Article
Importance of the petrosal vein during surgery of meningiomas involving the petrous apex
Die Bedeutung der Vena petrosa bei Operationen von Meningeomen mit Beteiligung der Felsenbeinspitze
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Authors
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A. Gharabaghi
- Klinik für Neurochirurgie, Universitätsklinikum Tübingen
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A. Körbel
- Klinik für Neurochirurgie, Universitätsklinikum Tübingen
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A. Samii
- Klinik für Neurochrirurgie, International Neuroscience Institute, Hannover
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S. Safavi-Abbasi
- Klinik für Neurochrirurgie, International Neuroscience Institute, Hannover
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M. Tatagiba
- Klinik für Neurochirurgie, Universitätsklinikum Tübingen
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M. Samii
- Klinik für Neurochrirurgie, International Neuroscience Institute, Hannover
| Published: | May 4, 2005 |
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Outline
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Objective
Meningiomas involving the petrous apex commonly present a close relationship with the petrosal venous complex. The superior petrosal vein drains brainstem and cerebellar veins into the superior petrosal sinus. Nonetheless, this vein has sometimes to be obliterated during posterior fossa surgery. The consequences of this obliteration are controversial in the literature. To our knowledge, there is no study available so far focusing on the occurrence and the frequency of postoperative venous complications following petrosal vein coagulation.
Methods
Fifty-nine patients with meningiomas involving the petrous apex were evaluated retrospectively reviewing pre- and postoperative radiological images, surgical reports and operation videos, intensive care unit protocols, patient notes and discharge letters. The study included the following preoperative parameters: patient gender and age, location and size of the meningioma as well as the grade of brainstem compression. The postoperative outcome was studied concerning all complications related to venous occlusion, as cerebellar or brainstem edema, hydrochephalus, venous infarction, cerebellar or brainstem hemorrhage.
Results
Of 59 patients studied, 28 (47.5%) presented with petro-clival, 19 (32.2%) with cerebello-pontine angle, 11 (18.6%) with petrous apex tumors and one with a spheno-petroclival lesion.
Intraoperatively, a single superior petrosal vein was identified in 42 cases (71.2%), while two veins were observed in 13 patients (22%), and three or more veins could be found in two cases (3.4%). No superior petrosal vein could be identified in two cases (3.4%).
Of 57 patients with identified petrosal veins, the complete superior petrosal venous complex could be preserved in 27 cases (47.4%). In the remaining 30 cases (52.6%) at least one petrosal vein was sacrificed during surgery. In the sacrificed-vein group, nine complications (30%) related to venous congestion occurred. In the preserved-vein group, there were no complications related to venous congestion (p<0.05). No other studied parameters were significantly different in these two groups.
Conclusions
Complications related to venous congestion may occur in approximately 30% of the cases in which the superior petrosal vein is sacrificed during surgery of meningiomas involving the petrous apex. Preservation of the petrosal venous complex should be attempted whenever possible to increase the safety of surgery.
