The Experience of Ligation of Transverse or Sigmoid Sinus in Surgery of Large Petroclival Meningiomas

Abstract

The authors present the experience of ligation of transverse or sigmoid sinus in the surgical removal of petroclival meningiomas. We reviewed the medical records and venograms of 14 patients with petroclival meningiomas, in whom the intraoperative ligation of transverse or sigmoid sinus had been done at our hospital between 1986 and 1999. All patients passed the intraoperative test clamping of the sinus. The drainage pattern of confluence of Herophili was classified into four types: type A, confluence and equal drainage on both transverse sinuses; type B, confluence and non-dominant transverse sinus on the tumor side; type C, confluence and dominant transverse sinus on the tumor side; and type D, unilateral transverse sinus only. Among the 14 cases, four cases were in type A, five cases in type B, and two were type C. There was no evidence of brain swelling after intraoperative test clamping of the sinus for more than 30 min. None of the patients experienced postoperative complications related with sinus ligation. Our observation suggests that the transverse or sigmoid sinus ligation is tolerable to patients who show the drainage patterns of type A, type B, and type C, if the test clamping proves to be safe.

Combined Pre- and Retrosigmoid Approach for Petroclival Meningiomas with the Aid of a Rotatable Head Frame: Peri-Auricular Three-Quarter Twist-Rotation Approach: Technical Note

“…It is contraindicated when the ipsilateral transverse sinus is hypoplastic. 9 Because our combined preand retrosigmoid approach does not require transection of the sigmoid sinus, obstruction of this sinus is not a contraindication.…”

Morphological study of sinus flow in the confluence of sinuses

“…To our knowledge, there is no information available regarding the frequency of incomplete mixing at the CS. In addition, when the TS or SS must be sacrificed, the likelihood of venous complications depends upon the patient's venous anatomy (Lanzieri et al, 1987;Hwang et al, 2002). However, preoperative venograms only provide information regarding the dominance of outflow sinuses, which are usually insufficient in predicting the risk of venous stasis and thus potential thrombosis.…”

“…Megerian et al (1996) reported immediate or delayed complications (up to 24-48 hr), including infarction and hemorrhage, after sinus ligation and resection, even when employing intraoperative monitoring. Hwang et al (2002) suggested that regardless of TS dominance in preoperative venograms, TS or sigmoid sinus ligation is tolerable if test clamping proves to be safe. It may be expected that opening of end-to-end anastomoses of the meningeal veins to other venous channels preserves a functioning vascular drainage system, but this process demonstrates great interindividual and interhemispheric variations (Jacobs et al, 1996).…”

Superior Sagittal Sinus Bifurcation Variation

“…In a study by Hwang et al (6) it was shown that the drainage pattern of the confluence of sinuses was important for clinical decision making in the surgical removal of the large petroclival meningiomas. Fiumara et al (7) reported a case of multiple dural arteriovenous fistulas of the transverse sinuses which was treated surgically.…”