Summary
Neurosurgery and the intracranial venous system
-
1)
Numerous of the so-called «unpredictable» post-operative complications are likely to be related to the lack of prevention or non-recognition of venous problems, especially damages to the dangerous venous structures, namely: the major dural sinuses, the deep cerebral veins and some of the dominant superficial veins like the vein of Labbé.
-
2)
Tumors invading the major dural sinuses (superior sagittal sinus, torcular, transverse sinus) — especially meningiomas — leave the surgeon confronted with a dilemma: leave the fragment invading the sinus and have a higher risk of recurrence, or attempt at total removal with or without venous reconstruction and expose the patient to a potentially greater operative danger. Such situations have been encountered in 106 patients over the last 25 years. For decision-making, meningiomas were classified into six types according to the degree of sinus invasion. Type 1: meningioma attached to outer surface of the sinus wall; Type II: one lateral recess invaded; Type III: one lateral wall invaded; Type IV: one lateral wall and the roof of the sinus both invaded; Types V and VI: sinus totally occluded, one wall being free of tumor in type V.
In brief, our surgical policy was the following: Type I: excision of outer layer and coagulation of dural attachment; Type II: removal of intraluminal fragment through the recess, then repair of the dural defect by resuturing recess. Type III: resection of sinus wall and repair with patch (fascia temporalis). Type IV: resection of both invaded walls and reconstruction of the two resected walls with patch. Type V: this type can be recognized from type VI only by direct surgical exploration of the sinus lumen. Opposite wall to the tumor side is free of tumor, it is possible to reconstruct the two resected walls with patch. Type VI: removal of involved portion of sinus and restoration with venous bypass.
-
3)
As 20% of the patients presenting with manifestations of intracranial hypertension due to occlusion of posterior third of the superior sagittal sinus, torcular, predominant lateral sinus or internal jugular vein(s) develop severe intracranial hypertension, venous revascularisation by sino-jugular bypass — implanted proximally to the occlusion and directed to the jugular venous system (external or internal jugular vein) — can be a solution.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
References
Alaywan M, Sindou M (1990) Fronto-temporal approach with orbito-zygomatic removal. Surgical anatomy. Acta Neurochir (Wien) 104: 79–83
Alaywan M, Sindou M (1996) Surgical anatomy of the lateral sinus approaches in the sigmoid region. In: Hakuba A (ed) Surgery of the intracranial venous system. Embryology, anatomy, pathophysiology, neuroradiology, diagnosis, Treatment. First International Workshop on Surgery of the Intracranial Venous System at Osaka September 1994. Springer, Berlin Heidelberg New York Tokyo, pp 63–72
Al-Mefty O, Krist AF (1996) The dangerous veins. In: Hakuba A (ed) Surgery of the intracranial venous system. Embryology, anatomy, pathophysiology, neuroradiology, diagnosis, treatment. First International Workshop on Surgery of the Intracranial Venous System at Osaka September 1994. Springer, Berlin Heidelberg New York Tokyo, pp 338–345
Apuzzo ML (1977) Surgery of the third ventricle. Williams & Wilkins, Baltimore
Auque J (1996) Le sacrifice veineux en neurochirurgie. Evaluation et gestion du risque. Neurochirurgie [Suppl] 1: 32–38
Auque J (1996) Microanatomie des veines profondes du cerveau. Neurochirurgie [Suppl] 1: 84–87
Bederson JB, Eisenberg MB (1995) Resection and replacement of the superior sagittal sinus for treatment of a parasagittal meningioma: Technical case report. Neurosurgery 37: 1015–1019
Bonnal J, Brotchi J (1978) Surgery of the superior sagittal sinus in parasagittal meningiomas. J Neurosurg 48: 935–945
Bonnal J, Brotchi J, Stevenaert A, Petrov VT, Mouchette R (1971) Excision of the intrasinusal portion of rolandic parasagittal meningiomas, followed by plastic surgery of the superior longitudinal sinus. Neurochirurgie 17: 341–354
Brotchi J, Patay Z, Baleriaux D (1996) Surgery of the superior sagittal sinus and neighbouring veins. In: Hakuba A (ed) Surgery of the intracranial venous system. Embryology, anatomy, pathophysiology, neuroradiology, diagnosis, treatment. First International Workshop on Surgery of the Intracranial Venous System at Osaka September 1994. Springer, Berlin Heidelberg New York Tokyo, pp 207–219
Delandsheer JM, Guyot JF, Jomin M, Scherpereel B, Laine E (1978) Accès au troisième ventricule par voie interthalamotrigonale. Neurochirurgie 24: 419–422
Donaghy RM, Wallman LJ, Flanagan MJ, Numoto M (1973) Sagittal sinus repair. Technical note. J Neurosurg 38: 244–248
Hakuba A (1996) Surgery of the intracranial venous system. Embryology, anatomy, pathophysiology, neuroradiology, diagnosis, treatment. First International Workshop on Surgery of the Intracranial Venous System at Osaka September 1994. Springer, Berlin Heidelberg New York Tokyo
Hakuba A, Huh CW, Tsujikawa S, Nishimura S (1979) Total removal of a parasagittal meningioma of the posterior third of the sagittal sinus and its repair by autogenous vein graft. Case report. J Neurosurg 51: 379–382
Kanno T, Kasama A, Shoda M, Yamaguchi C, Kato Y (1989) A pitfall in the interhemispheric translamina terminalis approach for the removal of a craniopharyngioma. Significance of preserving draining veins. Part I. Clinical study. Surg Neurol 32: 111–115
Kasama A, Kanno T (1989) A pitfall in the interhemispheric translamina terminalis approach for the removal of a craniopharyngioma. Significance of preserving draining veins. Part II. Experimental study. Surg Neurol 32: 116–120
Krause F (1926) Operative Freilegung der Vierhügel, nebst Beobachtungen über Hirndruck und Dekompression. Zentralbl Neurochir 53: 2812–2819
Logue V (1975) Parasagittal meningiomas. Adv Tech Stand Neurosurg 2: 171–198
Malis LI (1996) Venous involvement in tumor resection. In: Hakuba A (ed) Surgery of the intracranial venous system. Embryology, anatomy, pathophysiology, neuroradiology, diagnosis, treatment. First International Workshop on Surgery of the Intracranial Venous System at Osaka September 1994. Springer, Berlin Heidelberg New York Tokyo pp 281–288
Matsushima T, Rhoton AL Jr, de Oliveira E, Peace D (1983) Microsurgical anatomy of the veins of the posterior fossa. J Neurosurg 59: 63–105
Merrem G (1970) Die parasagittalen Meningeome. Fedor Krause Gedächtnivorlesung. Acta Neurochir (Wien) 23: 203–216
Park J, Hamm IS (2004) Anterior interhemispheric approach for distal anterior cerebral artery aneurysm surgery: Preoperative analysis of the venous anatomy can help to avoid venous infarction. Acta Neurochir (Wien) 146: 973–977
Sakaki T, Morimoto T, Takemura K, Miyamoto S, Kyoi K, Utsumi S (1987) Reconstruction of cerebral cortical veins using silicone tubing. Technical note. J Neurosurg 66: 471–473
Samii M (1994) Skull base surgery. Anatomy, diagnosis and treatment. 1st International Skull Base Congress Hannover 1992. Karger, Basel
Schmid-Elsaesser R, Steiger HJ, Yousry T, Seelos KC, Reulen HJ (1997) Radical resection of meningiomas and arteriousvenous fistulas involving critical dural sinus segments: Experience with intraoperative sinus pressure monitoring and elective sinus reconstruction in 10 patients. Neurosurgery 41: 1005–1018
Schmidek HH, Auer LM, Kapp JP (1985) The cerebral venous system. Review. Neurosurgery 17: 663–678
Sekhar LN, Tzortzidis FN, Bejjani GK, Schessel DA (1997) Saphenous vein graft bypass of the sigmoid sinus and jugular bulb during the removal of glomus jugular tumors. Report of two cases. J Neurosurg 86: 1036–1041
Sindou M (2000) Microvascular decompression for trigeminal neuralgia. Chapter 130. In: Kaye AH, Black P McL (eds) Operative neurosurgery, vol 2. Churchill-Livingstone, London, pp 1595–1614
Sindou M (2001) Meningiomas invading the sagittal or transverse sinuses, resection with venous reconstruction. J Clin Neurosci [Suppl] 1: 8–11
Sindou M, Auque J (2000) The intracranial venous system as a neurosurgeon's perspective. Review. Adv Tech Stand Neurosurg 26: 131–216
Sindou M, Hallacq P (1996) Microsurgery of the venous system in meningiomas invading the major dural sinuses. In: Hakuba A (ed) Surgery of the intracranial venous system. Embryology, anatomy, pathophysiology, neuroradiology, diagnosis, treatment. First International Workshop on Surgery of the Intracranial Venous System at Osaka September 1994. Springer, Berlin Heidelberg New York Tokyo pp 226–236
Sindou M, Mazoyer JF, Fischer G, Pialat J, Fourcade C (1976) Experimental bypass for sagittal sinus repair. Preliminary report. J Neurosurg 44: 325–330
Sindou M, Mercier P, Bokor J, Brunon J (1980) Bilateral thrombosis of the transverse sinuses: Microsurgical revascularization with venous bypass. Surg Neurol 13: 215–220
Sindou M, Hallacq P (1998) Venous reconstruction in surgery of meningiomas invading the sagittal and transverse sinuses. Skull Base Surgery 8: 57–64
Sindou M, Emery E, Acevedo G, Ben-David U (2001) Respective indications for orbital rim, zygomatic arch and orbitozygomatic osteotomies in the surgtical approach to central skull base lesions. Critical, retrospective review in 146 cases. Acta Neurochir (Wien) 143: 967–975
Steiger HJ, Reulen HJ, Huber P, Boll J (1989) Radical resection of superior sagittal sinus meningioma with venous interpostion graft and reimplantation of the rolandic veins. Case report. Acta Neurochir (Wien) 100: 108–111
Sugita K, Kobayashi S, Yokoo A (1982) Preservation of large bridgings veins during brain retraction. Technical note. J Neurosurg 57: 856–858
Yamamoto I, Sato M (1996) Obliteration and its consequences for the deep venous system in surgical approaches to the third ventricle. In: Hakuba A (ed) Surgery of the intracranial venous system. Embryology, anatomy, pathophysiology, neuroradiology, diagnosis, treatment. First International Workshop on Surgery of the Intracranial Venous System at Osaka September 1994. Springer, Berlin Heidelberg New York Tokyo pp 321–329
Yasargil MG (1984) Microneurosurgery. Microsurgical anatomy of the basal cisterns and vessels of the brain, diagnostic and studies, vol 1. Thieme, Stuttgart New York
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2005 Springer-Verlag
About this paper
Cite this paper
Sindou, M.P., Auque, J., Jouanneau, E. (2005). Neurosurgery and the intracranial venous system. In: Yonekawa, Y., Keller, E., Sakurai, Y., Tsukahara, T. (eds) New Trends of Surgery for Stroke and its Perioperative Management. Acta Neurochirurgica Supplements, vol 94. Springer, Vienna. https://doi.org/10.1007/3-211-27911-3_27
Download citation
DOI: https://doi.org/10.1007/3-211-27911-3_27
Publisher Name: Springer, Vienna
Print ISBN: 978-3-211-24338-1
Online ISBN: 978-3-211-27911-3
eBook Packages: MedicineMedicine (R0)