Abstract
The study aims to systematize neurosurgeons’ practical knowledge of venous sacrifice as applied to the posterior fossa region and to analyze the collected data to present and preserve relevant experience and expert knowledge for current and future practicing neurosurgeons. The venous structures assessed were the superior petrosal vein (SPV), sigmoid sinus (SS), and the tentorial veins (TV). The survey is constructed to obtain surgeons’ idea of assessed risk when sacrificing specific venous structures during posterior fossa surgery. They were asked how they prep for surgery, number of operations conducted, and their basis of knowledge. Collected data were mainly qualitative and analyzed with a mixed-method approach. A mean absolute deviation was calculated measuring rate of disagreement for a given substructure. Consensus existed among the participating surgeons that sacrificing the SPV and the TV was considered safe. Although, the risk of death when occluding major structures like the main trunk of the SPV, one of the SS’ and or a total occlusion of all TV yielded high risk of death. The risk of infarction was often too apparent to discredit even with low risk of death among an experienced class of surgeons. Our findings provide an overview of surgical risk associated with venous sacrifice. This will minimize cases where indispensable practical knowledge on safe handling veins in the cerebellopontine angle is either to be lost or taught among few when the neurosurgeons retire. This will lower the disagreement regarding risks and increase the quality of surgical decision-making.
Similar content being viewed by others
Data availability
See Appendix.
References
Adachi K, Hayakawa M, Ishihara K, Ganaha T, Nagahisa S, Hasegawa M, Hirose Y (2016) Study of changing intracranial venous drainage patterns in petroclival meningioma. World Neurosurg 92:339–348. https://doi.org/10.1016/j.wneu.2016.05.019
Anichini G, Iqbal M, Rafiq NM, Ironside JW, Kamel M (2016) Sacrificing the superior petrosal vein during microvascular decompression. Is it safe? Learning the hard way. Case report and review of literature. Surg Neurol Int 7:S415–S420. https://doi.org/10.4103/2152-7806.183520
Cheng L (2016) Complications after obliteration of the superior petrosal vein: are they rare or just underreported? J Clin Neurosci 31:1–3. https://doi.org/10.1016/j.jocn.2015.11.033
Dumot C, Sindou M (2018) Veins of the cerebellopontine angle and specific complications of sacrifice, with special emphasis on microvascular decompression surgery. A review. World Neurosurg 117:422–432. https://doi.org/10.1016/j.wneu.2018.06.160
Hernesniemi J, Romani R, Albayrak BS, Lehto H, Dashti R, Ramsey C 3rd, Karatas A, Cardia A, Navratil O, Piippo A, Fujiki M, Toninelli S, Niemela M (2008) Microsurgical management of pineal region lesions: personal experience with 119 patients. Surg Neurol 70:576–583. https://doi.org/10.1016/j.surneu.2008.07.019
Hollon TC, Savastano LE, Argersinger DP, Quint DJ, Thompson BG (2018) Microvascular brainstem ischemia after vestibular schwannoma surgery: a clinical and microanatomic study. World Neurosurg 112:e415–e424. https://doi.org/10.1016/j.wneu.2018.01.056
Ivy AC (1948) The history and ethics of the use of human subjects in medical experiments. Science 108:1–5
Jakola AS, Bartek J Jr, Mathiesen T (2013) Venous complications in supracerebellar infratentorial approach. Acta Neurochir 155:477–478. https://doi.org/10.1007/s00701-012-1614-8
Jannetta PJ (2007) Arterial compression of the trigeminal nerve at the pons in patients with trigeminal neuralgia. 1967. J Neurosurg 107:216–219. https://doi.org/10.3171/jns-07/07/0216
Koerbel A, Gharabaghi A, Safavi-Abbasi S, Samii A, Ebner FH, Samii M, Tatagiba M (2009) Venous complications following petrosal vein sectioning in surgery of petrous apex meningiomas. Eur J Surg Oncol 35:773–779. https://doi.org/10.1016/j.ejso.2008.02.015
Krogager ME, Jakola AS, Poulsgaard L, Couldwell W, Mathiesen T (2019) Safe handling of veins in the pineal region-a mixed method study. Neurosurg Rev. https://doi.org/10.1007/s10143-019-01189-y
Liebelt BD, Barber SM, Desai VR, Harper R, Zhang J, Parrish R, Baskin DS, Trask T, Britz GW (2017) Superior petrosal vein sacrifice during microvascular decompression: perioperative complication rates and comparison with venous preservation. World Neurosurg 104:788–794. https://doi.org/10.1016/j.wneu.2017.05.098
Masuoka J, Matsushima T, Hikita T, Inoue E (2009) Cerebellar swelling after sacrifice of the superior petrosal vein during microvascular decompression for trigeminal neuralgia. J Clin Neurosci 16:1342–1344. https://doi.org/10.1016/j.jocn.2008.12.024
Mathiesen T (2013) To operate or not--the impact of a lecture on radical glioblastoma surgery and different treatment options on decision-making for oneself and patients. Acta Neurochir 155:1425–1429. https://doi.org/10.1007/s00701-013-1796-8
Matsushima T, Rhoton AL Jr, de Oliveira E, Peace D (1983) Microsurgical anatomy of the veins of the posterior fossa. J Neurosurg 59:63–105. https://doi.org/10.3171/jns.1983.59.1.0063
Matsushima K, Matsushima T, Kuga Y, Kodama Y, Inoue K, Ohnishi H, Rhoton AL Jr (2014) Classification of the superior petrosal veins and sinus based on drainage pattern. Neurosurgery 10(Suppl 2):357–367; discussion 367. https://doi.org/10.1227/neu.0000000000000323
Matsushima T, Kawashima M, Inoue K, Matsushima K (2014) Anatomy of the superior petrosal veins and their exposure and management during petrous apex meningioma surgery using the lateral suboccipital retrosigmoid approach. Neurosurg Rev 37:535–456. https://doi.org/10.1007/s10143-014-0548-4
McLaughlin MR, Jannetta PJ, Clyde BL, Subach BR, Comey CH, Resnick DK (1999) Microvascular decompression of cranial nerves: lessons learned after 4400 operations. J Neurosurg 90:1–8. https://doi.org/10.3171/jns.1999.90.1.0001
Milano G (2016) The hierarchy of the evidence-based medicine pyramid: classification beyond ranking. Joints 3:101. https://doi.org/10.11138/jts/2015.3.3.101
Murad MH, Asi N, Alsawas M, Alahdab F (2016) New evidence pyramid. Evid Based Med 21:125–127. https://doi.org/10.1136/ebmed-2016-110401
Narayan V, Savardekar AR, Patra DP, Mohammed N, Thakur JD, Riaz M, Nanda A (2018) Safety profile of superior petrosal vein (the vein of Dandy) sacrifice in neurosurgical procedures: a systematic review. Neurosurg Focus 45:E3. https://doi.org/10.3171/2018.4.Focus18133
Palinkas LA, Aarons GA, Horwitz S, Chamberlain P, Hurlburt M, Landsverk J (2011) Mixed method designs in implementation research. Adm Policy Ment Health 38:44–53. https://doi.org/10.1007/s10488-010-0314-z
Patel NJ, Bervini D, Eftekhar B, Davidson AS, Walsh DC, Assaad NN, Morgan MK (2019) Results of surgery for low-grade brain arteriovenous malformation resection by early career neurosurgeons: an observational study. Neurosurgery 84:655–661. https://doi.org/10.1093/neuros/nyy088
Pathmanaban ON, O'Brien F, Al-Tamimi YZ, Hammerbeck-Ward CL, Rutherford SA, King AT (2017) Safety of superior petrosal vein sacrifice during microvascular decompression of the trigeminal nerve. World Neurosurg 103:84–87. https://doi.org/10.1016/j.wneu.2017.03.117
Rawlins M (2008) De Testimonio: on the evidence for decisions about the use of therapeutic interventions. Clin Med (Lond) 8:579–588
Rawlins MD (2014) Evidence, values, and decision making. Int J Technol Assess Health Care 30:233–238. https://doi.org/10.1017/S0266462314000154
Sackett DL (1997) Evidence-based medicine. Semin Perinatol 21:3–5. https://doi.org/10.1016/S0146-0005(97)80013-4
Sackett DL, Rosenberg WMC, Gray JAM, Haynes RB, Richardson WS (1996) Evidence based medicine: what it is and what it isn’t. BMJ 312:71–72. https://doi.org/10.1136/bmj.312.7023.71
Seo Y, Kim DG (2018) Contralateral trigeminal neuralgia in a rapidly growing vestibular schwannoma: a case report. J Clin Neurosci 47:132–134. https://doi.org/10.1016/j.jocn.2017.10.018
Staudt MD, Hebb MO (2018) Staged multi-modality treatment approaches for giant cerebellopontine angle hemangioblastomas. J Clin Neurosci 53:224–228. https://doi.org/10.1016/j.jocn.2018.04.027
Suzuki Y, Endo T, Ikeda H, Ikeda Y, Matsumoto K (2003) Venous infarction resulting from sacrifice of a bridging vein during clipping of a cerebral aneurysm: preoperative evaluation using three-dimensional computed tomography angiography--case report. Neurol Med Chir 43:550–554
Tahara A, de Santana PA Jr, Calfat Maldaun MV, Panagopoulos AT, da Silva AN, Zicarelli CA, Pires de Aguiar PH (2009) Petroclival meningiomas: surgical management and common complications. J Clin Neurosci 16:655–659. https://doi.org/10.1016/j.jocn.2008.08.011
Taylor CL, Dutton K, Rappard G, Pride GL, Replogle R, Purdy PD, White J, Giller C, Kopitnik TA Jr, Samson DS (2004) Complications of preoperative embolization of cerebral arteriovenous malformations. J Neurosurg 100:810–812. https://doi.org/10.3171/jns.2004.100.5.0810
Tekkok IH, Suzer T, Erbengi A (1992) Non-acoustic tumors of the cerebellopontine angle. Neurosurg Rev 15:117–123
Ueyama T, Al-Mefty O, Tamaki N (1998) Bridging veins on the tentorial surface of the cerebellum: a microsurgical anatomic study and operative considerations. Neurosurgery 43:1137–1145. https://doi.org/10.1097/00006123-199811000-00068
Watanabe T, Igarashi T, Fukushima T, Yoshino A, Katayama Y (2013) Anatomical variation of superior petrosal vein and its management during surgery for cerebellopontine angle meningiomas. Acta Neurochir 155:1871–1878. https://doi.org/10.1007/s00701-013-1840-8
Weindling P (1996) Human guinea pigs and the ethics of experimentation: the BMJ’s correspondent at the Nuremberg medical trial. BMJ 313:1467–1470
Yang A, Folzenlogen Z, Youssef AS (2018) Minimally invasive endoscopic-assisted approaches to the posterior fossa. J Neurosurg Sci 62:658–666. https://doi.org/10.23736/s0390-5616.18.04474-0
Zanoletti E, Cazzador D, Faccioli C, Martini A, Mazzoni A (2014) Closure of the sigmoid sinus in lateral skull base surgery. Acta Otorhinolaryngol Ital 34:184–188
Acknowledgment
We thank the following neurosurgeons, who contributed with their surgical knowledge and experience to the survey that formed the basis of this paper:
-
Tiit Mathiesen, MD, Chief Professor, Department of Neurosurgery, Rigshospitalet
-
Jannick Brennum, MD, Chairman of the Neurocenter, Rigshospitalet
-
Jacob Bertram Springborg, MD, Associate professor, Department of Neurosurgery, Rigshospitalet
-
Vagn Eksesen, MD, Associate professor, Department of Neurosurgery, Rigshospitalet
-
Kåre Fugleholm, MD, Dr. Med, PhD, Clinical associate professor, Department of Neurosurgery, Rigshospitalet
-
Lars Bøgeskov, MD, Department of Neurosurgery, Rigshospitalet
-
Domenico D’Avella, MD, PhD, Professor, Director, Department of Neurosciences University of Padova Medical School
-
Thomas Santarius, MD PhD, Cambridge University Hospitals NHS Trust (Addenbrooke’s)
-
Marc Sindou, MD and Dumot Chloé MSc, University of Lyon
-
Evandro de Oliveira, MD PhD, Adjunct Professor of Neurological Surgery at the Mayo Clinic
-
Ulrich Sure, MD, Professor at University Hospital of Essen.
-
M. Necmettin Pamir, MD, Professor, President at Acibadem University
-
Andreas Raabe MD, Professor, Chairman of Neurosurgery at Bern University Hospital
-
Henry W. S. Schroeder, MD PhD, Dept. of Neurosurgery at the University Medicine Greifswald
-
Fady T. Charbel MD, Professor and Chief at University of Illinois Hospital
-
Marcos Soares Tatagiba, MD, Professor and Chief at University of Tübingen
-
Veit Rohde, MD, Professor and Chief at University Medical Center Göttingen
-
Jafri Malin Abdullah, MD, Professor and Chief at University of Sciences Malaysia, Dept. of NS
-
Basant Misra, MD, Professor and Head of Dept. of NS. at Hinduja National Hospital
-
William Couldwell, MD PhD, Professor and Chair of Dept. of NS. at University of Utah
-
Ioan Stefan Florian, MD PhD, Professor of Dept. of NS. at University of Cluj-Napoca
-
Peter Nakaji, MD, Dept. of Neurosurgery at Barrow Neurological Institute
-
Vladimir Benes, MD PhD, Professor and Chairman of Dept. of NS. at University Hospital Prague
-
Nejat Akalan, MD PhD, Professor of Dept. of Neurosurgery at Hacettepe University
-
Kazuhiro Hongo, MD, Professor of Department of Neurosurgery at Shinshu University
-
Helmut Bertalanffy, MD, Professor and Dir. for Neurosurgery, Int. Neurosc. Insitute Hannover
-
Takanori Fukushima, MD, Professor of Neurosurgery at Duke University
-
Juha Hernesemi, MD PhD, Professor emeritus in Neurosurgery at University of Helsinki
Author information
Authors and Affiliations
Contributions
All authors contributed to the design of the study; Alaoui-Ismaili A and Mathiesen T undertook the literature review; Krogager ME collected and registered the data; Alaoui-Ismaili A and Mathiesen T drafted the paper; all authors contributed to the interpretation of data and revision of the paper; all have approved the final version.
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Ethical approval
Not applicable
Informed consent
No patients are directly involved. All questioned surgeons consented.
Code availability
Not applicable.
Disclaimer
This is an expert opinion-based article. We strongly advice surgeons conducting CPA surgery to study venous circulation, keeping in mind the changing nature of these structures.
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Electronic supplementary material
ESM 1
(DOCX 6.96 mb)
Rights and permissions
About this article
Cite this article
Alaoui-Ismaili, A., Krogager, M.E., Jakola, A.S. et al. Surgeons’ experience of venous risk with CPA surgery. Neurosurg Rev 44, 1675–1685 (2021). https://doi.org/10.1007/s10143-020-01365-5
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10143-020-01365-5