Surgical Repair of Iatrogenic Transverse-Sigmoid Sinus Laceration with a Dural Flap During Skull Base Tumor Surgery: A Technical Case Report

Oh, Gerald; Arnone, Gregory D.; Abou‐Al‐Shaar, Hussam; Barks, Ashley L; Wong, Andrew K.; Charbel, Fady T.

doi:10.1016/j.wneu.2017.06.100

Cited by 7 publications

(10 citation statements)

References 15 publications

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“…They were first described by Cushing, followed by further adjustments and alterations by Seiffert and Dandy among others, in order to gain entrance to the CPA (20). During this procedure with no advanced neuronavigation techniques available, the transverse and sigmoid sinus damage can cause minor injuries to major life threatening ones (11). Thus, when gaining entrance to the cranial cavity it is mandatory to have an idea of the location of tranverse and sigmoid dural venous sinuses.…”

Section: Discussionmentioning

confidence: 99%

“…During the cranial drilling process and visualization, the surrounding neurovascular structures are prone to get damaged (10). Transverse sinus and sigmoid sinus are susceptible for injury leading to morbidity and mortality in patients during retrosigmoid and translabyrinthine craniotomy (11,12). Neuronavigation is a novel neurosurgical adjunct used in operative management of brain pathologies (13).…”

Section: Introductionmentioning

confidence: 99%

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Anatomical landmarks to locate the junction between transverse and sigmoid sinuses in translabyrinthine and retrosigmoid open surgical approaches

et al. 2018

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Introduction Hematoma due to dural-sinus damage is a known complication when introducing burr holes in open transcranial surgery. Our objective was to identify safe areas to avoid dural-sinus damage based on anatomical landmarks in translabyrinthine and retrosigmoid open surgical approaches where neuronavigation facilities are not available. Methods A descriptive anatomical study was conducted on adult skulls. Distances to transverse and sigmoid sinuses on either side were measured using fixed anatomical landmarks: asterion, inion, margins of suprameatal triangle and superior nuchal line. Measurements were standardized according to the cranial indices (cranial index=anteroposterior diameter/transverse diameter) of each skull. Results Thirty-two adult skulls (male:female=22:10) were studied. Mean cranial index, width of transverse and sigmoid sinuses were 0.785±0.045, 9.1±2.3mm and 9.7±1.2mm respectively. Mean vertical distances from asterion and inion to the transverse sinus were 1.1±3.4mm and 14.7±5.9mm respectively. Posterior border of the sigmoid sinus was located 14.7±5.9mm, and 59.9±7.4mm anterior to asterion and inion respectively. t-tests did not show significant differences of these distances on either sides (p>.05). Pearson's correlations were insignificant between the measurements and the cranial indices (p>.05). Measurements from the suprameatal triangle to the dural-sinuses had the minimum variance. In >95% of the times the sigmoid sinus was located ≤23 mm posterior and ≤7 mm superior to the suprameatal triangle. Discussion and conclusions Suprameatal triangle was a consistent surface landmark to locate dural-sinuses. Dural-sinus damage could be avoided in 95% of the times by placing burr hole at least 7mm superior and 23 mm posterior to the suprameatal triangle.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Anatomical landmarks to locate the junction between transverse and sigmoid sinuses in translabyrinthine and retrosigmoid open surgical approaches

et al. 2018

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“…54 The first reaction should be to flood the surgical field with saline solution to prevent air from entering the venous system (Figure 2). 27,55 Communication with the anesthesia team should be immediate and continuous until the DVS system is sealed. An abrupt decrease in the end tidal pCO 2 , hypotension, and a characteristic "washing machine" sound on the precordial Doppler indicate that an air embolism may require urgent treatment.…”

Section: Surgical Techniques For Dural Sinus Repair Universal Maneuversmentioning

confidence: 99%

“…[12][13][14][15] Although burr-hole and craniotomy planning are based on anatomic landmarks and neuronavigation, the risk of injury is still significant during dissection of the dura mater and bone flap elevation. 13,[16][17][18][19][20][21][22][23][24][25][26][27][28] Meticulous preoperative planning of venous drainage anatomy should be undertaken, including an assessment of DVS dominance (eg, right vs left transverse sinus) and identification of common anomalous variations (eg, occipital sinus and hypoplastic unilateral transverse sinus), along with risk stratification for the potential DVS laceration; such planning empowers the surgeon to be prepared for repairing DVS lacerations at any stage of the surgery. In addition, adjunct technologies such as catheter angiography and venography can be used to comprehensively evaluate the venous drainage anatomy.…”

mentioning

confidence: 99%

Advanced Surgical Techniques for Dural Venous Sinus Repair: A Comprehensive Literature Review

Madriñán-Navia,

Scherschinski,

Benet

et al. 2024

Operative Neurosurgery

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The dural venous sinus (DVS) is a thin-walled blood channel composed of dura mater that is susceptible to injury during common neurosurgical approaches. DVS injuries are highly underreported, which is reflected by a lack of literature on the topic. Neurosurgeons should be familiar with appropriate techniques to successfully repair an injured DVS and prevent associated complications. This study presents a literature review on the surgical techniques for DVS repair after DVS injury during common neurosurgical approaches. The databases PubMed and Scopus were queried using the terms “cranial sinuses,” “superior sagittal sinus,” “transverse sinuses,” “injury,” and “surgery.” A total of 117 articles underwent full-text review and were analyzed for surgical approach, craniotomy, lesion location, lesion characteristics, and surgical repair techniques. A literature review was performed, and a comprehensive summary is presented. Data from publications describing DVS lacerations related to pathological conditions (eg, meningioma) were excluded. A total of 9 techniques aiding with bleeding control, hemostasis, and sinus repair and reconstruction were identified, including compression, hemostatic agents, bipolar cautery, dural tenting and tack-up suturing, dural flap, direct suturing, autologous patch, venous bypass, and ligation. The advantages and drawbacks of each technique are described. Multiple options to treat DVS injuries are available to the neurosurgeon. Treatment type is based on anatomic location, complexity of the laceration, cardiovascular status, the presence of air embolism, and the dexterity and experience of the surgeon.

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“…However, with the advent of modern equipment, the current standard technique involves drilling and joining two burr holes on either side of the midline just inferior to the transverse sinuses (6). Despite the fairly complex evolution of this surgical procedure, inadvertent injury to underlying intracranial venous sinuses, frequently involving the torcula, is still reported (7). The torcula, also referred to as the confluence of sinuses, is the junction of superior sagittal, straight and transverse Dural venous sinuses in the occipital region of the skull.…”

Section: Introductionmentioning

confidence: 99%

Inion Not a Reliable Landmark of the Torcula in Posterior Fossa Craniotomies

Otieno¹,

Mwachaka²,

Odula³

et al. 2020

Ann Afr Surg.

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Background: Sub-occipital craniotomies are used in surgical approaches into the posterior cranial fossa. The inion is used as an extracranial landmark of the torcula in burr hole placement. However, inadvertent damage to the torcula and the related sinuses due to variant intracranial location of the torcula has been reported. This study aimed at determining the position of the torcula in relation to the inion. Method: 40 adult open skulls were obtained and the positional relationship between the inion and the torcula assessed. Results: The torcula was at the same level with the inion in half of the cases (50%), below it in 12 cases (30%), and above in 8 cases (20%). The position above the inion ranged from 0.38 to 2.40 cm and below it from 0.75 to 2.45 cm. Conclusion: The torcula lies either at the level of the inion in only half of the cases. The surgeon should augment this physical landmark with radiographs to avoid iatrogenic injuries. Keywords: Inion, Posterior fossa, Craniotomies

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Surgical Repair of Iatrogenic Transverse-Sigmoid Sinus Laceration with a Dural Flap During Skull Base Tumor Surgery: A Technical Case Report

Cited by 7 publications

References 15 publications

Anatomical landmarks to locate the junction between transverse and sigmoid sinuses in translabyrinthine and retrosigmoid open surgical approaches

Anatomical landmarks to locate the junction between transverse and sigmoid sinuses in translabyrinthine and retrosigmoid open surgical approaches

Advanced Surgical Techniques for Dural Venous Sinus Repair: A Comprehensive Literature Review

Inion Not a Reliable Landmark of the Torcula in Posterior Fossa Craniotomies

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