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Anatomical variations and flow alterations of the uncal vein and its clinical implications in petroclival meningiomas

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Abstract

Background

The Uncal vein (UV), downstream of the deep middle cerebral vein (DMCV), has a similar drainage pattern to the superficial middle cerebral vein (SMCV) and may be involved in venous complications during the anterior transpetrosal approach (ATPA). However, in petroclival meningioma (PCM), where the ATPA is frequently used, there are no reports evaluating drainage patterns of the UV and the risk of venous complications associated with the UV during the ATPA.

Methods

Forty-three patients with petroclival meningioma (PCM) and 20 with unruptured intracranial aneurysm (control group) were included. Preoperative digital subtraction angiography was used to evaluate UV and DMCV drainage patterns on the side of the tumor and bilaterally in patients with PCM and the control group, respectively.

Results

In the control group, the DMCV drained to the UV, UV and BVR, and BVR in 24 (60.0%), eight (20.0%), and eight (20.0%) hemispheres, respectively. Conversely, the DMCV in the patients with PCM drained to the UV, UV and BVR, and BVR in 12 (27.9%), 19 (44.2%), and 12 (27.9%) patients, respectively. The DMCV was more likely to be drained to the BVR in the PCM group (p < 0.01). In three patients with PCM (7.0%), the DMCV drained only to the UV, and furthermore, the UV drained to the pterygoid plexus via the foramen ovale, posing a risk for venous complications during the ATPA.

Conclusions

In the patients with PCM, the BVR functioned as a collateral venous pathway of the UV. Preoperative evaluation of the UV drainage patterns is recommended to reduce venous complications during the ATPA.

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References

  1. Adachi K, Hasegawa M, Hayakawa M, Tateyama S, Hirose Y (2019) Susceptibility-weighted imaging of deep venous congestion in petroclival meningioma. World Neurosurg 122:e20–e31. https://doi.org/10.1016/j.wneu.2018.08.218

    Article  PubMed  Google Scholar 

  2. Adachi K, Hayakawa M, Ishihara K, Ganaha T, Nagahisa S, Hasegawa M, Hirose Y (2016) Study of changing intracranial venous drainage patterns in petroclival meningioma. World Neurosurg 92:339–348. https://doi.org/10.1016/j.wneu.2016.05.019

    Article  PubMed  Google Scholar 

  3. Almefty R, Dunn IF, Pravdenkova S, Abolfotoh M, Al-Mefty O (2014) True petroclival meningiomas: results of surgical management. J Neurosurg 120:40–51. https://doi.org/10.3171/2013.8.JNS13535

    Article  PubMed  Google Scholar 

  4. Di Ieva A, Matula C, Grizzi F, Grabner G, Trattnig S, Tschabitscher M (2012) Fractal analysis of the susceptibility weighted imaging patterns in malignant brain tumors during antiangiogenic treatment: technical report on four cases serially imaged by 7 T magnetic resonance during a period of four weeks. World Neurosurg 77(785):e711-721. https://doi.org/10.1016/j.wneu.2011.09.006

    Article  Google Scholar 

  5. Di Ieva A, Tschabitscher M, Galzio RJ, Grabner G, Kronnerwetter C, Widhalm G, Matula C, Trattnig S (2011) The veins of the nucleus dentatus: anatomical and radiological findings. Neuroimage 54:74–79. https://doi.org/10.1016/j.neuroimage.2010.07.045

    Article  PubMed  Google Scholar 

  6. Fukushima T, Day JD, Hirahara K (1996) Extradural total petrous apex resection with trigeminal translocation for improved exposure of the posterior cavernous sinus and petroclival region. Skull Base Surg 6:95–103. https://doi.org/10.1055/s-2008-1058650

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Haacke EM, Mittal S, Wu Z, Neelavalli J, Cheng YC (2009) Susceptibility-weighted imaging: technical aspects and clinical applications, part 1. AJNR Am J Neuroradiol 30:19–30. https://doi.org/10.3174/ajnr.A1400

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Haacke EM, Xu Y, Cheng YC, Reichenbach JR (2004) Susceptibility weighted imaging (SWI). Magn Reson Med 52:612–618. https://doi.org/10.1002/mrm.20198

    Article  PubMed  Google Scholar 

  9. Hafez A, Nader R, Al-Mefty O (2011) Preservation of the superior petrosal sinus during the petrosal approach. J Neurosurg 114:1294–1298. https://doi.org/10.3171/2010.6.JNS091461

    Article  PubMed  Google Scholar 

  10. Ichimura S, Yoshida K, Kagami H, Inaba M, Orii M, Kitamura Y, Saga I, Toda M (2012) Epidural anterior petrosectomy with subdural visualization of sphenobasal vein via the anterior transpetrosal approach–technical case report. Neurosurg Rev 35:609–613. https://doi.org/10.1007/s10143-012-0405-2. (discussion 613-604)

    Article  PubMed  Google Scholar 

  11. Ide S, Kiyosue H, Tanoue S, Okahara M, Sagara Y, Hori Y, Mori H (2014) Anatomical variations in termination of the Uncal vein and its clinical implications in cavernous sinus dural arteriovenous fistulas. Neuroradiology 56:661–668. https://doi.org/10.1007/s00234-014-1383-6

    Article  PubMed  PubMed Central  Google Scholar 

  12. Kiyosue H, Mori H, Sagara Y, Hori Y, Okahara M, Nagatomi H, Abe T (2009) Basal cerebral venous drainage from cavernous sinus Dural arteriovenous fistulas. Neuroradiology 51:175–181. https://doi.org/10.1007/s00234-008-0486-3

    Article  PubMed  Google Scholar 

  13. Kobkitsuksakul C, Jiarakongmun P, Chanthanaphak E, Pongpech S (2015) Radiographic evaluation and clinical implications of venous connections between Dural arteriovenous fistula of the cavernous sinus and cerebellum and the Pontomedullary venous system. World Neurosurg 84:1112–1126. https://doi.org/10.1016/j.wneu.2015.05.074

    Article  PubMed  Google Scholar 

  14. Nakase H, Shin Y, Nakagawa I, Kimura R, Sakaki T (2005) Clinical features of postoperative cerebral venous infarction. Acta Neurochir (Wien) 147:621–626. https://doi.org/10.1007/s00701-005-0501-y. (discussion 626)

    Article  CAS  PubMed  Google Scholar 

  15. Sehgal V, Delproposto Z, Haddar D, Haacke EM, Sloan AE, Zamorano LJ, Barger G, Hu J, Xu Y, Prabhakaran KP, Elangovan IR, Neelavalli J, Reichenbach JR (2006) Susceptibility-weighted imaging to visualize blood products and improve tumor contrast in the study of brain masses. J Magn Reson Imaging 24:41–51. https://doi.org/10.1002/jmri.20598

    Article  PubMed  Google Scholar 

  16. Shibao S, Toda M, Orii M, Fujiwara H, Yoshida K (2016) Various patterns of the middle cerebral vein and preservation of venous drainage during the anterior transpetrosal approach. J Neurosurg 124:432–439. https://doi.org/10.3171/2015.1.JNS141854

    Article  PubMed  Google Scholar 

  17. Shimada R, Kiyosue H, Tanoue S, Mori H, Abe T (2013) Superior petrosal sinus: hemodynamic features in normal and cavernous sinus dural arteriovenous fistulas. AJNR Am J Neuroradiol 34:609–615. https://doi.org/10.3174/ajnr.A3252

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Sindou M, Auque J (2000) The intracranial venous system as a neurosurgeon’s perspective. Adv Tech Stand Neurosurg 26:131–216. https://doi.org/10.1007/978-3-7091-6323-8_5

    Article  CAS  PubMed  Google Scholar 

  19. Tanriover N, Rhoton AL Jr, Kawashima M, Ulm AJ, Yasuda A (2004) Microsurgical anatomy of the insula and the sylvian fissure. J Neurosurg 100:891–922. https://doi.org/10.3171/jns.2004.100.5.0891

    Article  PubMed  Google Scholar 

  20. van der Schaaf IC, Velthuis BK, Gouw A, Rinkel GJ (2004) Venous drainage in perimesencephalic hemorrhage. Stroke 35:1614–1618. https://doi.org/10.1161/01.STR.0000131657.08655.ce

    Article  PubMed  Google Scholar 

  21. Watanabe A, Hirano K, Kamada M, Imamura K, Ishii N, Sekihara Y, Suzuki Y, Ishii R (2002) Perimesencephalic nonaneurysmal subarachnoid haemorrhage and variations in the veins. Neuroradiology 44:319–325. https://doi.org/10.1007/s00234-001-0741-3

    Article  CAS  PubMed  Google Scholar 

  22. Yamashiro K, Muto J, Wakako A, Murayama K, Kojima D, Omi T, Adachi K, Hasegawa M, Hirose Y (2021) Diploic veins as collateral venous pathways in patients with dural venous sinus invasion by meningiomas. Acta Neurochir (Wien) 163:1687–1696. https://doi.org/10.1007/s00701-021-04777-4

    Article  PubMed  Google Scholar 

  23. Yamashiro K, Wakako A, Omi T, Murayama K, Kojima D, Muto J, Adachi K, Hasegawa M, Hirose Y (2022) Evaluating diploic vein blood flow using time-resolved whole-head computed tomography angiography and determining the positional relationship between typical craniotomy approaches and diploic veins in patients with meningioma. Acta Neurochir (Wien). https://doi.org/10.1007/s00701-022-05349-w

    Article  PubMed  Google Scholar 

  24. Zhao JC, Liu JK (2008) Transzygomatic extended middle fossa approach for upper petroclival skull base lesions. Neurosurg Focus 25:5. https://doi.org/10.3171/FOC.2008.25.12.E5. (discussion E5)

    Article  Google Scholar 

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Acknowledgements

We would like to thank Editage (www.editage.com) for English language editing.

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Authors and Affiliations

  1. Department of Neurosurgery, Fujita Health University Okazaki Medical Center, Harisaki-Cho, 1 Gotanda, Okazaki, Aichi, 444-0827, Japan

    Kei Yamashiro, Tatsuo Omi & Motoharu Hayakawa

  2. Department of Neurosurgery, Fujita Health University, Toyoake, Aichi, 470-1192, Japan

    Kei Yamashiro, Kazuhide Aadchi, Tatsuo Omi, Motoharu Hayakawa, Akiyo Sadato, Mitsuhiro Hasegawa & Yuichi Hirose

  3. Tokyo D-Tower Hospital, Tokyo, 135-0061, Japan

    Mitsuhiro Hasegawa

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  1. Kei Yamashiro
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Contributions

Study conception and design: KY. Data collection: KY, TO, KA, and MH. Data Analysis: KY and KA. Writing of article: KY. Revising of article: all authors.

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Correspondence to Kei Yamashiro.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee (institutional review board at Fujita health university, Protocol Number: HM21-536) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Yamashiro, K., Aadchi, K., Omi, T. et al. Anatomical variations and flow alterations of the uncal vein and its clinical implications in petroclival meningiomas. Acta Neurochir 165, 1727–1738 (2023). https://doi.org/10.1007/s00701-023-05590-x

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  • DOI: https://doi.org/10.1007/s00701-023-05590-x

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