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Wu Y, Tian Q, Wang S, Li K, Feng D, Cai Q. Hemorrhagic cerebral venous infarction after vein injury during intraoperative lesion resection: incidence, hemorrhagic stages, risk factors and prognosis. Front Neurol 2024; 15:1371184. [PMID: 38651110 PMCID: PMC11034368 DOI: 10.3389/fneur.2024.1371184] [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: 01/16/2024] [Accepted: 03/18/2024] [Indexed: 04/25/2024] Open
Abstract
Objective Cerebral venous infarction (CVI) after vein injury during intraoperative lesion resection is associated with intracranial hemorrhage. We conducted this study to identify the incidence, clinical and imaging features, and prognosis of hemorrhage CVI. Methods We performed a retrospective analysis of patients with confirmed CVI after vein injury who underwent craniotomy in our hospital. Postoperative clinical symptoms were observed, and imaging features were compared between patients with and without intracranial hemorrhages through CT examination. Variables were analyzed using univariate and multivariate regression analyses. Results Among 2,767 patients who underwent craniotomy, 93 cases of injured veins were identified intraoperatively. Hemorrhagic CVI was found in 38% (35/93). Multivariate analysis revealed that midline approach, meningioma, postoperative seizures, disorders of consciousness and interval in hours < 72 h were identified as predictors of hemorrhagic CVI. After 3 months of follow-up, the prognosis was poor in 15 cases (16%, 15/93), including death (two cases), vegetative survival (four cases), and severe disability (nine cases). Conclusions Hemorrhagic CVI, as a critical complication after venous injury, can have disastrous consequences. Do not injure known veins intraoperatively. In case of injury, requisite remedial measures should be adopted during and after surgery.
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Affiliation(s)
| | | | | | | | - Dayun Feng
- Department of Neurosurgery, Tangdu Hospital, Air Force Medical University, Xi'an, Shanxi, China
| | - Qing Cai
- Department of Neurosurgery, Tangdu Hospital, Air Force Medical University, Xi'an, Shanxi, China
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2
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Ito Y, Hosoo H, Sato M, Marushima A, Hayakawa M, Matsumaru Y, Ishikawa E. Evaluation of Venous Structures that Are Involved in Transsylvian Approach Using 3D Rotational Venography. Neurol Med Chir (Tokyo) 2023; 63:555-562. [PMID: 37743508 PMCID: PMC10788483 DOI: 10.2176/jns-nmc.2022-0361] [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: 11/17/2022] [Accepted: 07/24/2023] [Indexed: 09/26/2023] Open
Abstract
In the transsylvian (TS) approach, as characterized by clipping surgery, the presurgical visualization of the superficial middle cerebral vein (SMCV) can help change the surgical approach to ensure safe microsurgery. Nevertheless, identifying preoperatively the venous structures that are involved in this approach is difficult. In this study, we investigated the venous structures that are involved in the TS approach using three-dimensional (3D) rotational venography (3D-RV) and evaluated the effectiveness of this method for presurgical simulation. Patients who underwent 3D-RV between August 2018 and June 2020 were involved in this retrospective study. The 3D-RV and partial maximum intensity projection images with a thickness of 5 mm were computationally reconstructed. The venous structures were subdivided into the following three portions according to the anatomic location: superficial, intermediate, and basal portions. In the superficial portion, predominant frontosylvian veins were observed on 31 (41%) sides, predominant temporosylvian veins on seven (9%) sides, and equivalent fronto- and temporosylvian veins on 28 (37%) sides. The veins in the intermediate (deep middle cerebral and uncal veins) and basal portions (frontobasal bridging veins) emptied into the SMCV on 57 (75%) and 34 (45%) sides, respectively. The 3D-RV images were highly representative of the venous structures observed during microsurgery. In this study, 3D-RV was utilized to capture the details of the venous structures from the superficial to the deep portions. Presurgical simulation of the venous structures that are involved in the TS approach using 3D-RV may increase the safety of microsurgical approaches.
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Affiliation(s)
- Yoshiro Ito
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba
| | - Hisayuki Hosoo
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba
| | - Masayuki Sato
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba
| | - Aiki Marushima
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba
| | - Mikito Hayakawa
- Division of Stroke Prevention, Faculty of Medicine, University of Tsukuba
| | - Yuji Matsumaru
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba
- Division of Stroke Prevention, Faculty of Medicine, University of Tsukuba
| | - Eiichi Ishikawa
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba
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Woo SB, Ko YS, Lee CY. Iatrogenic mixed pial and dural arteriovenous fistula after pterional approach for surgical clipping of aneurysm: A case report. J Cerebrovasc Endovasc Neurosurg 2023; 25:440-446. [PMID: 37189252 PMCID: PMC10774680 DOI: 10.7461/jcen.2023.e2022.12.004] [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: 12/25/2022] [Revised: 02/21/2023] [Accepted: 04/23/2023] [Indexed: 05/17/2023] Open
Abstract
Craniotomy is known as a cause of iatrogenic dural cerebral arteriovenous fistula (AVF). However, mixed pial and dural AVFs after craniotomy are extremely rare and require accurate diagnosis and prompt treatment due to their aggressiveness. We present a case of an iatrogenic mixed pial and dural AVF diagnosed 2 years after pterional craniotomy for surgical clipping of a ruptured anterior choroidal aneurysm. The lesion was successfully treated using single endovascular procedure of transvenous coil embolization through the engorged vein of Labbe and the superficial middle cerebral vein. The possibility of the AVF formation after the pterional approach should always be kept in mind because it usually occurs at the middle cranial fossa, which frequently has an aggressive nature owing to direct cortical venous or leptomeningeal drainage patterns. This complication is believed to be caused by angiogenetic conditions due to coagulation, retraction, and microinjuries of the perisylvian vessels, and can be prevented by performing careful sylvian dissection according to patient-specific perisylvian venous anatomy.
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Affiliation(s)
- Seung-Bin Woo
- Department of Neurosurgery, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Young San Ko
- Department of Neurosurgery, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Chang-Young Lee
- Department of Neurosurgery, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
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Tola S, Parenti A, Esposito A, Della Puppa A. Temporal lobe tumors modify local venous drainage. Clin Neurol Neurosurg 2023; 233:107953. [PMID: 37647747 DOI: 10.1016/j.clineuro.2023.107953] [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: 07/30/2023] [Revised: 08/21/2023] [Accepted: 08/24/2023] [Indexed: 09/01/2023]
Abstract
OBJECTIVE Superficial Middle Cerebral Vein (SMCV) is an anastomotic vein frequently exposed during surgery. Changes in the pattern of cerebral venous outflow can occur in many pathological settings. We explored the hypothesis that the growth of an intracranial tumor could determine alterations in the venous outflow. We analyzed SMCV anatomical variants in patients undergoing surgery for intracranial tumors; we furthermore focused on association with histology. METHODS We retrospectively collected data of 120 patients undergoing surgery, 60 presenting intracranial tumor and 60 presenting cerebral aneurysms (control group). Tumor series was divided into "Low Growth-Rate tumors" (WHO grade I and II) and "High Growth-Rate tumors" (WHO grade III and IV). Anatomical variants of SMCV were analyzed on intraoperative videos and then classified as Type 1 (normotrophic), 2 A (hypotrophic) and Type 2B (absent/atrophic). We furthermore defined as Type 2 any alteration of the SMCV (2 A+2B) encountered. Relationships among SMCV types and both populations were analyzed using the chi-squared test; values of p < 0.05 were considered statistically significant. RESULTS We found a positive correlation between the presence of a primary brain tumor and Type 2B SMCV (PC.004, p < 0.05) and Type 2 SMCV (PC.000, p < 0.05). Specifically, we found a strong correlation between the absence of SMCV (Type 2B) and both tumors subgroups. Thus, the growth of a primary brain tumor seems to affect the cerebral local outflow. CONCLUSIONS Primary brain tumors seem to alter local venous network of SMCV. Clinical and oncological implications remain subject of further investigation.
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Affiliation(s)
- Serena Tola
- Department of Neurosurgery, Careggi University Hospital, Department of NEUROFARBA, University of Florence, Florence, Italy.
| | - Alberto Parenti
- Department of Neurosurgery, Careggi University Hospital, Department of NEUROFARBA, University of Florence, Florence, Italy
| | - Alice Esposito
- Department of Neurosurgery, Careggi University Hospital, Department of NEUROFARBA, University of Florence, Florence, Italy
| | - Alessandro Della Puppa
- Department of Neurosurgery, Careggi University Hospital, Department of NEUROFARBA, University of Florence, Florence, Italy
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The transcerebral laterocavernous vein, a form of persisting primitive tentorial sinus. Surg Radiol Anat 2022; 44:1471-1474. [DOI: 10.1007/s00276-022-03038-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 10/15/2022] [Indexed: 11/25/2022]
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Imada Y, Mihara C, Kawamoto H, Kurisu K. Morphological Analysis of the Sylvian Fissure Stem to Guide a Safe Trans-sylvian Fissure Approach. Neurol Med Chir (Tokyo) 2022; 62:502-512. [PMID: 36130902 DOI: 10.2176/jns-nmc.2022-0064] [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: 11/20/2022] Open
Abstract
The sylvian fissure stem and its deep cisternal part (SDCP) consist mainly of the orbital gyrus (OG) and anterior medial portion of the temporal lobe. SDCP's adhesion has been found to make a trans-sylvian approach difficult due to the various patterns of adhesion. Thus, in this study, we aim to clarify the morphological features of the SDCP, and to guide a safe trans-sylvian approach. We retrospectively classified the morphology of the SDCP in 81 patients into 3 types (tight, moderate, loose type) according to the degree of adhesion of the arachnoid membrane and analyzed the morphological features of the OG and the temporal lobe using intraoperative video images. In addition, we have retrospectively measured each width of the SDCP's subarachnoid space at the three points (Point A, lateral superior portion; Point B, downward portion; Point C, medial inferior portion of SDCP) and analyzed their relationship to the degree of adhesion using the preoperative coronal three-dimensional computed tomography angiography (3D-CTA) images of 44 patients. As per the results, SDCP's adhesions were determined to be significantly tighter in cases with large OG and young cases. The temporal lobe had four surfaces (posterior, middle, anterior, and medial) that adhered to the OG in various patterns. The tighter the adhesion between the OG and each of the three distal surfaces of the temporal lobe, the narrower the width of the subarachnoid space at each point (A, B, C). Understanding of the morphological features of the SDCP, and estimating its adhesion preoperatively are useful in developing a surgical strategy and obtaining correct intraoperative orientation in the trans-sylvian approach.
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Affiliation(s)
| | - Chie Mihara
- Department of Neurosurgery, Yamada Memorial Hospital
| | | | - Kaoru Kurisu
- Department of Neurosurgery, Chugoku Rosai Hospital.,Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University
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Mincă DI, Rusu MC, Rădoi PM, Hostiuc S, Toader C. A New Classification of the Anatomical Variations of Labbé’s Inferior Anastomotic Vein. Tomography 2022; 8:2182-2192. [PMID: 36136879 PMCID: PMC9498553 DOI: 10.3390/tomography8050183] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 08/23/2022] [Accepted: 08/24/2022] [Indexed: 11/16/2022] Open
Abstract
(1) Background: The inferior anastomotic vein of Labbé (LV) courses on the temporal lobe, from the sylvian fissure towards the tentorium cerebelli and finishes at the transverse sinus (TS). The importance of the LV topography is related to skull base neurosurgical approaches. Based on the hypothesis of the existence of as yet unidentified anatomical possibilities of the LV, we aimed through this research to document the superficial venous topographic patterns at the lateral and inferior surfaces of the temporal lobe. (2) Methods: A retrospective cohort of 50 computed tomography angiograms (CTAs) of 32 males and 18 females was documented. (3) Results: Absent (type 0) LVs were found in 6% of cases. Anterior (temporal, squamosal–petrosal–mastoid, type 1) LVs were found in 12% of cases. LVs with a posterior, temporoparietal course (type 2) were found to be bilateral in 46% of cases and unilateral in 36% of cases. Type 3 LVs (posterior, parietooccipital) were found to be bilateral in 8% and unilateral in 32% of cases. In 24% of cases, duplicate LVs were found that were either complete or incomplete. A quadruplicate LV was found in a male case. On 78 sides, the LV drained either into a tentorial sinus or into the TS. (4) Conclusions: The anatomy of the vein of Labbé is variable in terms of its course, the number of veins and the modality of drainage; thus, it should determine personalized neurosurgical and interventional approaches. A new classification of the anatomical variations of Labbé’s vein, as detected on the CTAs, is proposed here (types 0–3).
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Affiliation(s)
- Dragoş Ionuţ Mincă
- Division of Anatomy, Department 1, Faculty of Dental Medicine, “Carol Davila” University of Medicine and Pharmacy, RO-020021 Bucharest, Romania
| | - Mugurel Constantin Rusu
- Division of Anatomy, Department 1, Faculty of Dental Medicine, “Carol Davila” University of Medicine and Pharmacy, RO-020021 Bucharest, Romania
- Correspondence: (M.C.R.); (P.M.R.)
| | - Petrinel Mugurel Rădoi
- Division of Neurosurgery, Department 6—Clinical Neurosciences, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, RO-020021 Bucharest, Romania
- Clinic of Neurosurgery, “Dr. Bagdasar-Arseni” Emergency Clinical Hospital, RO-041915 Bucharest, Romania
- Correspondence: (M.C.R.); (P.M.R.)
| | - Sorin Hostiuc
- Department of Legal Medicine and Bioethics, Faculty of Dental Medicine, “Carol Davila” University of Medicine and Pharmacy, RO-020021 Bucharest, Romania
| | - Corneliu Toader
- Division of Neurosurgery, Department 6—Clinical Neurosciences, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, RO-020021 Bucharest, Romania
- Clinic of Neurosurgery, “Dr. Bagdasar-Arseni” Emergency Clinical Hospital, RO-041915 Bucharest, Romania
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Imada Y, Mihara C, Kawamoto H, Kurisu K. Dissection of the Sylvian Fissure in the Trans-sylvian Approach Based on the Morphological Classification of the Superficial Middle Cerebral Vein. Neurol Med Chir (Tokyo) 2021; 61:731-740. [PMID: 34645716 PMCID: PMC8666298 DOI: 10.2176/nmc.oa.2021-0080] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The superficial middle cerebral vein (SMCV) is one of the main factors that can impede a wide opening of the sylvian fissure. To reveal the most efficient SMCV dissection for a wide operative field while preserving the veins in the trans-sylvian approach, we retrospectively investigated the SMCVs through intraoperative video images. We characterized the SMCV as composed of the frontosylvian trunk (FST; receiving frontosylvian veins [FSVs] or parietosylvian veins [PSVs]), the temporosylvian trunk (TST; receiving temporosylvian veins [TSVs]), and the superficial middle cerebral common trunk (SMCCT; receiving both FSV/PSV and TSV), and classified the SMCVs of the 116 patients into 5 types based on the morphological classification of the SMCV. Type A SMCV (60.4%) with the SMCCT anastomosed to the frontal side had few bridging veins (BVs) between the SMCCT and the temporal side during dissection. Type B (7.8%) had the SMCCT with no anastomoses to the frontal side. In Type C (17.2%) consisting of the FST and TST and Type D (12.9%) with a merging of the vein of Trolard and Labbé posteriorly and the SMCVs dividing into the FST and the TST again proximally, there were few BVs between the FST and the TST during dissection. Finally, in Type E (1.7%) showing an undeveloped SMCV, there were no BVs between the frontal and the temporal lobes. Postoperative venous infarction occurred in 2.6%. Morphological classification of the SMCV can inform appropriate dissection line to create a wide operative field while preserving the veins in the trans-sylvian approach.
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Affiliation(s)
| | - Chie Mihara
- Department of Neurosurgery, Yamada Memorial Hospital
| | | | - Kaoru Kurisu
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University.,Department of Neurosurgery, Chugoku Rosai Hospital
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