Mobilization of the Sphenoparietal Sinus

Hasegawa, Hirotaka; Inoue, Tomohiro; Sato, Kiyotaka; Tamura, Akira; Saito, Isamu

doi:10.1227/neu.0b013e3182889ff7

Cited by 11 publications

(4 citation statements)

References 11 publications

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“…Because there is no method to predict whether a vein can be sacrificed without causing complications, 39,40 a surgeon should thoroughly consider whether to sacrifice a vein. Our opinion is that it is possible to preserve each CHTB vein.…”

Section: Discussionmentioning

confidence: 99%

Preserving the cerebellar hemispheric tentorial bridging veins through a novel tentorial cut technique for supracerebellar approaches

Berker

Doğruel²,

Güngör

et al. 2024

Journal of Neurosurgery

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OBJECTIVE The objective of this study was to describe the distribution pattern of cerebellar hemispheric tentorial bridging (CHTB) veins on the tentorial surface in a case series of perimedian or paramedian supracerebellar approaches and to describe a novel technique to preserve these veins. METHODS A series of 141 patients with various pathological processes in different locations was operated on via perimedian or paramedian supracerebellar approaches by the senior author from July 2006 through October 2022 and was retrospectively evaluated. During surgery, the number and locations of all CHTB veins were recorded to establish a distribution map on the tentorial surface, divided into nine zones. Patients were classified into four groups according to the surgical technique used to manage CHTB veins: 1) group 1 consisted of CHTB veins preserved without intervention during surgery or no CHTB veins found in the surgical route; 2) group 2 included CHTB veins coagulated during surgery; 3) group 3 included CHTB veins preserved with arachnoid and/or tentorial dissection from the cerebellar or tentorial surface, respectively; and 4) group 4 comprised CHTB veins preserved using a novel tentorial cut technique. RESULTS Overall, 141 patients were included in the study. Of these 141 patients, 38 were in group 1 (27%), 32 in group 2 (22.7%), 47 in group 3 (33.3%), and 24 in group 4 (17%). The total number of CHTB veins encountered was 207 during surgeries on one side. According to the distribution zones of the tentorium, zone 5 had the highest density of CHTB veins, while zone 7 had the lowest. Of the patients in group 4, 6 underwent the perimedian supracerebellar approach and 18 had the paramedian supracerebellar approach. There were 39 CHTB veins on the surface of the 24 cerebellar hemispheres in group 4. The tentorial cut technique was performed for 27 of 39 CHTB veins. Twelve veins were not addressed because they did not present any obstacles during approaches. During surgery, no complications were observed due to the tentorial cut technique. CONCLUSIONS Because there is no way to determine whether a CHTB vein can be sacrificed without complications, it is important to protect these veins in supracerebellar approaches. This new tentorial cut technique in perimedian or paramedian supracerebellar approaches makes it possible to preserve CHTB veins encountered during supracerebellar surgeries.

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Section: Discussionmentioning

confidence: 99%

Preserving the cerebellar hemispheric tentorial bridging veins through a novel tentorial cut technique for supracerebellar approaches

Berker

Doğruel²,

Güngör

et al. 2024

Journal of Neurosurgery

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“…However, the course of the intradural segment of the sylvian vein is less visible, and this method is often accompanied by intense bleeding due to injury of the intradural segment of the bridging vein, which may cause severe damage to the venous drainage. Hasegawa et al 12 reported a method for preserving an FBBV via mobilization of the SPS without removal of the ACP during clipping surgery for an anterior communicating aneurysm. Our method, in contrast, includes anterior clinoidectomies for extending a dural incision near the ICA, which facilitates further posterior displacement of the dural entrance of the bridging veins and widens the surgical space around the retrocarotid space.…”

Section: Discussionmentioning

confidence: 99%

Sphenoparietal sinus transposition technique: optimization of the surgical corridor with preservation of prominent bridging veins between the brain and the cranial base during aneurysm clipping via the pterional approach

Niibo

Takizawa

Sakurai

et al. 2021

Journal of Neurosurgery

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OBJECTIVEThe sylvian bridging veins between the brain and the dura on the inner surface of the sphenoid wing can restrict brain retraction for widening of the lateral retrocarotid space during clipping surgery for internal carotid artery (ICA)–posterior communicating artery (PCoA) and basilar apex (BX) aneurysms. In such cases, the authors perform extradural anterior clinoidectomy with peeling of the temporal dura propria from the periosteal dura and inner cavernous membrane around the superior orbital fissure, with the incision of the dura mater stretching from the base of the temporal side to just before the distal dural ring of the ICA (termed by the authors as the sphenoparietal sinus transposition [SPST] technique). This technique displaces the bridging segment of the sylvian vein posteriorly and enables widening of the surgical space without venous injury. In this study, the authors observed the operative nuances and investigated the usefulness of this technique.METHODSThe authors retrospectively reviewed the medical charts of 66 consecutive patients with ICA-PCoA and BX aneurysms between January 2016 and July 2018. This technique was performed in 8 patients (5 patients with PCoA aneurysms and 3 with BX aneurysms) in whom the bridging segments of the sylvian veins between the brain and the skull base restricted brain retraction for widening of the surgical space. The surface areas of the lateral retrocarotid space and the aneurysm were measured at the most visible working angle before and after the SPST technique was performed.RESULTSWith the use of the SPST technique, an adequate surgical space for aneurysm clipping was obtained with preservation of the bridging veins in all patients. The mean surface areas of the lateral retrocarotid space (p = 0.002) and aneurysm (p = 0.001) were significantly increased from 18.3 ± 18.8 and 2.8 ± 2.5 cm2 before to 64.2 ± 21.1 and 20.9 ± 20.6 cm2, respectively, after the SPST technique was performed.CONCLUSIONSThe SPST technique enables displacement of the bridging segments of the sylvian veins without venous injury and enables widening of the surgical space around the lateral retrocarotid area.

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“…Therefore, several techniques have been described for preserving the bridging veins. [ 5 6 7 8 9 ] However, these bridging veins usually flow into the SSS at a right angle with the formation of venous lacunae, which will further limit the dural opening to the narrow working space of the interhemispheric fissure of the parietal lobe area.…”

Section: Discussionmentioning

confidence: 99%

Occipital interhemispheric approach for surgical removal of the middle third falx meningioma: Two case reports

et al. 2018

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Obtaining adequate working space is difficult for complete and safe resection of meningioma located in the middle third of the falx, because of the risk of damage to the bridging veins that flow into the superior sagittal sinus and the location near the eloquent area. Consequently, surgical resection of the meningioma in the middle third of the falx tends to result in neurological disorders caused by retraction of the brain and injury of the bridging vein. Two patients underwent tumor removal of the falx meningiomas located in the middle third of the falx through the occipital interhemispheric approach (OIA) in the lateral semiprone position with the affected side down. Tumor resection was achieved safely and less invasively. Both patients suffered numbness and motor weakness, but these neurological dysfunctions improved and clinical courses were uneventful. Postoperative computed tomography showed neither brain swelling nor contusion in both cases. The OIA can remove tumor in the middle third of the falx, because the approach avoids the bridging veins, and provides working space without excessive mechanical cerebral retraction.

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Mobilization of the Sphenoparietal Sinus

Abstract: This technique is useful for retracting the frontal lobe sufficiently to enable establishment of an appropriate surgical field for a pterional approach to ACoA aneurysms with prominent FBBVs.

Cited by 11 publications

References 11 publications

Preserving the cerebellar hemispheric tentorial bridging veins through a novel tentorial cut technique for supracerebellar approaches

Preserving the cerebellar hemispheric tentorial bridging veins through a novel tentorial cut technique for supracerebellar approaches

Sphenoparietal sinus transposition technique: optimization of the surgical corridor with preservation of prominent bridging veins between the brain and the cranial base during aneurysm clipping via the pterional approach

Occipital interhemispheric approach for surgical removal of the middle third falx meningioma: Two case reports

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