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Related Experiment Videos

The preoperative venogram in planning extended craniectomies.

C F Lanzieri, M Sacher, P M Duchesneau

    Neuroradiology
    |January 1, 1987
    PubMed
    Summary

    This study introduces a preoperative method to assess venous collateral drainage before extended craniectomy. Identifying venous collaterals can help determine patient operability and reduce the risk of venous infarction after surgery.

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    Area of Science:

    • Neurosurgery
    • Vascular Imaging
    • Cerebral Venous Anatomy

    Background:

    • Extended craniectomy enables removal of large intracranial mass lesions.
    • Ligation of the transverse venous sinus during this procedure carries a risk of venous infarction without adequate collateral drainage.
    • Preoperative assessment of venous collaterals is crucial for patient safety.

    Purpose of the Study:

    • To propose and evaluate a novel preoperative method for identifying collateral venous drainage.
    • To determine the incidence of potential venous collaterals in patients undergoing evaluation for craniectomy.
    • To assess the safety and efficacy of extended craniectomy based on preoperative venous assessment.

    Main Methods:

    • Carotid artery injections performed with the head in neutral and ipsilateral turned positions.

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  • Venous flow diversion technique used to assess collateral pathways.
  • Fifty patients evaluated, including seven undergoing assessment for craniectomy.

    • Main Results:

    • The technique identified potential venous collaterals in 9 out of 50 patients (20%).
    • Of six patients operated upon, two (33%) had identified collaterals and were previously considered nonoperable.
    • The procedure appeared safer on the left (45%) versus the right (20%), with specific attention needed for posterior temporal lobe drainage.

    Conclusions:

    • The proposed method can identify patients with crucial venous collaterals, expanding surgical candidacy.
    • Preoperative venous assessment is vital for optimizing extended craniectomy outcomes.
    • Careful consideration of venous drainage patterns, especially from the posterior temporal lobe, is essential.