scholarly journals Posterior Fossa Venous Drainage

2021 ◽  
Vol 12 ◽  
Author(s):  
María Angeles de Miquel
Keyword(s):  
Posterior Fossa ◽  
Special Interest ◽  
Fetal Development ◽  
Venous Drainage ◽  
Inferior Petrosal Sinus ◽  
Vein Of Galen ◽  
Venous Anatomy ◽  
Anatomical Structures ◽  
Superior Petrosal Sinus

This paper aims to make simple the evaluation of the main veins related to the brainstem and cerebellum. Posterior fossa venous drainage is best understood in context with its three main collectors: superior: toward the Vein of Galen; posterior: toward the torcular complex; and anterior: toward the superior petrosal sinus. A fourth possible drainage path, often harder to distinguish, is directed toward the inferior petrosal sinus. Veins of these four systems are frequently connected to one another. Despite traditionally being considered less regular than its arterial disposition, posterior fossa venous anatomy follows specific patterns that are easy to identify. The three more representative veins of each venous confluent have been selected, to help in recognizing them angiographically. Since pial large veins are primarily located over the surface of the encephalon, most related anatomical structures can be confidently identified. This is of special interest when angiographic 2D or 3D studies are evaluated and provide fundamental assistance in locating precise structures. To better aid in understanding venous disposition, an overview of embryologic and fetal development is also discussed.

scholarly journals Petrosal Approach With Preservation of the Superior Petrosal Sinus (the Graceful Petrosal) for Resection of Giant Trigeminal Schwannoma: 2-Dimensional Operative Video

2021 ◽  
Vol 20 (5) ◽  
pp. E342-E343
Author(s):  
Kaith K Almefty ◽  
Ossama Al-Mefty
Keyword(s):  
Magnetic Resonance ◽  
Surgical Resection ◽  
Posterior Fossa ◽  
Tumor Resection ◽  
Venous Drainage ◽  
Petrous Apex ◽  
Benign Tumors ◽  
Nerve Function ◽  
Trigeminal Schwannoma ◽  
Superior Petrosal Sinus

Abstract Trigeminal schwannomas are benign tumors amendable to curative surgical resection.1 Excellent outcomes, with preservation and improvement of cranial nerve function, including trigeminal nerve function, have been reported with microsurgical resection through skull base approaches.2 Dumbell shaped tumors, involving the middle and posterior fossa, are more challenging.3 They are resected via a middle cranial fossa approach with the expanded Meckel cave providing access to the posterior fossa. However, tumors with a large caudal extension below the internal auditory meatus typically cannot be adequately accessed with this approach and the posterior petrosal approach is utilized.2 Specific venous anatomy might deter from cutting the tentorium. This article describes the surgical resection of a trigeminal schwannoma with a large posterior fossa component through a petrosal approach without cutting the tentorium.4 The patient is a 34-yr-old man who presented with headaches and gait disturbance. Neurological exam revealed hypoesthesia and hypoalgesia in the left V1 and V2 distributions. Magnetic resonance imaging (MRI) revealed a large dumbbell-shaped schwannoma causing brainstem compression. Magnetic resonance venography (MRV) demonstrated temporal lobe venous drainage into the superior petrosal sinus and tentorium proximal to the transverse sigmoid junction. A single temporal-suboccipital bone flap and a retro-labrynthine mastoidectomy were performed. The petrous apex was drilled and Meckle's cave opened. The presigmoid dura was opened and extended toward the petrous apex region beneath the tentorium. This provided access to and safe resection of the tumor. A gross total tumor resection was achieved. The patient remained stable neurologically and was without tumor recurrence at 3 yr postoperatively. The patient had consented to the procedure. Figures in video at 4:06 from Jafez et al, Preservation of the superior petrosal sinus during the petrosal approach, J Neurosurg. 2011;114(5):1294-1298, with permission from JNSPG.

A cardiopulmonary bypass strategy to support a patient with vein of Galen malformation

Perfusion ◽  
2021 ◽  
pp. 026765912110015
Author(s):  
Alex Robertson ◽  
Nagarajan Muthialu ◽  
Mike Broadhead
Keyword(s):  
Cardiopulmonary Bypass ◽  
Surgical Repair ◽  
Circulatory Arrest ◽  
Ductus Arteriosus ◽  
Venous Drainage ◽  
Deep Hypothermic Circulatory Arrest ◽  
Vein Of Galen ◽  
Vein Of Galen Malformation ◽  
Neurological Sequelae ◽  
Ph Stat

We present a dissection of the patent ductus arteriosus and pulmonary artery for surgical repair utilising cardiopulmonary bypass in the setting of vein of Galen malformation. Several strategies were employed to attenuate the cerebral shunt including pH-stat, high cardiac index, restrictive venous drainage, continuous ventilation and deep hypothermic circulatory arrest. The patient recovered from surgery with no apparent neurological sequelae.

Characteristics of Brain Arteriovenous Malformations Presenting with Seizures without Acute or Remote Hemorrhage

2011 ◽  
Vol 24 (6) ◽  
pp. 886-888 ◽  
Author(s):  
P. Jiang ◽  
X. Lv ◽  
Z. Wu ◽  
Y. Li ◽  
C. Jiang ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Posterior Fossa ◽  
Arteriovenous Malformations ◽  
Venous Drainage ◽  
Brain Arteriovenous Malformations ◽  
Male Sex

We report on the predictors of seizure presention in unruptured brain arteriovenous malformations (AVMs). Between 1999 and 2008, 302 consecutive patients with AVMs were referred to our institution for endovascular treatment. Seventy-four patients (24.5%) experienced seizures without hemorrhage before treatment. We tested for statistical associations between angioarchitectural characteristics and seizure presentation. When we compared the 74 patients with seizures without hemorrhage with the 228 patients who did not experience seizures initially (total of 302 patients), male sex, cortical AVM location, AVM size of more than 3 cm, superficial venous drainage and presence of varices in the venous drainage were statistically associated with seizures (P=0.016, P=0.002, P=0.022, P=0.005, and P=0.022, respectively). Posterior fossa and deep locations and coexisting aneurysms were statistically associated with no seizures. The angioarchitectural characteristics of AVM associated with seizure presentation include male sex, cortical AVM location, AVM size of more than 3 cm, superficial venous drainage and presence of varices in the venous drainage.

scholarly journals The role of bilateral inferior petrosal sinus sampling in the diagnosis of Cushing's syndrome

2007 ◽  
Vol 51 (8) ◽  
pp. 1329-1338 ◽  
Author(s):  
Andrea Utz ◽  
Beverly M.K. Biller
Keyword(s):  
Cushing’S Syndrome ◽  
Venous Drainage ◽  
Cushing's Syndrome ◽  
Blood Levels ◽  
Inferior Petrosal Sinus ◽  
Ectopic Acth ◽  
Inferior Petrosal Sinus Sampling ◽  
Neoplastic Lesion ◽  
Before And After ◽  
Acth Secreting

Adrenocorticotropin hormone (ACTH)-dependent Cushing's syndrome is most often due to a pituitary corticotroph adenoma, with ectopic ACTH-secreting tumors representing approximately 15% of cases. Biochemical and radiological techniques have been established to help distinguish between these two entities, and thus aid in the localization of the neoplastic lesion for surgical resection. The test that offers the highest sensitivity and specificity is bilateral inferior petrosal sinus sampling (BIPSS). BIPSS is an interventional radiology procedure in which ACTH levels obtained from venous drainage very near the pituitary gland are compared to peripheral blood levels before and after corticotropin hormone (CRH) stimulation. A gradient between these two locations indicates pituitary Cushing's, whereas the absence of a gradient suggests ectopic Cushing's. Accurate BIPSS results require hypercortisolemia to suppress normal corticotroph ACTH production and hypercortisolemia at the time of the BIPSS to assure excessive ACTH secretion. In some cases, intrapituitary gradients from side-to-side can be helpful to localize small corticotroph adenomas within the sella. BIPSS has rare complications and is considered safe when performed at centers with experience in this specialized technique.

Surgical Management Of Posterior Fossa Arteriovenous Malformations

2006 ◽  
Vol 58 (suppl_4) ◽  
pp. ONS-189-ONS-201 ◽  
Author(s):  
John Sinclair ◽  
Michael E. Kelly ◽  
Gary K. Steinberg
Keyword(s):  
Stereotactic Radiosurgery ◽  
Surgical Resection ◽  
Posterior Fossa ◽  
Arteriovenous Malformations ◽  
Cranial Nerves ◽  
Venous Drainage ◽  
Cerebellar Nuclei ◽  
Preoperative Embolization ◽  
Frameless Stereotaxy ◽  
Microsurgical Resection

Abstract Objective: Arteriovenous malformations (AVMs) involving the cerebellum and brainstem are relatively rare lesions that most often present clinically as a result of a hemorrhagic episode. Although these AVMs were once thought to have a more aggressive clinical course in comparison with supratentorial AVMs, recent autopsy data suggests that there may be little difference in hemorrhage rates between the two locations. Although current management of these lesions often involves preoperative embolization and stereotactic radiosurgery, surgical resection remains the treatment of choice, conferring immediate protection to the patient from the risk of future hemorrhage. Methods: Most symptomatic AVMs that involve the cerebellum and the pial or ependymal surfaces of the brainstem are candidates for surgical resection. Preoperative angiography and magnetic resonance imaging studies are critical to determine suitability for resection and choice of operative exposure. In addition to considering the location of the nidus, arterial supply, and predominant venous drainage, the surgical approach must also be selected with consideration of the small confines of the posterior fossa and eloquence of the brainstem, cranial nerves, and deep cerebellar nuclei. Results: Since the 1980s, progressive advances in preoperative embolization, frameless stereotaxy, and intraoperative electrophysiologic monitoring have significantly improved the number of posterior fossa AVMs amenable to microsurgical resection with minimal morbidity and mortality. Conclusion: Future improvements in endovascular technology and stereotactic radiosurgery will likely continue to increase the number of posterior fossa AVMs that can safely be removed and further improve the clinical outcomes associated with microsurgical resection.

scholarly journals Posterior Fossa Dural Arteriovenous Fistulas with Subarachnoid Venous Drainage: Outcomes of Endovascular Treatment

2019 ◽  
Vol 40 (8) ◽  
pp. 1363-1368 ◽  
Author(s):  
L. Détraz ◽  
K. Orlov ◽  
V. Berestov ◽  
V. Borodetsky ◽  
A. Rouchaud ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Posterior Fossa ◽  
Venous Drainage ◽  
Arteriovenous Fistulas ◽  
Dural Arteriovenous Fistulas

scholarly journals Lateralization of inferior petrosal sinus sampling in Cushing's disease correlates with cavernous sinus venous drainage patterns, but not tumor lateralization

Heliyon ◽  
2020 ◽  
Vol 6 (10) ◽  
pp. e05299
Author(s):  
Mohammad Ghorbani ◽  
Hamideh Akbari ◽  
Christoph J. Griessenauer ◽  
Christoph Wipplinger ◽  
Alireza Dastmalchi ◽  
...  
Keyword(s):  
Cavernous Sinus ◽  
Cushing’S Disease ◽  
Venous Drainage ◽  
Cushing's Disease ◽  
Inferior Petrosal Sinus ◽  
Inferior Petrosal Sinus Sampling ◽  
Drainage Patterns

Common and Uncommon Variations of Pulmonary Venous Drainage in Patients Undergoing Thoracoscopic Lobectomy

2019 ◽  
Vol 68 (03) ◽  
pp. 256-260 ◽  
Author(s):  
Dario Amore ◽  
Dino Casazza ◽  
Pasquale Imitazione ◽  
Carlo Curcio
Keyword(s):  
Pulmonary Vein ◽  
Thoracoscopic Surgery ◽  
Pulmonary Veins ◽  
Lower Lobe ◽  
Venous Drainage ◽  
Middle Lobe ◽  
Vascular Anomalies ◽  
Apical Segment ◽  
Venous Anatomy ◽  
Video Assisted Thoracoscopic Surgery

Abstract Background Variations in pulmonary venous anatomy should not be undermined by thoracic surgeons during procedures which involve the pulmonary veins. Methods We have identified vascular anomalies in 25 of 346 patients undergoing video-assisted thoracoscopic surgery lobectomy at our Thoracic Surgery Unit, between December 2016 and November 2018. Results Some vascular anomalies described have not been reported in recent literature and include right V7 draining into the middle lobe pulmonary vein, accessory right V6 behind the bronchus intermedius, two V6 from the apical segment of left lower lobe, two V6 from the apical segment of right lower lobe, and one of them draining into the superior pulmonary vein. Conclusion Thoracic surgeons should be aware of this type of anomalies because failure in the preoperative or intraoperative identification of the pulmonary venous variations may lead to serious complications.

The Management of Vein of Galen Aneurysmal Malformations

Neurosurgery ◽  
2006 ◽  
Vol 59 (suppl_5) ◽  
pp. S3-184-S3-194 ◽  
Author(s):  
Pierre L. Lasjaunias ◽  
Soke M. Chng ◽  
Marina Sachet ◽  
Hortensia Alvarez ◽  
Georges Rodesch ◽  
...  
Keyword(s):  
Arteriovenous Malformation ◽  
Normal Growth ◽  
Venous Drainage ◽  
Treatment Method ◽  
Growth Conditions ◽  
Endovascular Embolization ◽  
Therapeutic Window ◽  
Vein Of Galen ◽  
Neurologically Normal ◽  
Level Of Understanding

Abstract OBJECTIVE: The vein of Galen aneurysmal malformation (VGAM) is a choroidal type of arteriovenous malformation involving the vein of Galen forerunner. This is distinct from an arteriovenous malformation with venous drainage into a dilated, but already formed, vein of Galen. Reports of endovascular treatment of VGAM in the literature approach the disease from a purely technical viewpoint and often fail to provide satisfactory midterm results. To focus the therapeutic challenge to a strictly morphological goal overlooks the fundamental aspects of neonatal and infant anatomy and fluid physiology. During the past 20 years, our approach to VGAM has remained the same. Our experience, based on 317 patients with VGAM who were studied in Hospital Bicêtre between October 1981 and October 2002, allows us to describe the angioarchitecture, natural history, and management of VGAM in neonates, infants, and children. METHODS: Of our cohort of 317 patients, 233 patients were treated with endovascular embolization; of these, 216 patients were treated in our hospital. The treatment method of choice was a transfemoral arterial approach to deliver glue at the fistulous zone. RESULTS: Of 216 patients, 23 died despite or because of the embolization (10.6%). Twenty out of the 193 (10.4%) surviving patients were severely retarded, 30 (15.6%) were moderately retarded, and 143 (74%) were neurologically normal on follow-up. CONCLUSION: Our data demonstrate that most treated children survive and undergo normal neurological development; an understanding of the clinical, anatomical, and pathophysiological features of VGAM has, therefore, reversed the former poor prognosis. Our level of understanding about the lesion allows us to predict most situations and remedy them by applying a strict evaluation protocol and working within an optimal therapeutic window. Patient selection and timing remain the keys in the management of this condition. It is more important to restore normal growth conditions than a normal morphological appearance, with the primary therapeutic objective being normal development in a child without neurological deficit.

scholarly journals Symptomatic Infratentorial Thrombosed Developmental Venous Anomaly: Case Report and Review of the Literature

2015 ◽  
Vol 4 (3-4) ◽  
pp. 130-137 ◽  
Author(s):  
Krishna Amuluru ◽  
Fawaz Al-Mufti ◽  
Stephen Hannaford ◽  
Inder Paul Singh ◽  
Charles J. Prestigiacomo ◽  
...  
Keyword(s):  
Posterior Fossa ◽  
High Dose ◽  
Developmental Venous Anomaly ◽  
Venous Anatomy ◽  
Short Term ◽  
Related Complication ◽  
Rare Type ◽  
Efficacious Treatment ◽  
Drainage Vein ◽  
Developmental Venous Anomalies

Background: Developmental venous anomalies (DVAs) are variations of normal transmedullary veins draining white and gray matter. In the vast majority of cases, DVAs are diagnosed incidentally and should be considered as benign entities. In extremely rare circumstances, DVAs may become symptomatic due to mechanical or flow-related etiologies. Thrombosis of the collector vein of a DVA is a rare type of a flow-related complication with only 29 cases reported in the literature, the majority of which are supratentorial. Infratentorial thrombosed DVAs are thus extremely rare and the few cases reported have typically caused symptoms due to venous ischemic infarctions. Summary: We report a case of an infratentorial DVA with a thrombosed drainage vein in a patient with nonhemorrhagic, noninfarcted venous congestive edema, which was successfully treated with high-dose glucocorticoids and short-term anticoagulation. We review the pertinent venous anatomy of the posterior fossa as well as the literature of symptomatic infratentorial thrombosed DVAs. Key Message: The presented case of an infratentorial thrombosed DVA with cerebellar and pontine venous congestive edema is extremely rare. A working knowledge of posterior fossa venous anatomy and possible pathomechanisms responsible for the rarely symptomatic lesion will aid in the timely and efficacious treatment of such lesions.

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