Saphenous vein graft bypass of the sigmoid sinus and jugular bulb during the removal of glomus jugulare tumors

✓ Glomus jugulare tumors always invade the jugular bulb and sigmoid sinus, making it difficult to resect these tumors totally without sacrificing the involved sinus. Although the sinus can be sacrificed safely in most patients, a few patients will have serious consequences. Reconstruction of the jugular bulb using a saphenous vein graft may enable tumor resection in these patients without complications. The authors describe two cases of saphenous vein grafting used to bypass the sigmoid sinus. The first case is that of a 61-year-old man with a glomus jugulare tumor that invaded the dominant sigmoid sinus, which was poorly collateralized. Temporary occlusion of the sinus during surgery caused a 15-mm Hg increase in intrasinus pressure, without brain swelling or changes in evoked potentials. A saphenous vein graft was used to bypass the sigmoid sinus and jugular bulb and to allow for total tumor removal. The patient had a good outcome. The second case is that of a 41-year-old man with a left glomus jugulare tumor and another smaller tumor on the opposite, dominant sinus. The left glomus jugulare tumor was resected via a two-stage procedure. A saphenous vein graft was used to reconstruct the left sigmoid sinus because of the presence of contralateral disease, with the potential for bilateral sigmoid sinus occlusion. An evaluation of the venous collateral circulation during jugular foramen surgery and the prevention of complications are also discussed.

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Cerebral revascularization to a main limb of the middle cerebral artery in the Sylvian fissure

Journal of Neurosurgery ◽

10.3171/jns.1985.63.1.0021 ◽

1985 ◽

Vol 63 (1) ◽

pp. 21-29 ◽

Cited By ~ 27

Author(s):

Fernando G. Diaz ◽

Felix Umansky ◽

Bharat Mehta ◽

Salvador Montoya ◽

Manuel Dujovny ◽

...

Keyword(s):

Carotid Artery ◽

Middle Cerebral Artery ◽

Cerebral Artery ◽

Saphenous Vein ◽

Vein Graft ◽

Saphenous Vein Graft ◽

Sylvian Fissure ◽

External Carotid ◽

Content Type ◽

Fine Print

✓ Thirteen patients underwent an anastomosis of the superficial temporal artery (STA) or a saphenous vein graft to one of the secondary trunks of the middle cerebral artery (MCA). They included five patients with giant MCA trifurcation aneurysms, four patients in whom an earlier conventional STA-MCA anastomosis had become occluded, two patients who had stenosis of one of the secondary limbs of the MCA, and one patient who had a carotid-cavernous fistula. One patient had a saphenous vein graft from the common carotid artery to a secondary trunk of the MCA to bypass an occluded internal carotid artery and severely stenosed external carotid artery. The primary advantages of this procedure are that a large-caliber anastomosis to one of the secondary limbs of the MCA immediately restores flow into the MCA tree with a larger amount of vessel filling than with a standard cortical bypass, and large vessels can be used for the anastomosis. The disadvantages are that one of the secondary branches of the MCA must be occluded, the cerebral hemisphere around the Sylvian fissure must be retracted, a lumbar subarachnoid drain is needed, and the anastomosis must be performed deep within the Sylvian fissure. The procedure is a satisfactory alternative in cases in which a conventional STA-MCA anastomosis has either failed or would be less likely to succeed.

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Saphenous vein graft bypass of the cavernous internal carotid artery

Journal of Neurosurgery ◽

10.3171/jns.1990.72.1.0035 ◽

1990 ◽

Vol 72 (1) ◽

pp. 35-41 ◽

Cited By ~ 118

Author(s):

Laligam N. Sekhar ◽

Chandra N. Sen ◽

Hae Dong Jho

Keyword(s):

Saphenous Vein ◽

Vein Graft ◽

Internal Carotid ◽

Saphenous Vein Graft ◽

Balloon Occlusion ◽

Neurological Deficits ◽

Content Type ◽

Occlusion Test ◽

Balloon Occlusion Test ◽

Fine Print

✓ Saphenous vein graft reconstruction was performed from the petrous to the supraclinoid internal carotid artery (ICA) to replace the cavernous ICA in six patients during direct intracavernous operations. Four of these patients had intracavernous neoplasms with invasion of the ICA and two had intracavernous ICA aneurysms that could not be clipped or occluded with intraluminal balloons. All but one patient had evidence of poor collateral flow reserve in a balloon occlusion test of the ICA. The superficial temporal artery was not present in four patients, was minuscule in one, and was damaged during the initial dissection in another, making it unsuitable for superficial temporal-to-middle cerebral artery branch anastomosis. Blood flow within the graft could not be established intraoperatively in one patient (who had excellent collateral circulation) due to the small size of the vein (3 mm). In all others, the grafts were patent on follow-up arteriography and transcranial Doppler studies. Three patients who had severe reduction of cerebral blood flow during test occlusion of the ICA exhibited temporary hemispheric neurological deficits postoperatively; the deficits were related to the duration of temporary ICA occlusion. All three recovered completely without evidence of infarction on computerized tomography (CT). One patient who clinically could not tolerate the balloon occlusion test of the ICA also had temporary neurological deficits with good recovery but showed evidence of border-zone infarction on CT scans. The present role of saphenous vein graft bypass of the cavernous ICA is discussed.

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Glomus jugulare tumor presenting with increased intracranial pressure

Journal of Neurosurgery ◽

10.3171/jns.1979.50.6.0823 ◽

1979 ◽

Vol 50 (6) ◽

pp. 823-825 ◽

Cited By ~ 12

Author(s):

David W. Beck ◽

Neal F. Kassell ◽

Charles G. Drake

Keyword(s):

Intracranial Pressure ◽

Visual Loss ◽

Intracranial Extension ◽

Increased Intracranial Pressure ◽

Content Type ◽

Glomus Jugulare Tumor ◽

Glomus Jugulare ◽

Venous Sinuses ◽

Arterial Blood ◽

Fine Print

✓ The authors report a case of glomus jugulare tumor presenting with papilledema and visual loss. The tumor was extremely vascular with significant shunting of arterial blood into venous sinuses. There was no intracranial extension of tumor, and papilledema resolved after removal of the lesion.

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Reversed-flow saphenous vein grafts for cerebral revascularization

Journal of Neurosurgery ◽

10.3171/jns.1997.87.5.0795 ◽

1997 ◽

Vol 87 (5) ◽

pp. 795-797 ◽

Cited By ~ 14

Author(s):

Carlos A. David ◽

Joseph M. Zabramski ◽

Robert F. Spetzler

Keyword(s):

Blood Flow ◽

Saphenous Vein ◽

Vein Graft ◽

Saphenous Vein Graft ◽

Bypass Graft ◽

Illustrative Case ◽

Reversed Flow ◽

Content Type ◽

Vein Grafts ◽

Good Patency

✓ The authors sought to create a saphenous vein interposition graft to be used in cerebral bypass procedures that would be more physiologically appropriate than standard vein grafts and would provide a better match between the graft and recipient vessels at the anastomotic sites. The saphenous vein graft was prepared by lysing the valves with a valvulotome. The blood flow could then be reversed in the vein, allowing it to be used in either direction as a bypass graft. An illustrative case including angiograms that confirm good patency and blood flow through the reversed-flow bypass graft is presented. It is concluded that the reversed-flow saphenous vein graft provides a more physiologically suitable conduit than standard vein grafts. Lysis of the valves allows the graft to be used in an orientation that takes advantage of the natural tapering of the vein to produce a better match with the recipient vessels at the anastomotic sites. Minimizing diameter changes at the proximal and distal anastomoses helps reduce turbulence, which has been implicated as a cause of early graft failure and thrombosis.

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Topical organization of the distal portion of the facial nerve

Journal of Neurosurgery ◽

10.3171/jns.1980.52.5.0671 ◽

1980 ◽

Vol 52 (5) ◽

pp. 671-673 ◽

Cited By ~ 20

Author(s):

Ludwig G. Kempe

Keyword(s):

Facial Nerve ◽

Distal Portion ◽

Content Type ◽

Glomus Jugulare Tumor ◽

Glomus Jugulare ◽

Anatomical Arrangement ◽

Distal Section ◽

Fine Print ◽

Stimulation Of

✓ Intraoperative stimulation of the distal section of the facial nerve was performed in 29 patients undergoing surgery for glomus jugulare tumor. A definite and persistent topical anatomical arrangement was observed.

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