the face and neck. Compromise to the bilateral IJVs has severe sequelae, but even unilateral IJV sacrifice or thrombosis after treatment can have sequelae. Despite the potential role of IJV reconstruction for head and neck surgeons, information about the indications, technique, and outcomes of the procedure are sparse.

PATIENTS AND METHODS

We present a woman who had IJV sacrifice for an oral cavity cancer along with a contralateral selective neck dissection and adjuvant chemoradiation who developed occlusion of the contralateral IJV after her treatment, resulting in unacceptable cervical lymphedema and extensive neck varicosities. An end-to-side bypass from the superior IJV to the ipsilateral external jugular vein was performed.

RESULTS

There were no complications from the procedure, which resulted in dissipation of her preoperative symptoms. We describe the literature surrounding IJV reconstruction, considerations for its use, the technique itself, and advice for perioperative management.

CONCLUSION

IJV reconstruction is a valuable but underutilized technique for the head and neck microvascular surgeon in cases of bilateral threatened IJV outflow.

Fenestrated Falx Cerebri and Additional Sinuses in the Tentorium Cerebelli

Morphological variations of falx cerebri and tentorium cerebelli are extremely rare. The authors report an extremely rare type of combined variation of falx cerebri and dural venous sinuses in the tentorium cerebelli. During the removal of the brain from cranial cavity, it was noted that the anterior part of the falx cerebri had fenestrations and it looked like a mesh. There was no associated variations of medial surface of cerebrum. Further, there were unusual sinuses within the tentorium cerebelli. Two of them were present in the right half of the tentorium cerebelli and one in the left half of the tentorium cerebelli. There variations could be of importance to radiologists and neurosurgeons. The fenestrations of falx cerebri might lead to misinterpretations in cases of head injuries and the additional sinuses in the tentorium cerebelli might cause unexpected bleeding during surgeries of posterior cranial fossa.

Diplopia-an unheralded consequence of neck dissection: case report

INTRODUCTION

Neck dissection is a part of the standard surgical procedure in the management of head and neck malignancy. Diplopia following neck dissection is a rare entity; hence, its diagnosis and management strategies needed to be discussed for prevention of its grave consequences.

CASE REPORT

A 30-year-old male patient presented with binocular horizontal diplopia following total thyroidectomy and neck dissection. On evaluation, there was internal jugular vein (IJV) thrombosis followed by cerebral venous sinus thrombosis (CVST). After meticulous medical management with diuretics and antiplatelet drugs, diplopia resolved completely and normal vision was restored.

CONCLUSION

Therapeutic ligation of internal jugular vein during neck dissection may result in IJV thrombosis followed by CVST leading to raised intracranial tension (ICT). It has to be anticipated and addressed as early as possible to prevent its grave consequences like blindness and death.

Thyroid carcinoma with extensive tumor thrombus in the superior vena cava: A case report

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This is an uncommon surgical case report of thyroid carcinoma with extensive tumor thrombus in the superior vena cava.

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Management criteria for thyroid carcinoma with venous tumor thrombus is considered for safe and effective operation.

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Treatment and natural history for pulmonary infarction that occurred for drop off of the tumor thrombus are recognizable.

Introduction

Venous tumor thrombus of thyroid cancer that extend to the great vein is rare, and management criteria for venous thrombus have not been established yet. We report a surgical case of thyroid carcinoma with extensive tumor thrombus in the superior vena cava (SVC) and consider the appropriate treatment strategy for venous thrombus.

Presentation of case

A 75-year-old woman consulted our hospital because of thyroid carcinoma with an extensive tumor thrombus. Computed tomography (CT) revealed a solitary thyroid mass with extensive continuous tumor thrombus in the left internal jugular vein, innominate vein, and SVC. We planned complete tumor resection. During operation, the tumor thrombus in the SVC disappeared, suggesting that pulmonary embolism occurred. Therefore, she underwent total thyroidectomy with extensive phlebectomy (the innominate and internal jugular veins). Although she had some morbidities during her postoperative course, she was followed up for 6 months without progression of thyroid cancer.

Discussion and conclusion

Intravascular tumor extension of thyroid carcinoma is rare, but is a life-threatening complication. For patients with thyroid tumor with venous tumor thrombus, segmental resection and thrombectomy should be considered if radical operation is possible. Therefore, preoperative correct imaging evaluation and operative planning are necessary to perform safe and effective operations. We suggest a management criteria for patients with thyroid carcinoma with venous tumor thrombus.

Diplopia as a sequel of unilateral neck dissection

BACKGROUND

The purpose of this study was to discuss the underlying etiology of raised intracranial pressure and its sequel after unilateral internal jugular vein ligation. In addition, the management protocol for such rare cases has been discussed along with literature review.

METHODS

PubMed and Google were used to search the literature for cases of raised intracranial pressure with complications after unilateral internal jugular vein (IJV) ligation. Twelve case reports with 17 patients were identified.

RESULTS

There were 13 male and 4 female patients ranging between the ages of 26 and 61 years. Headache (n = 12/17; 70.5%), diplopia (n = 10/17; 58.8%), impaired vision (n = 9/17; 52.9%), and aplasia or hypoplasia of the transverse sinus were seen in these patients.

CONCLUSION

Although very rare, this potential complication after unilateral IJV ligation should be kept in mind. Magnetic resonance venogram (MRV) is the investigation of choice to ascertain the underlying etiology. Conservative management should be started immediately. Surgical options are reserved for patients with progressive symptoms. © 2016 Wiley Periodicals, Inc. Head Neck, 2016 © 2016 Wiley Periodicals, Inc. Head Neck 38:E2475-E2478, 2016.

Changes in the jugular bulb associated with sacrifice of the internal jugular vein

OBJECTIVE

To determine whether sacrifice of the internal jugular vein (IJV) causes subsequent changes in the jugular bulb.

STUDY DESIGN

Retrospective chart review.

SETTING

Tertiary referral center.

PATIENTS

Patients were selected by CPT code for neck dissection and were included in the study if they had undergone unilateral neck dissection and had preoperative and postoperative computed tomographic scans through the temporal bone.

INTERVENTIONS

The jugular bulb was measured in the axial plane for anteroposterior and mediolateral diameters.

MAIN OUTCOME MEASURES

Cross-sectional area of the jugular bulb was calculated, and comparison was made between preoperative and postoperative studies in patients with or without ligation of the IJV.

RESULTS

After unilateral neck dissection, the mean change in the size of the jugular bulb ipsilateral to surgery with sacrifice of the IJV was found to be -10.4 mm (95% confidence interval [95% CI], ± 8.54 mm); ipsilateral to surgery without sacrifice of the internal jugular, -0.2 mm (95% CI, ± 3.24 mm); contralateral to surgery with sacrifice of the IJV, +1.9 mm (95% CI, ± 11.12 mm); and contralateral to surgery without sacrifice of the IJVa, +1.0 mm (95% CI, ± 2.66 mm). Analysis of variance demonstrated a significant difference for changes in the jugular bulb area ipsilateral to surgery with sacrifice of the IJV (p = 0.03) when compared with contralateral to surgery without sacrifice of the IJV.

CONCLUSION

Changes in size of the jugular bulb occur with surgical manipulation of the jugular vein. This study demonstrates a decrease in the size of the jugular bulb with ipsilateral IJV sacrifice.

A case of increased intracranial pressure after unilateral modified radical neck dissection

OBJECTIVE

This study aimed to study case reports and review the world literature concerning increased intracranial pressure secondary to unilateral radical neck dissection.

CASE REPORT

A male patient presented with a painless lump in the left side of his neck. Diagnostic investigation revealed papillary thyroid carcinoma and 4 x 2-cm left cervical lymph node. Total thyroidectomy with modified radical neck dissection on the left side that included removal of the internal jugular vein was undertaken. Eleven days after the operation, the patient presented with a history of headache and diplopia. Clinical examination showed bilateral papilledema and right-sided sixth cranial nerve palsy. A computed tomographic scan and magnetic resonance image of the brain was normal. Subsequent magnetic resonance venography revealed an aplastic contralateral transverse sinus.

CONCLUSION

Based on our case, vascular anomalies should be considered in any patient who exhibits signs of increased intracranial pressure after unilateral neck dissection.

Anterior ischemic optic neuropathy after unilateral radical neck dissection: case report and review

BACKGROUND

Blindness or visual deterioration after neck dissection is a known and a rare complication of the operation. Visual impairment usually occurs immediately after bilateral radical neck dissections either performed synchronously or in a stepwise manner, resulting in permanent blindness. Hypotension and blood loss during long operations, elevated venous pressure postoperatively result in optic neuropathies, which are anterior ischemic optic neuropathy (AION) or mostly posterior ischemic optic neuropathy (PION) affecting different portions of the nerve.

METHODS

Review of literature and case report.

RESULTS

To date there are only three cases of AION after neck dissection reported in the literature, with a different visual prognosis.

CONCLUSION

Vision loss may be reversible when both internal jugular veins are preserved, but permanent when any of them are resected. Here we present the first case of anterior ischemic optic neuropathy developed after unilateral radical neck dissection, resulting in partial visual deterioration.

Vantagens da conservação da veia jugular interna nos esvaziamentos cervicais unilaterais

OBJETIVO: Diante da dúvida sobre a existência ou não de vantagens relacionadas à conservação da veia jugular interna nos esvaziamentos cervicais unilaterais resolvemos observar se os pacientes que a tem sacrificada apresentam alterações ao exame de fundo de olho que indiquem um aumento da pressão intracraniana, avaliar a presença de alterações neurológicas e verificar as vantagens na evolução clínico-cirúrgica dos pacientes que tiveram a sua veia jugular interna conservada. MÉTODO: Trata-se de estudo prospectivo, não randomizado, de 15 pacientes portadores de carcinoma epidermóide da cabeça e pescoço, atendidos e operados no Serviço de Cirurgia de Cabeça e Pescoço do Hospital Heliópolis, que tiveram como parte de seu tratamento a realização de esvaziamento cervical completo (funcional ou não) unilateral, divididos em um grupo com ressecção da veia jugular interna e outro com sua conservação. Todos foram submetidos a exames de retinografia pré e pós-operatórios, além de avaliação neurológica e clínica. RESULTADOS: Não ocorreram alterações oftalmológicas detectáveis através da retinografia em nenhum dos grupos. O grupo que teve sua veia jugular interna ressecada apresentou maior incidência de queixas neurológicas no pós-operatório, além de uma evolução cirúrgica mais desfavorável, com um maior período de internação devido às complicações locais apresentadas. CONCLUSÕES: A conservação da veia jugular interna nos esvaziamentos cervicais unilaterais beneficia a evolução pós-operatória dos pacientes, com um menor período de internação, apesar de não termos identificado qualquer evidência pós-operatória de aumento da pressão intracraniana nos pacientes que tiveram a veia ligada.