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Xiao L, Ji X, Zhao H, Luo Y, Hu S, Zhao T, Hu Z, Duan J. A novel severe cerebral venous thrombosis rat model based on semi-ligation combined with ferric chloride and thrombin. CNS Neurosci Ther 2022; 28:2129-2140. [PMID: 36000206 PMCID: PMC9627376 DOI: 10.1111/cns.13950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 07/25/2022] [Accepted: 08/05/2022] [Indexed: 02/06/2023] Open
Abstract
AIMS An applicable cerebral venous sinus thrombosis (CVST) model is imperative for exploring its pathophysiology. We established a novel severe CVST model using semi-ligation, ferric chloride, and thrombin. METHODS A total of 138 male Sprague-Dawley rats were randomly divided into semi-ligation (n = 75) and non-semi-ligation (n = 63) groups. A sham group (n = 46) was also included. We compared short-term and long-term neurological and cognitive dysfunction, mortality rates, thrombus load, venous infarction volume, the blood-brain barrier permeability, brain water content, and microglia activation among the three groups. RESULTS Thrombi involving multiple venous sinuses appeared in all semi-ligation rats within 2 days postoperatively. Compared with the non-semi-ligation group, short-term and long-term neurological dysfunction were more severe (p < 0.05), and thrombus weight, venous infarction volumes, and microglia activation were more significant (p < 0.05) in the semi-ligation group. Further, the cognitive function of the semi-ligation group significantly decreased (p < 0.05) on postoperative day 21. Cumulative mortality rates between the semi-ligation and non-semi-ligation groups did not differ significantly. CONCLUSION Semi-ligation combined with ferric chloride and thrombin can produce a severe CVST model with multiple venous sinus involvement, which is suitable for short- and long-term neurological and cognitive dysfunction assessment.
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Affiliation(s)
- Lipo Xiao
- Department of Emergency, Xuanwu HospitalCapital Medical UniversityBeijingChina,Department of Neurology and Intracranial Hypertension & Cerebral Venous Disease CenterNational Health Commission of the People's Republic of China, Xuanwu Hospital, Capital Medical UniversityBeijingChina,Department of NeurologyThe People's Hospital of QingxianCangzhouChina
| | - Xunming Ji
- Department of Neurology and Intracranial Hypertension & Cerebral Venous Disease CenterNational Health Commission of the People's Republic of China, Xuanwu Hospital, Capital Medical UniversityBeijingChina
| | - Haiping Zhao
- Cerebrovascular Diseases Research Institute and Department of NeurologyXuanwu Hospital, Capital Medical UniversityBeijingChina
| | - Yumin Luo
- Cerebrovascular Diseases Research Institute and Department of NeurologyXuanwu Hospital, Capital Medical UniversityBeijingChina
| | - Shuyuan Hu
- Department of Emergency, Xuanwu HospitalCapital Medical UniversityBeijingChina,Department of Neurology and Intracranial Hypertension & Cerebral Venous Disease CenterNational Health Commission of the People's Republic of China, Xuanwu Hospital, Capital Medical UniversityBeijingChina
| | - Tingyu Zhao
- Department of Emergency, Xuanwu HospitalCapital Medical UniversityBeijingChina,Department of Neurology and Intracranial Hypertension & Cerebral Venous Disease CenterNational Health Commission of the People's Republic of China, Xuanwu Hospital, Capital Medical UniversityBeijingChina
| | - Zeliang Hu
- Department of Pathology, Xuanwu HospitalCapital Medical UniversityBeijingChina
| | - Jiangang Duan
- Department of Emergency, Xuanwu HospitalCapital Medical UniversityBeijingChina,Department of Neurology and Intracranial Hypertension & Cerebral Venous Disease CenterNational Health Commission of the People's Republic of China, Xuanwu Hospital, Capital Medical UniversityBeijingChina
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Tomasi SO, Umana GE, Scalia G, Raudino G, Graziano F, Palmisciano P, Priola SM, Cappai PF, Capone C, Lawrence PM, Erös CA, Martin KD, Chaurasia B, Maugeri R, Iacopino G, Da Ros V, Lawton MT, Griessenauer CJ, Winkler PA. The Superficial Anastomosing Veins of the Human Brain Cortex: A Microneurosurgical Anatomical Study. Front Surg 2022; 8:817002. [PMID: 35083275 PMCID: PMC8784509 DOI: 10.3389/fsurg.2021.817002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 11/30/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: In this microneurosurgical and anatomical study, we characterized the superficial anastomosing veins of the human brain cortex in human specimens. Material and Methods: We used 21 brain preparations fixed in formalin (5%) that showed no pathological changes and came from the autopsy sections. The superficial veins were dissected out of the arachnoid with the aid of a surgical microscope. Results: We dissected nine female and 12 male brain specimens, with an average age of 71 ± 11 years (range 51–88 years). We classified the superficial veins in five types: (I) the vein of Trolard as the dominat vein; (II) the vein of Labbé as the dominant vein; (III) a dominant sylvian vein group, and the veins of Trolard and Labbé nonexistent or only rudimentary present without contact to the Sylvian vein group; (IV) very weak sylvian veins with the veins of Trolard and Labbé codominant; and V) direct connection of Trolard and Labbé bypassing the Sylvian vein group. The vein of Trolard was dominant (Type I) in 21.4% and the vein of Labbé (Type II) in 16.7%. A dominant sylvian vein group (Type III) was found in 42.9%. Type IV and Type V were found in 14.3 and 4.7% respectively. Conclusion: No systematic description or numerical distribution of the superior anastomotic vein (V. Trolard) and inferior anastomotic vein (V. Labbé) has been found in the existing literature. This study aimed to fill this gap in current literature and provide data to neurosurgeons for the practical planning of surgical approaches.
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Affiliation(s)
- S. Ottavio Tomasi
- Christian Doppler Clinic, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
- *Correspondence: S. Ottavio Tomasi
| | | | | | | | | | | | - Stefano M. Priola
- Division of Neurosurgery Health Sciences North, Northern Ontario School of Medicine, Sudbury, ON, Canada
| | | | - Crescenzo Capone
- Department of Neurosurgery, University Hospital Zürich, Zurich, Switzerland
| | - Peter M. Lawrence
- Department of Neurosurgery, Barrow Neurological Institute (BNI), Phoenix, AZ, United States
| | - Christian A. Erös
- Department of Neurosurgery, Städtisches Klinikum Dresden, Dresden, Germany
| | | | - Bipin Chaurasia
- Department of Neurosurgery, University of Rome Tor Vergata, Rome, Italy
| | - Rosario Maugeri
- Department of Neurosurgery, University of Palermo, Palermo, Italy
| | - Gerardo Iacopino
- Department of Neurosurgery, University of Palermo, Palermo, Italy
| | - Valerio Da Ros
- Department of Neurosurgery, University of Rome Tor Vergata, Rome, Italy
| | - Michael T. Lawton
- Department of Neurosurgery, Barrow Neurological Institute (BNI), Phoenix, AZ, United States
| | - Christoph J. Griessenauer
- Christian Doppler Clinic, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Peter A. Winkler
- Christian Doppler Clinic, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
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Aldea S, Apra C, Chauvet D, Le Guérinel C, Bourdillon P. Interhemispheric transcallosal approach: going further based on the vascular anatomy. Neurosurg Rev 2021; 44:2831-2835. [PMID: 33469779 DOI: 10.1007/s10143-021-01480-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 10/31/2020] [Accepted: 01/11/2021] [Indexed: 10/22/2022]
Abstract
Preserving cortical frontal bridging veins draining into the superior sagittal sinus is a factor of good neurological outcome in anterior interhemispheric transcallosal approaches, classically performed to reach intraventricular tumors. Challenging the idea that veins are utterly variable, we propose a statistical analysis of 100 selective cerebral angiographies to determine where to place the craniotomy in order to expose the most probable vein-free area. The mean distance to the first pre-coronal vein was 6.66 cm (± 1.73, 1.80 to 13.00) and to the first post-coronal vein 0.94 cm (± 0.92, 0 to 3.00) (p < 0.001). The probability of absence of bridging veins was 92.0% at 4 cm anterior to the coronal suture versus 37.5% at 1 cm and 12.5% at 2 cm posteriorly. The length of the surgical corridor (distance between the first pre-coronal and post-coronal vein) was 7.60 cm (± 1.72, 3.00 to 14.10). Overall, the ideal centering point of the craniotomy was 2.86 cm (± 1.08, - 0.65 to 6.50) ahead of the coronal suture. The mean number of veins within 6 cm behind the coronal suture was 8.47 (± 2.11, from 3 to 15) versus 0.530 (± 0.82, from 0 to 3) ahead of the coronal suture (p < 0.001). These findings support a purely pre-coronal 5 cm craniotomy for interhemispheric approaches.
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Affiliation(s)
- Sorin Aldea
- Department of Neurosurgery, Rothschild Foundation Hospital, Paris, France
| | - Caroline Apra
- Department of Neurosurgery, Pitié Salpêtrière Hospital, 43-81, bd de l'Hôpital, 73013, Paris, France. .,Sorbonne Université, Paris, France. .,Brain and Spine Institute, INSERM U1127, CNRS, UMR7225, Paris, France.
| | - Dorian Chauvet
- Department of Neurosurgery, Rothschild Foundation Hospital, Paris, France
| | | | - Pierre Bourdillon
- Department of Neurosurgery, Rothschild Foundation Hospital, Paris, France
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Tomasi SO, Umana GE, Scalia G, Rubio-Rodriguez RL, Cappai PF, Capone C, Raudino G, Chaurasia B, Salvati M, Jorden N, Winkler PA. Importance of Veins for Neurosurgery as Landmarks Against Brain Shifting Phenomenon: An Anatomical and 3D-MPRAGE MR Reconstruction of Superficial Cortical Veins. Front Neuroanat 2020; 14:596167. [PMID: 33384587 PMCID: PMC7771049 DOI: 10.3389/fnana.2020.596167] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 11/05/2020] [Indexed: 11/13/2022] Open
Abstract
Modern neurosurgery uses preoperative imaging daily. Three-dimensional reconstruction of the cortical anatomy and of the superficial veins helps the surgeons plan and perform neurosurgical procedures much more safely. The target is always to give the patient maximum benefit in terms of outcome and minimize intraoperative and postoperative complications. This study aims to develop a method for the combined representation of the cerebral cortex anatomy and the superficial cerebral veins, whose integration is beneficial in daily practice. Only those patients who underwent surgical procedures with craniotomy and a large opening of the dura mater were included in this study, for a total of 23 patients, 13 females (56.5%) and 10 males (43.5%). The average age was 50.1 years. We used a magnetic resonance tomograph Magnetom Vision® 1.5T (Siemens AG). Two sequences were applied: a strongly T1-weighted magnetization-prepared rapid acquisition with gradient echo (MPRAGE) sequence to visualize cerebral anatomical structures, and a FLASH-2D-TOF angiography sequence to visualize the venous vessels on the cortical surface after the administration of a paramagnetic contrast agent. The two data sets were superimposed manually, co-registered in an interactive process, and merged to create a combined data set, segmented and visualized as a three-dimensional reconstruction. Furthermore, we present our method for visualizing superficial veins, which helps manage brain shift (BS). We also performed anatomical observations on the reconstructions. The reconstructions of the cortical and venous anatomy proved to be a valuable tool in surgical planning and positively influenced the surgical procedure. Due to the good correlation with the existing surgical site, this method should be validated on a larger cohort or in a multicentric study.
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Affiliation(s)
- Santino Ottavio Tomasi
- Department of Neurological Surgery, Christian Doppler Klinik, Salzburg, Austria.,Paracelsus Medical University, Salzburg, Austria.,Laboratory for Microsurgical Neuroanatomy, Christian Doppler Klinik, Salzburg, Austria
| | - Giuseppe Emmanuele Umana
- Department of Neurosurgery, Trauma Center, Gamma Knife Center, Cannizzaro Hospital, Catania, Italy
| | - Gianluca Scalia
- Neurosurgery Unit, Highly Specialized Hospital and of National Importance "Garibald", Catania, Italy
| | - Roberto Luis Rubio-Rodriguez
- Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, San Francisco, CA, United States.,Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United States.,Department of Otolaryngology- Head and Neck Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Pier Francesco Cappai
- Department of Neurosurgery, Azienda Ospedaliera G. Brotzu, Universitá degli Studi di Sassari, Sassari, Italy
| | - Crescenzo Capone
- Department of Peripheral Nerve Surgery, Azienda Unità Sanitaria Locale Romagna, Ospedale Civile di Faenza, Faenza, Italy
| | - Giuseppe Raudino
- Department of Neurosurgery, Istituto di Ricovero e Cura ad Alta Specializzazione Policlinico di Monza, Monza, Italy
| | - Bipin Chaurasia
- Department of Neurosurgery, Neurosurgery Clinic, Birgunj, Nepal
| | - Maurizio Salvati
- Department of Neurosurgery, Policlinico Tor Vergata, Rome, Italy
| | - Nicolas Jorden
- Radiologie und Nuklearmedizin Dachau, Karlsfeld, Germany
| | - Peter A Winkler
- Department of Neurological Surgery, Christian Doppler Klinik, Salzburg, Austria.,Paracelsus Medical University, Salzburg, Austria.,Laboratory for Microsurgical Neuroanatomy, Christian Doppler Klinik, Salzburg, Austria
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Cai Q, Luo J, Ge S, Li Y, Cui W, Wu X, Li C, Wu Y, Feng X, Guo B, Wang Y, Qin H, Qu Y, Feng D. The characteristics of brain injury following cerebral venous infarction induced by surgical interruption of the cortical bridging vein in mice. Brain Res 2020; 1739:146823. [PMID: 32272097 DOI: 10.1016/j.brainres.2020.146823] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 04/03/2020] [Accepted: 04/04/2020] [Indexed: 02/07/2023]
Abstract
Cerebral venous infarction (CVI) caused by the injury of cortical bridging veins (CBVs), is one of the most serious complications following neurosurgical craniotomy. Different from cerebral artery infarction, this CVI pathological process is more complicated, accompanied by acute venous hypertension, brain edema, cerebral ischemia and hemorrhage in the veins bridged brain area. Therefore, a reliable and stable small animal model is particularly important for the pathological study of CVI induced by surgical CBV interruption (CBVi). A mouse model established by cutting off the right CBVs from bregma to lambda with microsurgical technique is used for the assessment of the pathological process. Adult male mice underwent craniotomy after transection of the parietal skin under anesthesia. The right CBVs were exposed by removing the right skull along the right lateral edge of the sagittal sinus (forming a 4 mm × 3 mm bone window from bregma to lambda) with a drill under the operating microscope. Following the final inspection of the cerebral veins, the CBVs (30% one, 60% two, 10% none) were sacrificed using bipolar coagulation technique. Intracranial pressure (ICP) monitoring, motor function examination, brain edema assessment and brain histopathological observation after perfusion were performed at different time points (6 h, 12 h, 24 h, and 48 h) in the postoperative mice. Cerebral hemisphere swelling, midline shift and subcortical petechial hemorrhage were found on histological sections 6 h after CBVs dissection. The change of ICP was consistent with cerebral edema and peaked at 12 h after surgery, as well as the disruption of the blood-brain barrier assessed by Evans Blue staining. Tissue necrosis, nerve cell loss and monocytes infiltration were also dynamically increased in the postoperative hemispheric cortex. Behavioral tests showed obvious somato- and forelimb-motor dysfunction, and severe somatosensory disorder on the operative mice at 12 h, which were substantially recovered at 48 h. Our study provided a novel mouse model of CVI caused by surgical CBVi that was close to clinical practice, and preliminarily confirmed its pathological process. This model might become an important tool to study the clinical pathology and the molecular mechanism of nerve injury following CVI.
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Affiliation(s)
- Qing Cai
- Department of Neurosurgery and Institute for Functional Brain Disorders, Tangdu Hospital, Fourth Military Medical University, Xi'an, PR China
| | - Jianing Luo
- Department of Neurosurgery and Institute for Functional Brain Disorders, Tangdu Hospital, Fourth Military Medical University, Xi'an, PR China
| | - Shunnan Ge
- Department of Neurosurgery and Institute for Functional Brain Disorders, Tangdu Hospital, Fourth Military Medical University, Xi'an, PR China
| | - Yang Li
- Department of Neurosurgery and Institute for Functional Brain Disorders, Tangdu Hospital, Fourth Military Medical University, Xi'an, PR China
| | - Wenxing Cui
- Department of Neurosurgery and Institute for Functional Brain Disorders, Tangdu Hospital, Fourth Military Medical University, Xi'an, PR China
| | - Xun Wu
- Department of Neurosurgery and Institute for Functional Brain Disorders, Tangdu Hospital, Fourth Military Medical University, Xi'an, PR China
| | - Chen Li
- Department of Neurosurgery and Institute for Functional Brain Disorders, Tangdu Hospital, Fourth Military Medical University, Xi'an, PR China
| | - Yilin Wu
- Department of Neurosurgery and Institute for Functional Brain Disorders, Tangdu Hospital, Fourth Military Medical University, Xi'an, PR China
| | - Xiao Feng
- Department of Anthropotomy and Histo-Embryology, School of Basic Medicine, Fourth Military Medical University, Xi'an, PR China
| | - Baolin Guo
- Department of Neurobiology, School of Basic Medicine, Fourth Military Medical University, Xi'an, PR China
| | - Yazhou Wang
- Department of Neurobiology, School of Basic Medicine, Fourth Military Medical University, Xi'an, PR China
| | - Huaizhou Qin
- Department of Neurosurgery and Institute for Functional Brain Disorders, Tangdu Hospital, Fourth Military Medical University, Xi'an, PR China
| | - Yan Qu
- Department of Neurosurgery and Institute for Functional Brain Disorders, Tangdu Hospital, Fourth Military Medical University, Xi'an, PR China.
| | - Dayun Feng
- Department of Neurosurgery and Institute for Functional Brain Disorders, Tangdu Hospital, Fourth Military Medical University, Xi'an, PR China; Department of Neurobiology, School of Basic Medicine, Fourth Military Medical University, Xi'an, PR China.
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Fang Q, Jiang A, Tao W, Xin L. Anatomic comparison of veins of Labbé between autopsy, digital subtraction angiography and computed tomographic venography. Biomed Eng Online 2017. [PMID: 28651592 PMCID: PMC5485712 DOI: 10.1186/s12938-017-0374-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Objective The drainage portion of the vein of Labbé varies, and it is difficult to predict whether the operation is likely to damage this vein. The aim of this study was to correlate the microanatomy of the vein of Labbé with digital subtraction angiography (DSA) and computed tomographic venography (CTV), in order to provide a basis for the preservation of the vein of Labbé during a supratentorial surgical approach. Methods A total of 30 human cadavers (60 sides) and 61 living patients (110 sides) were examined in this study. Each cadaver head was injected with blue latex via the superior sagittal sinus and the internal jugular veins. The venograms of each patient were obtained from the venous phases of DSA (60 sides for 36 patients) or CTV (50 sides for 25 patients). Results The patients were divided into four subgroups based on the location where a vein entered the dural sinus: the transverse sinus group, the tentorial group, the petrosal group, and the upper-transverse sinus group. The veins of Labbé in transverse sinus group and petrosal group directly entered dural sinus. The veins of Labbé in tentorial group and upper-transverse sinus group indirectly entered transverse sinus via the tentorium sinus or the upper-transverse sinus. These sinuses were meningeal veins running through two layers of the cerebral dura mater. The length of meningeal veins in these groups was 10.0 ± 7.2 mm. The veins of Labbé were mainly localized around the STP junction, which was the confluence of sigmoid sinus, transverse sinus, and superior petrosal sinus. The distance between the dural entrance of veins and the STP junction was 16.8 ± 10.2 mm. There was no significant difference in the results of the DSA and CTV examinations when compared to the observations in cadavers. Conclusions Preoperative venograms are useful to design an individualized surgical approach for the preservation of the vein of Labbé. In general, the supratentorial median approach has the least chance to damage this vein. However, when preoperative venograms show that the vein of Labbé is too close to the confluence of sinuses or the meningeal veins are too long, an alternative approach should be chosen.
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Affiliation(s)
- Qiong Fang
- Department of Anatomy, Anhui Medical College, Hefei, 230601, Anhui, China
| | - Anhong Jiang
- Department of Radiology, The Second Affiliated Hospital of Anhui Medical University, Hefei, 230601, China
| | - Wei Tao
- Department of Anatomy, School of Medicine, Anhui University of Science & Technology, 25 Dongshan Road, Huainan, 232001, China.
| | - Lin Xin
- Department of Cardiology, Guangzhou General Hospital of Guangzhou Military Region, PLA, Guangzhou, 510010, China
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Yenigün M, Jünemann M, Gerriets T, Stolz E. Sinus thrombosis-do animal models really cover the clinical syndrome? ANNALS OF TRANSLATIONAL MEDICINE 2015. [PMID: 26207231 DOI: 10.3978/j.issn.2305-5839.2015.05.14] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Cerebral venous sinus thrombosis (CVST) is an important cause of stroke in young patients. CVST represents with 0.5-3% of stroke cases a relatively rare disease. CVST affects 3-4 cases per 1 million overall and 7 cases per 1 million children and neonates. Typical clinical symptoms include headache, visual deficits and seizures. Beside the main condition associated with CVST in women in pregnancy and puerperium, the most frequently identified risk factors are oral hormonal contraceptives in combination with coagulation disorders. The initial treatment contains heparin and its efficacy is based on two randomized placebo-controlled trials including 79 patients together. A lack of understanding of the pathophysiology of CSVT makes animal models of this disease indispensable. Previously developed animal models of sinus sagittalis superior contributes to further clarify the pathophysiologic mechanisms and surrounding circumstances in the topic of cerebral venous thrombosis.
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Affiliation(s)
- Mesut Yenigün
- 1 Department of Neurology, University Hospital Giessen and Marburg, Klinikstrasse 33, 35392 Giessen, Germany ; 2 Department of Neurology, Buergerhospital Friedberg, Ockstaedter Strasse 3-5, 61169 Friedberg, Germany ; 3 Department of Neurology, Caritasklinikum Saarbruecken, St. Theresia, Rheinstrasse 2, 66113, Saarbruecken, Germany
| | - Martin Jünemann
- 1 Department of Neurology, University Hospital Giessen and Marburg, Klinikstrasse 33, 35392 Giessen, Germany ; 2 Department of Neurology, Buergerhospital Friedberg, Ockstaedter Strasse 3-5, 61169 Friedberg, Germany ; 3 Department of Neurology, Caritasklinikum Saarbruecken, St. Theresia, Rheinstrasse 2, 66113, Saarbruecken, Germany
| | - Tibo Gerriets
- 1 Department of Neurology, University Hospital Giessen and Marburg, Klinikstrasse 33, 35392 Giessen, Germany ; 2 Department of Neurology, Buergerhospital Friedberg, Ockstaedter Strasse 3-5, 61169 Friedberg, Germany ; 3 Department of Neurology, Caritasklinikum Saarbruecken, St. Theresia, Rheinstrasse 2, 66113, Saarbruecken, Germany
| | - Erwin Stolz
- 1 Department of Neurology, University Hospital Giessen and Marburg, Klinikstrasse 33, 35392 Giessen, Germany ; 2 Department of Neurology, Buergerhospital Friedberg, Ockstaedter Strasse 3-5, 61169 Friedberg, Germany ; 3 Department of Neurology, Caritasklinikum Saarbruecken, St. Theresia, Rheinstrasse 2, 66113, Saarbruecken, Germany
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Cranial dural arteriovenous shunts. Part 1. Anatomy and embryology of the bridging and emissary veins. Neurosurg Rev 2014; 38:253-63; discussion 263-4. [PMID: 25468011 DOI: 10.1007/s10143-014-0590-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Accepted: 06/22/2014] [Indexed: 10/24/2022]
Abstract
We reviewed the anatomy and embryology of the bridging and emissary veins aiming to elucidate aspects related to the cranial dural arteriovenous fistulae. Data from relevant articles on the anatomy and embryology of the bridging and emissary veins were identified using one electronic database, supplemented by data from selected reference texts. Persisting fetal pial-arachnoidal veins correspond to the adult bridging veins. Relevant embryologic descriptions are based on the classic scheme of five divisions of the brain (telencephalon, diencephalon, mesencephalon, metencephalon, myelencephalon). Variation in their exact position and the number of bridging veins is the rule and certain locations, particularly that of the anterior cranial fossa and lower posterior cranial fossa are often neglected in prior descriptions. The distal segment of a bridging vein is part of the dural system and can be primarily involved in cranial dural arteriovenous lesions by constituting the actual site of the shunt. The veins in the lamina cribriformis exhibit a bridging-emissary vein pattern similar to the spinal configuration. The emissary veins connect the dural venous system with the extracranial venous system and are often involved in dural arteriovenous lesions. Cranial dural shunts may develop in three distinct areas of the cranial venous system: the dural sinuses and their interfaces with bridging veins and emissary veins. The exact site of the lesion may dictate the arterial feeders and original venous drainage pattern.
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Della Puppa A, Rustemi O, Gioffrè G, Rolma G, Grandis M, Munari M, Scienza R. Application of indocyanine green video angiography in parasagittal meningioma surgery. Neurosurg Focus 2014; 36:E13. [DOI: 10.3171/2013.12.focus13385] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
There are no doubts about the role that indocyanine green video angiography (ICGVA) can play in current vascular neurosurgery. Conversely, in brain tumor surgery, and particularly in meningioma surgery, this role is still unclear. Vein management is pivotal for approaching parasagittal meningiomas, because venous preservation is strictly connected to both extent of resection and clinical outcome. The authors present the technical traits and the postoperative outcome of the application of ICGVA in patients undergoing parasagittal meningioma surgery.
Methods
The authors retrospectively collected demographic, radiological, intraoperative, and follow-up data in 43 patients with parasagittal meningiomas who underwent surgery with the assistance of ICGVA at Padua Neurosurgical Department between October 2010 and July 2013. Intraoperative ICGVA findings at different stages (before dural opening, after dural opening, during resection, after resection) were reviewed. Additional data on functional monitoring, temporary venous clipping, and flow measurements were also recorded. The overall postoperative outcome was evaluated by assessing both the extent of resection and the clinical outcome data.
Results
The ICGVA studies were performed 125 times in 43 patients, providing helpful data for vein management and tumor resection in all stages of surgery. In 16% of meningiomas completely occluding the superior sagittal sinus, the ICGVA data differed from radiological findings and changed the surgical approach. In 20% of cases the intraoperative ICGVA findings directly guided the surgical strategy: venous sacrifice was necessary in 7 cases, without postoperative consequences; temporary clipping with neurophysiological monitoring proved to be predictive of safe venous sacrifice. In 7% of cases the ICGVA data needed to be supplemented with flow measurements. Simpson Grade I–II and Grade III resections were achieved in 86% and 14% of cases, respectively, with a 4.6% rate of overall morbidity.
Conclusions
This study shows that ICGVA can assist the different stages of parasagittal meningiomas surgery, guiding the vein management and tumor resection strategies with a favorable final clinical outcome. However, in the authors' experience the use of other complementary tools was mandatory in selected cases to preserve functional areas. Further studies are needed to confirm that the application of ICGVA in parasagittal meningioma surgery may improve the morbidity rate, as reported in this study.
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Affiliation(s)
| | | | | | - Giuseppe Rolma
- 2Neuroradiology Unit, Padua University Hospital, Padua; and
| | - Marzia Grandis
- 3Department of Anaesthesiology, University of Padua, Italy
| | - Marina Munari
- 3Department of Anaesthesiology, University of Padua, Italy
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Nakase H, Nagata K, Ohtsuka H, Sakaki T, Kempski O. An experimental model of intraoperative venous injury in the rat. Skull Base Surg 2011; 7:123-8. [PMID: 17171021 PMCID: PMC1656632 DOI: 10.1055/s-2008-1058603] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Intraoperative obliteration of cerebral veins occasionally causes unexpected severe complications, especially in elderly patients. However, very title information is available on the pathophysiology of cerebral venous circulation disturbance. Occlusion of cortical veins in rats by a photochemical thrombotic technique is a less invasive, clinically relevant and reproducible model that is suitable for the study of venous circulation disturbance. In the present study, 54 male Wistar rats were used. We examined changes of the cerebral venous flow pattern by fluorescence anglography and brain damage histologically in a one- or two-(cortical) vein occlusion model using a photochemical thrombotic technique. Approximately 30% (9 of 27) of animals in the single-vein occlusion group and 90% (15 of 17) of those in the two-vein occlusion group had microcirculation perturbation, which results very soon in the formation of venous thrombus accompanied by severe venous infarction. In addition, infarction size in the two-vein occlusion group (9.7 +/- 3.2%) was significantly larger than in the single-vein group (2.9 +/- 1.3%) (unpaired T-test, P < 0.01).In conclusion, the photochemical dye technique of attaining cerebral venous occlusion is a worth while addition to the study of circulation perturbations of the brain.
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11
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Nussbaum ES, Defillo A, Janjua T, Nussbaum LA. Microvascular repair of an injured cortical draining vein. ACTA ACUST UNITED AC 2009; 72:530-1. [PMID: 19604558 DOI: 10.1016/j.surneu.2009.03.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2009] [Accepted: 03/13/2009] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cortical venous injury can occur during any intracranial procedure with potentially severe consequences. We describe a simple technique that allowed for successful repair of a large cortical draining vein. CASE DESCRIPTION A 43-year-old, right-handed woman presented with 6 months of headaches and progressive difficulty with right-sided hemiparesis. She had significant loss of hand coordination and writing ability. Computed tomography and MR imaging revealed a parasagittal meningioma in the left, posterior frontal region. The patient underwent craniotomy with resection of the lesion. CONCLUSION When a cortical vein is injured, collateral drainage pathways may prevent the development of a clinical problem. Because of the unpredictability of these collateral channels, venous reconstruction may be feasible and even straightforward in some cases.
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Affiliation(s)
- Eric S Nussbaum
- National Brain Aneurysm Center, St. Joseph's Hospital, St. Paul, MN 55102, USA.
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12
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Vignes JR, Dagain A, Guérin J, Liguoro D. A hypothesis of cerebral venous system regulation based on a study of the junction between the cortical bridging veins and the superior sagittal sinus. J Neurosurg 2007; 107:1205-10. [DOI: 10.3171/jns-07/12/1205] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
The cerebral venous regulation involved in various physiological and pathological processes has received little attention. Here the authors describe the anatomy of the junction between the cortical vein and the superior sagittal sinus (SSS) and propose a new theory of cerebral venous regulation.
Methods
Ten adult human cadaveric heads (20 sides), including five specimens into which stained latex had been injected, were used for anatomical study. Formalin-fixed cadaver heads were dissected to demonstrate the cortical veins along the SSS. The characteristics of the cortical bridging veins and their openings into the SSS were established by anatomical, histological, immunohistochemical, and ultrastructural study of the junction.
Results
After their subarachnoid course, the cortical bridging veins penetrated the SSS at different points in the dura mater depending on their rostrocaudal position. The venous endothelium stretched beyond the sinus endothelium. The orientation of the collagen fibers changed at the level of the venous openings, with the luminal diameter becoming narrow and oval-shaped. The major finding was the organization of the smooth-muscle cells at the end of each cortical vein. At this site and particularly in the frontoparietal region, the vessel resembled a myoendothelial “sphincter.” The authors hypothesize that this organization is involved in cerebral venous system regulation.
Conclusions
The point of convergence between the cortical veins and the SSS is a key area. The authors also hypothesize that the myoendothelial junction acts as a smooth sphincter and that it plays a role in cerebral venous hemodynamics and pathological conditions.
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Affiliation(s)
| | - Arnaud Dagain
- 2Laboratoire d'Anatomie, Université Bordeaux 2, Bordeaux, France
| | - Jean Guérin
- 2Laboratoire d'Anatomie, Université Bordeaux 2, Bordeaux, France
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Wang J, Ji X, Ling F, Luo Y, He X, Guo M, Li S, Miao Z, Zhu F, Xuan Y. A new model of reversible superior sagittal sinus thrombosis in rats. Brain Res 2007; 1181:118-24. [DOI: 10.1016/j.brainres.2007.08.070] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2007] [Revised: 08/19/2007] [Accepted: 08/25/2007] [Indexed: 11/29/2022]
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Liebetrau M, Gabriejcic-Geiger D, Meyer P, Roether J, Hamann GF. Increased calpain expression following experimental cerebral venous thrombosis in rats. Thromb Res 2003; 112:239-43. [PMID: 14987918 DOI: 10.1016/j.thromres.2003.12.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2003] [Revised: 10/28/2003] [Accepted: 12/13/2003] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Calpains are intracellular proteases that are activated by increased intracellular calcium with proteolytic activity mainly against the cytoskeleton. We tested the expression of calpains and their substrates in an animal model of experimental cerebral venous thrombosis. MATERIALS AND METHODS Cerebral venous thrombosis was induced in seven male rats by rostral and caudal ligation of the superior sagittal sinus and injection of a thrombogenic cephalin suspension. Each animal survived 3 h of thrombosis. Using a polyclonal antibody against the 80 kD subunit of micro-calpain, immunohistochemistry of the region of interest (venous infarction) showed a loss of microtubule-associated protein-2. The micro-calpain-positive cells in the region of interest and normal tissue were measured using a video-imaging microscopy unit with magnification power of 400x. A cell was considered calpain positive when the nucleus and the periplasma were stained by the micro-calpain antibody. RESULTS The mean infarct size was 13.4+/-3.7% of one whole coronal section. A total of 57+/-14% of the cells were found to be calpain positive in the region of interest, whereas 5+/-2% of all cellular elements in unaffected tissue were calpain positive (p<0.001). CONCLUSIONS In conclusion, cerebral venous thrombosis causes an increase in calpain expression in affected tissue which is manifested by a loss of microtubule-associated protein-2. This increase might mediate secondary neuronal injury.
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Affiliation(s)
- Martin Liebetrau
- Department of Neurology, Klinikum Grosshadern, Ludwig-Maximilians University, Marchioninistr. 15, Munich 81377, Germany
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Schaller C, Nakase H, Kotani A, Nishioka T, Meyer B, Sakaki T. Impairment of autoregulation following cortical venous occlusion in the rat. Neurol Res 2002; 24:210-4. [PMID: 11877906 DOI: 10.1179/016164102101199620] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Recent experiments showed an upward shift of the lower limit of autoregulation (AR) following photochemical occlusion of cortical veins in the rat. The goal of the present study was to prove the hypothesis that occlusion of cortical veins will be associated with impairment of the upper limit of autoregulation as well. In n = 28 Wistar rats unilateral frontoparietal cranial windows were drilled for transdural assessment of regional cerebral blood flow (rCBF) by laser Doppler scanning. The animals were allotted to two groups: (1) Group A (n = 5), control group for determination of the upper limit of autoregulation with stepwise induced arterial hypertension by intravenous administration of the alpha adrenergic drug methoxamine under continuous monitoring of mean arterial blood pressure (MABP); (2) Group B (n = 23), in which two cortical veins were photochemically occluded with rose bengal dye and fiberoptic illumination upon baseline CBF measurement. This was followed by repeated rCBF measurements under AR testing. Loss of AR in control Group A with passive increase of rCBF occurred at MABP of 147.5 +/- 2.9 mmHg. In Group B venous occlusion was followed by an initial phase of reduced rCBF, and then by pressure passive increases, thereby indicating loss of AR. Statistically significant changes of rCBF when compared to baseline MABP occurred at MABPbaseline + 10% (112.7 +/- 6.6 mmHg). We conclude that AR is impaired upon cortical venous occlusion with the propensity for hyperperfusion injury at a lower level of MABP when compared with a control group. In the context with earlier findings this may lead to narrowing of the corridor for MABP management following intra-operative occlusion of large cortical veins.
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Affiliation(s)
- Carlo Schaller
- Department of Neurosurgery, University of Bonn, Germany.
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Kaido T, Nakase H, Nagata K, Otsuka H, Sakaki T. Intermittent isometric exposure prevents brain retraction injury under venous circulatory impairment. Neurol Res 2001; 23:739-44. [PMID: 11680514 DOI: 10.1179/016164101101199261] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
It is recognized that surgical obliteration of the cerebral veins by additional brain compression using retractors is dangerous. However, there is a lack of satisfactory management of this problem. We investigated whether intermittent brain compression can reduce brain injury from cerebral venous circulation disturbances (CVCDs). In Wistar rats (n = 25), a solitary cortical vein was occluded photochemically. The brain surface was compressed by a spring balance and constant compression at 30 mmHg was carried out for 60 min. Intermittent procedure compression protocols included four 15 min compressions at 5 min intervals, intermittent isometric exposure (IM), and intermittent isotonic exposure (IT). Local cerebral blood flow (ICBF) in the compressed area was measured together by laser-Doppler (LD) with the degree of brain compression. After 24 h, the brains were examined histologically. The animals were divided into the following five groups (each n = 5): 1, a sham operated control; 2, cortical vein occlusion (VO); 3, VO + continuous brain compression (CC); 4, VO + IM; and 5, VO + IT. The ICBF decreased significantly during the compression; however, recovery after the series of compressions was observed only in the VO + IM group, not in the VO + CC and the VO + IT groups (p < 0.05). The depth of the brain surface increased stepwise in the VO + IT group compared with the VO + IM group (p < 0.01). The resulting tissue damage was significantly larger in the VO + CC and VO + IT groups than in the vein occlusion group (p < 0.05), but not in the VO + IM group. The results of the present study suggest that intermittent isometric exposure under CVCDs could decrease brain retraction injury during neurosurgical operations and be more beneficial than continuous compression, providing that the compression pressure declines as the process advances.
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Affiliation(s)
- T Kaido
- Department of Neurosurgery, Nara Medical University, Kashihara, Japan
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Yamashita T, Hayashida O, Nagamitsu T, Nagatsuna T, Wakuta Y, Fudaba H. The regional cerebral blood flow amelioration of argatroban in the acute stage of cerebral thrombosis. Keio J Med 2000. [PMID: 10750366 DOI: 10.2335/scs.29.178] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Cerebral blood flow changes by argatroban in the acute stage of cerebral thrombosis have been investigated with the use of stable xenon computed tomography (Xe/CT). The study group consisted of 14 cases (7 males, 7 females) with the average age of 59 years old (ranging from 21 to 79 years of age). We evaluated the cerebral blood flow change after an intravenous drip infusion of 10 mg of argatroban. After the administration of argatroban, we recognized a significant increase in the blood flow (24.4 +/- 5.0 ml/100 g/min to 28.4 +/- 2.7 ml/100 g/min, p < 0.05) in the blood flow area of lower than 30 ml/100 g/min in the affected vascular territory. As a conclusion, we found that argatroban improves ischemic symptoms through the amelioration of blood flow in the penumbra area.
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Affiliation(s)
- T Yamashita
- Department of Neurosurgery, Central Hospital of Yamaguchi, Yamaguchi University, Japan
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Nakase H, Nagata K, Otsuka H, Sakaki T, Kempski O. Local cerebral blood flow autoregulation following "asymptomatic" cerebral venous occlusion in the rat. J Neurosurg 1998; 89:118-24. [PMID: 9647182 DOI: 10.3171/jns.1998.89.1.0118] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Maintenance of cerebral blood flow (CBF) autoregulation in the brain is of major importance for patient outcome in various clinical conditions. The authors assessed local autoregulation after "asymptomatic" cortical vein occlusion. METHODS In Wistar rats, a single cortical vein was occluded photochemically by using rose bengal and fiberoptic illumination. In rats with bilateral carotid artery occlusion, mean arterial blood pressure (MABP) was lowered in 5-mm Hg increments down to 40 mm Hg by using hypobaric hypotension. Local CBF at each pressure level was assessed by performing laser Doppler (LD) scanning at 25 (5 x 5) locations within bilateral cranial windows. In this manner, the lower limit of autoregulation (LLA) was detected. The LLA was 60 mm Hg in both right and left hemispheres in Group A (five rats), in which the animals received illumination without rose bengal and had no venous occlusion. Of the 11 rats that underwent vein occlusion, three developed severe reductions in local CBF and/or a growing venous thrombus and were distinguished as Group C (symptomatic; three rats); from previous work we know that those animals are bound to experience venous infarction. The remaining rats formed Group B (asymptomatic; eight rats). In this group the LLA remained at 60 mm Hg in the left hemisphere without occlusion, whereas, in the right cortex with the occluded vein, the LLA was found to be 65 mm Hg. Below a carotid stump pressure of 25 mm Hg regional CBF in the affected hemisphere dropped more abruptly to a possibly ischemic range than that in the opposite normal hemisphere. CONCLUSIONS The results of the present study suggest that cerebral venous circulation disorders are manifested via additional pathways, that is, from a partially impaired local autoregulation in the vicinity of the occluded vein, even under conditions in which the vein occlusion itself does not cause brain damage. Care should be taken in the control of blood pressure in patients with this pathological condition.
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Affiliation(s)
- H Nakase
- Department of Neurosurgery, Nara Medical University, Kashihara, Japan
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Nakase H, Kempski OS, Heimann A, Takeshima T, Tintera J. Microcirculation after cerebral venous occlusions as assessed by laser Doppler scanning. J Neurosurg 1997; 87:307-14. [PMID: 9254098 DOI: 10.3171/jns.1997.87.2.0307] [Citation(s) in RCA: 65] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Research on cerebral venous circulation disturbances (CVCDs) has been limited partly by the paucity of animal models that produce consistent venous infarction. Occlusion of two adjacent cortical veins in rats by means of a photochemical thrombotic technique provides a minimally invasive, clinically relevant, and reproducible model suited to study the pathophysiology of CVCDs. In this study, the effects of venous occlusion on regional cortical blood flow and the brain damage that ensues were evaluated. Cortical vein occlusion was induced by photoactivation of rose bengal via 100-microm fiberoptic illumination. The cerebral venous flow pattern was examined using fluorescence angiography until 90 minutes after venous occlusion, and regional cerebral blood flow (rCBF) was determined at 48 locations by using laser Doppler scanning. Histological damage was assessed 48 hours after vein occlusion. Occlusion of two cortical veins (Group T; seven animals) was compared with single-vein occlusion and its ensuing brain damage (Group S; five animals) and with sham-operated control (five animals). An rCBF reduction occurred 30 minutes after occlusion in Group T and was more extensive than the decrease in Group S after 60 minutes. Observation frequency histograms based on local CBF data obtained in Group T demonstrated that local CBF at some sites decreased to a level below the ischemic threshold within 90 minutes. Six of the seven rats in Group T had a growing venous thrombus with extravasation of fluorescein. The resulting infarction was significantly larger in Group T (9.8 +/- 4.5% of the hemispheric area) than in Group S (only 3 +/- 1.5% of the hemispheric area). In conclusion, microcirculation perturbations occur early after venous occlusion and result in the formation of a venous thrombus accompanied by local ischemia and severe venous infarction. The extent of vein occlusion determines the resulting brain damage. Based on the results of this study, the authors conclude that CVCDs may be attenuated by prevention of venous thrombus progression together with the use of protective measures against the consequences of ischemia.
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Affiliation(s)
- H Nakase
- Institute for Neurosurgical Pathophysiology, Johannes Gutenberg-University of Mainz, Germany
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Yoshimoto Y, Endo M, Mori T, Wakai S. Correlation between venous stump pressure and brain damage after cortical vein occlusion: an experimental study. J Neurosurg 1997; 86:694-8. [PMID: 9120634 DOI: 10.3171/jns.1997.86.4.0694] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
A canine model of cortical vein occlusion was used to evaluate whether data obtained from monitoring venous stump pressure could help predict cerebral infarction after venous obstruction. Following bilateral parasagittal craniotomy, the cortical vein in each hemisphere was temporarily occluded and the increase in pressure was directly measured. Permanent venous obstruction was subsequently produced, and parenchymal brain damage 24 hours later was classified as: Stage 0, no parenchymal damage; Stage I, mild edema; Stage II, moderate parenchymal edema and/or ischemic changes in neurons; and Stage III, moderate-to-severe hemorrhage. The histological stages correlated closely with the rise in venous pressure: mean pressure increases (+/- standard deviation) were 5.5 +/- 2.9 mm Hg in hemispheres graded as Stage 0 (12 hemispheres), 7.7 +/- 3.2 mm Hg in those graded as Stage I (five), 11.2 +/- 4.1 mm Hg in those classed as Stage II (five), and 16.4 +/- 5 in those categorized as Stage III (seven). There were significant differences between Stages 0 and II (p < 0.01) and between Stages 0 and III (p < 0.001). Disruption of the blood-brain barrier as indicated by extravasation of Evans blue dye correlated well with the pressure increment. These results may indicate the threshold for injury after cortical venous occlusion. Venous stump pressure measurements obtained during a test occlusion may be a useful adjunct in predicting brain damage and may be helpful for intraoperative vessel selection for venous resection.
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Affiliation(s)
- Y Yoshimoto
- Department of Neurosurgery, Dokkyo University School of Medicine, Tochigi, Japan
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