Sacrificing the superior petrosal vein during microvascular decompression. Is it safe? Learning the hard way. Case report and review of literature
Identifieur interne : 000530 ( Main/Exploration ); précédent : 000529; suivant : 000531Sacrificing the superior petrosal vein during microvascular decompression. Is it safe? Learning the hard way. Case report and review of literature
Auteurs : Giulio Anichini [Royaume-Uni] ; Mazhar Iqbal [Royaume-Uni] ; Nasir Muhammad Rafiq [Royaume-Uni] ; James W. Ironside [Royaume-Uni] ; Mahmoud Kamel [Royaume-Uni]Source :
- Surgical Neurology International [ 2229-5097 ] ; 2016.
Abstract
Venous infarction as a complication of microvascular decompression (MVD) is a recognized but extremely rare occurrence in an otherwise standard neurosurgical procedure. Sacrificing one or more veins is considered safe by majority of experienced surgeons and authors. However, in the recent years, there has been growing debate about the management of venous trigeminal compression and/or superior petrosal complex (separation vs. coagulation and cutting of the vein), with few papers describing mild to severe complications related to venous sacrifice.
We report our dramatic experience during re-exploration for MVD on a male who developed massive cerebellar, brainstem, and brain infarction. Extensive analysis of surgical planning and literature debate about this topic is also reported.
Despite rare, venous infarction after venous sacrifice in MVD is possible and can have catastrophic consequences. We would advise: (1) To try preserving the vein anytime this is possible, especially if it is large in size; (2) if it is decided to sacrifice the vein temporary occlusion while observing changed in the neurophysiology might be safer; (3) when planning an MVD for suspected venous compression, possible alternative forms of treatment should also be considered.
Url:
DOI: 10.4103/2152-7806.183520
PubMed: 27313970
PubMed Central: 4901823
Affiliations:
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Sacrificing the superior petrosal vein during microvascular decompression. Is it safe? Learning the hard way. Case report and review of literature</title><author><name sortKey="Anichini, Giulio" sort="Anichini, Giulio" uniqKey="Anichini G" first="Giulio" last="Anichini">Giulio Anichini</name><affiliation wicri:level="3"><nlm:aff id="aff1">Department of Neurosurgery, Charing Cross Hospital, Imperial College of London, London</nlm:aff><country>Royaume-Uni</country><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName><wicri:orgArea>Department of Neurosurgery, Charing Cross Hospital, Imperial College of London</wicri:orgArea></affiliation></author><author><name sortKey="Iqbal, Mazhar" sort="Iqbal, Mazhar" uniqKey="Iqbal M" first="Mazhar" last="Iqbal">Mazhar Iqbal</name><affiliation wicri:level="1"><nlm:aff id="aff2">Department of Neurosurgery, Aberdeen Royal Infirmary, NHS Grampian, Edinburgh, Scotland, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Department of Neurosurgery, Aberdeen Royal Infirmary, NHS Grampian, Edinburgh, Scotland</wicri:regionArea><wicri:noRegion>Scotland</wicri:noRegion></affiliation></author><author><name sortKey="Rafiq, Nasir Muhammad" sort="Rafiq, Nasir Muhammad" uniqKey="Rafiq N" first="Nasir Muhammad" last="Rafiq">Nasir Muhammad Rafiq</name><affiliation wicri:level="1"><nlm:aff id="aff2">Department of Neurosurgery, Aberdeen Royal Infirmary, NHS Grampian, Edinburgh, Scotland, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Department of Neurosurgery, Aberdeen Royal Infirmary, NHS Grampian, Edinburgh, Scotland</wicri:regionArea><wicri:noRegion>Scotland</wicri:noRegion></affiliation></author><author><name sortKey="Ironside, James W" sort="Ironside, James W" uniqKey="Ironside J" first="James W." last="Ironside">James W. Ironside</name><affiliation wicri:level="1"><nlm:aff id="aff3">Department of Pathology, NHS Lothian, Western General Hospital, Edinburgh, Scotland, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Department of Pathology, NHS Lothian, Western General Hospital, Edinburgh, Scotland</wicri:regionArea><wicri:noRegion>Scotland</wicri:noRegion></affiliation></author><author><name sortKey="Kamel, Mahmoud" sort="Kamel, Mahmoud" uniqKey="Kamel M" first="Mahmoud" last="Kamel">Mahmoud Kamel</name><affiliation wicri:level="1"><nlm:aff id="aff2">Department of Neurosurgery, Aberdeen Royal Infirmary, NHS Grampian, Edinburgh, Scotland, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Department of Neurosurgery, Aberdeen Royal Infirmary, NHS Grampian, Edinburgh, Scotland</wicri:regionArea><wicri:noRegion>Scotland</wicri:noRegion></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">27313970</idno><idno type="pmc">4901823</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4901823</idno><idno type="RBID">PMC:4901823</idno><idno type="doi">10.4103/2152-7806.183520</idno><date when="2016">2016</date><idno type="wicri:Area/Pmc/Corpus">000565</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000565</idno><idno type="wicri:Area/Pmc/Curation">000565</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">000565</idno><idno type="wicri:Area/Pmc/Checkpoint">000466</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Checkpoint">000466</idno><idno type="wicri:Area/Ncbi/Merge">006806</idno><idno type="wicri:Area/Ncbi/Curation">006806</idno><idno type="wicri:Area/Ncbi/Checkpoint">006806</idno><idno type="wicri:doubleKey">2229-5097:2016:Anichini G:sacrificing:the:superior</idno><idno type="wicri:Area/Main/Merge">000530</idno><idno type="wicri:Area/Main/Curation">000530</idno><idno type="wicri:Area/Main/Exploration">000530</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Sacrificing the superior petrosal vein during microvascular decompression. Is it safe? Learning the hard way. Case report and review of literature</title><author><name sortKey="Anichini, Giulio" sort="Anichini, Giulio" uniqKey="Anichini G" first="Giulio" last="Anichini">Giulio Anichini</name><affiliation wicri:level="3"><nlm:aff id="aff1">Department of Neurosurgery, Charing Cross Hospital, Imperial College of London, London</nlm:aff><country>Royaume-Uni</country><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName><wicri:orgArea>Department of Neurosurgery, Charing Cross Hospital, Imperial College of London</wicri:orgArea></affiliation></author><author><name sortKey="Iqbal, Mazhar" sort="Iqbal, Mazhar" uniqKey="Iqbal M" first="Mazhar" last="Iqbal">Mazhar Iqbal</name><affiliation wicri:level="1"><nlm:aff id="aff2">Department of Neurosurgery, Aberdeen Royal Infirmary, NHS Grampian, Edinburgh, Scotland, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Department of Neurosurgery, Aberdeen Royal Infirmary, NHS Grampian, Edinburgh, Scotland</wicri:regionArea><wicri:noRegion>Scotland</wicri:noRegion></affiliation></author><author><name sortKey="Rafiq, Nasir Muhammad" sort="Rafiq, Nasir Muhammad" uniqKey="Rafiq N" first="Nasir Muhammad" last="Rafiq">Nasir Muhammad Rafiq</name><affiliation wicri:level="1"><nlm:aff id="aff2">Department of Neurosurgery, Aberdeen Royal Infirmary, NHS Grampian, Edinburgh, Scotland, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Department of Neurosurgery, Aberdeen Royal Infirmary, NHS Grampian, Edinburgh, Scotland</wicri:regionArea><wicri:noRegion>Scotland</wicri:noRegion></affiliation></author><author><name sortKey="Ironside, James W" sort="Ironside, James W" uniqKey="Ironside J" first="James W." last="Ironside">James W. Ironside</name><affiliation wicri:level="1"><nlm:aff id="aff3">Department of Pathology, NHS Lothian, Western General Hospital, Edinburgh, Scotland, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Department of Pathology, NHS Lothian, Western General Hospital, Edinburgh, Scotland</wicri:regionArea><wicri:noRegion>Scotland</wicri:noRegion></affiliation></author><author><name sortKey="Kamel, Mahmoud" sort="Kamel, Mahmoud" uniqKey="Kamel M" first="Mahmoud" last="Kamel">Mahmoud Kamel</name><affiliation wicri:level="1"><nlm:aff id="aff2">Department of Neurosurgery, Aberdeen Royal Infirmary, NHS Grampian, Edinburgh, Scotland, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Department of Neurosurgery, Aberdeen Royal Infirmary, NHS Grampian, Edinburgh, Scotland</wicri:regionArea><wicri:noRegion>Scotland</wicri:noRegion></affiliation></author></analytic><series><title level="j">Surgical Neurology International</title><idno type="ISSN">2229-5097</idno><idno type="eISSN">2152-7806</idno><imprint><date when="2016">2016</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec id="st1"><title>Background:</title><p>Venous infarction as a complication of microvascular decompression (MVD) is a recognized but extremely rare occurrence in an otherwise standard neurosurgical procedure. Sacrificing one or more veins is considered safe by majority of experienced surgeons and authors. However, in the recent years, there has been growing debate about the management of venous trigeminal compression and/or superior petrosal complex (separation vs. coagulation and cutting of the vein), with few papers describing mild to severe complications related to venous sacrifice.</p></sec><sec id="st2"><title>Case Description:</title><p>We report our dramatic experience during re-exploration for MVD on a male who developed massive cerebellar, brainstem, and brain infarction. Extensive analysis of surgical planning and literature debate about this topic is also reported.</p></sec><sec id="st3"><title>Conclusion:</title><p>Despite rare, venous infarction after venous sacrifice in MVD is possible and can have catastrophic consequences. We would advise: (1) To try preserving the vein anytime this is possible, especially if it is large in size; (2) if it is decided to sacrifice the vein temporary occlusion while observing changed in the neurophysiology might be safer; (3) when planning an MVD for suspected venous compression, possible alternative forms of treatment should also be considered.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Akhaddar, A" uniqKey="Akhaddar A">A Akhaddar</name></author><author><name sortKey="Gazzaz, M" uniqKey="Gazzaz M">M Gazzaz</name></author><author><name sortKey="Elmostarchid, B" uniqKey="Elmostarchid B">B Elmostarchid</name></author><author><name sortKey="Boucetta, M" uniqKey="Boucetta M">M Boucetta</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Cannizzaro, D" uniqKey="Cannizzaro D">D Cannizzaro</name></author><author><name sortKey="Rammos, Sk" uniqKey="Rammos S">SK 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uniqKey="Anichini G" first="Giulio" last="Anichini">Giulio Anichini</name></region><name sortKey="Iqbal, Mazhar" sort="Iqbal, Mazhar" uniqKey="Iqbal M" first="Mazhar" last="Iqbal">Mazhar Iqbal</name><name sortKey="Ironside, James W" sort="Ironside, James W" uniqKey="Ironside J" first="James W." last="Ironside">James W. Ironside</name><name sortKey="Kamel, Mahmoud" sort="Kamel, Mahmoud" uniqKey="Kamel M" first="Mahmoud" last="Kamel">Mahmoud Kamel</name><name sortKey="Rafiq, Nasir Muhammad" sort="Rafiq, Nasir Muhammad" uniqKey="Rafiq N" first="Nasir Muhammad" last="Rafiq">Nasir Muhammad Rafiq</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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