Abstract
Background
The transsylvian approach is a versatile treatment method for aneurysms of the anterior circulatory system. Studies have shown that sylvian veins run in various patterns, suggesting the need for dissection between veins to obtain appropriate surgical corridor. In case of inadvertent sylvian vein injury, serious complications such as venous congestion may occur.
Method
We herein describe the “side-to-side anastomosis reconstruction technique” of the resected superficial sylvian vein.
Conclusion
This technique can be effective for the reconstruction of other cortical veins, and indocyanine green videoangiography was effective in determining the indications for venous reconstruction.
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Key points
• The SSV running pattern and derivation route should be carefully considered via preoperative cerebral angiography.
• The flap should be inverted in two layers to sufficiently expose the bone surface required for craniotomy.
• During craniotomy, the portion leading to SPS should be sufficiently exposed, bone should be sufficiently removed from the sphenoid ridge to the temporal base, and the lateral wall of the orbit should be sufficiently exposed.
• SSV outflow dynamics should be confirmed via ICG videoangiography and Doppler ultrasonography.
• Determine whether reconstruction via side-to-side anastomosis is possible or whether rerouting via end-to-side anastomosis is necessary.
• Ensure the stump of the dissected vein and reveal the anastomotic surface through methylrosaniline chloride (pyoctaninum blue) staining.
• Given that veins have lower pressure than arteries, the posterior wall is continuously anastomosed and the anterior wall is single anastomosed during anastomosis. Moreover, anastomosis is performed slightly loosely to prevent acute thrombosis [8].
• Reassess for the presence of obstruction and preservation of normal venous return intraoperatively using ICG videoangiography or Doppler ultrasonography.
• Dura mater reconstruction should be performed using the fascia while taking care not to induce venous obstruction due to dura mater attachment.
• The patency of the vein should be confirmed via CT venography or digital subtraction angiography early after the operation. If obstruction is suspected, introduction of anticoagulant therapy should be considered.
This article is part of the Topical Collection on Vascular Neurosurgery - Aneurysm
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Segawa, M., Inoue, T., Tsunoda, S. et al. How do I: Venous reconstruction of accidentally injured superficial sylvian vein during the clipping of an unruptured cerebral aneurysm. Acta Neurochir 164, 2547–2550 (2022). https://doi.org/10.1007/s00701-022-05184-z
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DOI: https://doi.org/10.1007/s00701-022-05184-z