Superior Petrosal Vein Sacrifice During Microvascular Decompression: Perioperative Complication Rates and Comparison with Venous Preservation

Liebelt, Brandon D.; Barber, Sean M.; Desai, Viren R.; Harper, Richard P.; Zhang, Jonathan; Parrish, Rob; Baskin, David S.; Trask, Todd; Britz, Gavin W.

doi:10.1016/j.wneu.2017.05.098

Cited by 41 publications

(33 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A frequently discussed issue is whether the superior petrosal vein should be sacrificed or preserved. 3,12,13,18,22 There is conflicting literature on this issue. 3,12,13,18,22 Sacrificing the superior petrosal vein is safe in most cases, 16,18 and a cerebellar swelling can occur even if the veins are preserved, as seen in our case; however, severe and dangerous venous congestion may oc- cur after sacrificing the superior petrosal vein.…”

Section: Discussionmentioning

confidence: 99%

“…plications. 3,12,13,22 To elucidate safe and effective methods of venous dissection, we reviewed our surgical series of microvascular decompressions for trigeminal neuralgia and hemifacial spasm. We preserved the superior petrosal vein and its tributaries in the surgeries for trigeminal neuralgia, whereas we cut the inferior petrosal vein near the accessory nerve early in the surgeries for hemifacial spasm.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Bridging veins and veins of the brainstem in microvascular decompression surgery for trigeminal neuralgia and hemifacial spasm

Toda

Iwasaki

Yoshimoto

et al. 2018

Neurosurgical Focus

View full text Add to dashboard Cite

OBJECTIVEIn microvascular decompression surgery for trigeminal neuralgia and hemifacial spasm, the bridging veins are dissected to provide the surgical corridors, and the veins of the brainstem may be mobilized in cases of venous compression. Strategy and technique in dissecting these veins may affect the surgical outcome. The authors investigated solutions for minimizing venous complications and reviewed the outcome for venous decompression.METHODSThe authors retrospectively reviewed their surgical series of microvascular decompression for trigeminal neuralgia and hemifacial spasm in patients treated between 2005 and 2017. Surgical strategies included preservation of the superior petrosal vein and its tributaries, thorough dissection of the arachnoid sleeve that enveloped these veins, cutting of the inferior petrosal vein over the lower cranial nerves, and mobilization or cutting of the veins of the brainstem that compressed the nerve roots. The authors summarized the patient characteristics, operative findings, and postoperative outcomes according to the vascular compression types as follows: artery alone, artery and vein, and vein alone. They analyzed the data using chi-square and 1-way ANOVA tests.RESULTSThe cohort was composed of 121 patients with trigeminal neuralgia and 205 patients with hemifacial spasm. The superior petrosal vein and its tributaries were preserved with no serious complications in all patients with trigeminal neuralgia. Venous compression alone and arterial and venous compressions were observed in 4% and 22%, respectively, of the patients with trigeminal neuralgia, and in 1% and 2%, respectively, of those with hemifacial spasm (p < 0.0001). In patients with trigeminal neuralgia, 35% of those with artery and venous compressions and 80% of those with venous compression alone had atypical neuralgia (p = 0.015). The surgical cure and recurrence rates of trigeminal neuralgias with venous compression were 60% and 20%, respectively, and with arterial and venous compressions the rates were 92% and 12%, respectively (p < 0.0001, p = 0.04). In patients with hemifacial spasm who had arterial and venous compressions, their recurrence rate was 60%, and that was significantly higher compared to other compression types (p = 0.0008).CONCLUSIONSDissection of the arachnoid sleeve that envelops the superior petrosal vein may help to reduce venous complications in surgery for trigeminal neuralgia. Venous compression may correlate with worse prognosis even with thorough decompression, in both trigeminal neuralgia and hemifacial spasm.

show abstract

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Bridging veins and veins of the brainstem in microvascular decompression surgery for trigeminal neuralgia and hemifacial spasm

Toda

Iwasaki

Yoshimoto

et al. 2018

Neurosurgical Focus

View full text Add to dashboard Cite

show abstract

“…Conversely, one paper [18] reported a predominance of 2 SPVs, but this is likely attributable to their smaller sample. Operative studies are larger but lack detailed anatomical evaluation [15,16,22,25,33,34]. A large non-English operative study found that 2 SPVs was the most prevalent [34].…”

Section: Spvc Anatomymentioning

confidence: 99%

“…Herein, bFFE helped to overcome such pitfalls. An unspecific definition of SPVC components is frequent in the literature [1,12,15,16,21,25,27,33]. We suggested thorough and practical definitions of SPVC components, and differentiated between direct and the surgically irrelevant indirect tributaries to avoid confusion.…”

Section: Spvc Anatomymentioning

confidence: 99%

“…The superior petrosal vein (SPV) complex is a major draining system in the posterior fossa and a consistent landmark within the cerebellopontine angle (CPA) [18,26]. Injury of a part of the SPV complex (SPVC) has been frequently reported in large case series, with an incidence ranging from 55 to 84% of cases [16,25,34]. However, serious complications range from 0.01 to 7% of cases [1,9,13,16,17,23,24,27,28], while minor events are probably common but underreported [5].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Individual variations of the superior petrosal vein complex and their microsurgical relevance in 50 cases of trigeminal microvascular decompression

2019

View full text Add to dashboard Cite

Background We investigated the understudied anatomical variations of the superior petrosal vein (SPV) complex (SPVC), which may play some role in dictating the individual complication risk following SPVC injury. Methods Microvascular decompressions of the trigeminal nerve between September 2012 and July 2016. All operations utilized an SPVC preserving technique. Preoperative balanced fast field echo (bFFE) magnetic resonance imaging, or equivalent sequences, and operative videos were studied for individual SPVC anatomical features. Results Applied imaging and operative SPVC anatomy were described for fifty patients (mean age, 67.18 years; female sex and right-sided operations, 58% each). An SPVC component was sacrificed intentionally in 6 and unintentionally in only 7 cases. Twenty-nine different individual variations were observed; 80% of SPVCs had either 2 SPVs with 3 or 1 SPV with 2, 3, or 4 direct tributaries. Most SPVCs had 1 SPV (64%) and 2 SPVs (32%). The SPV drainage point into the superior petrosal sinus was predominantly between the internal auditory meatus and Meckel cave (85.7% of cases). The vein of the cerebellopontine fissure was the most frequent direct tributary (86%), followed by the pontotrigeminal vein in 80% of SPVCs. Petrosal-galenic anastomosis was detected in at least 38% of cases. At least 1 SPV in 54% of the cases and at least 1 direct tributary in 90% disturbed the operative field. The tributaries were more commonly sacrificed. Conclusions The extensive anatomical variation of SPVC is depicted. Most SPVCs fall into 4 common general configurations and can usually be preserved. BFFE or equivalent sequences remarkably facilitated the intraoperative understanding of the individual SPVC in most cases.

show abstract

Microvascular Decompression for Trigeminal Neuralgia and Other Neurovascular Compression Syndromes

Martinez

Lowe

Vandergrift

et al. 2019

Management of Cerebrovascular Disorders

View full text Add to dashboard Cite

Superior Petrosal Vein Sacrifice During Microvascular Decompression: Perioperative Complication Rates and Comparison with Venous Preservation

Cited by 41 publications

References 20 publications

Bridging veins and veins of the brainstem in microvascular decompression surgery for trigeminal neuralgia and hemifacial spasm

Bridging veins and veins of the brainstem in microvascular decompression surgery for trigeminal neuralgia and hemifacial spasm

Individual variations of the superior petrosal vein complex and their microsurgical relevance in 50 cases of trigeminal microvascular decompression

Microvascular Decompression for Trigeminal Neuralgia and Other Neurovascular Compression Syndromes

Contact Info

Product

Resources

About