Effect of Different Surgical Positions on the Changes in Cerebral Venous Drainage (CVD) and Intracranial Pressure (ICP) in Patients Undergoing Elective Neurosurgery

Endovascular embolization has evolved to become the primary therapeutic option for dural arteriovenous fistulas (DAVFs). While guaranteeing complete occlusion of the fistula orifice, the goal of DAVF embolization is also to ensure the patency of normal cerebral venous drainage. This paper describes a case of successful embolization of a complex DAVF in the superior sagittal sinus with a multistaged approach using a combination of transvenous and transarterial tactics. The strategies and techniques are discussed.

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Studies on the Pathophysiology of Encephalopathy in Reye's Syndrome: Hyperammonemia in Reye's Syndrome

PEDIATRICS ◽

10.1542/peds.56.6.999 ◽

1975 ◽

Vol 56 (6) ◽

pp. 999-1004

Author(s):

Daniel C. Shannon ◽

Robert De Long ◽

Barry Bercu ◽

Thomas Glick ◽

John T. Herrin ◽

...

Keyword(s):

Metabolic Acidosis ◽

Venous Drainage ◽

Respiratory Alkalosis ◽

Ammonia Concentration ◽

Reye's Syndrome ◽

Acid Base ◽

Arterial Blood ◽

Cerebral Venous Drainage ◽

Acid Base Status ◽

The Brain

The initial acid-base status of eight survivors of Reye's syndrome was characterized by acute respiratory alkalosis (Pco2=32 mm Hg; Hco3-= 22.0 mEq/liter) while that of eight children who died was associated with metabolic acidosis as well (HCO3-=10.0 mEq/liter). Arterialinternal jugular venous ammonia concentration differences on day 1 (299 mg/100 ml) and day 2 (90 mg/ 100 ml) reflected cerebral uptake of ammonia while those on days 3 and 4 (-43 and -55 mg/100 ml) demonstrated cerebral release. Arterial blood hyperammonemia can be detoxified safely in the brain as long as the levels do not exceed approximately 300µg/100 ml. Beyond that level lactic acidosis is observed, particularly in cerebral venous drainage. Arterial blood hyperammonemia was also related to the extent of alveolar hyperventilation. These findings are very similar to those seen in experimental hyperammonemia and support the concept that neurotoxicity in children with Reye's syndrome is at least partly due to impaired oxidative metabolism secondary to hyperammonemia.

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Cerebral Venous Drainage in Patients With Space-Occupying Middle Cerebral Artery Infarction: Effects on Functional Outcome After Hemicraniectomy

Frontiers in Neurology ◽

10.3389/fneur.2018.00876 ◽

2018 ◽

Vol 9 ◽

Author(s):

Volker Puetz ◽

Johannes C. Gerber ◽

Philipp Krüger ◽

Matthias Kuhn ◽

Heinz Reichmann ◽

...

Keyword(s):

Middle Cerebral Artery ◽

Functional Outcome ◽

Cerebral Artery ◽

Venous Drainage ◽

Middle Cerebral Artery Infarction ◽

Cerebral Venous Drainage

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Intracranial Hypertension and the Importance of Cerebral Venous Drainage Variability: A Case Report of Headache as the Initial Clinical Presentation of an Intraspinal Paraganglioma

Journal of Neurological Surgery Part A Central European Neurosurgery ◽

10.1055/s-0032-1313719 ◽

2012 ◽

Vol 74 (02) ◽

pp. 124-127

Author(s):

S. Kroppenstedt ◽

P. Vajkoczy ◽

C. Sprung ◽

F. Freimann

Keyword(s):

Case Report ◽

Intracranial Hypertension ◽

Clinical Presentation ◽

Venous Drainage ◽

Cerebral Venous Drainage

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Concerning “Nonaneurysmal Perimesencephalic Hemorrhage Is Associated with Deep Cerebral Venous Drainage Anomalies: A Systematic Literature Review and Meta-Analysis”

American Journal of Neuroradiology ◽

10.3174/ajnr.a4984 ◽

2016 ◽

Vol 38 (2) ◽

pp. E14-E14

Author(s):

X. Wu ◽

R. Liu ◽

A. Malhotra

Keyword(s):

Literature Review ◽

Systematic Literature Review ◽

Meta Analysis ◽

Venous Drainage ◽

Perimesencephalic Hemorrhage ◽

Cerebral Venous Drainage

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Extrajugular pathways of human cerebral venous blood drainage assessed by duplex ultrasound

Journal of Applied Physiology ◽

10.1152/japplphysiol.00782.2002 ◽

2003 ◽

Vol 94 (5) ◽

pp. 1802-1805 ◽

Cited By ~ 63

Author(s):

Stephan J. Schreiber ◽

Frank Lürtzing ◽

Rainer Götze ◽

Florian Doepp ◽

Randolf Klingebiel ◽

...

Keyword(s):

Blood Volume ◽

Venous Blood ◽

Duplex Ultrasound ◽

Venous Drainage ◽

Volume Flow ◽

Venous System ◽

Jugular Veins ◽

Ultrasound Studies ◽

Cerebral Venous Drainage ◽

Venous Blood Volume

Cerebral venous drainage in humans is thought to be ensured mainly via the internal jugular veins (IJVs). However, anatomic, angiographic, and ultrasound studies suggest that the vertebral venous system serves as an important alternative drainage route. We assessed venous blood volume flow in vertebral veins (VVs) and IJVs of 12 healthy volunteers using duplex ultrasound. Measurements were performed at rest and during a transient bilateral IJV and a circular neck compression. Total venous blood volume flow at rest was 766 ± 226 ml/min (IJVs: 720 ± 232, VVs: 47 ± 33 ml/min). During bilateral IJV compression, VV flow increased to 128 ± 64 ml/min. Circular neck compression, causing an additional deep cervical vein obstruction, led to a further rise in VV volume flow (186 ± 70 ml/min). As the observed flow increase did not compensate for IJV flow cessation, other parts of the vertebral venous system, like the intraspinal epidural veins and the deep cervical veins, have to be considered as additional alternative drainage pathways.

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Cerebral venous drainage through internal jugular vein

Veins and Lymphatics ◽

10.4081/vl.2019.8379 ◽

2019 ◽

Vol 8 (3) ◽

Author(s):

Nadiya Y. Mohammed ◽

Giovanni Di Domenico ◽

Mauro Gambaccini

Keyword(s):

Internal Jugular Vein ◽

Superior Vena Cava ◽

Jugular Vein ◽

Superior Vena ◽

Vena Cava ◽

Venous Drainage ◽

Doppler Spectrum ◽

Cerebral Venous Drainage ◽

The Right ◽

Venous Pulse

Internal jugular veins (IJVs) are the largest veins in the neck and are considered the primary cerebral venous drain for the intracranial blood in supine position. Any reduction in their flow could potentially results an increase in cerebral blood volume and intracranial pressure (ICP). The right internal jugular vein communicates with the right atrium via the superior vena cava, in which a functional valve is located at the union of the internal jugular vein and the superior vena cava. The atrium aspiration is the main mechanism governing the rhythmic leaflets movement of internal jugular vein valve synchronizing with the cardiac cycle. Cardiac contractions and intrathoracic pressure changes are reflecting in Doppler spectrum of the internal jugular vein. The evaluation of the jugular venous pulse provides valuable information about cardiac hemodynamics and cardiac filling pressures. The normal jugular venous pulse wave consists of three positive waves, a, c, and v, and two negative waves, x and y. A normal jugular vein gradually reduces its longitudinal diameter, as described in anatomy books; it is possible to segment IJV into three different segments J3 to J1, as it proposed in ultrasound US studies and CT scan. In this review, the morphology and methodology of the cerebral venous drainage through IJV are presented.

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Color Doppler Ultrasound Evaluation of Internal Jugular Vein Before Radical Neck Dissection

Journal of Medical Imaging and Health Informatics ◽

10.1166/jmihi.2019.2619 ◽

2019 ◽

Vol 9 (2) ◽

pp. 371-375

Author(s):

Zhiyong Chen ◽

Binshan Zha ◽

Yan Li ◽

Yongchao Chen

Keyword(s):

Blood Flow ◽

Neck Dissection ◽

Color Doppler ◽

Radical Neck Dissection ◽

Venous Drainage ◽

Color Doppler Ultrasound ◽

Sitting Position ◽

Section Area ◽

Cerebral Venous Drainage ◽

The Right

Objective: There is a great controversy about whether the internal jugular vein (IJV) should be retained during radical neck dissection. In this study, the right and left IJV under different body position were observed by color Doppler ultrasound, in order to provide a experimental basis for the preservation of IJV in neck dissections. Methods: A total of 40 patients with thyroid cancer undergoing radical neck dissection were examined in this study. The hemodynamic data such as section area, velocity, and volume of blood flow were measured by Doppler in supine and sitting position under quiet breath. Results: In supine position, the cross sectional area, the velocity and the blood flow volume in the right side were 58%, 23% and 91% more than left side respectively. The right side advantage, symmetrical, and left side advantage of IJV was in 65%, 25%, and 10% of patients. The blood flow of bilateral IJV was 74% of total cerebral outflow. The IJV predominate, balanced type, and no-IJV predominate cerebral venous drainage was in 73%, 23% and 5% of patients. In sitting position, the section area, the velocity and the blood flow volume in the right side were 29%, 35% and 56% more than left side respectively. The right side advantage, symmetrical, and left side advantage of IJV was in 45%, 45%, and 10% of patients. The blood flow of bilateral IJV was 23% of total cerebral outflow. The balanced type and no-IJV predominate cerebral venous drainage was in 23% and 78% of patients. Conclusions: There are side advantage of IJV. With quiet breathing, IJV is not the main pathway of cerebral venous drainage in sitting position. The preoperative ultrasound is useful to design the individualized surgical approach for the radical neck dissections.

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