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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; 27:137-147. [PMID: 38330415 DOI: 10.1227/ons.0000000000001069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [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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Liu J, Fan D, Chen L, Zou Z, Li X, Zhou M, Wen Z, Gong S, Liang G. Technique notes on the management of superior sagittal or transverse sinus during the falcotentorial meningioma surgery: a case report. Front Neurol 2024; 15:1284038. [PMID: 38872820 PMCID: PMC11169871 DOI: 10.3389/fneur.2024.1284038] [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: 08/27/2023] [Accepted: 05/09/2024] [Indexed: 06/15/2024] Open
Abstract
Background Falcotentorial meningiomas (FM) are surgical challenges for protecting sinus, and the technique notes on the management of superior sagittal or transverse sinus are required for good results. Methods We improved the technique notes on the management of superior sagittal or transverse sinus in three FM patients with signs of increased intracranial pressure or chronic headache. Results All patients underwent surgeries in the prone position, and occipital/sup-occipital/sub-occipital craniotomy was performed. In one patient, the skull was removed traditionally with exposure of the confluence of sinuses, superior sagittal, and transverse sinus, while the longitudinal skull bridge was left to suspend the dura for protecting the superior sagittal sinus in one patient, and the transverse skull bridge was left to suspend the dura for protecting the transverse sinus in one patient. The dura was opened infratentorially or supratentorially to spare the sinus and then the "skull bridge" was suspended. The tumor was then removed completely without brain swelling or significant venous bleeding. Complete tumor resection was confirmed by early postoperative imaging, and all patients recovered well without postoperative morbidity. Conclusion The authors recommend the "skull bridge" to suspend the dura for optimal control of the venous sinuses during FM surgery (less venous bleeding).
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Affiliation(s)
| | | | | | | | | | | | | | - Shun Gong
- Department of Neurosurgery, General Hospital of Northern Theater Command, Shenyang, China
| | - Guobiao Liang
- Department of Neurosurgery, General Hospital of Northern Theater Command, Shenyang, China
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Demir BT, Akduman D, Bilecenoğlu B, Orhan K. Evaluation of the Sigmoid Sinus Morphology by Cone Beam Computed Tomography; Touchstone of the Posterior Cranial Fossa. World Neurosurg 2024; 183:e127-e135. [PMID: 38043743 DOI: 10.1016/j.wneu.2023.11.139] [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: 09/04/2023] [Revised: 11/27/2023] [Accepted: 11/28/2023] [Indexed: 12/05/2023]
Abstract
OBJECTIVE In this study, we aimed to analyze the relationship of the sigmoid sinus (SS) with the external auditory canal, facial nerve, and mastoid cells from an anatomic point of view, to define the position of the SS during transmastoid, translabyrinthine, retrosigmoid (lateral suboccipital) approaches, in tympanomastoidectomy and posterior cranial fossa surgery. METHODS In this study, the morphologic structures associated with the sigmoid sinus were evaluated in cone beam computed tomography images taken between 2015 and 2022. The images of 68 men and 106 women, aged 18-65 years, obtained from the archive of Ankara University Faculty of Dentistry, Department of Oral and Maxillofacial Radiology were analyzed. RESULTS The most common SS pattern was type II, with a rate of 60.8% (n = 209); the second was type III, with 20.6% (n = 71); and the least common was type I, with 18.6% (n = 64). Although the distance between the horizontal line passing through the external auditory canal and facial nerve and the anterior contour of the SS was highest in type I (right, 7.26 ± 1.62; left, 7.44 ± 0.97), it was lowest in type III (right, 4.40 ± 1.50; left, 4.84 ± 1.16) (P < 0.05). CONCLUSIONS This study highlights the importance of the SS position in surgery, with special reference to otologic, neurotologic, and posterior cranial fossa surgery. To avoid intraoperative complications, each patient should be evaluated preoperatively by appropriate radiologic methods.
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Affiliation(s)
- Berin Tuğtağ Demir
- Department of Anatomy, Faculty of Medicine, Ankara Medipol University, Ankara, Turkey.
| | - Davut Akduman
- Department of Otorhinolaryngology, Gulhane Faculty of Medicine, Ankara Atatürk Sanatoryum Training and Research Hospital, University of Health Science, Ankara, Turkey
| | - Burak Bilecenoğlu
- Department of Anatomy, Faculty of Medicine, Ankara Medipol University, Ankara, Turkey
| | - Kaan Orhan
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Ankara University, Ankara, Turkey
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Lui JT, Dahm V, Chen JM, Lin VY, Irish JC, Le TN, Chan HHL. Using augmented reality to guide bone conduction device implantation. Sci Rep 2023; 13:7182. [PMID: 37137995 PMCID: PMC10156678 DOI: 10.1038/s41598-023-33523-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 04/14/2023] [Indexed: 05/05/2023] Open
Abstract
Exact placement of bone conduction implants requires avoidance of critical structures. Existing guidance technologies for intraoperative placement have lacked widespread adoption given accessibility challenges and significant cognitive loading. The purpose of this study is to examine the application of augmented reality (AR) guided surgery on accuracy, duration, and ease on bone conduction implantation. Five surgeons surgically implanted two different types of conduction implants on cadaveric specimens with and without AR projection. Pre- and postoperative computer tomography scans were superimposed to calculate centre-to-centre distances and angular accuracies. Wilcoxon signed-rank testing was used to compare centre-to-centre (C-C) and angular accuracies between the control and experimental arms. Additionally, projection accuracy was derived from the distance between the bony fiducials and the projected fiducials using image guidance coordinates. Both operative time (4.3 ± 1.2 min. vs. 6.6 ± 3.5 min., p = 0.030) and centre-to-centre distances surgery (1.9 ± 1.6 mm vs. 9.0 ± 5.3 mm, p < 0.001) were significantly less in augmented reality guided surgery. The difference in angular accuracy, however, was not significantly different. The overall average distance between the bony fiducial markings and the AR projected fiducials was 1.7 ± 0.6 mm. With direct intraoperative reference, AR-guided surgery enhances bone conduction implant placement while reduces operative time when compared to conventional surgical planning.
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Affiliation(s)
- Justin T Lui
- Section of Otolaryngology-Head & Neck Surgery, Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Valerie Dahm
- Department of Otolaryngology-Head & Neck Surgery, Temerty School of Medicine, University of Toronto, Toronto, Canada
| | - Joseph M Chen
- Department of Otolaryngology-Head & Neck Surgery, Temerty School of Medicine, University of Toronto, Toronto, Canada
| | - Vincent Y Lin
- Department of Otolaryngology-Head & Neck Surgery, Temerty School of Medicine, University of Toronto, Toronto, Canada
| | - Jonathan C Irish
- Department of Otolaryngology-Head & Neck Surgery, Temerty School of Medicine, University of Toronto, Toronto, Canada
- Guided Therapeutics (GTx) Program, Techna Research Institute, University Health Network, Toronto, Canada
| | - Trung N Le
- Department of Otolaryngology-Head & Neck Surgery, Temerty School of Medicine, University of Toronto, Toronto, Canada
| | - Harley H L Chan
- Guided Therapeutics (GTx) Program, Techna Research Institute, University Health Network, Toronto, Canada.
- Techna Institute for the Advancement of Technology for Health, University Health Network, 100 College Street, Room 7-207, MaRS Building, Princess Margaret Cancer Research Tower, 7th Floor (STTARR), Toronto, ON, M5G 1P5, Canada.
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Valero-Moreno F, Pullen MW, Navarro-Martínez G, Ruiz-Garcia H, Domingo RA, Martínez JL, Suarez-Meade P, Damon A, Quiñones-Hinojosa A, Sandhu SJ, Tawk RG, Fox WC. Absence of the torcular, review of venous sinus anatomy, and the simplified dural sinus classification. Acta Neurochir (Wien) 2023:10.1007/s00701-023-05559-w. [PMID: 37014451 DOI: 10.1007/s00701-023-05559-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 03/08/2023] [Indexed: 04/05/2023]
Abstract
BACKGROUND Classically, the torcular Herophili is described as the symmetric junction between the superior sagittal sinus (SSS), transverse sinuses (TSs), and straight sinus (SS). However, finding this pattern in practice is not standard. Anatomical variations are common, and different drainage patterns should be expected. Existing literature proposes highly detailed descriptions and classifications of this region. Still, a simplified and practical categorization is not available. METHODS We present an anatomical finding of the torcular Herophili discovered on a cadaveric dissection. Then, we conducted a retrospective study examining the 100 most recent cranial magnetic resonance venographies (MRVs) from the Mayo Clinic, labeling them with a new proposed dural sinus classification system. Images were initially classified by two authors and further validated by a board-certified neurosurgeon and a board-certified neuroradiologist from our institution. To measure consistency in image identification, two additional international neurosurgeons were asked to classify a subset of the same MRV images, and their answers were compared. RESULTS Of the MRV cohort, 33 patients were male and 67 were female. Their ages ranged from 18 to 86 years, with a mean of 47.35 years and a median of 49 years. Upon examination, 53 patients presented as confluent (53%), 9 as SSS divergent (9%), 25 as SS divergent (25%), 11 as circular (11%), and 2 as trifurcated (2%). The inter-rater reliability ranked very good; agreement between the two neurosurgeons was 83% (κ = 0.830, p < 0.0005). CONCLUSION The confluence of the venous sinuses is a highly variable anatomical area that is rarely evaluated with neuroimaging before surgery. The classic textbook configuration is not the rule. Using a simplified classification system may increase awareness and hopefully patient safety by preparing the physician for anatomical variations that they will encounter in a surgical or clinical scenario.
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Affiliation(s)
- Fidel Valero-Moreno
- Department of Neurological Surgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Michael W Pullen
- Department of Neurological Surgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | | | - Henry Ruiz-Garcia
- Department of Neurological Surgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Ricardo A Domingo
- Department of Neurosurgery, Medical University of South Carolina, Charleston, SC, USA
| | | | - Paola Suarez-Meade
- Department of Neurological Surgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Aaron Damon
- Department of Neurological Surgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | | | - Sukhwinder Js Sandhu
- Department of Neurological Surgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
- Department of Radiology, Mayo Clinic, Jacksonville, FL, USA
| | - Rabih G Tawk
- Department of Neurological Surgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - W Christopher Fox
- Department of Neurological Surgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA.
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Kutz JW, Tan D, Hunter JB, Barnett S, Isaacson B. Management of Complications in Vestibular Schwannoma Surgery. Otolaryngol Clin North Am 2023; 56:567-576. [PMID: 36964095 DOI: 10.1016/j.otc.2023.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2023]
Abstract
Microsurgical removal of acoustic neuroma has advanced tremendously; however, complications still occur. Facial nerve injury is the most common detrimental complication and should take precedence over gross tumor removal in cases where there is an unfavorable tumor-facial nerve interface. Cerebrospinal fluid leakage can occur even with meticulous closure techniques and is generally treatable with either lumbar-subarachnoid drainage or revision wound closure. Meningitis is a serious complication that requires a high index of suspicion in the postoperative period. Other less common complications include intraoperative and postoperative vascular injuries. Early identification and treatment can prevent devastating outcomes.
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Affiliation(s)
- Joe Walter Kutz
- Departments of Otolaryngology and Neurological Surgery, The University of Texas Southwestern Medical Center, 2001 Inwood Road, Dallas TX 75390, USA.
| | - Donald Tan
- The University of Texas Southwestern Medical Center, 2001 Inwood Road, Dallas TX 75390, USA
| | - Jacob B Hunter
- The University of Texas Southwestern Medical Center, 2001 Inwood Road, Dallas TX 75390, USA
| | - Samuel Barnett
- Departments of Neurological Surgery and Otolaryngology, The University of Texas Southwestern Medical Center, 2001 Inwood Road, Dallas TX 75390, USA
| | - Brandon Isaacson
- Departments of Otolaryngology and Neurological Surgery, The University of Texas Southwestern Medical Center, 2001 Inwood Road, Dallas TX 75390, USA
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Matsushima K, Kohno M. In Reply: Management of Sigmoid Sinus Injury: Retrospective Study of 450 Consecutive Surgeries in the Cerebellopontine Angle and Intrapetrous Region. Oper Neurosurg (Hagerstown) 2021; 20:E394-E395. [PMID: 33582817 DOI: 10.1093/ons/opab031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ken Matsushima
- Department of Neurosurgery Tokyo Medical University Tokyo, Japan
| | - Michihiro Kohno
- Department of Neurosurgery Tokyo Medical University Tokyo, Japan
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Mongardi L, Dones F. Letter: Management of Sigmoid Sinus Injury: Retrospective Study of 450 Consecutive Surgeries in the Cerebellopontine Angle and Intrapetrous Region. Oper Neurosurg (Hagerstown) 2021; 20:E393. [PMID: 33582799 DOI: 10.1093/ons/opab030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Lorenzo Mongardi
- Neurosurgery Sant'Anna University Hospital of Ferrara Ferrara, Italy
| | - Flavia Dones
- Neurosurgery Sant'Anna University Hospital of Ferrara Ferrara, Italy
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Takata Y, Anzai T, Hara S, Okada H, Matsumoto F, Ikeda K. Cholesteatoma Surgery With a Dehiscent High Jugular Bulb Treated With Surgery Assisted With Underwater Endoscopy: A Case Report. EAR, NOSE & THROAT JOURNAL 2021:1455613211009135. [PMID: 33915058 DOI: 10.1177/01455613211009135] [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: 11/16/2022] Open
Abstract
A dehiscent high jugular bulb would be a pitfall in middle ear surgery especially for cholesteatoma. We report a case of cholesteatoma attached to a dehiscent high jugular bulb successfully treated with surgery assisted with underwater endoscopy. To the best of our knowledge, no previous study has reported a case of cholesteatoma with dehiscent high jugular bulb treated with surgery assisted with underwater endoscopy. Owing to the risk of jugular bulb injury, underwater endoscopy is a good indication for middle ear cases with a dehiscent high jugular bulb to obtain a clear operative field and avoid an unexpected air embolism.
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Affiliation(s)
- Yusuke Takata
- Department of Otorhinolaryngology, 12847Juntendo University Faculty of Medicine, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Takashi Anzai
- Department of Otorhinolaryngology, 12847Juntendo University Faculty of Medicine, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Satoshi Hara
- Department of Otorhinolaryngology, 12847Juntendo University Faculty of Medicine, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Hiroko Okada
- Department of Otorhinolaryngology, 12847Juntendo University Faculty of Medicine, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Fumihiko Matsumoto
- Department of Otorhinolaryngology, 12847Juntendo University Faculty of Medicine, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Katsuhisa Ikeda
- Department of Otorhinolaryngology, 12847Juntendo University Faculty of Medicine, Hongo, Bunkyo-ku, Tokyo, Japan
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