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Dang DD, Rechberger JS, Leonel LC, Hallak H, Graepel S, Link MJ, Daniels DJ, Peris-Celda M. Anatomical Step-by-Step Dissection of Midline Suboccipital Approaches to the Fourth Ventricle for Trainees: Surgical Anatomy of the Telovelar, Transvermian, and Superior Transvelar Routes, Surgical Principles, and Illustrative Cases. J Neurol Surg B Skull Base 2024; 85:172-188. [PMID: 38449580 PMCID: PMC10914463 DOI: 10.1055/a-2018-4745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 01/17/2023] [Indexed: 01/26/2023] Open
Abstract
Introduction Safe, effective access to the fourth ventricle for oncologic resection remains challenging given the depth of location, restricted posterior fossa boundaries, and surrounding eloquent neuroanatomy. Despite description in the literature, a practical step-by step dissection guide of the suboccipital approaches to the fourth ventricle targeted to all training levels is lacking. Methods Two formalin-fixed, latex-injected specimens were dissected under microscopic magnification and endoscopic visualization. Dissections of the telovelar, transvermian, and supracerebellar infratentorial-superior transvelar approaches were performed by one neurosurgery resident (D.D.D.), under guidance of senior authors. The dissections were supplemented with representative clinical cases to highlight pertinent surgical principles. Results The telovelar and transvermian corridors afford excellent access to the caudal two-thirds of the fourth ventricle with the former approach offering expanded access to the lateral recess, foramen of Luschka, adjacent skull base, and cerebellopontine angle. The supracerebellar infratentorial-superior transvelar approach reaches the rostral third of the fourth ventricle, the cerebral aqueduct, and dorsal mesencephalon. Key steps described include positioning and skin incision, myofascial dissection, burr hole and craniotomy, durotomy, the aforementioned transventricular routes, and identification of relevant skull base landmarks. Conclusion The midline suboccipital craniotomy represents a foundational cranial approach, particularly for lesions involving the fourth ventricle. Operatively oriented resources that combine stepwise neuroanatomic dissections with representative cases provide a crucial foundation for neurosurgical training. We present a comprehensive guide for trainees in the surgical anatomy laboratory to optimize familiarity with fourth ventricle approaches, mastery of relevant microsurgical anatomy, and simultaneous preparation for learning in the operating room.
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Affiliation(s)
- Danielle D. Dang
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
- Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota, United States
| | - Julian S. Rechberger
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
- Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota, United States
| | - Luciano C.P.C. Leonel
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
- Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota, United States
| | - Hana Hallak
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
- Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota, United States
| | - Stephen Graepel
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | - Michael J. Link
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
- Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota, United States
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | - David J. Daniels
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | - Maria Peris-Celda
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
- Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota, United States
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, United States
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Hiramatsu M, Ozaki T, Tanoue S, Mizutani K, Nakamura H, Tokuyama K, Sakata H, Matsumaru Y, Nakahara I, Niimi Y, Fujinaka T, Kiyosue H. Detailed Anatomy of Bridging Veins Around the Foramen Magnum: a Multicenter Study Using Three-dimensional Angiography. Clin Neuroradiol 2024; 34:67-74. [PMID: 37552244 PMCID: PMC10881699 DOI: 10.1007/s00062-023-01327-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 06/14/2023] [Indexed: 08/09/2023]
Abstract
BACKGROUND AND PURPOSE There has been limited literature regarding the bridging veins (BVs) of the medulla oblongata around the foramen magnum (FM). The present study aims to analyze the normal angioarchitecture of the BVs around the FM using slab MIP images of three-dimensional (3D) angiography. METHODS We collected 3D angiography data of posterior fossa veins and analyzed the BVs around the FM using slab MIP images. We analyzed the course, outlet, and number of BVs around the FM. We also examined the detection rate and mean diameter of each BV. RESULTS Of 57 patients, 55 patients (96%) had any BV. The median number of BVs was two (range: 0-5). The BVs originate from the perimedullary veins and run anterolaterally to join the anterior condylar vein (ACV), inferior petrosal sinus, sigmoid sinus, or jugular bulb, inferolaterally to join the suboccipital cavernous sinus (SCS), laterally or posterolaterally to join the marginal sinus (MS), and posteriorly to join the MS or occipital sinus. We classified BVs into five subtypes according to the draining location: ACV, jugular foramen (JF), MS, SCS, and cerebellomedullary cistern (CMC). ACV, JF, MS, SCS, and CMC BVs were detected in 11 (19%), 18 (32%), 32 (56%), 20 (35%), and 16 (28%) patients, respectively. The mean diameter of the BVs other than CMC was 0.6 mm, and that of CMC BV was 0.8 mm. CONCLUSION Using venous data from 3D angiography, we detected FM BVs in most cases, and the BVs were connected in various directions.
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Affiliation(s)
- Masafumi Hiramatsu
- Department of Neurological Surgery, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan.
| | - Tomohiko Ozaki
- Department of Neurosurgery, National Hospital Organization, Osaka National Hospital, Osaka, Japan
| | - Shuichi Tanoue
- Department of Radiology, Kurume University School of Medicine, Kurume, Japan
| | - Katsuhiro Mizutani
- Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan
| | - Hajime Nakamura
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kohei Tokuyama
- Department of Radiology, Oita University Faculty of Medicine, Yuhu, Japan
| | - Hiroyuki Sakata
- Department of Neuroendovascular Therapy, Kohnan Hospital, Sendai, Japan
| | - Yuji Matsumaru
- Division of Stroke Prevention and Treatment, Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Ichiro Nakahara
- Department of Comprehensive Strokology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Yasunari Niimi
- Department of Neuroendovascular Therapy, St Luke's International Hospital, Tokyo, Japan
| | - Toshiyuki Fujinaka
- Department of Neurosurgery, National Hospital Organization, Osaka National Hospital, Osaka, Japan
| | - Hiro Kiyosue
- Department of Diagnostic Radiology, Kumamoto University Faculty of Medicine, Kumamoto, Japan
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Wang Y, Piras G, Lauda L, Caruso A, Russo A, Taibah A, Sanna M. Superior petrosal vein sacrifice in translabyrinthine approach for resection of vestibule schwannoma. Eur Arch Otorhinolaryngol 2024; 281:1195-1203. [PMID: 37665344 DOI: 10.1007/s00405-023-08208-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 08/22/2023] [Indexed: 09/05/2023]
Abstract
PURPOSE The aim of this study was to evaluate the safety and surgical outcome of superior petrosal vein (SPV, Dandy's vein) sacrifice in translabyrinthine approach (TLA) for resection of vestibule schwannoma (VS) as compared with SPV preservation, with further investigation of preoperational factors associated with the implement of SPV sacrifice. METHODS The authors prospectively collected data from patients surgically treated for VS through TLA between June 2021 and April 2022 at the Gruppo Otologico. RESULTS There were 30 and 49 patients in SPV sacrifice and preservation groups, respectively. SPV sacrifice group had significantly larger tumor size (2.46 vs. 1.40 cm), less percentage of solid tumor (26.7% vs. 83.7%), higher incidence of brainstem compression (80% vs. 26.5%), and higher percentage of facial numbness (20.0% vs. 4.1%) than SPV preservation group. Gross total resection (GTR) rates were 73.3% after SPV sacrifice and 87.8% after SPV preservation. Facial nerve preservation rates were similar. No complication related with SPV sacrifice was observed. Logistic regression analysis showed tumor size and complete solid consistency as significant risk factors associated with SPV sacrifice. ROC curve further demonstrated tumor size as a fair predictor (AUC = 0.833), with optimum cutoff value of 1.68 cm. CONCLUSION SPV sacrifice via TLA as needed is a safe and effective maneuver for removal of relatively large VS. Tumor size and consistency can be used as a guidance in preoperational decision-making, with cutoff value of 1.68 cm and cystic formation as predictive indicators.
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Affiliation(s)
- Yongjie Wang
- Department of Neurosurgery, 2nd Affiliated Hospital, School of Medicine, Zhejiang University, #88 Jiefang Road, Hangzhou, Zhejiang, China
| | - Gianluca Piras
- Gruppo Otologico, c/o Casa di Cura, Via Emmanueli, 42-29100, Piacenza, Italy.
| | - Lorenzo Lauda
- Gruppo Otologico, c/o Casa di Cura, Via Emmanueli, 42-29100, Piacenza, Italy
| | - Antonio Caruso
- Gruppo Otologico, c/o Casa di Cura, Via Emmanueli, 42-29100, Piacenza, Italy
| | - Alessandra Russo
- Gruppo Otologico, c/o Casa di Cura, Via Emmanueli, 42-29100, Piacenza, Italy
| | - Abdelkader Taibah
- Gruppo Otologico, c/o Casa di Cura, Via Emmanueli, 42-29100, Piacenza, Italy
| | - Mario Sanna
- Gruppo Otologico, c/o Casa di Cura, Via Emmanueli, 42-29100, Piacenza, Italy
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Madriñán-Navia HJ, Scherschinski L, Benet A, Lawton MT. Advanced Surgical Techniques for Dural Venous Sinus Repair: A Comprehensive Literature Review. Oper Neurosurg (Hagerstown) 2024:01787389-990000000-01047. [PMID: 38330415 DOI: 10.1227/ons.0000000000001069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 12/05/2023] [Indexed: 02/10/2024] Open
Abstract
The dural venous sinus (DVS) is a thin-walled blood channel composed of dura mater that is susceptible to injury during common neurosurgical approaches. DVS injuries are highly underreported, which is reflected by a lack of literature on the topic. Neurosurgeons should be familiar with appropriate techniques to successfully repair an injured DVS and prevent associated complications. This study presents a literature review on the surgical techniques for DVS repair after DVS injury during common neurosurgical approaches. The databases PubMed and Scopus were queried using the terms "cranial sinuses," "superior sagittal sinus," "transverse sinuses," "injury," and "surgery." A total of 117 articles underwent full-text review and were analyzed for surgical approach, craniotomy, lesion location, lesion characteristics, and surgical repair techniques. A literature review was performed, and a comprehensive summary is presented. Data from publications describing DVS lacerations related to pathological conditions (eg, meningioma) were excluded. A total of 9 techniques aiding with bleeding control, hemostasis, and sinus repair and reconstruction were identified, including compression, hemostatic agents, bipolar cautery, dural tenting and tack-up suturing, dural flap, direct suturing, autologous patch, venous bypass, and ligation. The advantages and drawbacks of each technique are described. Multiple options to treat DVS injuries are available to the neurosurgeon. Treatment type is based on anatomic location, complexity of the laceration, cardiovascular status, the presence of air embolism, and the dexterity and experience of the surgeon.
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Affiliation(s)
- Humberto José Madriñán-Navia
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
- Center for Research and Training in Neurosurgery (CIEN), Hospital Universitario de la Samaritana, Bogotá, Colombia
| | - Lea Scherschinski
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Arnau Benet
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Michael T Lawton
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
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Miyauchi T, Mizutani K, Akiyama T, Toda M. Bridging veins at the craniocervical junction: from anatomy to clinical significance in dural arteriovenous shunts. Neuroradiology 2024; 66:55-62. [PMID: 37828277 DOI: 10.1007/s00234-023-03232-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 10/03/2023] [Indexed: 10/14/2023]
Abstract
PURPOSE Bridging veins (BVs) serve as a route of pial venous reflux, and its anatomy is essential to understand the pathophysiology of dural arteriovenous shunts (dAVSs) around the craniocervical junction (CCJ) (from the jugular foramen level to the atlantal level). However, the anatomical variations of the BVs and their proximal connections remained poorly elucidated. This study aimed to radiologically investigate the anatomy of the bridging veins around CCJ and discuss the clinical significance of these BVs in the dAVS. METHODS We investigated normal venous anatomy of the BVs from the jugular foramen level to the atlantal level using preoperative computed tomography digital subtraction venography in patients undergoing elective neurosurgery. BVs affected by the dAVSs in the same region were also evaluated. The three types of dAVS, craniocervical junction, anterior condylar, and proximal sigmoid sinus, were investigated. RESULTS We identified six BV groups: superolateral, anterolateral, lateral, posterior, inferolateral, and inferoposterior. The superolateral and inferolateral groups, connected with the proximal sigmoid sinus and suboccipital cavernous sinus, respectively, were the largest groups. Each group has a specific downstream venous connection. The association with dVASs was observed only in the inferolateral group, which was typically the sole venous drainage in most dAVSs at the CCJ. CONCLUSION We reported detailed anatomy of BVs from the jugular level to the atlantal level, which enhanced our understanding of the pathophysiology of dAVSs in the corresponding region.
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Affiliation(s)
- Tsubasa Miyauchi
- Department of Neurosurgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
| | - Katsuhiro Mizutani
- Department of Neurosurgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan.
| | - Takenori Akiyama
- Department of Neurosurgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
| | - Masahiro Toda
- Department of Neurosurgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
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Rusu MC, Lazăr M, Vrapciu AD. Ring-shaped Dandy's superior petrosal vein. Surg Radiol Anat 2023; 45:1563-1565. [PMID: 37812287 DOI: 10.1007/s00276-023-03248-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 09/25/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND Dandy's superior petrosal vein (SPV) anatomy is highly relevant for neurosurgeons. The SPV drains into the superior petrosal sinus (SPS), closely related to the trigeminal and internal auditory pores. METHOD The archived enhanced MRI files of a male patient were studied. RESULTS An infratentorial ring-shaped (RS) SPV was found on the petrosal surface of the right cerebellar hemisphere. It was inserted in the SPS above the internal auditory pore, postero-lateral to the trigeminal pore. The anterior arm of that venous ring received a delicate supratrigeminal plexus of veins from the pontine surface and continued as a single venous trunk on the cerebellar surface. CONCLUSION Such previously unreported RS-SPV is of utmost importance to be identified before subtemporal transtentorial and retrosigmoid approaches for different neurosurgical reasons.
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Affiliation(s)
- Mugurel Constantin Rusu
- Division of Anatomy, Department 1, Faculty of Dentistry, "Carol Davila" University of Medicine and Pharmacy, 8 Eroilor Sanitari Blvd., 050474, Bucharest, Romania.
| | - Mihai Lazăr
- Division of Physiopathology II, Department 2, Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, 050474, Bucharest, Romania
| | - Alexandra Diana Vrapciu
- Division of Anatomy, Faculty of Stomatology, "Carol Davila" University of Medicine and Pharmacy, 050474, Bucharest, Romania
- University Emergency Hospital Bucharest, Bucharest, Romania
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Jeon C, Kim M, Lee HS, Kong DS, Park K. Outcomes after Microvascular Decompression for Hemifacial Spasm without Definite Radiological Neurovascular Compression at the Root Exit Zone. Life (Basel) 2023; 13:2064. [PMID: 37895445 PMCID: PMC10608077 DOI: 10.3390/life13102064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 09/24/2023] [Accepted: 09/29/2023] [Indexed: 10/29/2023] Open
Abstract
The purpose of this study was to investigate the outcome of microvascular decompression (MVD) in patients with hemifacial spasm (HFS) who have no definite radiological neurovascular compression (NVC). Sixteen HFS patients without radiological NVC on preoperative MRI underwent MVD surgery. The symptoms were left-sided in fourteen (87.5%) and right-sided in two patients (12.5%). Intraoperatively, the most common vessel compressing the facial nerve was the AICA (8, 44.4%), followed by arterioles (5, 27.8%), veins (4, 22.2%), and the PICA (1, 5.6%). The most common compression site was the cisternal portion (13, 76.5%) of the facial nerve, followed by the REZ (4, 23.5%). One patient (6.3%) was found to have multiple NVC sites. Arachnoid type (7, 50%) was the most common compressive pattern, followed by perforator type (4, 28.6%), sandwich type (2, 14.3%), and loop type (1, 7.1%). A pure venous compression was seen in two patients, while a combined venous-arterial "sandwich" compression was detected in two patients. Symptom improvement was observed in all of the patients. Only one patient experienced recurrence after improvement. Based on our experience, MVD surgery can be effective for primary HFS patients with no definite radiological NVC. MVD can be considered if the patient shows typical HFS features, although NVC is not evident on MRI.
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Affiliation(s)
- Chiman Jeon
- Department of Neurosurgery, Korea University Ansan Hospital, Ansan 15355, Republic of Korea;
| | - Minsoo Kim
- Department of Neurosurgery, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung 25440, Republic of Korea;
| | - Hyun-Seok Lee
- Department of Neurosurgery, Konkuk University Medical Center, Seoul 05030, Republic of Korea;
| | - Doo-Sik Kong
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea;
| | - Kwan Park
- Department of Neurosurgery, Konkuk University Medical Center, Seoul 05030, Republic of Korea;
- Department of Neurosurgery, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
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Basamh M, Sinning N, Ajabnoor W, Illies T, Kehler U. Preoperative assessment of the individual anatomy of the superior petrosal vein complex using balanced fast field echo magnetic resonance imaging. Surg Radiol Anat 2023; 45:1273-1285. [PMID: 37548655 DOI: 10.1007/s00276-023-03220-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 07/24/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND Here, we sought to examine the validity and reproducibility of balanced fast field echo (bFFE) for assessing superior petrosal vein (SPV) complex (SPVC) anatomy. METHODS Preoperative bFFE or equivalent scans and operative videos were studied and directly compared with regard to the individual anatomical features of SPVCs and their relation to the operative field. The anatomical details of the bFFE findings of the non-operated side (group 2) of all 50 patients were then reviewed, including the presence of petrosal-galenic anastomosis, and finally compared to the operated SPVCs (group 1). RESULTS A complete correlation between bFFE and intraoperative findings was observed in 62% of cases and had a significant correlation with 3 Tesla magnet strength and higher pixel bandwidth (rbis = - 0.47; p = 0.005). The sensitivity and specificity of bFFE magnetic resonance imaging were 93.7 and 95.2%, respectively, for detecting an SPV disturbing the operative field, and 97.3% and 95% for a disturbing tributary, respectively. Each group had 50 SPVCs, with a total of 70 and 64 SPVs, 10 and 11 general SPVC configurations, as well as 29 and 28 different individual anatomical variations in groups 1 and 2, respectively. Both groups had 1-3 SPVs with a similar distribution of frequencies [Chi-square (4) = 27.56; p = 0.0145 (Fisher's exact test)]. The similarity of the general configurations was not statistically significant. The same four predominant configurations constituted 80% of the SPVCs in each group. The vein of the cerebellopontine fissure was most frequently found in 86% and 88% of cases, and a petrosal-galenic anastomosis was seen in 38% and 40% of groups 1 and 2, respectively. CONCLUSIONS Individual SPVC variations are extensive. Good quality bFFE or equivalents are feasible for preoperative SPVC assessments. However, methods improving vascular visualization are recommended.
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Affiliation(s)
- Mohammed Basamh
- Division of Neurosurgery, King Abdul-Aziz University Hospital, P. O. Box 80125, 21589, Jeddah, Saudi Arabia.
| | - Nico Sinning
- Department of Neurosurgery, Asklepios Klinik Altona, Hamburg, Germany
| | - Waleed Ajabnoor
- Department of Radiology, King Abdul-Aziz University Hospital, Jeddah, Saudi Arabia
| | - Till Illies
- Department of Neuroradiology, Asklepios Klinik Altona, Hamburg, Germany
| | - Uwe Kehler
- Department of Neurosurgery, Asklepios Klinik Altona, Hamburg, Germany
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Amano Y, Asayama B, Noro S, Okuma M, Honjo K, Seo Y, Nakamura H. Objectively-captured Changes in Trigeminal Fibers before and after Microvascular Decompression Using 3D T2-SPACE MRI Might Relate to Eventual Residual Symptoms. Neurol Med Chir (Tokyo) 2023; 63:400-408. [PMID: 37495521 PMCID: PMC10556207 DOI: 10.2176/jns-nmc.2022-0354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 04/17/2023] [Indexed: 07/28/2023] Open
Abstract
Although microvascular decompression (MVD) is a reliable treatment for trigeminal neuralgia (TN), neurosurgeons sometimes encounter patients whose symptoms do not improve postoperatively or who experience good treatment efficacy but develop other sensory disturbances. This study aims to objectively identify changes in nerve fibers before and after surgery by MRI and to clarify the relationship between the changes and residual postoperative symptoms. We retrospectively analyzed data from 36 consecutive patients who underwent MVD for classical TN at our hospital between November 2019 and November 2020. Cases that fulfilled the diagnostic criteria for multiple sclerosis were excluded. We confirmed the changes on the brainstem side of the trigeminal nerve preoperatively and at seven days postoperatively using 3D T2-SPACE MRI, in which the patients were divided into three groups: preoperative T2 high intensity positive (A), postoperative T2 high intensity positive (B), and no T2 high-intensity region (C). The primary outcome measures were therapeutic efficacy and frequency of postoperative numbness. The results of MVD surgery were evaluated one year postoperatively. The percentage of cases in which treatment outcomes were rated as excellent or good at one year: group A: 0 (0%), group B: 6 (100%), and group C: 25 (96.2%) (p < 0.05); the frequency of numbness: 2 (50%) in group A, 3 (50%) in group B, and 1 (3.8%) in group C, indicating significant differences between the three groups (p < 0.05). 3D T2-SPACE MRI sequences can be used to identify changes in trigeminal nerve fibers before and after MVD, which might correlate with eventual residual symptoms.
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Affiliation(s)
- Yuki Amano
- Department of Neurosurgery, Nakamura Memorial Hospital
| | | | - Shusaku Noro
- Department of Neurosurgery, Nakamura Memorial Hospital
| | | | - Kaori Honjo
- Department of Neurosurgery, Nakamura Memorial Hospital
| | - Yoshinobu Seo
- Department of Neurosurgery, Nakamura Memorial Hospital
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Krogager ME, Dahl RH, Poulsgaard L, Fugleholm K, Sehested T, Mikkelsen R, Tranum-Jensen J, Mathiesen TI, Benndorf G. Combined cone-beam CT imaging and microsurgical dissection of cadaver specimens to study cerebral venous anatomy: a technical note. Surg Radiol Anat 2023; 45:1177-1184. [PMID: 37542573 PMCID: PMC10514096 DOI: 10.1007/s00276-023-03195-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 06/28/2023] [Indexed: 08/07/2023]
Abstract
PURPOSE Cadaver dissections and X-ray based 3D angiography are considered gold standards for studying neurovascular anatomy. We sought to develop a model that utilize the combination of both these techniques to improve current tools for anatomical research, teaching and preoperative surgical planning, particularly addressing the venous system of the brain. MATERIALS AND METHODS Seven ethanol-fixed human cadaveric heads and one arm were injected with a latex-barium mixture into the internal jugular veins and the brachial artery. After the ethanol-based fixation, specimens were scanned by high-resolution cone-beam CT and images were post-processed on a 3D-workstation. Subsequent, microsurgical dissections were performed by an experienced neurosurgeon and venous anatomy was compared with relevant 3D venograms. RESULTS Latex-barium mixtures resulted in a homogenous cast with filling of the cerebral venous structures down to 150 μm in diameter. The ethanol-based preparation of the cadaveric brains allowed for near-realistic microsurgical maneuverability during dissection. The model improves assessment of the venous system for anatomical education and hands-on surgical training. CONCLUSION To our knowledge we describe the first preparation method which combines near-realistic microsurgical dissection of human heads with high-resolution 3D imaging of the cerebral venous system in the same specimens.
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Affiliation(s)
- Markus E Krogager
- Department of Neurosurgery, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark.
| | - Rasmus H Dahl
- Department of Radiology, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark
- Department of Radiology, Hvidovre Hospital, Copenhagen, Denmark
| | - Lars Poulsgaard
- Department of Neurosurgery, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Kåre Fugleholm
- Department of Neurosurgery, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Tom Sehested
- Department of Neurosurgery, Aarhus University Hospital, Aarhus, Denmark
| | - Ronni Mikkelsen
- Department of Neuroradiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Jørgen Tranum-Jensen
- Department of Cellular and Molecular Medicine, The Panum Institute, University of Copenhagen, Copenhagen, Denmark
| | - Tiit I Mathiesen
- Department of Neurosurgery, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Goetz Benndorf
- Department of Radiology, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark
- Department of Radiology, Baylor College of Medicine, Houston, TX, USA
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Campagnaro L, Bonaudo C, Capelli F, Della Puppa A. Microscope neuronavigation-guided microsurgical fenestration of quadrigeminal cistern arachnoid cysts: how I do it. Acta Neurochir (Wien) 2023; 165:2561-2565. [PMID: 36849831 DOI: 10.1007/s00701-023-05531-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 02/12/2023] [Indexed: 03/01/2023]
Abstract
BACKGROUND Management options for treatment of quadrigeminal arachnoid cysts (QAC) include microsurgical/endoscopic fenestration or shunt. There is an open debate about which method is the best. Microsurgical fenestration is well suited for treatment of QAC with predominant infratentorial component and without hydrocephalus making endoscopic procedures more challenging. METHOD We describe the microsurgical technique and related anatomy to fenestrate infratentorial QAC through supracerebellar infratentorial approach. We also discuss our experiences with this approach, some of the drawbacks and nuances. CONCLUSION Navigation-guided microsurgical fenestration of infratentorial QAC is the authors' surgical approach of choice for treating these rare challenging lesions when not associated with hydrocephalus.
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Affiliation(s)
- Luca Campagnaro
- Neurosurgery, Department of Neuroscience, Psychology, Pharmacology and Child Health, Careggi University Hospital and University of Florence, Largo Palagi 1, 50134, Florence, Italy.
| | - Camilla Bonaudo
- Neurosurgery, Department of Neuroscience, Psychology, Pharmacology and Child Health, Careggi University Hospital and University of Florence, Largo Palagi 1, 50134, Florence, Italy
| | - Federico Capelli
- Neurosurgery, Department of Neuroscience, Psychology, Pharmacology and Child Health, Careggi University Hospital and University of Florence, Largo Palagi 1, 50134, Florence, Italy
| | - Alessandro Della Puppa
- Neurosurgery, Department of Neuroscience, Psychology, Pharmacology and Child Health, Careggi University Hospital and University of Florence, Largo Palagi 1, 50134, Florence, Italy
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12
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Su H, Yu J. Treatment of high cervical arteriovenous fistulas in the craniocervical junction region. Front Neurol 2023; 14:1164548. [PMID: 37441609 PMCID: PMC10335834 DOI: 10.3389/fneur.2023.1164548] [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: 02/13/2023] [Accepted: 06/13/2023] [Indexed: 07/15/2023] Open
Abstract
The craniocervical junction (CCJ) is a complex region. Rarely, arteriovenous fistulas (AVFs) can occur in the CCJ region. Currently, it is accepted that CCJ AVFs should only refer to AVFs at the C1-C2 levels. It is reasonable to assume that high cervical CCJ AVFs are being referred to when discussing CCJ AVFs. High cervical CCJ AVFs can be divided into the following four types: dural AVF, radicular AVF, epidural AVF and perimedullary AVF. Until now, it was difficult to understand high cervical CCJ AVFs and provide a proper treatment for them. Therefore, an updated review of high cervical CCJ AVFs is necessary. In this review, the following issues are discussed: the definition of high cervical CCJ AVFs, vessel anatomy of the CCJ region, angioarchitecture of high cervical CCJ AVFs, treatment options, prognoses and complications. Based on the review and our experience, we found that the four types of high cervical CCJ AVFs share similar clinical and imaging characteristics. Patients may present with intracranial hemorrhage or congestive myelopathy. Treatment, including open surgery and endovascular treatment (EVT), can be used for symptomatic AVFs. Most high cervical CCJ AVFs can be effectively treated with open surgery. EVT remains challenging due to a high rate of incomplete obliteration and complications, and it can only be performed in superselective AVFs with simple angioarchitecture. Appropriate treatment can lead to a good prognosis.
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13
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Sattari SA, Shahbandi A, Xu R, Hung A, Feghali J, Yang W, Lee RP, Bettegowda C, Huang J. Sacrifice or preserve the superior petrosal vein in microvascular decompression surgery: a systematic review and meta-analysis. J Neurosurg 2023; 138:390-398. [PMID: 35901727 DOI: 10.3171/2022.5.jns22143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 05/05/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE In microvascular decompression (MVD) surgery through the retrosigmoid approach, the surgeon may have to sacrifice the superior petrosal vein (SPV). However, this is a controversial maneuver. To date, high-level evidence comparing the operative outcomes of patients who underwent MVD with and without SPV sacrifice is lacking. Therefore, this study sought to bridge this gap. METHODS The authors searched the Medline and PubMed databases with appropriate Medical Subject Heading (MeSH) terms and keywords. The primary outcome was vascular-related complications; secondary outcomes were new neurological deficit, cerebrospinal fluid (CSF) leak, and neuralgia relief. The pooled proportions of outcomes and OR (95% CI) for categorical data were calculated by using the logit transformation and Mantel-Haenszel methods, respectively. RESULTS Six studies yielding 1143 patients were included, of which 618 patients had their SPV sacrificed. The pooled proportion (95% CI) values were 3.82 (0.87-15.17) for vascular-related complications, 3.64 (1.0-12.42) for new neurological deficits, 2.85 (1.21-6.58) for CSF leaks, and 88.90 (84.90-91.94) for neuralgia relief. The meta-analysis concluded that, whether the surgeon sacrificed or preserved the SPV, the odds were similar for vascular-related complications (2.5% vs 1.5%, OR [95% CI] 1.01 [0.33-3.09], p = 0.99), new neurological deficits (1.2% vs 2.8%, OR [95% CI] 0.55 [0.18-1.66], p = 0.29), CSF leak (3.1% vs 2.1%, OR [95% CI] 1.16 [0.46-2.94], p = 0.75), and neuralgia relief (86.6% vs 87%, OR [95% CI] 0.96 [0.62-1.49], p = 0.84). CONCLUSIONS SPV sacrifice is as safe as SPV preservation. The authors recommend intentional SPV sacrifice when gentle retraction fails to enhance surgical field visualization and if the surgeon encounters SPV-related neurovascular conflict and/or anticipates impeding SPV-related bleeding.
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Affiliation(s)
- Shahab Aldin Sattari
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; and
| | - Ataollah Shahbandi
- 2Tehran School of Medicine, Tehran University of Medical Science, Tehran, Iran
| | - Risheng Xu
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; and
| | - Alice Hung
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; and
| | - James Feghali
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; and
| | - Wuyang Yang
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; and
| | - Ryan P Lee
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; and
| | - Chetan Bettegowda
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; and
| | - Judy Huang
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; and
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14
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Liu L, Wu Y, Zhang K, Meng R, Duan J, Zhou C, Ji X. Anatomy imaging and hemodynamics research on the cerebral vein and venous sinus among individuals without cranial sinus and jugular vein diseases. Front Neurosci 2022; 16:999134. [PMID: 36238084 PMCID: PMC9551167 DOI: 10.3389/fnins.2022.999134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 09/12/2022] [Indexed: 11/15/2022] Open
Abstract
In recent years, imaging technology has allowed the visualization of intracranial and extracranial vascular systems. However, compared with the cerebral arterial system, the relative lack of image information, individual differences in the anatomy of the cerebral veins and venous sinuses, and several unique structures often cause neurologists and radiologists to miss or over-diagnose. This increases the difficulty of the clinical diagnosis and treatment of cerebral venous system diseases. This review focuses on applying different imaging methods to the normal anatomical morphology of the cerebral venous system and special structural and physiological parameters, such as hemodynamics, in people without cranial sinus and jugular vein diseases and explores its clinical significance. We hope this study will reinforce the importance of studying the cerebral venous system anatomy and imaging data and will help diagnose and treat systemic diseases.
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Affiliation(s)
- Lu Liu
- Department of Neurology, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Yan Wu
- Department of Emergency, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Kaiyuan Zhang
- Department of Radiology, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Ran Meng
- Department of Neurology, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Jiangang Duan
- Department of Neurology, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Chen Zhou
- Department of Neurology, Xuanwu Hospital of Capital Medical University, Beijing, China
- Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China
- *Correspondence: Chen Zhou,
| | - Xunming Ji
- Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China
- Department of Neurosurgery, Xuanwu Hospital of Capital Medical University, Beijing, China
- Xunming Ji,
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15
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Krogager ME, Jespersen B, Mathiesen TI, Benndorf G. Three underdogs among galenic veins: anatomical analysis and literature review of surgical relevant veins in the quadrigeminal cistern. Neurosurg Rev 2022; 45:3245-3258. [PMID: 35947231 DOI: 10.1007/s10143-022-01842-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 06/30/2022] [Accepted: 07/30/2022] [Indexed: 11/25/2022]
Abstract
Recent studies (Alaou-Ismaili et al. 2020; Kilic et al. Eur J Radiol 56:212-219, 2005) among experienced sub-specialized neurosurgeons described divergent perceptions of surgical risk for venous sacrifice in posterior fossa surgery. Three galenic veins stood out as controversial in venous risk assessment and underexplored in the literature: the internal occipital vein (IOV), the precentral cerebellar vein (PCV), and the superior vermian vein (SVV). We have conducted a narrative review based on a systematic literature search to analyze terminology and anatomic descriptions and to suggest a coherent synthesis of published data on these veins. A systematic PubMed literature search was carried out using the keywords: "posterior fossa," "venous anatomy," and "radiology." Relevant radiological, microsurgical, and anatomical articles were selected if they described the anatomy of the three veins. Anatomical descriptions were analyzed with hermeneutic methodology alongside the articles' radiological and anatomical dissection pictures. New illustrations were created to depict the synthesized image of the venous anatomy. A total of 13 articles described the anatomy and terminology of the relevant veins. The descriptions of the IOV included smaller non-occipital vessels that confused the identification of the vessel. IOV is analyzed to be the vein draining the primary visual cortex, which drains into the vein of Galen (VG). The PCV and SVV enter the VG from below and are fused in almost half of all studied patients, creating a third vessel by the name of the superior cerebellar vein. A conscientious narrative review and hermeneutic analysis produced a synthesized, uniform picture of terminology and anatomy. Consensus on anatomical descriptions and definitions are indispensable for validation of anatomy, research into anatomical variation, for surgical planning and documentation.
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Affiliation(s)
- M E Krogager
- Department of Neurosurgery, Rigshospitalet, Copenhagen, Denmark.
| | - B Jespersen
- Department of Neurosurgery, Rigshospitalet, Copenhagen, Denmark
| | - T I Mathiesen
- Department of Neurosurgery, Rigshospitalet, Copenhagen, Denmark.,IKM University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - G Benndorf
- Department of Diagnostic Radiology, University Hospital Rigshospitalet, Copenhagen, Denmark.,Department of Radiology, Baylor College of Medicine, Houston, TX, USA
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16
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Shapiro M, Raz E, Nossek E, Srivatanakul K, Young M, Narayan V, Ali A, Sharashidze V, Esparza R, Nelson PK. Cerebral venous anatomy: implications for the neurointerventionalist. J Neurointerv Surg 2022; 15:452-460. [PMID: 35803732 DOI: 10.1136/neurintsurg-2022-018917] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 06/12/2022] [Indexed: 11/03/2022]
Abstract
Meaningful contributions to neurointerventional practice may be possible by considering the dynamic aspects of angiography in addition to fixed morphologic information. The functional approach to venous anatomy requires integration of the traditional static anatomic features of the system-deep, superficial, posterior fossa, medullary veins, venous sinuses, and outflow routes into an overall appreciation of how a classic model of drainage is altered, embryologically, or pathologically, depending on patterns of flow-visualization made possible by angiography. In this review, emphasis is placed on balance between alternative venous networks and their redundancy, and the problems which arise when these systems are lacking. The role of veins in major neurovascular diseases, such as dural arteriovenous fistulae, arteriovenous malformations, pulsatile tinnitus, and intracranial hypertension, is highlighted, and deficiencies in knowledge emphasized.
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Affiliation(s)
- Maksim Shapiro
- Department of Radiology and Neurology, NYU, New York, New York, USA .,Department of Radiology and Neurology, Bellevue Hospital Center, New York, New York, USA
| | - Eytan Raz
- Department of Radiology, NYU, New York, New York, USA.,Department of Radiology, Bellevue Hospital Center, New York, New York, USA
| | - Erez Nossek
- Department of Neurosurgery, NYU, New York, New York, USA.,Department of Neurosurgery, Bellevue Hospital Center, New York, New York, USA
| | - Kittipong Srivatanakul
- Department of Neurosurgery, Tokai University School of Medicine Graduate School of Medicine, Isehara, Japan
| | - Matthew Young
- Department of Radiology, NYU, New York, New York, USA.,Department of Radiology, Bellevue Hospital Center, New York, New York, USA
| | - Vinayak Narayan
- Department of Radiology, NYU, New York, New York, USA.,Department of Radiology, Bellevue Hospital Center, New York, New York, USA
| | - Aryan Ali
- Department of Radiology, NYU, New York, New York, USA.,Department of Radiology, Bellevue Hospital Center, New York, New York, USA
| | - Vera Sharashidze
- Department of Radiology, NYU, New York, New York, USA.,Department of Radiology, Bellevue Hospital Center, New York, New York, USA
| | - Rogelio Esparza
- Department of Neurosurgery, NYU, New York, New York, USA.,Department of Neurosurgery, Bellevue Hospital Center, New York, New York, USA
| | - Peter Kim Nelson
- Department of Radiology and Neurology, Bellevue Hospital Center, New York, New York, USA.,Department of Radiology and Neurosurgery, NYU, New York, New York, USA
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17
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Wang M, Wang J, Zhang X, Chai S, Cai Y, Dai X, Yang B, Liu W, Lu T, Mei Z, Zheng Z, Zhou Y, Yang J, Shen L, Zhao J, Ho J, Cai M, Chen J, Xiong N. Intraoperative Findings of Inferior Petrosal Vein During Microvascular Decompression for Hemifacial Spasm: A Single-Surgeon Experience. Front Surg 2022; 9:921589. [PMID: 35756473 PMCID: PMC9226572 DOI: 10.3389/fsurg.2022.921589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 05/24/2022] [Indexed: 11/13/2022] Open
Abstract
Objective This study aims to evaluate the impact of the inferior petrosal veins (IPVs) on operational exploration and to analyze related anatomic features. Methods A total of 317 patients were retrospectively studied. Surgical outcomes and postoperative complications were analyzed, and patients were divided into two groups according to whether the IPV was sacrificed or preserved. The diameter of the IPV was also recorded during operation. Furthermore, the position where the IPV drained into the jugular bulb was recorded in each patient, and the influence of different injection points on the operation was analyzed. Results IPVs were conclusively identified in 242/317 (76.3%) of patients, with 110/242 (45.5%) of patients categorized as “IPV sacrifice” versus 132/242 (54.5%) categorized as “IPV preservation.” IPV diameter was observed to be <0.5 mm in 58 cases (23.9%), 0.5 mm–1.0 mm (≥0.5 mm and ≤1.0 mm) in 145 cases (59.9%), and >1 mm in 39 cases (16.2%). The position of IPV drainage into the jugular bulb was at the level of the accessory nerve in 163 cases (67.3%), the level of the vagus nerve in 42 cases (17.4%), and the level of the glossopharyngeal nerve or above in 37 cases (15.3%). The diameters of IPV in the sacrifice group were mainly less than 1 mm (94.5% vs. 75%, P < 0.01), and the cases with draining points near the glossopharyngeal nerve were more than that in the preservation group (27.3% vs. 5.3%, P < 0.01). Conclusion IPV is an obstructive structure in MVD for HFS, with considerable variations in diameters and draining points. IPV near the glossopharyngeal nerve significantly impacts surgical exposure and is often sacrificed for a better view of the operation field. Meanwhile, it is feasible to maintain IPVs with a diameter >1 mm.
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Affiliation(s)
- Mengyang Wang
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Jiajing Wang
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiuling Zhang
- Department of Neurology, Xiaogan Hospital Affiliated to Wuhan University of Science and Technology, Xiaogan, China
| | - Songshan Chai
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Yuankun Cai
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Xuan Dai
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Bangkun Yang
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Wen Liu
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Taojunjin Lu
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Zhimin Mei
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Zhixin Zheng
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - YiXuan Zhou
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Jingyi Yang
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Lei Shen
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Jingwei Zhao
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Joshua Ho
- School of Biomedical Sciences, LKS Faculty of Medicine, Hongkong University, Hongkong, China
| | - Meng Cai
- iRegene Therapeutics Ltd., Wuhan, Hongkong, China
| | - Jincao Chen
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
- Correspondence: Jincao Chen Nanxiang Xiong
| | - Nanxiang Xiong
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
- Correspondence: Jincao Chen Nanxiang Xiong
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18
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Corniola MV, Meling TR. How I do it: minimally invasive resection of a sub-ependymoma of the fourth ventricle. Acta Neurochir (Wien) 2022; 164:767-770. [PMID: 33051754 PMCID: PMC8913570 DOI: 10.1007/s00701-020-04601-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 09/30/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND A 54-year-old female was referred to our clinic with a lesion of the lower fourth ventricle extending to the median aperture. Here, we report the use a minimally invasive sub-occipital approach (MISA) as a safe and effective surgical management. METHOD We performed a MISA using a short midline incision and a 1-cm sub-occipital craniectomy. Dissection of the lesion was performed, and "en bloc" resection could be achieved. The lesion was confirmed to be a grade I sub-ependymoma. CONCLUSION MISA can be safely used when confronted to a lesion of the lower fourth ventricle.
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Affiliation(s)
- Marco V Corniola
- Department of Clinical Neurosciences, Division of Neurosurgery, Geneva University Hospitals, 4, Rue Gabrielle Perret Gentil, 1205, Geneve, Switzerland.
| | - Torstein R Meling
- Department of Clinical Neurosciences, Division of Neurosurgery, Geneva University Hospitals, 4, Rue Gabrielle Perret Gentil, 1205, Geneve, Switzerland
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19
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Toro EF, Celant M, Zhang Q, Contarino C, Agarwal N, Linninger A, Müller LO. Cerebrospinal fluid dynamics coupled to the global circulation in holistic setting: Mathematical models, numerical methods and applications. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2022; 38:e3532. [PMID: 34569188 PMCID: PMC9285081 DOI: 10.1002/cnm.3532] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 09/13/2021] [Indexed: 06/13/2023]
Abstract
This paper presents a mathematical model of the global, arterio-venous circulation in the entire human body, coupled to a refined description of the cerebrospinal fluid (CSF) dynamics in the craniospinal cavity. The present model represents a substantially revised version of the original Müller-Toro mathematical model. It includes one-dimensional (1D), non-linear systems of partial differential equations for 323 major blood vessels and 85 zero-dimensional, differential-algebraic systems for the remaining components. Highlights include the myogenic mechanism of cerebral blood regulation; refined vasculature for the inner ear, the brainstem and the cerebellum; and viscoelastic, rather than purely elastic, models for all blood vessels, arterial and venous. The derived 1D parabolic systems of partial differential equations for all major vessels are approximated by hyperbolic systems with stiff source terms following a relaxation approach. A major novelty of this paper is the coupling of the circulation, as described, to a refined description of the CSF dynamics in the craniospinal cavity, following Linninger et al. The numerical solution methodology employed to approximate the hyperbolic non-linear systems of partial differential equations with stiff source terms is based on the Arbitrary DERivative Riemann problem finite volume framework, supplemented with a well-balanced formulation, and a local time stepping procedure. The full model is validated through comparison of computational results against published data and bespoke MRI measurements. Then we present two medical applications: (i) transverse sinus stenoses and their relation to Idiopathic Intracranial Hypertension; and (ii) extra-cranial venous strictures and their impact in the inner ear circulation, and its implications for Ménière's disease.
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Affiliation(s)
| | - Morena Celant
- Department of MathematicsUniversity of TrentoTrentoItaly
| | - Qinghui Zhang
- Laboratory of Applied Mathematics, DICAMUniversity of TrentoTrentoItaly
| | | | | | - Andreas Linninger
- Department of BioengineeringUniversity of Illinois at ChicagoChicagoIllinoisUSA
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20
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Johnson J, Anand A, Crowley S, Srivatsan A, Srinivasan V, Chintalapani G, Kan P. A retrospective anatomical study of the cerebral dural venous sinus outflow pathways utilizing three-dimensional rotational venography. Brain Circ 2022; 8:38-44. [PMID: 35372723 PMCID: PMC8973444 DOI: 10.4103/bc.bc_76_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 12/29/2021] [Accepted: 01/07/2022] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE: Proper blood flow is essential for the maintenance of homeostasis for the human cerebrum. The dural venous sinuses comprise the dominant cerebral venous outflow path. Understanding the spatial configuration of the dural venous sinuses can provide valuable insight into several pathological conditions. Previously, only two-dimensional or cadaveric data have been used to understand cerebral outflow. For the first time, we applied three-dimensional rotational venography (3D-RV) to study and provide detailed quantitative morphological measurements of the terminal cerebral venous sinus system in several pathological states. SUBJECTS AND METHODS: Patients who underwent a 3D-RV procedure were identified by reviewing our local institution's endovascular database. Patients with high-quality angiographic images were selected. Eighteen patients were included (37.1 ± 3.8 years). Sinuses were divided into four segments, starting at the torcula and ending at the internal jugular vein. Segment length, 3D displacement, and cross-sectional area were measured. RESULTS: The transverse sinus (60.2 mm) was the longest segment, followed by the sigmoid sinus (55.1 mm). Cross-sectional areas were smallest at the middle of the transverse sinus (21.3 mm2) but increased at the sigmoid sinus (33.5 mm2) and at the jugular bulb (49.7 mm2). The only variation in displacements of venous flow was at the sigmoid-jugular junction, where 55% of cases had lateral displacements versus 45% medial, and 78% superior versus 22% inferior. CONCLUSIONS: We describe the terminal venous sinus system of patients with a variety of diagnoses, detailing segment length, cross-sectional area, and 3D path.
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21
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Tsunoda S, Inoue T, Segawa M, Akabane A. Vein-related Trigeminal Neuralgia: How to Determine the Treatment Method of the Causative Vein: A Technical Note. Neurol Med Chir (Tokyo) 2021; 62:105-109. [PMID: 34732593 PMCID: PMC8841236 DOI: 10.2176/nmc.tn.2021-0154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Trigeminal neuralgia (TN) is often caused by various vein forms. Herein, we report two cases of vein-related TN. In the first case, the vein of the cerebellopontine fissure (VCPF), along with the thickened surrounding arachnoid, clung to the trigeminal nerve. As the perfusion range of this vein was expected to be wide and its injury might cause extensive venous infarction, the anchor between the trigeminal nerve and the vein was carefully dissected and the vein was successfully transposed. In the second case, the involvement of the vein of the middle cerebellar peduncle (VMCP), which penetrates the nerve bundle of the trigeminal nerve, was suspected. Because vein transposition was impossible, the vein was transected at the nerve penetration site after confirming that there was sufficient collateral venous outflow. The superior petrosal vein and its tributaries are the primary causative veins of vein-related TN, and their contact patterns are infinite. Moreover, their perfusion range and the presence or absence of collateral venous outflow vary from case to case. Therefore, it is necessary to judge the perfusion range as well as collateral venous outflow based on preoperative images and intraoperative findings and to determine the appropriate treatment method for each case.
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Affiliation(s)
- Sho Tsunoda
- Department of Neurosurgery, NTT Medical Center Tokyo
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22
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An infantile case of posterior fossa arachnoid cyst presenting with marked engorgement of contralateral supraorbital vein. Radiol Case Rep 2021; 16:3680-3684. [PMID: 34630800 PMCID: PMC8493502 DOI: 10.1016/j.radcr.2021.08.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 08/23/2021] [Accepted: 08/25/2021] [Indexed: 01/24/2023] Open
Abstract
A 6-month-old, previously healthy boy presented with poor feeding and vomiting for 2 weeks. At presentation, his left supraorbital vein was found to engorge considerably. A cranial computed tomography (CT) scan revealed a large cyst in the posterior fossa with a prominent left superior ophthalmic vein (SOV). Magnetic resonance imaging delineated the well-demarcated cyst markedly compressing the right cerebellar hemisphere. The patient underwent microscopic fenestration of the cyst wall through lateral suboccipital craniotomy. The cyst wall, comprising multi-layered, opacified membranes, was extensively resected and communicated with the prepontine cistern. The histological appearance of the cyst wall was consistent with an arachnoid cyst. Engorgement of the left supraorbital vein resolved immediately after surgery. A postoperative CT scan did not identify the SOV in the left orbit. In the present case, engorgement of the supraorbital vein might reflect the increased venous pressure of the SOV caused by compression of the contralateral cerebellar hemisphere.
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Tomasi SO, Umana GE, Scalia G, Rubio-Rodriguez RL, Raudino G, Rechberger J, Geiger P, Chaurasia B, Yaǧmurlu K, Lawton MT, Winkler PA. Perforating Arteries of the Lemniscal Trigone: A Microsurgical Neuroanatomic Description. Front Neuroanat 2021; 15:675313. [PMID: 34512277 PMCID: PMC8427497 DOI: 10.3389/fnana.2021.675313] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 07/16/2021] [Indexed: 11/24/2022] Open
Abstract
Background: The perforating arteries in the dorsolateral zone of the midbrain play a crucial role in the functions of the brain stem. Their damage due to herniation, pathological lesions, or surgery, favored by the narrow tentorial incisura, can lead to hemorrhages or ischemia and subsequently to severe consequences for the patient. Objective: In literature, not much attention has been directed to the perforating arteries in the lemniscus; in fact, no reports on the perforators of this anatomical region are available. The present study aims to a detailed analysis of the microanatomy and the clinical implications of these perforators, in relation to the parent vessels. We focused on the small vessels that penetrate the midbrain's dorsolateral surface, known as lemniscal trigone, to understand better their microanatomy and their functional importance in the clinical practice during the microsurgical approach to this area. Methods: Eighty-seven alcohol-fixed cadaveric hemispheres (44 brains) without any pathological lesions provided the material for studying the perforating vessels and their origin around the dorsolateral midbrain using an operating microscope (OPMI 1 FC, Zeiss). Measurements of the perforators' distances, in relation to the parent vessels, were taken using a digital caliper. Results: An origin from the SCA could be found in 70.11% (61) and from the PCA in 27.58% (24) of the hemispheres. In one hemisphere, an origin from the posterior choroidal artery was found (4.54%). No perforating branches were discovered in 8.04% of specimens (7). Conclusion: The perforating arteries of the lemniscal trigone stem not only from the superior cerebellar artery (SCA), as described in the few studies available in literature, but also from the posterior cerebral artery (PCA). Therefore, special attention should be paid during surgery to spare those vessels and associated perforators. A comprehensive understanding of the lemniscal trigone's perforating arteries is vital to avoid infarction of the brainstem when treating midbrain tumors or vascular malformations.
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Affiliation(s)
- Santino Ottavio Tomasi
- Department of Neurological Surgery - Christian Doppler Klinik, Salzburg, Austria
- Department of Neurosurgery, Paracelsus Medical University Salzburg, Salzburg, Austria
- Laboratory for Microsurgical Neuroanatomy - Christian Doppler Klinik, Salzburg, Austria
| | - Giuseppe Emmanuele Umana
- Department of Neurosurgery, Cannizzaro Hospital, Trauma Center, Gamma Knife Center, Catania, Italy
| | - Gianluca Scalia
- Neurosurgery Unit, Highly Specialized Hospital and of National Importance “Garibaldi”, 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
| | - Giuseppe Raudino
- Department of Neurosurgery - Humanitas, Istituto Clinico Catanese, Catania, Italy
| | - Julian Rechberger
- Department of Neurosurgery, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Philipp Geiger
- Department of Neurosurgery, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Bipin Chaurasia
- Department of Neurosurgery, Neurosurgery Clinic, Birgunj, Nepal
| | - Kaan Yaǧmurlu
- Department of Neurosurgery, University of Virginia, Charlottesville, VA, United States
| | - Michael T. Lawton
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, United States
| | - Peter A. Winkler
- Department of Neurological Surgery - Christian Doppler Klinik, Salzburg, Austria
- Department of Neurosurgery, Paracelsus Medical University Salzburg, Salzburg, Austria
- Laboratory for Microsurgical Neuroanatomy - Christian Doppler Klinik, Salzburg, Austria
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Almeida JP, Quinones-Hinojosa A, Dagi TF. Commentary: Evandro de Oliveira in the Historical Context of Brazilian Neurosurgery. Neurosurgery 2021; 89:E264-E265. [PMID: 34392361 DOI: 10.1093/neuros/nyab313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 06/28/2021] [Indexed: 11/13/2022] Open
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Haq IBI, Permana AT, Susilo RI, Wahyuhadi J. Deadly complication of sacrificing superior petrosal vein during cerebellopontine angle tumor resection: A case report and literature review. Surg Neurol Int 2021; 12:306. [PMID: 34345447 PMCID: PMC8326145 DOI: 10.25259/sni_948_2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 04/01/2021] [Indexed: 11/10/2022] Open
Abstract
Background: Tumors of the cerebellopontine angle (CPA) are challenging to resect and have been proven difficult for neurosurgeons to manage optimally. Superior petrosal vein complex (SPVC) as the main drainage system and close proximity to CPA could be an obstacle during operation. There is an incidence ranging from 55% to 84% of injury to one part of the SPVC during CPA tumor surgery. Case Description: We report a case of 65-year-old woman with CPA tumor, who complained of unilateral hearing loss, dizziness, and facial pain. During tumor resection, one part of SPV complex was injured, then cerebellar edema develops. Conclusion: This case provides an overview of surgical complication associated with venous sacrifice. This would support the agreement to preserve SPV regarding risks and improve the quality of surgical decision making.
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Affiliation(s)
- Irwan Barlian Immadoel Haq
- Department of Neurosurgery, Faculty of Medicine Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, East Java, Indonesia
| | - Andhika Tomy Permana
- Department of Neurosurgery, Faculty of Medicine Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, East Java, Indonesia
| | - Rahadian Indarto Susilo
- Department of Neurosurgery, Faculty of Medicine Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, East Java, Indonesia
| | - Joni Wahyuhadi
- Department of Neurosurgery, Faculty of Medicine Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, East Java, Indonesia
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Xia Y, Kim TY, Mashouf LA, Patel KK, Xu R, Casaos J, Choi J, Kim ES, Hung AL, Wu A, Garzon-Muvdi T, Bender MT, Jackson CM, Bettegowda C, Lim M. Absence of Ischemic Injury after Sacrificing the Superior Petrosal Vein during Microvascular Decompression. Oper Neurosurg (Hagerstown) 2021; 18:316-320. [PMID: 31214696 DOI: 10.1093/ons/opz163] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 03/25/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Sacrificing the superior petrosal vein (SPV) is controversial during a microvascular decompression (MVD). There have been multiple reports of complications including life-threatening brainstem infarction and cerebellar edema. OBJECTIVE To analyze the potential for vascular complications when the SPV is sacrificed during an MVD. METHODS Retrospective chart review was performed to identify all MVDs for trigeminal neuralgia and hemifacial spasm from 2007 to 2018 at 1 institution. Cases with ≥1 mo of follow-up were included and SPV sacrifice was noted. The primary outcome was complications related to SPV sacrifice including sinus thrombosis, cerebellar edema, and midbrain or pontine infarction. Imaging was used to confirm all potential vascular complications noted in medical records. Fisher's exact test and unpaired t-tests were used to compare between groups. RESULTS A total of 732 MVD cases were identified and 592 met inclusion criteria with an average follow-up of 11.8 ± 16.4 mo and a male-to-female ratio of 1:2.2. The SPV was sacrificed in 217 cases and retained in 375 cases. No SPV-related vascular complications were found in this study. Two unrelated cases of vascular complications were identified and both were in the nonsacrificed group. One case involved cerebellar bleeding while the other was an ipsilateral transverse sinus thrombosis that was present preoperatively. CONCLUSION In MVDs, there is no difference in the rate of vascular complications when the SPV is sacrificed compared to preserved. To best visualize a cranial nerve and optimize safe decompression, surgeons should feel free to sacrifice the SPV.
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Affiliation(s)
- Yuanxuan Xia
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Timothy Y Kim
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Leila A Mashouf
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kisha K Patel
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Risheng Xu
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Joshua Casaos
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - John Choi
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Eileen S Kim
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Alice L Hung
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Adela Wu
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Tomas Garzon-Muvdi
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Matthew T Bender
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Christopher M Jackson
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Chetan Bettegowda
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Michael Lim
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Wen H, Jin D, Chen Y, Cui B, Xiao T. Cerebellar venous thrombosis mimicking a cerebellar tumor due to polycythemia vera: a case report. BMC Neurol 2021; 21:225. [PMID: 34134639 PMCID: PMC8207742 DOI: 10.1186/s12883-021-02261-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 05/28/2021] [Indexed: 11/10/2022] Open
Abstract
Background Cerebral venous thrombosis (CVT) occurs rarely in the general population and is frequently associated with confused clinical findings and delayed diagnosis. Isolated cerebellar cortical vein thrombosis is a very rare phenomenon. Case presentation This report describes a case with CVT, which is manifested as space-occupying lesions of the cerebellar hemisphere and mimics a cerebellar tumor at the beginning. The diagnosis of CVT was finalized given the laboratory and brain biopsy findings. The etiology may be related to polycythemia vera with Janus Kinase 2 V617F mutation. Conclusion Isolated cerebellar vein thrombosis should be considered when swelling and enhancing cerebellar lesions are detected. Polycythemia vera, especially with a positive JAK2 V617F mutation, may be a rare risk factor for CVT.
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Affiliation(s)
- Hongfeng Wen
- Department of Neurology, Aerospace Center Hospital, Beijing, China
| | - Di Jin
- Department of Neurology, Aerospace Center Hospital, Beijing, China
| | - Yu Chen
- Department of Neurology, Aerospace Center Hospital, Beijing, China
| | - Bin Cui
- Department of Radiology, Aerospace Center Hospital, Beijing, China
| | - Tianyi Xiao
- Department of Neurology, Aerospace Center Hospital, Beijing, China.
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Xia Y, Lim M. In Reply: Absence of Ischemic Injury After Sacrificing the Superior Petrosal Vein During Microvascular Decompression. Oper Neurosurg (Hagerstown) 2021; 20:E260. [PMID: 33442747 DOI: 10.1093/ons/opaa437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Yuanxuan Xia
- Department of Neurosurgery Johns Hopkins University School of Medicine Baltimore, Maryland
| | - Michael Lim
- Department of Neurosurgery Stanford University School of Medicine Stanford, California
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Arachnoid and dural reflections. HANDBOOK OF CLINICAL NEUROLOGY 2021; 169:17-54. [PMID: 32553288 DOI: 10.1016/b978-0-12-804280-9.00002-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
The dura mater is the major gateway for accessing most extra-axial lesions and all intra-axial lesions of the central nervous system. It provides a protective barrier against external trauma, infections, and the spread of malignant cells. Knowledge of the anatomical details of dural reflections around various corners of the skull bases provides the neurosurgeon with confidence during transdural approaches. Such knowledge is indispensable for protection of neurovascular structures in the vicinity of these dural reflections. The same concept is applicable to arachnoid folds and reflections during intradural excursions to expose intra- and extra-axial lesions of the brain. Without a detailed understanding of arachnoid membranes and cisterns, the neurosurgeon cannot confidently navigate the deep corridors of the skull base while safely protecting neurovascular structures. This chapter covers the surgical anatomy of dural and arachnoid reflections applicable to microneurosurgical approaches to various regions of the skull base.
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Bridging veins of the cerebellum: a magnetic resonance imaging study. Surg Radiol Anat 2021; 43:437-444. [PMID: 33423146 DOI: 10.1007/s00276-020-02664-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 12/19/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE To date, no study has yet explored the bridging veins (BVs) of the cerebellum using neuroimaging modalities. Therefore, this study aimed to characterize them using magnetic resonance imaging (MRI). METHODS A total of 90 patients with intact cerebellar hemispheres and intracranial dural sinuses underwent thin-sliced, contrast-enhanced MRI. RESULTS The BVs were classified into six routes based on the draining pattern into the dural sinuses. The superior vermian vein emptying into the straight sinus was delineated in 100% of the patients. The inferior vermian vein emptying into the confluence of the sinuses was identified in 66.7% of the patients. The inferior hemispheric and cerebellar cortical veins emptying into the transverse sinus were identified in 54.4% and 26.7% of the patients, respectively. The inferior vermian and cerebellar cortical veins emptying into the straight sinus were identified in 77.8% and 12.2% of the patients, respectively. The cerebellar cortical vein emptying into the tentorial sinus was identified in 83.3% of the patients; it was delineated on 54 sides with an average number per right hemisphere of 1.9 and 63 sides with an average number per left hemisphere of 2. The pontine-trigeminal and anterior hemispheric veins emptying into the superior petrosal sinus were identified in 42.2% of the patients. CONCLUSIONS The BVs of the cerebellum can be classified into six distinct routes. Radiological classification may be useful for understanding the drainage pattern of the cerebellum.
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Kadooka K, Anagnostakou V, Bozinov O, Kulcsár Z. Delayed mesencephalic venous infarction after endovascular treatment of a giant aneurysm of the posterior cerebral artery: Case report and anatomical review. Interv Neuroradiol 2020; 26:593-597. [PMID: 32873105 DOI: 10.1177/1591019920954618] [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] [Indexed: 11/15/2022] Open
Abstract
A 54-year old male patient underwent stent reconstruction of the P1-2 segment of the left posterior cerebral artery (PCA) and concomitant coil embolization of a symptomatic giant partially thrombosed P1 segment aneurysm. After an uneventful postinterventional period, on the 7th day the patient developed severe disturbance of consciousness. The imaging workup demonstrated acute venous infarction in the midbrain, caused by the compressive occlusion of the median anterior pontomesncephalic vein by the aneurysm in the interpeduncular fossa.
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Affiliation(s)
- Keisuke Kadooka
- Department of Neuroendovascular Surgery, Kameda Medical Center, Kamogawa, Japan.,Department of Neuroradiology, University Hospital Zurich, Zurich, Switzerland
| | - Vaia Anagnostakou
- Department of Radiology, University of Massachusetts Medical School, Worcester, MA, USA
| | - Oliver Bozinov
- Department of Neurosurgery, St Gallen Cantonal Hospital, St Gallen, Switzerland
| | - Zsolt Kulcsár
- Department of Neuroradiology, Clinical Neurocenter, University Hospital of Zurich, Zurich, Switzerland.,Center of Applied Biotechnology and Molecular Medicine, University of Zurich, Zurich, Switzerland
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Tanoue S, Hirohata M, Takeuchi Y, Orito K, Kajiwara S, Abe T. Venous Anatomy of the Cavernous Sinus and Relevant Veins. JOURNAL OF NEUROENDOVASCULAR THERAPY 2020; 14:547-557. [PMID: 37502139 PMCID: PMC10370663 DOI: 10.5797/jnet.ra.2020-0086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 05/20/2020] [Indexed: 07/29/2023]
Abstract
The cavernous sinus (CS) is a dural sinus located on each side of the pituitary fossa. Neoplastic and vascular lesions, such as arteriovenous fistulas, frequently involve the CS. This sinus plays a role as a crossroad receiving venous blood flow from the facial, orbital, meningeal, and neural venous tributaries. The relationship between these surrounding relevant veins and the CS, as well as the CS itself, varies anatomically. For safe and effective surgical and endovascular treatment of lesions involving the CS, knowledge of the anatomy and variations of the CS and the relevant surrounding veins is highly important. In this section, the anatomy and variations of the CS and the relevant surrounding veins are outlined.
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Affiliation(s)
- Shuichi Tanoue
- Department of Radiology, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Masaru Hirohata
- Department of Neurosurgery, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Yasuharu Takeuchi
- Department of Neurosurgery, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Kimihiko Orito
- Department of Neurosurgery, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Sosho Kajiwara
- Department of Neurosurgery, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Toshi Abe
- Department of Radiology, Kurume University School of Medicine, Kurume, Fukuoka, Japan
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Surgeons' experience of venous risk with CPA surgery. Neurosurg Rev 2020; 44:1675-1685. [PMID: 32772296 DOI: 10.1007/s10143-020-01365-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 07/23/2020] [Accepted: 08/03/2020] [Indexed: 10/23/2022]
Abstract
The study aims to systematize neurosurgeons' practical knowledge of venous sacrifice as applied to the posterior fossa region and to analyze the collected data to present and preserve relevant experience and expert knowledge for current and future practicing neurosurgeons. The venous structures assessed were the superior petrosal vein (SPV), sigmoid sinus (SS), and the tentorial veins (TV). The survey is constructed to obtain surgeons' idea of assessed risk when sacrificing specific venous structures during posterior fossa surgery. They were asked how they prep for surgery, number of operations conducted, and their basis of knowledge. Collected data were mainly qualitative and analyzed with a mixed-method approach. A mean absolute deviation was calculated measuring rate of disagreement for a given substructure. Consensus existed among the participating surgeons that sacrificing the SPV and the TV was considered safe. Although, the risk of death when occluding major structures like the main trunk of the SPV, one of the SS' and or a total occlusion of all TV yielded high risk of death. The risk of infarction was often too apparent to discredit even with low risk of death among an experienced class of surgeons. Our findings provide an overview of surgical risk associated with venous sacrifice. This will minimize cases where indispensable practical knowledge on safe handling veins in the cerebellopontine angle is either to be lost or taught among few when the neurosurgeons retire. This will lower the disagreement regarding risks and increase the quality of surgical decision-making.
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Gailloud P. The antireflux mechanism - Angiographic anatomy and clinical implications. Interv Neuroradiol 2020; 26:691-702. [PMID: 32664775 DOI: 10.1177/1591019920941309] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Early anatomists suspected that the radiculomedullary veins draining the spinal cord had valves preventing their retrograde filling with anatomical casting material. Modern investigations have discarded the presence of true valves and introduced instead the notion of a pseudo-valvular configuration for which the term antireflux mechanism was coined in the 1970s. The angiographic anatomy of the antireflux mechanism has not been well documented so far. METHODS This article discusses anatomical and clinical features of the antireflux mechanism with a series of 12 angiographic observations documenting the antireflux mechanism under normal and pathological circumstances. RESULTS The antireflux mechanism divides radiculomedullary veins into intradural and extradural segments. While the structure of the antireflux mechanism is not yet fully clarified, it includes at least a tight narrowing of the radiculomedullary vein at its point of passage through the thecal sac, which is angiographically detectable and likely protects the intradural venous system from transient or persistent surges in venous pressure (e.g. sneezing, pregnancy). This tight narrowing of the antireflux mechanism likely also represents an obstacle to normal anterograde flow, potentially leading to venous stagnation and thrombosis. CONCLUSIONS The antireflux mechanism includes at least a tight narrowing of the radiculomedullary vein, which likely influences the development and clinical expression of low-flow spinal arteriovenous fistulas and might impact the spinal venous drainage even in the absence of arteriovenous shunts.
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Affiliation(s)
- Philippe Gailloud
- Division of Interventional Neuroradiology, The Johns Hopkins Hospital, Baltimore, MD, USA
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Tabani H, Tayebi Meybodi A, Benet A. Venous anatomy of the supratentorial compartment. HANDBOOK OF CLINICAL NEUROLOGY 2020; 169:55-71. [PMID: 32553298 DOI: 10.1016/b978-0-12-804280-9.00003-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The cerebral venous drainage system in humans has several unique characteristics that set it apart from its arterial counterpart. The intracranial drainage system can be broadly divided into supra- and infratentorial components. The supratentorial venous drainage is further subclassified into superficial and deep systems, each with a unique set of features. A thorough knowledge of the normal and variant venous drainage pathways is important to understand the different pathologic processes involving the venous vasculature, to identify and anticipate the different venous channels encountered during surgery and also to predict the possible sequelae of intentional or inadvertent venous sacrifice during surgery. This chapter summarizes the anatomic and radiologic characteristics of the venous supply of the supratentorial compartment of the brain, reviews its general characteristics, sheds light on the different classifications and nomenclature used for its descriptions, and briefly discusses its embryologic development.
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Affiliation(s)
- Halima Tabani
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, United States
| | - Ali Tayebi Meybodi
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ, United States
| | - Arnau Benet
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ, United States.
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Basamh M, Sinning N, Kehler U. Individual variations of the superior petrosal vein complex and their microsurgical relevance in 50 cases of trigeminal microvascular decompression. Acta Neurochir (Wien) 2020; 162:197-209. [PMID: 31768757 PMCID: PMC6942005 DOI: 10.1007/s00701-019-04109-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 10/14/2019] [Indexed: 11/24/2022]
Abstract
Background We investigated the understudied anatomical variations of the superior petrosal vein (SPV) complex (SPVC), which may play some role in dictating the individual complication risk following SPVC injury. Methods Microvascular decompressions of the trigeminal nerve between September 2012 and July 2016. All operations utilized an SPVC preserving technique. Preoperative balanced fast field echo (bFFE) magnetic resonance imaging, or equivalent sequences, and operative videos were studied for individual SPVC anatomical features. Results Applied imaging and operative SPVC anatomy were described for fifty patients (mean age, 67.18 years; female sex and right-sided operations, 58% each). An SPVC component was sacrificed intentionally in 6 and unintentionally in only 7 cases. Twenty-nine different individual variations were observed; 80% of SPVCs had either 2 SPVs with 3 or 1 SPV with 2, 3, or 4 direct tributaries. Most SPVCs had 1 SPV (64%) and 2 SPVs (32%). The SPV drainage point into the superior petrosal sinus was predominantly between the internal auditory meatus and Meckel cave (85.7% of cases). The vein of the cerebellopontine fissure was the most frequent direct tributary (86%), followed by the pontotrigeminal vein in 80% of SPVCs. Petrosal-galenic anastomosis was detected in at least 38% of cases. At least 1 SPV in 54% of the cases and at least 1 direct tributary in 90% disturbed the operative field. The tributaries were more commonly sacrificed. Conclusions The extensive anatomical variation of SPVC is depicted. Most SPVCs fall into 4 common general configurations and can usually be preserved. BFFE or equivalent sequences remarkably facilitated the intraoperative understanding of the individual SPVC in most cases.
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Affiliation(s)
- Mohammed Basamh
- Department of Neurosurgery, Asklepios Klinik Altona, Paul-Ehrlich Strasse 1, 22763, Hamburg, Germany.
- Division of Neurosurgery, King Abdul-Aziz University Hospital, Jeddah, Saudi Arabia.
| | - Nico Sinning
- Department of Neurosurgery, Asklepios Klinik Altona, Paul-Ehrlich Strasse 1, 22763, Hamburg, Germany
| | - Uwe Kehler
- Department of Neurosurgery, Asklepios Klinik Altona, Paul-Ehrlich Strasse 1, 22763, Hamburg, Germany
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Telovelar surgical approach. Neurosurg Rev 2019; 44:61-76. [PMID: 31807931 DOI: 10.1007/s10143-019-01190-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 08/26/2019] [Accepted: 10/09/2019] [Indexed: 10/25/2022]
Abstract
Surgical access to lesions in the fourth ventricle may be achieved utilizing transvermian or transtelovelar trajectories. We performed a search of the PubMed database for studies describing the microsurgical details and evaluating the clinical utility of the telovelar surgical approach. The telovelar approach has proven to be a safe, effective, and versatile alternative to the transvermian approach. The operative strategy utilizes midline suboccipital craniotomy without or with C1 laminectomy, followed by cerebellar hemispheric and tonsillar retraction, and wide durotomy. Access is generously provided to the fourth ventricle from calamus scriptorius to Sylvian aqueduct and foramen Luschkae bilaterally. Anatomic dissection studies evaluating and comparing the relative benefits of the operative exposure offered by these approaches have demonstrated improved access to the lateral recess gained by the telovelar trajectory and facilitated exposure of rostral reaches of the fourth ventricle by the vermian trajectory. In general, operative exposure may be significantly improved with tonsillar retraction or resection, bilateral telovelar opening, and performing C1 laminectomy in order to improve access to the rostral fourth ventricle, which may be variably combined depending on location of pathology. Cerebellar mutism, a high incidence of which occurs with vermian approaches, is not commonly observed with use of the telovelar trajectory, though injury to the dentate nuclei may precipitate this syndrome. Deficits incurred with the vermian approach may include cerebellar mutism, dysequilibrium, truncal ataxia, posterior fossa syndrome, cranial nucleopathies and nerve palsies, and vascular injury to the posterior inferior cerebellar artery. The telovelar surgical approach has proven a safe and useful alternative to the transvermian trajectory. A significantly lower incidence of cerebellar mutism and cerebellogenic deficits represents the principal advantage of the telovelar approach. Further studies are necessary in order to prospectively evaluate and compare extents of resection, morbidity, and mortality utilizing the telovelar versus vermian approaches for microsurgically resecting fourth ventricular tumors.
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Safe handling of veins in the pineal region-a mixed method study. Neurosurg Rev 2019; 44:317-325. [PMID: 31729586 DOI: 10.1007/s10143-019-01189-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 09/05/2019] [Accepted: 10/09/2019] [Indexed: 10/25/2022]
Abstract
Surgical experience in pineal surgery is largely confined to a few experienced surgeons and may be lost when they stop their practice. The objective of this study is to systematically preserve and analyze valuable practical knowledge of pineal region surgical venous anatomy. A survey was constructed to obtain experienced surgeons' perception of estimated risks and individual experience following occlusion of veins during pineal surgery. Data were qualitative and analyzed with a mixed methods approach. Of the 126 invited neurosurgeons, 40 submitted completed questionnaires. General agreement existed of which veins were associated with high and low risks following occlusion. The risk of death was estimated to be high with sacrifice of the vein of Galen (83%), both internal cerebral veins (69%) and the basal veins (58%). The risk of death was estimated to be lower with the sacrifice of both superior vermian veins (13%) and one internal occipital vein (10%). Importantly, a sub-group of experienced surgeons reported substantial risk of death and consequences with the sacrifice of cerebellar bridging veins (8-13%). Our findings provide a coherent picture of surgical risk with venous sacrifice, which can inform the surgical community of systematically gathered views from aggregated surgeries of a very large cohort of patients. Extensive presurgical radiological workup and anatomical studies seemed to correlate more cautious risk estimations. Our findings increase available knowledge of risks of venous complications.
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Candanedo C, Moscovici S, Spektor S. The infratranstentorial subtemporal approach (ITSTA): a valuable skull base approach to deep-seated non-skull base pathology. Acta Neurochir (Wien) 2019; 161:2335-2342. [PMID: 31486891 DOI: 10.1007/s00701-019-04050-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Accepted: 08/22/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Surgical access to space-occupying lesions such as tumors and vascular malformations located in the area of the tentorial notch, mediobasal temporal lobe, and para-midbrain is difficult. Lesions in this area are typically resected with supratentorial approaches demanding significant elevation of the temporal lobe or even partial lobectomy, or via a supracerebellar transtentorial approach. We introduce an alternative, the skull base infratranstentorial subtemporal approach (ITSTA), which provides excellent exposure of the incisural area while minimizing risk to the temporal lobe. METHODS We included consecutive patients with pathology involving the area of the tentorial incisura, para-midbrain, and mediobasal temporal area who underwent surgery via ITSTA from 2012 to 2018. The approach includes partial mastoidectomy, temporal craniotomy, and tentorial section. Space obtained by mastoidectomy provides a sharp high-rising angle-of-attack, significantly diminishing the need for temporal lobe retraction. Surgeries were performed using microsurgical techniques, neuronavigation, and electrophysiological monitoring. Clinical presentation, tumor characteristics, extent of resection, complications, and outcome were retrospectively reviewed under a waiver of informed consent. RESULTS Nine patients met inclusion criteria (five female, four male; mean age 44 years, range 7-72). They underwent surgery for removal of para-midbrain arteriovenous malformation (AVM, 3/9), medial tentorial meningioma (2/9), mediobasal epidermoid cyst (2/9), oculomotor schwannoma (1/9), or pleomorphic xanthoastrocytoma (PXA) of the fusiform gyrus (1/9). Three AVMs were removed completely; among six patients with tumors, gross total resection was achieved in three and subtotal resection in three. All surgeries were uneventful without complications. There were no new permanent neurological deficits. At late follow-up (mean 42.5 months), eight patients had a Glasgow Outcome Score (GOS) of 5. One 66-year-old female died 18 months after surgery for reasons not related to her disease or surgery. CONCLUSIONS The ITSTA is a valuable skull base approach for removal of non-skull base pathologies located in the difficult tentorial-incisural parabrainstem area.
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Affiliation(s)
- Carlos Candanedo
- Department of Neurosurgery, Hadassah-Hebrew University Medical Center, P.O. Box 12000, 91120, Jerusalem, Israel
| | - Samuel Moscovici
- Department of Neurosurgery, Hadassah-Hebrew University Medical Center, P.O. Box 12000, 91120, Jerusalem, Israel
| | - Sergey Spektor
- Department of Neurosurgery, Hadassah-Hebrew University Medical Center, P.O. Box 12000, 91120, Jerusalem, Israel.
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Narayan V, Savardekar AR, Patra DP, Mohammed N, Thakur JD, Riaz M, Nanda A. Safety profile of superior petrosal vein (the vein of Dandy) sacrifice in neurosurgical procedures: a systematic review. Neurosurg Focus 2019; 45:E3. [PMID: 29961377 DOI: 10.3171/2018.4.focus18133] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Walter E. Dandy described for the first time the anatomical course of the superior petrosal vein (SPV) and its significance during surgery for trigeminal neuralgia. The patient's safety after sacrifice of this vein is a challenging question, with conflicting views in current literature. The aim of this systematic review was to analyze the current surgical considerations regarding Dandy's vein, as well as provide a concise review of the complications after its obliteration. METHODS A systematic review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A thorough literature search was conducted on PubMed, Web of Science, and the Cochrane database; articles were selected systematically based on the PRISMA protocol and reviewed completely, and then relevant data were summarized and discussed. RESULTS A total of 35 publications pertaining to the SPV were included and reviewed. Although certain studies report almost negligible complications of SPV sectioning, there are reports demonstrating the deleterious effects of SPV obliteration when achieving adequate exposure in surgical pathologies like trigeminal neuralgia, vestibular schwannoma, and petroclival meningioma. The incidence of complications after SPV sacrifice (32/50 cases in the authors' series) is 2/32 (6.2%), and that reported in various case series varies from 0.01% to 31%. It includes hemorrhagic and nonhemorrhagic venous infarction of the cerebellum, sigmoid thrombosis, cerebellar hemorrhage, midbrain and pontine infarct, intracerebral hematoma, cerebellar and brainstem edema, acute hydrocephalus, peduncular hallucinosis, hearing loss, facial nerve palsy, coma, and even death. In many studies, the difference in incidence of complications between the SPV-sacrificed group and the SPV-preserved group was significant. CONCLUSIONS The preservation of Dandy's vein is a neurosurgical dilemma. Literature review and experiences from large series suggest that obliterating the vein of Dandy while approaching the superior cerebellopontine angle corridor may be associated with negligible complications. However, the counterview cannot be neglected in light of some series showing an up to 30% complication rate from SPV sacrifice. This review provides the insight that although the incidence of complications due to SPV obliteration is low, they can happen, and the sequelae might be worse than the natural history of the existing pathology. Therefore, SPV preservation should be attempted to optimize patient outcome.
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Matsushima T, Matsushima K, Kobayashi S, Lister JR, Morcos JJ. The microneurosurgical anatomy legacy of Albert L. Rhoton Jr., MD: an analysis of transition and evolution over 50 years. J Neurosurg 2019; 129:1331-1341. [PMID: 29393756 DOI: 10.3171/2017.7.jns17517] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 07/13/2017] [Indexed: 11/06/2022]
Abstract
The authors chronologically categorized the 160 original articles written by Dr. Rhoton and his fellows to show why they selected their themes and how they carried out their projects. The authors note that as neurosurgery progresses and new techniques and approaches are developed, accurate and safe treatment will depend upon continued clarification of microsurgical anatomy.
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Affiliation(s)
- Toshio Matsushima
- 1International University of Health and Welfare.,2Neuroscience Center, Fukuoka Sanno Hospital, Fukuoka
| | - Ken Matsushima
- 3Department of Neurosurgery, Tokyo Medical University, Tokyo
| | - Shigeaki Kobayashi
- 4Medical Research and Education Center, Aizawa Hospital, Matsumoto, Japan
| | - J Richard Lister
- 5Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville; and
| | - Jacques J Morcos
- 6Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida
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Zhao X, Belykh E, Przybylowski CJ, Borba Moreira L, Gandhi S, Tayebi Meybodi A, Cavallo C, Valli D, Wicks RT, Nakaji P. Surgical treatment of falcotentorial meningiomas: a retrospective review of a single-institution experience. J Neurosurg 2019; 133:630-641. [PMID: 31374550 DOI: 10.3171/2019.4.jns19208] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 04/18/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Meningiomas at the falcotentorial junction represent a rare subgroup of complex meningiomas. Debate remains regarding the appropriate treatment strategy for and optimal surgical approach to these tumors, and surgical outcomes have not been well described in the literature. The authors reviewed their single-institution experience in the management, approach selection, and outcomes for patients with falcotentorial meningiomas. METHODS From the medical records, the authors identified all patients with falcotentorial meningiomas treated with resection at the Barrow Neurological Institute between January 2007 and October 2017. Perioperative clinical, surgical, and radiographic data were retrospectively collected. For patients who underwent the supracerebellar infratentorial approach, the tentorial angle was defined as the angle between the line joining the nasion with the tuberculum sellae and the tentorium in the midsagittal plane. RESULTS Falcotentorial meningiomas occurred in 0.97% (14/1441) of the patients with meningiomas. Most of the patients (13/14) were female, and the mean patient age was 59.8 ± 11.3 years. Of 17 total surgeries (20 procedures), 11 were single-stage primary surgeries, 3 were two-stage primary surgeries (6 procedures), 2 were reoperations for recurrence, and 1 was a reoperation after surgery had been aborted because of brain edema. Hydrocephalus was present in 5 of 17 cases, 4 of which required additional treatment. Various approaches were used, including the supracerebellar infratentorial (4/17), occipital transtentorial/transfalcine (4/17), anterior interhemispheric transsplenial (3/17), parietal transventricular (1/17), torcular (2/17), and staged supracerebellar infratentorial and occipital transtentorial/transfalcine (3/17) approaches. Of the 17 surgeries, 9 resulted in Simpson grade IV resection, and 3, 1, and 4 surgeries resulted in Simpson grades III, II, and I resection, respectively. The tentorial angle in cases with Simpson grade I resection was significantly smaller than in those with an unfavorable resection grade (43.3° ± 4.67° vs 54.0° ± 3.67°, p = 0.04). Complications occurred in 10 of 22 approaches (17 surgeries) and included visual field defects (6 cases, 2 permanent and 4 transient), hemiparesis (2 cases), hemidysesthesia (1 case), and cerebellar hematoma (1 case). CONCLUSIONS Falcotentorial meningiomas are challenging lesions. A steep tentorial angle is an unfavorable preoperative radiographic factor for achieving maximal resection with the supracerebellar infratentorial approach. Collectively, the study findings show that versatility is required to treat patients with falcotentorial meningiomas and that treatment goals and surgical approach must be individualized to obtain optimal surgical results.
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Affiliation(s)
- Xiaochun Zhao
- 1Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
| | - Evgenii Belykh
- 1Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
- 2Irkutsk State Medical University, Irkutsk, Russia
| | - Colin J Przybylowski
- 1Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
| | - Leandro Borba Moreira
- 1Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
| | - Sirin Gandhi
- 1Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
| | - Ali Tayebi Meybodi
- 1Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
| | - Claudio Cavallo
- 1Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
| | - Daniel Valli
- 1Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
| | - Robert T Wicks
- 1Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
| | - Peter Nakaji
- 1Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
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Bender B, Hauser TK, Korn A, Klose U, Tatagiba M, Ernemann U, Ebner FH. Depiction of the Superior Petrosal Vein Complex by 3D Contrast-Enhanced MR Angiography. AJNR Am J Neuroradiol 2018; 39:2249-2255. [PMID: 30409853 DOI: 10.3174/ajnr.a5864] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 09/10/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Intraoperative obliteration of the superior petrosal vein complex has a relevant risk of postoperative complications. A large venous diameter and the absence of anastomoses have been previously suggested as possible risk factors. 3D contrast-enhanced MRA was evaluated for the identification of superior petrosal vein anatomy. MATERIALS AND METHODS Twenty-five patients (10 men; age, 20-77 years) with a 3D-MRA (voxel size, 0.4 × 0.4 × 0.5 mm3) at 3T, including the posterior fossa, were retrospectively identified. Image evaluation was performed independently by 2 neuroradiologists with respect to overall image quality and the presence, location, size, tributaries, and anastomotic veins of the superior petrosal vein complex. Additionally, 8 neurosurgical cases with intraoperative validation of the venous anatomy were examined. RESULTS All studies were of diagnostic image quality. Interobserver agreement was excellent for image-quality measurements (r = 0.751-0.982) and good for measured vessel size (r = 0.563-0.828). A total of 83 superior petrosal veins were identified. The distribution of drainage locations and identification of tributaries and anastomotic veins were consistent with previous anatomic studies. The results showed that 4.8% of superior petrosal veins had a diameter of >2 mm and lacked a visible anastomosis. All surgical cases showed excellent agreement between the MRA and the intraoperative observations. CONCLUSIONS 3D-MRA with high resolution is appropriate for analyzing the size, course, tributaries, and anastomoses of the superior petrosal vein. A total of 4.8% of the identified superior petrosal veins had to be classified as potential high-risk veins. The measurements correlated with the intraoperative findings.
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Affiliation(s)
- B Bender
- From the Department of Radiology (B.B., T.-K.H., A.K., U.K., U.E.), Diagnostic and Interventional Neuroradiology
| | - T-K Hauser
- From the Department of Radiology (B.B., T.-K.H., A.K., U.K., U.E.), Diagnostic and Interventional Neuroradiology
| | - A Korn
- From the Department of Radiology (B.B., T.-K.H., A.K., U.K., U.E.), Diagnostic and Interventional Neuroradiology.,Radiologie in Hof (A.K.), Hof, Germany
| | - U Klose
- From the Department of Radiology (B.B., T.-K.H., A.K., U.K., U.E.), Diagnostic and Interventional Neuroradiology
| | - M Tatagiba
- Department of Neurosurgery (M.T., F.H.E.), University Hospital Tübingen, Tübingen, Germany
| | - U Ernemann
- From the Department of Radiology (B.B., T.-K.H., A.K., U.K., U.E.), Diagnostic and Interventional Neuroradiology
| | - F H Ebner
- Radiologie in Hof (A.K.), Hof, Germany
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Peris-Celda M, Perry A, Carlstrom LP, Graffeo CS, Driscoll CLW, Link MJ. Key anatomical landmarks for middle fossa surgery: a surgical anatomy study. J Neurosurg 2018; 131:1561-1570. [PMID: 30497156 DOI: 10.3171/2018.5.jns1841] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Accepted: 05/29/2018] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Middle fossa surgery is challenging, and reliable surgical landmarks are essential to perform accurate and safe surgery. Although many descriptions of the middle fossa components have been published, a clinically practical description of this very complex anatomical region is lacking. Small structure arrangements in this area are often not well visualized or accurately demarcated with neuronavigation systems. The objective is to describe a "roadmap" of key surgical reference points and landmarks during middle fossa surgery to help the surgeon predict where critical structures will be located. METHODS The authors studied 40 dry skulls (80 sides) obtained from the anatomical board at their institution. Measurements of anatomical structures in the middle fossa were made with a digital caliper and a protractor, taking as reference the middle point of the external auditory canal (MEAC). The results were statistically analyzed. RESULTS The petrous part of the temporal bone was found at a mean of 16 mm anterior and 24 mm posterior to the MEAC. In 87% and 99% of the sides, the foramen ovale and foramen spinosum, respectively, were encountered deep to the zygomatic root. The posterior aspect of the greater superficial petrosal nerve (GSPN) groove was a mean of 6 mm anterior and 25 mm medial to the MEAC, nearly parallel to the petrous ridge. The main axis of the IAC projected to the root of the zygoma in all cases. The internal auditory canal (IAC) porus was found 5.5 mm lateral and 4.5 mm deep to the lateral aspect of the trigeminal impression along the petrous ridge (mean measurement values). A projection from this point to the middle aspect of the root of the zygoma, being posterior to the GSPN groove, could estimate the orientation of the IAC. CONCLUSIONS In middle fossa approaches, the external acoustic canal is a reliable reference before skin incision, whereas the zygomatic root becomes important after the skin incision. Deep structures can be related to these 2 anatomical structures. An easy method to predict the location of the IAC in surgery is described. Careful study of the preoperative imaging is essential to adapt this knowledge to the individual anatomy of the patient.
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Affiliation(s)
| | | | | | | | - Colin L W Driscoll
- Departments of1Neurologic Surgery and
- 2Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | - Michael J Link
- Departments of1Neurologic Surgery and
- 2Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
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Abstract
Surgery of the posterior fossa represents a technical challenge because of the proximity of the vessels of the cerebellum. If the arterial vascularization of the cerebellum is well known, the main arterial variations and the whole venous vascularization are probably under recognized. We describe the vascular organization and the main variations through photographs of colored latex perfused brains, obtained with a surgical microscope. The arterial vascularization of the cerebellum is based on three arteries which all originate from the vertebrobasilar system: the superior cerebellar artery (SCA), the anterior and inferior cerebellar artery (AICA), and the posterior and inferior cerebellar artery (PICA). The main arterial variations involve essentially the origin of these vessels. Concerning the SCA, its origin depends on the embryology. The AICA can arise from a common trunk AICA-PICA. It can be sometimes doubled and rarely absent. The PICA also can arise from a common trunk AICA-PICA and sometimes from the extradural segment of the vertebral artery. Concerning the venous organization, we distinguish the superficial and deep veins. The superficial veins drain the cerebellar cortex and transit on the surface of the cerebellum. The deep veins refer to the veins transiting in the fissures between the cerebellum and the brainstem. All these veins terminate as bridging veins that we can divide in three groups: a superior group emptying into the great vein, a posterior group emptying into the transtentorial sinus, and a lateral group ending into the superior petrosal sinus. The surgical implications are discussed.
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Zhao X, Hao S, Wang M, Han C, Xing D, Wang C. Management of veins during microvascular decompression for idiopathic trigeminal neuralgia. Br J Neurosurg 2018; 32:484-488. [PMID: 29792350 DOI: 10.1080/02688697.2018.1476674] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
OBJECT To summarize our experience in treating veins during microvascular decompression (MVD) procedures for idiopathic trigeminal neuralgia (TN). METHODS A total of 210 patients who underwent single MVD for idiopathic TN were retrospectively studied. The offending vessels were summarized. The treatment choices for veins during the operation were reviewed. Postoperative long-term outcomes were determined by follow-up. RESULTS Veins accounted for 26.7% of the total 262 offending vessels. Neurovascular conflicts were caused by veins alone in 23 patients (11.2%), and they were caused by arteries and veins together in 47 patients (22.8%). The offending veins were cut (15.7%) or saved (84.3%) during the operation. Excellent long-term outcomes were acquired in 78.3% of the patients with venous type TN. CONCLUSION There are no acknowledged principles guiding the treatment of veins during MVD. Our primary treatment principle is to retain veins as often as possible.
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Affiliation(s)
- Xu Zhao
- a Department of Neurosurgery , The Second Hospital of Shandong University , Jinan , Shandong Province , China
| | - Shuai Hao
- b Department of Neurosurgery , People's Hospital of Juye County , Juye , Shandong Province , China
| | - Minqing Wang
- a Department of Neurosurgery , The Second Hospital of Shandong University , Jinan , Shandong Province , China
| | - Chao Han
- a Department of Neurosurgery , The Second Hospital of Shandong University , Jinan , Shandong Province , China
| | - Deguang Xing
- a Department of Neurosurgery , The Second Hospital of Shandong University , Jinan , Shandong Province , China
| | - Chengwei Wang
- a Department of Neurosurgery , The Second Hospital of Shandong University , Jinan , Shandong Province , China
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Mercier P, Bernard F. Surgical anatomy for hemifacial spasm. Neurochirurgie 2018; 64:124-132. [PMID: 29779610 DOI: 10.1016/j.neuchi.2018.04.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 02/05/2018] [Accepted: 04/13/2018] [Indexed: 02/08/2023]
Abstract
Classically in the cerebello-pontine angle the facial (CN VII) and vestibular-cochlear (CN VIII) nerves should run parallel with the anterior inferior cerebellar artery, whereas the lower nerves (CN IX-XI) continue with the posterior-inferior-cerebellar artery (PICA). In fact, this is not always true, particularly when dealing with hemispasm surgery where the relationships between CN VII, CN VIII and PICA are often different and closer. Knowledge of anatomical bases in surgical situation will help neurosurgeons to appreciate anatomical nuances, that are important to increase effectiveness and safety of hemifacial spasm surgery.
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Affiliation(s)
- P Mercier
- Department of anatomy, UFR de médecine, university of Angers, rue haute-de-reculée, 49045 Angers cedex, France.
| | - F Bernard
- Department of anatomy, UFR de médecine, university of Angers, rue haute-de-reculée, 49045 Angers cedex, France; Department of neurosurgery, CHU d'Angers, rue Larrey, 49033 Angers cedex, France
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Iampreechakul P, Tanpun A, Lertbusayanukul P, Siriwimonmas S. Contralateral extensive cerebral hemorrhagic venous infarction caused by retrograde venous reflux into the opposite basal vein of Rosenthal in posttraumatic carotid-cavernous fistula: A case report and literature review. Interv Neuroradiol 2018; 24:546-558. [PMID: 29781369 DOI: 10.1177/1591019918776615] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We describe a patient with traumatic carotid-cavernous fistula (CCF), subsequently developing contralateral extensive hemorrhagic venous infarction from retrograde venous reflux into the opposite basal vein of Rosenthal. A 54-year-old woman was involved in a motor vehicle accident and sustained severe traumatic brain injury. Two months later, she developed bilateral proptosis and audible bruit. Magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) of the brain demonstrated the right direct CCF. Fluid-attenuated inversion recovery (FLAIR) images showed a small hyperintense area at the left basal ganglia. Ten days later, she developed right-sided grade 2/5 hemiparesis, facial upper motor neuron weakness, and cognitive impairment. Follow-up MRI showed significant progression of hyperintensities involving the left-sided centrum semiovale, basal ganglia, thalamus, midbrain, pons, cerebellum, basal frontal, temporal lobes, especially subcortical white matter on FLAIR images, and multiple hypointense foci of hemorrhagic component on T2*-weighted gradient-echo images, representing hemorrhagic venous infarction. While waiting for embolization, she rapidly developed right hemiplegia and aphasia, and became somnolent. Under general anesthesia, emergency endovascular treatment was performed successfully to obliterate the fistula without surgical intervention. Five months after endovascular treatment, MRI and MRA confirmed no residual fistula and revealed nearly complete resolution of abnormal increased signal intensity. In the present case, the factors related to the presence of this rare condition were absence of the ipsilateral basal vein of Rosenthal (BVR), occlusion of posterior segment of the contralateral superior petrosal sinus, and a developed uncal vein with hypoplastic second and third segments of the contralateral BVR.
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Affiliation(s)
| | - Adisak Tanpun
- 1 Department of Neurosurgery, Prasat Neurological Institute, Bangkok, Thailand
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Akamatsu Y, Hayashi T, Sato K, Karibe H, Kameyama M, Tominaga T. Bilateral Upper Cerebellar Hemorrhage Due to Pial Arteriovenous Fistula and Its Pathophysiological Insight. World Neurosurg 2018; 115:388-392. [PMID: 29753902 DOI: 10.1016/j.wneu.2018.05.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 04/30/2018] [Accepted: 05/02/2018] [Indexed: 10/16/2022]
Abstract
OBJECTIVES Bilateral upper cerebellar hemorrhage is extremely rare clinical entity but relatively known as postoperative neurosurgical complication with as-yet unknown etiology. Here, we report a case of bilateral upper cerebellar hemorrhage due to pial arteriovenous fistula (pAVF) and discuss the possible pathophysiology of this bleeding pattern. CASE DESCRIPTION A 4-year-old boy who was previously healthy presented with a sudden onset of headache, vomiting, and gait instability. Computed tomography revealed atypical bleeding in the sulci of bilateral cerebellar hemispheres facing the tentorium. Despite the symmetric distribution of bleeding, T2-weighted magnetic resonance imaging showed flow void adjacent to the lateral margin of bleeding. Diffusion-weighted magnetic resonance imaging showed increased apparent diffusion coefficient value in the hemorrhagic lesion, suggesting vasogenic edema. Vertebral angiogram revealed a pAVF, which was fed by the hemispheric branch of superior cerebellar artery. It drained via the venous varix, inferiorly into the tortuous and engorged inferior hemispheric vein, indicating venous congestion. On the venous phase of vertebral angiogram, the superior vermian vein, which is one of the main drainers of the superior part of the cerebellum, was not opacified. Transarterial n-butyl-2-cyanoacrylate embolization was performed to prevent rebleeding, and the pAVF was treated successfully. The patient's follow-up has been uneventful for 3 years. CONCLUSIONS We reported an extremely rare case of cerebellar pAVF presenting as bilateral upper cerebellar hemorrhage. Severe congestion of upper cerebellar veins seemed to be a possible pathophysiology of this specific bleeding pattern.
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Affiliation(s)
- Yosuke Akamatsu
- Department of Neurosurgery, Sendai City Hospital, Sendai, Japan.
| | | | - Kenichi Sato
- Department of Neuroendovascular Therapy, Kohnan Hospital, Sendai, Japan
| | - Hiroshi Karibe
- Department of Neurosurgery, Sendai City Hospital, Sendai, Japan
| | | | - Teiji Tominaga
- Department of Neurosurgery, Tohoku University, Graduate School of Medicine, Sendai, Japan
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Fujimoto S, Takai K, Nakatomi H, Kin T, Saito N. Three-dimensional angioarchitecture and microsurgical treatment of arteriovenous fistulas at the craniocervical junction. J Clin Neurosci 2018; 53:140-146. [PMID: 29731281 DOI: 10.1016/j.jocn.2018.04.065] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 04/23/2018] [Indexed: 10/17/2022]
Abstract
Digital subtraction angiography (DSA) is the gold standard for diagnosing vascular malformations; however, difficulties are associated with visualizing the angioarchitecture of arteriovenous fistulas at the craniocervical junction (CCJ AVFs) using DSA because of their complex regional neurovascular anatomy. The present study evaluated the application of 3-dimensional computer graphics (3D CG) to the surgical planning of CCJ AVFs. Six patients with CCJ AVFs who underwent microsurgery and/or endovascular treatment were included. The results of DSA and 3D CG were compared in the last 3 patients. The visibility of important anatomical structures were evaluated using visibility grading scores. Clinical outcomes were assessed based on the rate of occlusion of AVFs, surgical complications, neurological status, and recurrence in long-term follow-ups. The 3D CG images could combine arteries, veins, the spinal cord and dura mater in one single picture to evaluate the anatomy of CCJ AVFs. The image interpretation of vascular structures, particularly narrow arterial feeders, was significantly better using 3D CG than DSA (overall visibility scores, 97% vs 51%, p = 0.001). In all patients, the complete occlusion of AVFs was achieved by microsurgery except for 2 patients without surgical planning with 3D CG. Postoperatively, the neurological status of all patients improved or stabilized without the recurrence of AVFs (median, 5.4 years). 3D CG may help to improve the quality of the microsurgical procedures in complex AVFs. However, it should be used as a complementary diagnostic modality rather than the alternative of DSA because 3D CG has no hemodynamic information at this time.
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Affiliation(s)
- So Fujimoto
- Department of Neurosurgery, The University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Keisuke Takai
- Department of Neurosurgery, Tokyo Metropolitan Neurological Hospital, 2-6-1, Musashidai, Fuchu, Tokyo 183-8524, Japan.
| | - Hirofumi Nakatomi
- Department of Neurosurgery, The University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Taichi Kin
- Department of Neurosurgery, The University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Nobuhito Saito
- Department of Neurosurgery, The University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
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