Drainage Pathway of the Superior Petrosal Vein Evaluated by CT Venography in Petroclival Meningioma Surgery

 

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Abstract

Objectives This study aimed to clarify the drainage location of the superior petrosal vein (SPV) in relation to Meckel's cave and the internal acoustic meatus (IAM) and to discuss its significance in petroclival meningioma surgery.

Design Prospective clinical study.

Setting Hospital-based.

Participants Five patients with petroclival meningioma and 50 patients (primarily unruptured supratentorial aneurysm patients, with a few hemifacial spasm patients) with no posterior fossa lesions.

Main Outcome Measures On computed tomography venography (CTV), the drainage site was classified into three patterns based on its relationship to Meckel's cave and the IAM: Meckel's cave type, Intermediate type, and Meatal type.

Results In all patients, the SPV was patent and emptied into the superior petrosal sinus (SPS). In patients without posterior fossa lesions, 35% had Meckel's cave type, 54% had Intermediate type, and 11% had Meatal type. Of the five patients with petroclival meningioma, three had Intermediate type, and two had Meckel's cave type.

Conclusion The SPV is a significant vein that should be preserved to prevent venous complications. Preoperative knowledge of the SPV drainage site is helpful for planning the approach and preserving the SPV in petroclival meningioma surgery.

• References

• 1 Al-Mefty O, Fox JL, Smith RR. Petrosal approach for petroclival meningiomas. Neurosurgery 1988; 22: 510-517
  CrossrefPubMedGoogle Scholar
• 2 Lawton MT, Daspit CP, Spetzler RF. Transpetrosal and combination approaches to skull base lesions. Clin Neurosurg 1996; 43: 91-112
  PubMedGoogle Scholar
• 3 Samii M, Ammirati M, Mahran A, Bini W, Sepehrnia A. Surgery of petroclival meningiomas: report of 24 cases. Neurosurgery 1989; 24: 12-17
  CrossrefPubMedGoogle Scholar
• 4 Deda H, Erden I, Yagmurlu B. Evaluation of petrosal sinus patency with 3-dimensional contrast-enhanced magnetic resonance venography in petroclival meningiomas for surgical strategy. Surg Neurol 2005; 64: 67-71
  CrossrefPubMedGoogle Scholar
• 5 Malis LI. Surgical resection of tumors of the skull base. In: Wilkins RH, Rengachary SS, eds. Neurosurgery. New York, NY: McGraw-Hill; 1985. 1. 1011-1021
  Google Scholar
• 6 Oka K, Rhoton Jr AL, Barry M, Rodriguez R. Microsurgical anatomy of the superficial veins of the cerebrum. Neurosurgery 1985; 17: 711-748
  CrossrefPubMedGoogle Scholar
• 7 Yamakami I, Hirai S, Yamaura A, Ono J. Venous system playing a key role in transpetrosal approach. No Shinkei Geka 1998; 26: 699-707
  PubMedGoogle Scholar
• 8 Yasargil MG, Mortara RW, Curcic M. Meningiomas of basal posterior cranial fossa. In: Krayenbuhl H, ed. Advances and Technical Standards in Neurosurgery. Vienna, Austria: Springer-Verlag; 1980. 7. 1-115
  CrossrefGoogle Scholar
• 9 Tanriover N, Abe H, Rhoton Jr AL, Kawashima M, Sanus GZ, Akar Z. Microsurgical anatomy of the superior petrosal venous complex: new classifications and implications for subtemporal transtentorial and retrosigmoid suprameatal approaches. J Neurosurg 2007; 106: 1041-1050
  CrossrefPubMedGoogle Scholar
• 10 Kawase T, Shiobara R, Toya S. Middle fossa transpetrosal-transtentorial approaches for petroclival meningiomas: Selective pyramid resection and radicality. Acta Neurochir (Wien) 1994; 129: 113-120
  CrossrefPubMedGoogle Scholar
• 11 Samii M, Tatagiba M. Experience with 36 surgical cases of petroclival meningiomas. Acta Neurochir (Wien) 1992; 118: 27-32
  CrossrefPubMedGoogle Scholar
• 12 Toda M, Yoshida K, Kawase T. Subtemporal approach –Venous drainage and surgical anatomy. Jpn J Neurosurg (Tokyo) 2010; 19: 742-752 . Available at http://ci.nii.ac.jp/naid/110007730743
  PubMedGoogle Scholar
• 13 Fujitsu K, Kitsuta Y, Takemoto Y, Matsunaga S, Tateishi K. Combined pre- and retrosigmoid approach for petroclival meningiomas with the aid of a rotatable head frame: peri-auricular three-quarter twist-rotation approach: technical note. Skull Base 2004; 14: 209-215
  Article in Thieme ConnectPubMedGoogle Scholar