Analysis of diagnosis and treatment of dural arteriovenous fistula of super petrosal venous drainage / 中国脑血管病杂志

Objective To investigate the clinical manifestations and imaging features of dural arterio-venous fistula of super petrosal venous drainage and treatment. Methods From May 2013 to September 2014,9 patients with petrosal vein drained dural arteriovenous fistula at the Department of Neurosurgery, Xuanwu Hospital,Capital Medical University and the Department of Neurosurgery,Beijing Haidian Hospital were enrolled retrospectively. The patients were treated with endovascular embolization or microsurgery,and the MRI and DSA examinations were improved,and the scores of the modified Aminoff&Logue scale (ALS) were performed before and after treatment. Results In the 9 patients,there were 3 females and 6 males. They all had different degrees of limb sensory and motor abnormalities,7 of them also had urination and/or bowel disorders,4 had cranial nerve dysfunction,including hoarseness,bucking,hiccup,and paralysis. Six patients received embolization treatment,3 received microsurgery,and they all achieved anatomic cure. The preoperative ALS score was 6. 0 ± 2. 7,and the score at 3 months after procedure was 2. 8 ± 1. 7. There was significant difference between before and after treatment (t=4. 816,P<0. 05). Conclusions The petrosal vein drained dural arteriovenous fistula is a kind of rare cerebrovascular malformation. The lesion involves a wide range. The clinical manifestations are severe. Both endovascular embolization and microsurgery can achieve a more ideal therapeutic effect. If the vascular condition is permitted,the interventional embolization treatment should be preferred.

Protection of the superior petrosal vein in microneurosurgery for acoustic neuroma / 中南大学学报(医学版)

Objective:To explore the clinical signiifcance of the protection of superior petrosal vein (SPV) in the microneurosurgery for acoustic neuroma. Methods:From January 2009 to July 2011, 149 cases of acoustic neuroma microsurgery were observed. hTe difference in hematoma in surgical area, cerebellar hematoma and cerebellar edema were compared between a SPV without protection group (SPVWP group, n=8) and a SPV protection group (SPVP group, n=141). Results:In the 149 patients with acoustic neuroma, the SPV was reserved in 141 patients. In the SPVWP group (8 patients), hematoma in the surgery area occurred in 4 patients, cerebellar edema in 5, and cerebellar hemorrhage in 3. In the SPVP group (141 patients), hematoma in the surgery area occurred in 40 patients, cerebellar edema in 56, and cerebellar hemorrhage in 12. hTere was signiifcant difference in the incidence of cerebellar hemorrhage (χ2=3.84, P=0.05), no signiifcant difference in the incidence of hematoma in the surgical area (χ2=0.646, respectively, P=0.422), and no significant difference in the incidence of cerebellar edema (χ2=0.611, P=0.434) between the SPVWP group and the SPVP group. Conclusion:In acoustic neuroma surgery, the SPV should be protected, which may reduce the risk of cerebellar hemorrhage.

The comprehension of preservation for petrosal vein in 147 operative cases with acoustic neuroma / 中华显微外科杂志

Objective To discuss the preservation and clinical significance of petrosal vein in microsurgical operation of acoustic neuroma. Methods 147 patients with acoustic neuroma were operated, with internal decompression of the tumor firstly then dissected the tumor with surrounding structures, the petrosal vein were protected well in 143 cases and failed to protect in 4 cases. Results No hemorrhagic infarction in cerebellar was observed in 143 cases with intact petrosal vein. One case occurred with extensive cerebellar edema, which has gait disturbance after 18 months follow-up. The other three cases occurred with vein infarction and hemorrhagic edema after petrosal vein damage. One was dead and the other two were recovered well after decompression of posterior cranial fossa. One has no significant neurological deficit after 33 months follow-up, while the other has difficulty in line walking after 12 months follow-up. Conclusion Petrosal vein should be well protected in the operation of acoustic neuroma, the decompression of posterior cranial fossa should be considered if petrosal vein failed to protect.

Microanatomy of the Petrosal Vein and Its Management during Microvascular Decompressionn / 中国微创外科杂志

Objective To study the microanatomy of the petrosal vein(PV) and discuss the surgical management of the vessel during microvascular decompression.Methods A total of 15 cadaveric(30 PVs) heads were obtained from dead adults.The position,morphology,branches,and variation of the PV,and anatomical relationship between the trigeminal,facial and acoustic nerves and the vessel were observed.Sixty patients with trigeminal neuralgia or hemifacial spasm were also enrolled in this study.Microvascular decompression was performed on the cases,and the PV and its branches were observed during the operation.Results The PV is formed by the union of 2 to 3 branches.It passes through the the subarachnoid space and terminates in the inner two third of the superior petrosal sinus.Classfied by number of the unilateral PVs,3 types of the vessel has been observed:single-stem(9 sides,30.0%),double-stem(17 sides,56.7%) and triple-stem types(4 sides,13.3%).Moreover,according to the anatomical relationship between the end of the PV and auditory meatus,the vein has 3 subgroups:interior-side(17/55,30.9%),intermediate(24/55,43.6%),and exterior-side(14/55,25.5%) subgroups.In our specimens,8 PVs(the main stem or a branch) touched the trigeminal nerve,and 19 PVs were less than 1 mm away from the nerve.None of the PVs connected to the faical and acoustic nerves.In the 60 patients who recieved microvascular decompression,107 PV branches(19 single-stem veins,35 double-stem vessels,and 6 triple-stem veins) were found during the operation,among which 33 belonged to interior-side subgroup,46 were classifed as intermediate type,and 28 were exterior-side veins.Conclusions Management of the PV is the key step for cerebellopontine angle surgery.The vein or its branches can be cut off when they compress the surrounding tissues or obstruct the surgical field.

The clinical significance of petrosal vein in operation of cerebellopontine angle tumor / 中华显微外科杂志

Objective To discuss the clinical significance of petrosal vein in operation of cerebel- lopontine angle(CPA)tumor.Methods From Dec.2004 to Mar.2006,33 patients with tumor in CPA were operated,the petrosal vein were protected well in 31 cases and failed to protect in 2 cases.Results No hemorrhagic infarction observed in 31 cases with well protection of petrosal vein.Two cases with petrosal vein damage occured with vein infarction and hemorrhagic edema.One was dead and the other was recovered well after decompression of posterior cranial fossa.Conclusion Petrosal vein should be well protected in the tumor operation of CPA area,the decompression of posterior cranial fossa should be considered if petrosal vein failed to protect.

A Postoperative Venous Hemorrhagic Infarction of Cerebellopontine Angle Tumor:1 Cases

The authors present a case of cerebrellar venous hemorrhagic infarction which developed after removal of a cerebellopontine angle meningioma. The clinical course was rapidly fatal inspite of an aggressive management including surgical decompression beginning from 30 minutes after complete recovery from anesthesia. The brain C-T scan showed flame-shaped subcortical hemorrhage which is known to be a typical finding of a venous hemorrhagic infarction. The causes may be two fold:One is the cautrization and resection of multiple petrosal veins which were inevitable because of a bleeding from the vein and the other is the venous congestion caused by the compression of an internal jugular vein in oblique supine position. Reminding of one or oth of the above possibilities whenever we are performing surgery around the superior petrosal vein may help us to prevent the rare but fatal complication of this kind.

Trigeminal Neuralgia Caused by Epidermoid Tumor in the Cerebellopontine Angle

The authors report two cases of trigeminal neuralgia caused by epidermoid tumor in the cerebellopontine angle. The one case showed that trigeminal nerve was displaced superiorly by the tumor and was adhesed to the superior cerebellar artery. The other case showed that tumor mass encircled the facial, acoustic nerves as well as trigeminal nerve entirely and after removal of the tumor petrosal vein was found at the root entry zone of the trigeminal nerve. Interestingly these two cases were devoid of neurologic deficit. We tried microvascular decompression as well as removal of tumor and were satisfied with its result. We reviewed the literature and discussed these cases in point of mechanisms of trigeminal neuralgia.