Venous-Preserving Sylvian Dissection

Maekawa, Hidetsugu; Hadeishi, Hiromu

doi:10.1016/j.wneu.2015.07.050

Cited by 32 publications

(24 citation statements)

References 16 publications

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“…For example, a vein-preserving sylvian fissure dissection is important to avoid venous infarction, which can dramatically affect patient outcomes. 16,17 Neuronavigation systems can be used to help anticipate surgical trajectories. Our model is, to the best of our knowledge, the first attempt to assess vascular integrity using a sound alert if there is any contact between the surgical instrument and a metal wire representing an intracranial vessel.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the effect of standard neuronavigation and augmented reality on the integrity of the perifocal structures during a neurosurgical approach

Davidovic

Chavaz

Meling

et al. 2021

Neurosurgical Focus

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OBJECTIVE Intracranial minimally invasive procedures imply working in a restricted surgical corridor surrounded by critical structures, such as vessels and cranial nerves. Any damage to them may affect patient outcome. Neuronavigation systems may reduce the risk of such complications. In this study, the authors sought to compare standard neuronavigation (NV) and augmented reality (AR)–guided navigation with respect to the integrity of the perifocal structures during a neurosurgical approach using a novel model imitating intracranial vessels. METHODS A custom-made box, containing crisscrossing hard metal wires, a hidden nail at its bottom, and a wooden top, was scanned, fused, and referenced for the purpose of the study. The metal wires and an aneurysm clip applier were connected to a controller, which counted the number of contacts between them. Twenty-three naive participants were asked to 1) use NV to define an optimal entry point on the top, perform the smallest craniotomy possible on the wooden top, and to use a surgical microscope when placing a clip on the nail without touching the metal wires; and 2) use AR to preoperatively define an ideal trajectory, navigate the surgical microscope, and then perform the same task. The primary outcome was the number of contacts made between the metal wires and the clip applier. Secondary outcomes were craniotomy size, and trust in NV and AR to help avoid touching the metal wires, as assessed by a 9-level Likert scale. RESULTS The median number of contacts tended to be lower with the use of AR than with NV (AR, median 1 [Q1: 1, Q3: 2]; NV, median 3 [Q1: 1, Q3: 6]; p = 0.074). The size of the target-oriented craniotomy was significantly lower with the use of AR compared with NV (AR, median 4.91 cm2 [Q1: 4.71 cm2, Q3: 7.55 cm2]; and NV, median 9.62 cm2 [Q1: 7.07 cm2; Q3: 13.85 cm2]). Participants had more trust in AR than in NV (the differences posttest minus pretest were mean 0.9 [SD 1.2] and mean −0.3 [SD 0.2], respectively; p < 0.05). CONCLUSIONS The results of this study show a trend favoring the use of AR over NV with respect to reducing contact between a clip applier and the perifocal structures during a simulated clipping of an intracranial aneurysm. Target-guided craniotomies were smaller with the use of AR. AR may be used not only to localize surgical targets but also to prevent complications associated with damage to structures encountered during the surgical approach.

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Section: Discussionmentioning

confidence: 99%

Evaluation of the effect of standard neuronavigation and augmented reality on the integrity of the perifocal structures during a neurosurgical approach

Davidovic

Chavaz

Meling

et al. 2021

Neurosurgical Focus

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“…The peeling off of the arachnoid membrane that wraps the SSVs allows the vein to stretch, and freeing the veins from the brain enables the vein to be lifted when the brain moves away from the dura at the skull base. 9,11 These maneuvers were used in our series before the SPST technique was performed. However, in the cases in which the tributaries from the obstructive bridging veins were situated near the side of the skull base, the bridging segments of these veins were not stretched effectively with these manipulations.…”

Section: Discussionmentioning

confidence: 99%

“…5,6 Although clinical complications caused by intracranial venous sacrifice are rare, 7 sacrifice of these veins can cause venous congestion, hemorrhage, and edema in cases in which the sacrificed veins that are damaged during surgery are involved in major drainage pathways. 6,8,9 At present, there is no established method for predicting the consequences of sacrificing the veins. Thus, surgeons should aim to preserve intracranial veins while reserving a wide enough space within the surgical field for safe manipulation.…”

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confidence: 99%

Sphenoparietal sinus transposition technique: optimization of the surgical corridor with preservation of prominent bridging veins between the brain and the cranial base during aneurysm clipping via the pterional approach

Niibo

Takizawa

Sakurai

et al. 2021

Journal of Neurosurgery

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OBJECTIVEThe sylvian bridging veins between the brain and the dura on the inner surface of the sphenoid wing can restrict brain retraction for widening of the lateral retrocarotid space during clipping surgery for internal carotid artery (ICA)–posterior communicating artery (PCoA) and basilar apex (BX) aneurysms. In such cases, the authors perform extradural anterior clinoidectomy with peeling of the temporal dura propria from the periosteal dura and inner cavernous membrane around the superior orbital fissure, with the incision of the dura mater stretching from the base of the temporal side to just before the distal dural ring of the ICA (termed by the authors as the sphenoparietal sinus transposition [SPST] technique). This technique displaces the bridging segment of the sylvian vein posteriorly and enables widening of the surgical space without venous injury. In this study, the authors observed the operative nuances and investigated the usefulness of this technique.METHODSThe authors retrospectively reviewed the medical charts of 66 consecutive patients with ICA-PCoA and BX aneurysms between January 2016 and July 2018. This technique was performed in 8 patients (5 patients with PCoA aneurysms and 3 with BX aneurysms) in whom the bridging segments of the sylvian veins between the brain and the skull base restricted brain retraction for widening of the surgical space. The surface areas of the lateral retrocarotid space and the aneurysm were measured at the most visible working angle before and after the SPST technique was performed.RESULTSWith the use of the SPST technique, an adequate surgical space for aneurysm clipping was obtained with preservation of the bridging veins in all patients. The mean surface areas of the lateral retrocarotid space (p = 0.002) and aneurysm (p = 0.001) were significantly increased from 18.3 ± 18.8 and 2.8 ± 2.5 cm2 before to 64.2 ± 21.1 and 20.9 ± 20.6 cm2, respectively, after the SPST technique was performed.CONCLUSIONSThe SPST technique enables displacement of the bridging segments of the sylvian veins without venous injury and enables widening of the surgical space around the lateral retrocarotid area.

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“…Some reports recommend dissection between multiple SMCVs or between the SMCV and the temporal lobe in the trans-sylvian approach for such ideal dissection of the SMCV. 17,18,[26][27][28][29][30][39][40][41] In our 116 cases, almost FSVs and FBBVs, and all SMCVs (FST, SMCCT, TST) and TSVs were preserved. The mobility of the frontal and temporal lobes was sufficient to obtain the wide operative field in almost cases.…”

Section: Table 3 Characteristics Of Type E Smcvmentioning

confidence: 96%

“…9,12,15,16,[23][24][25] Recently, dissection between multiple SMCVs or between the SMCV and the temporal lobe has been recommended. 17,18,[26][27][28][29] However, the method of dissection is rarely discussed in detail in the clinical literature, and a consensus for a best approach has not been obtained, 8,17,18,22,27,28,30) likely due to the various patterns of SMCV anastomoses.…”

Section: Introductionmentioning

confidence: 99%

Dissection of the Sylvian Fissure in the Trans-sylvian Approach Based on the Morphological Classification of the Superficial Middle Cerebral Vein

Imada

Mihara

Kawamoto

et al. 2021

Neurol. Med. Chir.(Tokyo)

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The superficial middle cerebral vein (SMCV) is one of the main factors that can impede a wide opening of the sylvian fissure. To reveal the most efficient SMCV dissection for a wide operative field while preserving the veins in the trans-sylvian approach, we retrospectively investigated the SMCVs through intraoperative video images. We characterized the SMCV as composed of the frontosylvian trunk (FST; receiving frontosylvian veins [FSVs] or parietosylvian veins [PSVs]), the temporosylvian trunk (TST; receiving temporosylvian veins [TSVs]), and the superficial middle cerebral common trunk (SMCCT; receiving both FSV/PSV and TSV), and classified the SMCVs of the 116 patients into 5 types based on the morphological classification of the SMCV. Type A SMCV (60.4%) with the SMCCT anastomosed to the frontal side had few bridging veins (BVs) between the SMCCT and the temporal side during dissection. Type B (7.8%) had the SMCCT with no anastomoses to the frontal side. In Type C (17.2%) consisting of the FST and TST and Type D (12.9%) with a merging of the vein of Trolard and Labbé posteriorly and the SMCVs dividing into the FST and the TST again proximally, there were few BVs between the FST and the TST during dissection. Finally, in Type E (1.7%) showing an undeveloped SMCV, there were no BVs between the frontal and the temporal lobes. Postoperative venous infarction occurred in 2.6%. Morphological classification of the SMCV can inform appropriate dissection line to create a wide operative field while preserving the veins in the trans-sylvian approach.

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Venous-Preserving Sylvian Dissection

Cited by 32 publications

References 16 publications

Evaluation of the effect of standard neuronavigation and augmented reality on the integrity of the perifocal structures during a neurosurgical approach

Evaluation of the effect of standard neuronavigation and augmented reality on the integrity of the perifocal structures during a neurosurgical approach

Sphenoparietal sinus transposition technique: optimization of the surgical corridor with preservation of prominent bridging veins between the brain and the cranial base during aneurysm clipping via the pterional approach

Dissection of the Sylvian Fissure in the Trans-sylvian Approach Based on the Morphological Classification of the Superficial Middle Cerebral Vein

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