Study of changing intracranial venous drainage patterns in petroclival meningioma

• Published in: World neurosurgery Vol. 92; pp. 339 - 348
• Main Authors: Adachi, Kazuhide, MD, PhD, Hayakawa, Motoharu, MD, PhD, Ishihara, Kohei, MD, PhD, Ganaha, Tukasa, MD, PhD, Nagahisa, Shinya, MD, PhD, Hasegawa, Mituhiro, MD, PhD, Hirose, Yuichi, MD, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.08.2016
• Subjects: Adolescent; Adult; Aged; Cerebral Veins - surgery; Cerebrovascular Circulation; Computed Tomography Angiography; Cranial Sinuses - diagnostic imaging; Cranial Sinuses - surgery; Drainage - methods; Female; Humans; Imaging, Three-Dimensional; Intracranial venous drainage; Male; Meningeal Neoplasms - diagnostic imaging; Meningeal Neoplasms - surgery; Meningioma - diagnostic imaging; Meningioma - surgery; Middle Aged; Neurosurgery; Petroclival meningioma; Petrous Bone - surgery; Transpetrosal approach; Vascular Surgical Procedures - methods; Young Adult; internal auditory meatus; 3D-CTAV; superior petrosal sinus; superficial middle cerebral vein; 3-dimensional computed tomography angiography; Petroclival meningioma; IPS; 3D-CTA; transverse sinus; cavernous sinus; superior sagittal sinus; SPS; PCMs; petroclival meningioma cases; 3-dimensional computed tomography angiography and venography; Intracranial venous drainage; superior ophthalmic vein; inferior petrosal sinus; SMCV; Transpetrosal approach; CS; SSS; 3D-CTV; IAM; PCM; SOV; 3-dimensional computed tomography venography; TS; 3D; CT
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2016.05.019

Abstract Objective Elucidating the venous drainage patterns to avoid damage to the venous drainage route in the middle cranial fossa and superior petrosal sinus (SPS) when employing the transpetrosal approach. Methods Venous drainage patterns were assessed using three-dimensional computed tomography venography in 22 hemispheres of primary-operated petroclival meningioma cases (PCMs) and 40 hemispheres of controls. We compared intracranial venous drainage patterns between controls and PCMs. Results The proportion of hemispheres with complete and medial SPS drainage patterns was lower in PCMs. With regard to the superficial middle cerebral vein (SMCV) drainage pattern, the proportion of hemispheres with the cavernous sinus (CS) capture-type was lower and that with the emissary-type was higher in PCMs. The proportion of hemispheres with multiple greater anastomosis of the SMCV was higher in PCMs without the emissary-type and CS capture-type patterns. When the venous drainage route of the CS capture-type and/or emissary-type was disturbed, in particular, greater anastomosis via the vein of Labbѐ and the vein of Trolard was needed to control venous drainage flow. Conclusion In cases of venous drainage impairment secondary to PCM progression, the drainage route changed to the pterygoid plexus route through the emissary foramen and/or superior sagittal sinus, and to the transverse sinus route through the greater anastomosis of the SMCV. In the anterior transpetrosal approach, peeling off the dura propria of the trigeminal nerve of the foramen rotundum for petrous apex exposure may be associated with the potential risk of pterygoid plexus drainage route impairment.