The Analysis of the Petrosal Vein to Prevent Venous Complications During the Anterior Transpetrosal Approach in the Resection of Petroclival Meningioma.
BACKGROUND
The anterior transpetrosal approach (ATPA) has been used in the resection of petroclival meningioma (PCM) for more than 20 years. Although PCM sometimes involves the petrosal vein and its preservation has been an important issue, the precise risk of petrosal vein sacrifice and subsequent venous complications associated with the use of the ATPA in patients with PCM has not yet been elucidated.


METHODS
We used computed tomographic (CT) digital subtraction venography (DSV) in the retrospective analysis of the petrosal vein and its tributaries in patients with PCM before and after surgery. We also examined the incidence of postoperative venous complications in each of the patients.


RESULTS
The detection rate of the petrosal vein and some of its tributaries on CT-DSV in patients with PCM was significantly lower than that in controls. Preoperatively, CT-DSV detected the petrosal vein in 71.8% of patients with PCM. The detected petrosal veins were preserved after the operation in 64.3% of these patients. No venous complications involving petrosal vein were observed in any of the patients. Anastomosis between the petrosal vein and the basal vein via the pontotrigeminal vein was found to be significantly more developed in the patients with PCM compared with the controls.


CONCLUSIONS
Our study demonstrated that the ATPA could be performed safely on patients with PCM from the viewpoint of venous preservation. Preoperative CT-DSV is important for assessing the petrosal vein and its tributaries to facilitate a safer operation.
Department of Neurosurgery, Keio University School of Medicine, Shinjukuku, Tokyo, Japan. Electronic address: katsu512@yahoo.co.jp.
Katsuhiro
K
Mizutani
Department of Neurosurgery, Keio University School of Medicine, Shinjukuku, Tokyo, Japan.
Masahiro
M
Toda
Department of Neurosurgery, Keio University School of Medicine, Shinjukuku, Tokyo, Japan.
Kazunari
K
Yoshida
D000328:Adult; D000368:Aged; D002550:Cerebral Veins / Q000000981:diagnostic imaging* / Q000293:injuries*; D003388:Cranial Fossa, Posterior / Q000000981:diagnostic imaging / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008577:Meningeal Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D008579:Meningioma / Q000000981:diagnostic imaging / Q000601:surgery*; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods*; D010579:Petrous Bone / Q000000981:diagnostic imaging / Q000601:surgery; D016896:Treatment Outcome; D057772:Vascular System Injuries / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control*
Anterior transpetrosal approach; Petroclival meningioma; Petrosal vein