Life without the vein of Galen: Clinical and radiographic sequelae

Youssef, A. Samy; Downes, Angela E.; Agazzi, Siviero; Loveren, Harry R. van

doi:10.1002/ca.21176

Cited by 9 publications

(5 citation statements)

References 21 publications

(21 reference statements)

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“…Resection of these tumors is complicated by their deep location and proximity to vulnerable anatomical structures, such as the pineal gland, tectum, veins of the galenic group, and medial posterior choroidal arteries. 6,34 Meningiomas of a pure falcotentorial location are also rare, with the largest series of 15 cases reported by Qiu et al in 2014. 23 Two classification systems have been proposed for falcotentorial meningiomas: one by Asari et al 1 in 1995, which is based on tumor projection and classifies the tumors as anterior, superior, posterior, and inferior types; and the other by Bassiouni et al 2 in 2008, which classifies tumors according to tumor base location and includes type I (between the 2 falx leaflets), type II (middle inferior tentorial surface), type III (unilateral tentorium), and type IV (unilateral falx or straight sinus).…”

Section: Discussionmentioning

confidence: 99%

Surgical treatment of falcotentorial meningiomas: a retrospective review of a single-institution experience

Zhao

Belykh

Przybylowski

et al. 2020

Journal of Neurosurgery

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OBJECTIVEMeningiomas at the falcotentorial junction represent a rare subgroup of complex meningiomas. Debate remains regarding the appropriate treatment strategy for and optimal surgical approach to these tumors, and surgical outcomes have not been well described in the literature. The authors reviewed their single-institution experience in the management, approach selection, and outcomes for patients with falcotentorial meningiomas.METHODSFrom the medical records, the authors identified all patients with falcotentorial meningiomas treated with resection at the Barrow Neurological Institute between January 2007 and October 2017. Perioperative clinical, surgical, and radiographic data were retrospectively collected. For patients who underwent the supracerebellar infratentorial approach, the tentorial angle was defined as the angle between the line joining the nasion with the tuberculum sellae and the tentorium in the midsagittal plane.RESULTSFalcotentorial meningiomas occurred in 0.97% (14/1441) of the patients with meningiomas. Most of the patients (13/14) were female, and the mean patient age was 59.8 ± 11.3 years. Of 17 total surgeries (20 procedures), 11 were single-stage primary surgeries, 3 were two-stage primary surgeries (6 procedures), 2 were reoperations for recurrence, and 1 was a reoperation after surgery had been aborted because of brain edema. Hydrocephalus was present in 5 of 17 cases, 4 of which required additional treatment. Various approaches were used, including the supracerebellar infratentorial (4/17), occipital transtentorial/transfalcine (4/17), anterior interhemispheric transsplenial (3/17), parietal transventricular (1/17), torcular (2/17), and staged supracerebellar infratentorial and occipital transtentorial/transfalcine (3/17) approaches. Of the 17 surgeries, 9 resulted in Simpson grade IV resection, and 3, 1, and 4 surgeries resulted in Simpson grades III, II, and I resection, respectively. The tentorial angle in cases with Simpson grade I resection was significantly smaller than in those with an unfavorable resection grade (43.3° ± 4.67° vs 54.0° ± 3.67°, p = 0.04). Complications occurred in 10 of 22 approaches (17 surgeries) and included visual field defects (6 cases, 2 permanent and 4 transient), hemiparesis (2 cases), hemidysesthesia (1 case), and cerebellar hematoma (1 case).CONCLUSIONSFalcotentorial meningiomas are challenging lesions. A steep tentorial angle is an unfavorable preoperative radiographic factor for achieving maximal resection with the supracerebellar infratentorial approach. Collectively, the study findings show that versatility is required to treat patients with falcotentorial meningiomas and that treatment goals and surgical approach must be individualized to obtain optimal surgical results.

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Section: Discussionmentioning

confidence: 99%

Surgical treatment of falcotentorial meningiomas: a retrospective review of a single-institution experience

Zhao

Belykh

Przybylowski

et al. 2020

Journal of Neurosurgery

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“…The various surgical approaches used for the removal of the pineal tumour are supra- cerebellar-infratentorial, occipital interhemispheric transtentorial, posterior transcallosal posterior trans ventricular and combined supra and infra tentorial approach. The approaches are selected based on the location of the pineal tumour [ 1 , 3 , 4 ]. The various surgical approaches to the pineal gland tumour is given in Table 4 .…”

Section: Discussionmentioning

confidence: 99%

“…The vein of Galen begins just rostral to the pineal gland in the middle of the quadrigeminal cistern. The quadrigeminal cistern is the area where the supratentorial and infratentorial compartments meet together [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

“…10, 16] Midline tumours which extend into the lower part of the posterior incisural space displacing the collicular plate and the cerebellum.Most commonly used-Safe, effective and provides a better visualisation of deep venous system compared to other approaches 2 Occipital interhemispheric transtentorial[3,10, 16] Lesions-extending supratentorially, above vein of Galen, posteriorly into corpus callosum, cerebral hemisphere, thalamus and third ventricle provided the lesion is not extending into the opposite side or into the posterior fossa Internal occipital vein-is at risk of injury while retraction leading to lateral homonymous hemianopia Even though the operating space can be enlarged by splitting the tentorium, the dissecting of deep veins is challenging as the operating space is still too less 3 Posterior transcallosal approach[3,10, 16] Atrium, glomus of choroid plexus extending into pulvinar part of thalamus Approached through superior parietal lobule to reach the posterior incisural space 4 Posterior trans ventricular approach[3,10, 16] Splenium, above vein of Galen Posterior incisural space is reached by dividing the splenium of corpus callosum 5 Combined supra and infra tentorial approach[3] Tumours extending above and below the tentorium, tumours extending into venous structures and Vascular tumours that cannot be debulked prior to the capsule dissection Increase the exposure space but it carries th risk of injuring the confluence of sinuses and non-dominant transverse sinus as well as the increased exposure time www.acbjournal.org https://doi.org/10.5115/acb.22.051…”

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confidence: 99%

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Morphometric evaluation of great vein of Galen and its clinical implications

Veeramani

et al. 2022

Anat Cell Biol

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The Galenic venous system plays a vital role in the drainage of blood from deeper parts of the brain. This venous system is contributed by many major veins. These veins are located closer to the pineal gland making the surgical approach in this region difficult. Any accidental injury or occlusion of the vein of Galen could lead to devasting results. Thus, studying the dimensions of the vein of Galen is more important. Hence, we aimed to evaluate the morphometry and trajectory to the vein of Galen. About 100 computed tomographic venography records were evaluated and the length, diameter of vein of Galen, angle between straight sinus and vein of Galen and distance from internal occipital protuberance and roof of fourth ventricle to vein of Galen were studied. The mean length and diameter of vein of Galen were 9.8±2.7 and 4.08±1.04 respectively. The mean angle between straight sinus and vein of Galen was 64.2°. The mean distance between external occipital protuberance and roof of fourth ventricle to vein of Galen were 52±6.9 and 33.3±4.5 respectively. No significant morphometric differences were observed between the age groups as well as between the sexs. The results obtained from this study may be helpful for the neurosurgeons in better understanding of the anatomy of the Galenic venous system and to adopt a safe surgical approach to improve the efficacy of the surgeries of the pineal gland and also in the region of vein of Galen.

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“…Youssef et al . [41] emphasized the importance of the meticulous planning of the surgical approach and avoidance of the venous occlusion with a case of pineocytoma in which the vein of Galen was ligated without postoperative adverse sequelae. The question frequently arises whether to preserve the bridging veins and compromise exposure, or to sacrifice veins to obtain good exposure.…”

Section: Discussionmentioning

confidence: 99%

Absence of the superior petrosal veins and sinus: Surgical considerations

Matsushima¹,

Ribas²,

Kiyosue³

et al. 2015

Surg Neurol Int

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Background:The superior petrosal vein, one of the most constant and largest drainage pathways in the posterior fossa, may result in complications if occluded. This study calls attention to a unique variant in which the superior petrosal veins and sinus were absent unilaterally, and the venous drainage was through the galenic and tentorial drainage groups.Methods:This study examines one venogram and another anatomic specimen in which the superior petrosal vein and sinus were absent.Results:The superior petrosal veins, described as 1–3 bridging veins, emptying into the superior petrosal sinus, are the major drainage pathways of the petrosal group of posterior fossa veins. In the cases presented, the superior petrosal vein and sinus were absent and venous drainage was through the galenic and tentorial groups, including the lateral mesencephalic or bridging vein on the tentorial cerebellar surface.Conclusions:In cases in which the superior petrosal sinus and veins are absent, care should be directed to preserving the collateral drainage through the galenic and tentorial tributaries. Although surgical strategies for intraoperative management and preservation of venous structures are still controversial, knowledge of the possible anatomical variations is considered to be essential to improve surgical outcomes.

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Life without the vein of Galen: Clinical and radiographic sequelae

Cited by 9 publications

References 21 publications

Surgical treatment of falcotentorial meningiomas: a retrospective review of a single-institution experience

Surgical treatment of falcotentorial meningiomas: a retrospective review of a single-institution experience

Morphometric evaluation of great vein of Galen and its clinical implications

Absence of the superior petrosal veins and sinus: Surgical considerations

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