Republished: Embolization of a cavernous carotid fistula through the vein of Labbé: a new alternative transvenous access route

2018 ◽  
Vol 10 (6) ◽  
pp. e11-e11
Author(s):  
Angelos Aristeidis Konstas ◽  
Alice Song ◽  
Julia Song ◽  
Aristomenis Thanos ◽  
Ian B Ross
Keyword(s):  
Venous Access ◽  
Uneventful Recovery ◽  
Cerebral Vein ◽  
Access Route ◽  
Surgical Access ◽  
Superficial Middle Cerebral Vein ◽  
Vein Of Labbé ◽  
Carotid Cavernous Fistulas ◽  
Transvenous Approach ◽  
Careful Navigation

Endovascular treatment of carotid cavernous fistulas (CCFs) via a transvenous approach is standard, but in rare cases this approach is challenging due to absence or thrombosis of the commonly used venous routes. A 61-year-old woman presented with a symptomatic CCF with all but one of the venous access routes to the CCF thrombosed, leaving an engorged superficial middle cerebral vein (SMCV) as the only venous outflow from the cavernous sinus. Access to the CCF was made possible after careful navigation of the sigmoid sinus, the vein of Labbé and the SMCV, bypassing the need for surgical access to the SMCV or for a direct transorbital puncture. The CCF was completely occluded by coiling and Onyx embolization. The patient made an uneventful recovery, with resolution of her symptoms. To the best of our knowledge, this access route has not been previously reported in the treatment of CCFs.

Combined Surgical and Endovascular Access of the Superficial Middle Cerebral Vein to Occlude a High-Grade Cavernous Dural Arteriovenous Fistula: Case Report

Neurosurgery ◽  
2011 ◽  
Vol 69 (2) ◽  
pp. E475-E482 ◽  
Author(s):  
Michael C. Hurley ◽  
Rudy J. Rahme ◽  
Andrew J. Fishman ◽  
H. Hunt Batjer ◽  
Bernard R. Bendok
Keyword(s):  
Arteriovenous Fistula ◽  
Dural Arteriovenous Fistula ◽  
Venous Drainage ◽  
Uneventful Recovery ◽  
Cerebral Vein ◽  
High Grade ◽  
Direct Puncture ◽  
Superficial Middle Cerebral Vein ◽  
Endovascular Approach ◽  
Cortical Venous Drainage

Abstract BACKGROUND AND IMPORTANCE: High-grade cavernous sinus (CS) dural arteriovenous fistulae with cortical venous drainage often have a malignant presentation requiring urgent treatment. In the absence of a venous access to the lesion, transarterial embolization can potentially cure these lesions; however, the high concentration of eloquent arterial territories adjacent to the fistula creates a precarious risk of arterial-arterial reflux. In such cases, a combined surgical and endovascular approach may provide the least invasive option. CLINICAL PRESENTATION: We describe a patient presenting with a venous hemorrhagic infarct caused by a high-grade CS dural arteriovenous fistula (Barrow type D caroticocavernous fistula) with isolated drainage via the superficial middle cerebral vein into engorged perisylvian cortical veins. No transfemoral or ophthalmic strategy was angiographically apparent, and the posterior location of the involved CS compartment mitigated a direct puncture. The patient underwent direct puncture of the superficial middle cerebral vein via an orbitozygomatic craniotomy and the CS was catheterized under fluoroscopic guidance. The CS was coil-embolized back into the distal superficial middle cerebral vein with complete obliteration of the fistula. The patient did well with no new deficits and made an uneventful recovery. CONCLUSION: This novel combined open surgical and endovascular approach enables obliteration of a CS dural arteriovenous fistula with isolated cortical venous drainage and avoids the additional manipulation with direct dissection and puncture of the CS itself.

scholarly journals Anatomical Configurations of Dominant Anastomotic Veins of the Superficial Cortical Venous System

2021 ◽  
Author(s):  
Joastin Naidoo ◽  
Rohen Harrichandparsad ◽  
Lelika Lazarus
Keyword(s):  
Iatrogenic Injury ◽  
Venous System ◽  
Cerebral Hemispheres ◽  
Cerebral Vein ◽  
Neurosurgical Procedures ◽  
Significant Relationships ◽  
Dominant Pattern ◽  
Superficial Middle Cerebral Vein ◽  
Vein Of Labbé ◽  
Left And Right

Abstract Understanding the anatomy of the anastomotic veins (AV) of the superficial cortical venous system (SCVS), viz. superficial Sylvian vein (SSV) - also known as the superficial middle cerebral vein; vein of Labbe (VL) and vein of Trolard (VT), are imperative for neurosurgical procedures. This study aimed to investigate variant anatomical patterns of dominance of the AV, to elucidate the haemodynamically balanced SCVS, by reporting variations between the presence, diameter and dominant patterns of the AV. Two hundred lateral angiograms were included, depicting left and right cerebral hemispheres of the same patient (n = 100 patients). Angiograms were analysed and variations recorded. Results were statistically compared against laterality, age, sex and ethnicity. Presence of the VL had the highest occurrence (96.5%), whereas the SSV and VT had an occurrence of 75.5% and 64.5%, respectively. This study reports presence of double veins of the AV: SSV (12.0%), VL (22.0%) and VT (19.5%). Furthermore, presence of a triple vein for each AV is reported. Diameters for the SSV, VL and VT were 1.99 ± 0.500mm, 2.18 ± 0.579mm and 2.14 ± 0.472mm, respectively. Statistically significant relationships were established between diameters and the SSV, VL, VT and VT2 (double VT). Seven types of dominant patterns were recorded: Equilibrium; singular dominance of SSV, VL and VT; co-dominance of SSV/VL, SSV/VT and VL/VT. The Equilibrium dominant pattern of drainage had the highest occurrence (54.5%). Patterns of dominance of these AV can aid the neurosurgeon in curbing the risk of iatrogenic injury and postoperative infarcts even after an otherwise successful surgery.

The vein of Labbe masquerading as an epidural abscess

2007 ◽  
Vol 121 (8) ◽  
Author(s):  
M Kraus ◽  
I Shelef ◽  
A Niv ◽  
D M Kaplan
Keyword(s):  
Ct Scan ◽  
Computerized Tomography ◽  
Epidural Abscess ◽  
Transverse Sinus ◽  
Ct Scans ◽  
Cerebral Vein ◽  
Subperiosteal Abscess ◽  
Superficial Middle Cerebral Vein ◽  
Vein Of Labbé ◽  
Vascular Variant

AbstractThe occipitotemporal vein (OTV) courses over the temporal lobe, connecting the superficial middle cerebral vein and the transverse sinus. This vein is rarely identifiable on computerized tomography (CT) scans and a large amount of contrast is needed to identify such a relatively small vessel. We present a 12-month-old male with acute coalescent mastoiditis and a subperiosteal abscess. An epidural abscess was suspected on pre-operative CT scan. No abscess was found on surgery. Based on the surgical finding, we determined that this misdiagnosis was due to a vascular variant, the occipitotemporal vein (vein of Labbe) that masqueraded as an abcess on the CT scan. Recognition of the vein of Labbe on CT scan is therefore essential for the appropriate management of otological and neurotological disease.

scholarly journals Venous Anatomy of the Sphenoparietal Sinus: Evaluation by MR Imaging

2007 ◽  
Vol 13 (1_suppl) ◽  
pp. 84-89 ◽  
Author(s):  
S. Takahashi ◽  
I. Sakuma ◽  
T. Otani ◽  
K. Yasuda ◽  
N. Tomura ◽  
...  
Keyword(s):  
Cavernous Sinus ◽  
Three Dimensional ◽  
Venous Sinus ◽  
Cerebral Vein ◽  
Venous Anatomy ◽  
Anterior Branch ◽  
Bony Canal ◽  
Superficial Middle Cerebral Vein ◽  
Magnetic Resonance Imaging Mri ◽  
Spgr Sequence

The termination of the superficial middle cerebral vein (SMCV) has been described as entering or being partially equivalent to the venous sinus coursing under the lesser sphenoid wing, which has classically been called the sphenoparietal sinus. However, the recent literature reports that the SMCV is not connected to the sphenoparietal sinus. In this study, the venous anatomy was evaluated to clarify the anatomy of the sphenoparietal sinus and the termination of the SMCV. Magnetic resonance imaging (MRI) was performed on 1.5-T superconductive units using a three-dimensional fast spoiled gradient-recalled acquisition in the steady state (3-D fast SPGR) sequence with fat suppression in a total of 48 sides of 24 patients. Coronal source images and reconstructed axial images were displayed on the Advantage Window Console, and connections to the cavernous sinus were then evaluated for the venous sinus coursing under the lesser sphenoid wing (hereafter called the sinus of the lesser sphenoid wing), the middle meningeal vein, and the SMCV. The following findings were observed bilaterally in all patients. The sinus of the lesser sphenoid wing was connected medially with the cavernous sinus and laterally with the anterior branch of the middle meningeal vein near the pterion. The anterior branch of the middle meningeal vein entered the bony canal laterally above the junction with the sinus of the lesser sphenoid wing and coursed along the inner table of the skull or emerged into the diploic vein, indicating its parietal portion. Although the termination of the SMCV had several patterns, the SMCV was not connected with the sinus of the lesser sphenoid wing in any of the patients. The sphenoparietal sinus is considered to consist of the sinus of the lesser sphenoid wing and the parietal portion of the anterior branch of the middle meningeal vein; these were identified as venous structures distinct to the SMCV.

Vascular access

2020 ◽  
pp. 43-69
Author(s):  
Andrew Mitchell ◽  
Giovanni Luigi De Maria ◽  
Adrian Banning
Keyword(s):  
Cardiac Catheterization ◽  
Vascular Access ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Venous Access ◽  
Seldinger Technique ◽  
Access Route ◽  
Arterial Access ◽  
Alternative Approach ◽  
Different Types

This chapter discusses different types of vascular access in cardiac catheterization. It starts by describing the Seldinger technique, then goes on to explain which arterial access route to use, including difficulties and reasons for choosing an alternative approach and trends in vascular access. The ways of obtaining arterial access (both radial and femoral) are covered, and venous access is examined for the femoral, internal jugular, and subclavian veins. Anticoagulation issues including warfarin and direct oral anticoagulants are then discussed, and the chapter ends by describing compression devices and arterial closure devices.

Operative Approach Via the Superior Ophthalmic Vein for the Endovascular Treatment of Carotid Cavernous Fistulas That Fail Traditional Endovascular Access

2010 ◽  
Vol 66 (suppl_2) ◽  
pp. ons293-ons299 ◽  
Author(s):  
Stacey Quintero Wolfe ◽  
Nadia M.A. Cumberbatch ◽  
Mohammad Ali Aziz-Sultan ◽  
Ramachandra Tummala ◽  
Jacques J. Morcos
Keyword(s):  
Signs And Symptoms ◽  
Endovascular Embolization ◽  
Operative Approach ◽  
Superior Ophthalmic Vein ◽  
Contrast Extravasation ◽  
Surgical Access ◽  
Clinical Complications ◽  
Alternative Approach ◽  
Eyebrow Incision ◽  
Carotid Cavernous Fistulas

Abstract BACKGROUND Endovascular embolization is the preferred treatment for carotid-cavernous fistulas (CCFs), but failure to catheterize the cavernous sinus may occur as a result of tortuosity, hypoplasia, or stenosis of the normal venous routes. In these cases, direct operative cannulation of the arterialized superior ophthalmic vein (SOV) offers an excellent alternative approach. METHODS We reviewed the records of patients who underwent surgical cannulation of the SOV in preparation for embolization and identified 10 patients with indirect CCF, all of whom presented with ocular signs and symptoms. All had previously undergone unsuccessful endovenous attempts at treatment at our institution. In the operating room, the SOV was catheterized under microscopic magnification through an eyelid or eyebrow incision, and the patients were taken directly to the angiographic suite for embolization. RESULTS In 9 of 10 patients, embolization of the CCF was complete with clinical improvement. In 1 case, navigation of the catheter into the SOV proved difficult, and the procedure was aborted because of contrast extravasation after partial embolization. One patient required a small orbital osteotomy to localize the SOV. There were no clinical complications and no known recurrences. Cosmetic results were excellent in all patients. CONCLUSION Surgical access to the superior ophthalmic vein for embolization of a CCF is an excellent and definitive alternative treatment when traditional endovenous routes are inaccessible. The operative approach to the SOV is straightforward and can be performed safely and expeditiously by the neurovascular team.

Squamosal type superficial middle cerebral vein: A rare venous drainage pattern

2012 ◽  
Vol 60 (5) ◽  
pp. 546 ◽  
Author(s):  
PS Chandra ◽  
DipankerS Mankotia ◽  
Manjari Tripathi ◽  
Ajay Garg ◽  
AshokK Mahapatra ◽  
...  
Keyword(s):  
Venous Drainage ◽  
Cerebral Vein ◽  
Drainage Pattern ◽  
Superficial Middle Cerebral Vein

scholarly journals Prognostic Evaluation Based on Cortical Vein Score Difference in Stroke

Stroke ◽  
2013 ◽  
Vol 44 (10) ◽  
pp. 2748-2754 ◽  
Author(s):  
Rajsrinivas Parthasarathy ◽  
Mahesh Kate ◽  
Jeremy L. Rempel ◽  
David S. Liebeskind ◽  
Thomas Jeerakathil ◽  
...  
Keyword(s):  
Ct Angiography ◽  
Odds Ratio ◽  
Arterial Occlusion ◽  
Venous Drainage ◽  
Cerebral Vein ◽  
Anterior Circulation ◽  
Prognostic Evaluation ◽  
Cortical Vein ◽  
Score Difference ◽  
Superficial Middle Cerebral Vein

Background and Purpose— Multimodal imaging in acute ischemic stroke defines the extent of arterial collaterals, resultant penumbra, and associated infarct core, yet limitations abound. We identified superficial and deep venous drainage patterns that predict outcomes in patients with a proximal arterial occlusion of the anterior circulation. Methods— An observational study that used computed tomography (CT) angiography to detail venous drainage in a consecutive series of patients with a proximal anterior circulation arterial occlusion. The principal veins that drain the cortex (superficial middle cerebral, vein of Trolard, vein of Labbé, and basal vein of Rosenthal) and deep structures were scored with a categorical scale on the basis of degree of contrast enhancement. The Prognostic Evaluation based on Cortical vein score difference In Stroke score encompassing the interhemispheric difference of the composite scores of the veins draining the cortices (superficial middle cerebral+vein of Trolard+vein of Labbé+basal vein of Rosenthal) was analyzed with respect to 90-day modified Rankin Scale outcomes. Results— Thirty-nine patients were included in the study. A Prognostic Evaluation based on Cortical vein score difference In Stroke score of 4 to 8 accurately predicted poor outcomes (modified Rankin Scale, 3–6; odds ratio, 20.53; P <0.001). On stepwise logistic regression analyses adjusted for CT Alberta stroke program early CT score, CT angiography collateral grading and National Institutes of Health Stroke Scale score, a Prognostic Evaluation based on Cortical vein score difference In Stroke score of 4 to 8 (odds ratio, 23.598; P =0.009) and an elevated admission National Institutes of Health Stroke Scale (odds ratio, 1.423; P =0.023) were independent predictors of poor outcome. Conclusions— The Prognostic Evaluation based on Cortical vein score difference In Stroke score, a novel measure of venous enhancement on CT angiography, accurately predicts clinical outcomes. Venous features on computed tomography angiography provide additional characterization of collateral perfusion and prognostication in acute ischemic stroke.

Far Posterior Subtemporal Approach to the Dorsolateral Brainstem and Tentorial Ring: Technique and Clinical Experience

Neurosurgery ◽  
2003 ◽  
Vol 52 (2) ◽  
pp. 364-369 ◽  
Author(s):  
Edward R. Smith ◽  
Paul H. Chapman ◽  
Christopher S. Ogilvy
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Arteriovenous Malformation ◽  
Transverse Sinus ◽  
Dural Arteriovenous Malformation ◽  
Trochlear Nerve ◽  
Temporal Fossa ◽  
Cavernous Malformations ◽  
Subtemporal Approach ◽  
Surgical Access ◽  
Vein Of Labbé

Abstract OBJECTIVE Surgical access to the posterolateral mesencephalon or tentorial ring can be problematic, depending on the angle of the tentorium and associated venous structures. A far posterior subtemporal approach was developed that uses the wide opening of the tentorium and the option of supratentorial retraction of the cerebellum to provide an excellent angle of approach to this region. Details of this technique and a series of eight patients with lesions treated by this approach are presented. METHODS Seven cavernous malformations and one dural arteriovenous malformation were approached in eight patients. In this far posterior subtemporal approach, a horseshoe incision is centered slightly behind the ear, with the caudal extent of the craniotomy defined by the temporal fossa floor. The entry of the vein of Labbé into transverse sinus is identified intradurally. If the vein enters anteriorly in the exposure, it is mobilized. Retractors are then placed, and the tentorium is visualized and opened laterally, avoiding the trochlear nerve. A thin, tapered retractor can be used to retract the cerebellum posterolaterally away from the brainstem. RESULTS This approach was used to treat eight patients, and their lesions were successfully resected. Seven patients experienced good outcomes, and one patient, who presented with Hunt-Hess Grade IV subarachnoid hemorrhage from a dural arteriovenous malformation, experienced a fair outcome. CONCLUSION The far posterior subtemporal approach is effective for approaching carefully selected lesions of the posterolateral mesencephalon and tentorial ring.

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