The Clinical Significance of Preserving the Petrosal Vein in Surgery of Petrous Apex Meningiomas

Abstract IMPORTANCE Preservation of venous drainage during surgery of the cerebellopontine angle has received little attention. CLINICAL PRESENTATION We describe changes in brainstem auditory evoked potentials after temporary obstruction of the superior petrosal vein during surgical resection of a small meningioma at the petrous apex via a standard suboccipital-lateral approach. Temporary clipping of the petrosal vein resulted in deterioration of the brainstem auditory evoked potentials. The tumor was removed with preservation of the superior petrosal vein. CONCLUSION A transient postoperative cochlear nerve deficit emphasizes the importance of venous drainage and its preservation during surgery for small lesions of the cerebellopontine angle that do not distort normal anatomic structures.

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The Impact of Petrosal Vein Preservation on Postoperative Auditory Function in Surgery of Petrous Apex Meningiomas

Operative Neurosurgery ◽

10.1227/01.neu.0000219821.34450.59 ◽

2006 ◽

Vol 59 (suppl_1) ◽

pp. ONS-68-ONS-74 ◽

Cited By ~ 3

Author(s):

Alireza Gharabaghi ◽

Andrei Koerbel ◽

Löwenheim Hubert ◽

Jan Kaminsky ◽

Madjid Samii ◽

...

Keyword(s):

Hearing Loss ◽

Clinical Study ◽

Surgical Treatment ◽

Auditory Nerve ◽

Petrous Apex ◽

Auditory Function ◽

Petrosal Vein ◽

Superior Petrosal Vein ◽

Nerve Dysfunction ◽

The Impact

Abstract OBJECTIVE: The importance of preserving the superior petrosal vein has received increasing attention in the surgical treatment of pathologies involving the petrous apex. Recent reports have associated postoperative auditory nerve dysfunction with petrosal vein sacrifice. However, there is no systematic clinical study available thus far focusing on the postoperative auditory function after petrosal vein obliteration. METHODS: In 55 patients with meningiomas involving the petrous apex, pre- and intraoperative findings including petrosal vein sectioning were analyzed retrospectively concerning their impact on postoperative auditory function. RESULTS: The petrosal vein was preserved in 26 (47%) cases. In 27 (49%) cases, this vein was not preserved. Hearing loss occurred in 11% of all cases. In the preserved-vein group, postoperative hearing loss occurred in 3 of 26 (11%) cases and in the sacrificed-vein group in 3 of 27 (11%) cases. CONCLUSION: Sacrifice of the petrosal vein during surgery of petrous apex meningiomas seems not to have an impact on postoperative auditory function.

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Venous complications following petrosal vein sectioning in surgery of petrous apex meningiomas

European Journal of Surgical Oncology ◽

10.1016/j.ejso.2008.02.015 ◽

2009 ◽

Vol 35 (7) ◽

pp. 773-779 ◽

Cited By ~ 40

Author(s):

A. Koerbel ◽

A. Gharabaghi ◽

S. Safavi-Abbasi ◽

A. Samii ◽

F.H. Ebner ◽

...

Keyword(s):

Petrous Apex ◽

Petrosal Vein

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Fatal hemorrhagic complication after coil embolization of a petrosal arteriovenous shunt

Interventional Neuroradiology ◽

10.1177/15910199211057705 ◽

2021 ◽

pp. 159101992110577

Author(s):

David Volders ◽

Elena Adela Cora ◽

Chiraz Chaalala ◽

Maxime Cartier ◽

Michihiro Tanaka ◽

...

Keyword(s):

Posterior Fossa ◽

Coil Embolization ◽

Arteriovenous Shunt ◽

Embolic Agent ◽

Petrous Apex ◽

Hemorrhagic Complication ◽

Contrast Extravasation ◽

Petrosal Vein ◽

Hemorrhagic Risk ◽

Superior Petrosal Sinus

Background Cerebello-pontine AVMs (CPAVMs) and petrous apex dural arteriovenous fistulae (DAVFs) are rare and sometimes difficult to distinguish. We report a fatal hemorrhagic complication after coil embolization of the petrosal vein draining a trigeminal AVM misdiagnosed as a DAVF. Case presentation A 73-year-old woman with a petrous apex arteriovenous shunt with dual dural and pial arterial supply presented with posterior fossa hemorrhage. The draining petrosal vein was catheterized and coiled via the superior petrosal sinus. Two episodes of contrast extravasation occurred during coiling, but the lesion was completely occluded at the end of the procedure. The patient developed a fatal posterior fossa hemorrhage in the recovery room. Microscopic pathology revealed numerous dilated vessels within the trigeminal nerve. Conclusion CPAVMs and DAVFs with pial drainage should be distinguished pre-operatively. Occlusion of a pial vein (as opposed to a sinus) in the treatment of an arteriovenous shunt carries hemorrhagic risk if a liquid embolic agent is not used to completely occlude all pathological vessels.

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