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Reconstruction of vein of Labbé in temporo-occipital meningioma invading transverse sinus: technical report

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Abstract

Objective and importance

Meningiomas invading major venous sinuses and veins are not uncommon. However, meningiomas involving both the transverse sinus and vein of Labbé are exceedingly rare. Venous reconstruction can be challenging after radical removal of the meningioma which invades major venous sinuses and veins. In this report, we present reconstruction of vein of Labbé in the surgery of temporo-occipital meningioma invading the transverse sinus.

Clinical presentation

A 55-year-old woman was admitted to our institution with a 13-year history of focal epilepsy in the form of transient aphasia with vertigo. Cranial magnetic resonance imaging revealed a homogeneously contrast enhancing lesion measuring 40 mm in diameter in the left temporo-occipital area. Cerebral magnetic resonance venography and venous phase of cerebral digital subtraction angiography revealed invasion of the upper wall of left transverse sinus and total occlusion of the lumen of the vein of Labbé.

Technique

After removal of all the tumors except the piece attached to the transverse sinus and vein of Labbé with standard neurosurgical techniques, the left transverse sinus lumen and vein of Labbé lumen were explored. The tumor tissue inside the transverse sinus and vein of Labbé were removed along with tumor-invaded venous wall. Venous reconstruction of the transverse sinus and vein of Labbé was performed using autologous dura mater as a patch for the defect.

Conclusion

This is the first report in the literature in which the vein of Labbé was reconstructed in the surgery of temporo-occipital meningioma invading the vein of Labbé and transverse sinus together.

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Authors and Affiliations

  1. Department of Neurosurgery, Hopital Neurologique Pierre Wertheimer, Université Claude-Bernard de Lyon, Lyon, France

    Bulent Guclu & Marc Sindou

  2. Department of Neurosurgery, Yeditepe University Hospital, Devlet Yolu Ankara Caddesi, No: 102/104, Kozyatagi, 34752, Istanbul, Turkey

    Bulent Guclu

Authors
  1. Bulent Guclu
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  2. Marc Sindou
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Corresponding author

Correspondence to Bulent Guclu.

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Comments

This well-documented technical note describes an elegantly performed application of the general priciple of neurosurgery of preserving vascular structures during the resection of intracranial tumors.

Domenico d'Avella

Padova, Italy

Comments

This is a nice technical note on the venous reconstruction of the origin of vein of Labbe and the transverse sigmoid junction using an autologous dural patch. It is important to note that the individual veins were not reconstructed separately but rather as a single dural patch covering both the vessels. Thus, the origin of vein of Labbe from the transverse sigmoid junction became triangular and larger: one lateral wall being formed by the vein of Labbe-patch; the other by transverse sinus-patch; and, the third wall of the triangle formed by the transverse sigmoid sinuses-patch. The transverse sinus towards the side of the meningioma was nondominant and blocked. In many patients, especially on the dominant side, the sinus may be patent and have blood flow. In those circumstances, there is usually profuse bleeding from both ends of the sinuses after tumor removal from within. When the two ends of the sinus are temporarily clamped for placement and suturing of flap, there is the risk of development of irreversible venous infarction during the vessel clamping time. In many patients, even when there is apparent venous sinus block on angiogram, the sinus may be patent and any attempts to reconstruct it may actually increase the risk of venous infarction. Thus, preservation of venous sinuses is important since the risk of venous infarction cannot be predicted even with good venous collateralization and apparent venous sinus blockade by the tumor. A number of studies have quoted that even when the sinus was totally excised with the meningioma, there was a high recurrence rate. Thus, the recurrence of meningiomas may still occur despite tumor removal from within venous sinuses and their reconstruction. Collateral drainage by newly formed venous channels may be disturbed by attempts to remove the tumor from within the sinuses in every case. Finally, a good long-term prognosis is anticipated even when small amounts of tumor tissue is left within the venous sinuses. Therefore, this technique, though useful, should be used judiciously.

Sanjay Behari

Lucknow, India

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Guclu, B., Sindou, M. Reconstruction of vein of Labbé in temporo-occipital meningioma invading transverse sinus: technical report. Acta Neurochir 152, 941–945 (2010). https://doi.org/10.1007/s00701-009-0572-2

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  • DOI: https://doi.org/10.1007/s00701-009-0572-2

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