Superficial Anastomotic Veins: Neurosurgical View Depending on 251 Cranitotomies

Evaluation of cortical venous drainage in patients with Acute Ischemic Stroke

The emergence of Mechanical thrombectomy (MT) has changed the treatment modalities for Acute Ischemic Stroke (AIS). But still 45 to 55% of patients cannot achieve functional independence after sufficient recanalization through endovascular treatment, defined as "futile reperfusion." Poor collateral circulation and microcirculation are key factors affecting prognosis. In the past, the assessment of these mainly focused on intracranial arteries and their collateral, neglecting the important role of the venous system in acute brain injury. More and more studies have found that "poor venous drainage" is associated with poor prognosis. However, there is currently no unified standard for the assessment of "cortical venous drainage." This paper reviews the pathophysiology of the relationship between "cortical venous drainage" and prognosis, as well as the assessment methods and indicators of "cortical venous drainage," aiming to provide a strong basis for the preoperative assessment of AIS patients and the selection of treatment plans.

The benefit of favorable venous outflow profile is mediated through reduced microvascular dysfunction in acute ischemic stroke

INTRODUCTIONS

Venous outflow (VO) is emerging as a marker of microvascular integrity in acute ischemic stroke. Using hemorrhagic transformation (HT) and infarct growth as mediators, we tested whether a favorable VO profile benefited functional outcome by reducing consequences of microvascular dysfunction.

PATIENTS AND METHODS

Patients receiving thrombectomy in three comprehensive stroke centers due to acute anterior circulation occlusion were included. VO was assessed semi-quantitatively by the opacification of ipsilateral vein of Labbé, Trolard and superficial middle cerebral vein. HT was graded on follow-up CT. Infarct growth volume (IGV) was the difference of final infarct volume and baseline core volume. The association of VO and functional independence (90-day modified Rankin Scale ⩽ 2) was examined by logistic regression. Mediation analysis was performed among VO, HT or IGV, and functional outcome in patients with or without recanalization, respectively.

RESULTS

In 242 patients analyzed, VO was strongly correlated with functional independence and VO ⩾ 4 was defined favorable. In 175 patients recanalized, favorable VO was associated with a reduced risk of HT (OR = 0.82, 95% CI 0.71-0.95, p = 0.008), which accounted for 13.1% of the association between VO and favorable outcome. In 67 patients without recanalization, favorable VO was associated with decreased IGV (β = -0.07, 95% CI -0.11 to -0.02, p = 0.007). The association of favorable VO and functional independence was no longer significant (aOR = 4.84, 95% CI 0.87-38.87, p = 0.089) after including IGV in the model, suggesting a complete mediation.

DISCUSSION AND CONCLUSION

In patients with acute anterior large vessel occlusion, the clinical benefit of VO may be mediated through reduced microvascular dysfunction.

Eponyms in Vascular Neurosurgery: Comprehensive Review of 18 Veins

This review is the first comprehensive anatomic report of all venous eponyms used in vascular neurosurgery and provides the historical context of their authors as well as the surgical relevance of every structure. A PubMed literature review identified 13 individuals for whom 18 eponymous venous structures of the brain were named. These structures are the Batson plexus, veins of Breschet, Breschet sinus, vein of Dandy, vein of Galen, prosencephalic vein of Markowski, torcular Herophili, vein of Labbé, venous plexus of Rektorzik, vein of Rolando, basal vein of Rosenthal, sylvian veins, lateral lakes of Trolard, vein of Trolard, hypoglossal plexus of Trolard, petro-occipital vein of Trolard, venous circle of Trolard, and the vein of Vesalius. Eponyms provide a valuable shorthand that encompasses anatomic nuances, variabilities, and surgical relevance. In addition, they elucidate the historical context in which these structures were described and are an academic honor to our predecessors.

Reliability of CT angiography scoring systems used for brain death and the effect of cranial interventions on the results

OBJECTIVE

To assess vascular opacifications, the efficiency, and interobserver agreement (IOA) of five different computed tomography angiography (CTA) brain death (BD) scoring systems in patients with and without cranial interventions, for determining alternative findings correctly supporting BD diagnosis by CTA even in cranial intervention presence.

METHODS

45 patients clinically identified with BD and evaluated with CTA were included. IOA of five different scoring systems used for CTA BD diagnosis, the effect of intracranial interventions on scoring systems, and vascular opacification were evaluated.

RESULTS

IOA was almost perfect (κ = 0.843-0.911, p < 0.05) and substantial (κ = 0.771-0.776, p < 0.05) in all scoring systems. Significant relationships were observed between craniectomy presence and middle cerebral artery M4 segment and internal cerebral vein (ICV) opacification. No opacification was observed in straight sinus (SS) by observers in any of the craniectomized patients.

CONCLUSION

IOA of CTA scoring systems is adequate. But a significant degree of false-negative results is observed due to ICV filling in craniectomy cases. Opacification presence in SS can give an idea of BD in these cases.

Anatomic Eponyms in Neuroradiology: Brain, Cerebral Vasculature, and Calvarium

Medical eponyms are ubiquitous, numerous, and at times controversial. They are often useful for succinctly conveying complex concepts, and familiarity with eponyms is important for proper usage and appropriate communication. In this historical review, we identify 18 anatomic eponyms used to describe structures of the brain, cerebral vasculature, and calvarium. For each structure, we first offer a biographical sketch of the individual for whom the structure is named. This is followed by a description of the anatomic structure and a brief discussion of its clinical relevance.

Computed tomographic angiography of the superficial cerebral venous anastomosis based on volume rendering, multi-planar reconstruction, and integral imaging display

As damage to the superficial cerebral venous anastomosis may create catastrophic complications even after successful surgery, it is important to visualize and determine the normal features of the venous anastomosis with computed tomographic angiography. A total of 90 patients underwent a 64-detector row helical CT scan of head. The superficial cerebral venous anastomosis was reconstructed by volume rendering, multi-planar reconstruction, and integral display algorithm. In particular, we examined the vein of Trolard, the vein of Labbe, and the vein of Sylvian, in order to analyze the venous anastomosis. The superficial cerebral venous anastomosis varied across different individuals, and in this study, six types of anastomosis were found. In 28 % of patients, no venous anastomosis was found in the unilateral cerebral hemisphere. The display rate of the vein of Trolard, the vein of Labbe, and the vein of Sylvian in contributing to venous anastomosis was 70, 80, and 91 %, respectively. The number of vein of Trolard and vein of Labbe on the left side was greater than that of those on the right side. We implemented the 64-detector row helical CT as a rapid and noninvasive method to investigate the superficial cerebral venous anastomosis in our group of patients. We performed substantial image processing for the visualization of the superficial cerebral venous anastomosis; this would not only enable the early diagnosis of cerebral venous disease, but also protect the cerebral vein during neurosurgical intervention.

Isolated cortical vein thrombosis: case series

OBJECT

Isolated cortical vein thrombosis (ICVT) accounts for less than 1% of all cerebral infarctions. ICVT may cause irreversible parenchymal damage, rendering early and accurate diagnosis critical. This case series and literature review presents the clinical and radiological findings in 7 patients with ICVT, and highlights risk factors and imaging modalities that may be most beneficial in rendering an accurate and timely diagnosis.

METHODS

Patients with CT and MRI findings consistent with ICVT examined between January 2011 and June 2014 were included in this retrospective review.

RESULTS

Seven patients (5 females, 2 males), ranging in age from 11 months to 34 years, met the inclusion criteria. The most common clinical presentations were headaches (n = 4) and seizures (n = 3). The most common comorbidities noted in these patients were hypercoagulable states (n = 4) and intracranial hypotension (n = 3). Five patients had intraparenchymal involvement. CT suggested the correct diagnosis in 4 patients, and MRI confirmed the diagnosis in all 7 patients. All patients who received anticoagulation therapy (n = 5) experienced complete resolution of their symptoms.

CONCLUSIONS

The majority of these patients were adult females, consistent with published data. Seizures and headaches were the most common presenting symptoms. Hypercoagulable state and intracranial hypotension, both known risk factors for thrombosis, were the most commonly noted ICVT risk factors. Intraparenchymal involvement was prevalent in nearly all ICVT cases and presented as vasogenic edema, early intraparenchymal hemorrhage, or hemorrhagic venous infarction. Susceptibility-weighted imaging was the most sensitive imaging technique in diagnosing ICVT.

Microsurgical anatomy of the temporal lobe and its implications on temporal lobe epilepsy surgery

Objective. We review the neuroanatomical aspects of the temporal lobe related to the temporal lobe epilepsy. The neuronal, the ventricular, and the vascular structures are demonstrated. Methods. The previous articles published from the laboratory of the senior author are reviewed. Results. The temporal lobe has four surfaces. The medial surface has a complicated microanatomy showing close relation to the intraventricular structures, such as the amygdala or the hippocampus. There are many white matter bundles in the temporal lobe showing relation to the extra- and intraventricular structures. The surgical approaches commonly performed to treat temporal lobe epilepsy are discussed under the light of these data. Conclusion. A thorough knowledge of the microanatomy is necessary in cortical, subcortical, and intraventricular structures of the temporal lobe to achieve better results.