Related Experiment Video
Updated: Jul 19, 2025
Microvascular Decompression: Salient Surgical Principles and Technical Nuances
Published on: July 5, 2011
Catastrophic Outcome Following Apparently Trivial Nondominant Transverse Sinus Injury During Resection of a Tentorial
1Bombay Hospital and Institute of Medical Sciences, Mumbai, India. kekiturel@rediffmail.com.
Abstract:
A 52-year-old man was admitted to our hospital with symptoms of raised intracranial pressure and cerebellar dysfunction caused by a medium-sized (4 cm in diameter) tentorial meningioma with an infratentorial extension. Preoperative magnetic resonance imaging showed that the tumor indented and possibly partially invaded the adjacent junction of the nondominant transverse and sigmoid sinuses. The contralateral dominant transverse sinus was fully patent. Total surgical removal of the lesion was done through the left retrosigmoid approach. During dissection of the meningioma, some bleeding from the venous sinus was noted, which was easily controlled by packing with hemostatic materials. The initial postoperative period was unremarkable, but approximately 48 h after surgery, acute clinical deterioration caused by hemorrhagic venous infarction of the left cerebellar hemisphere and brain stem developed and necessitated urgent reoperation for the evacuation of hematoma and brain decompression. Thereafter, the patient remained in a prolonged coma with a severe neurological deficit. After several years of extensive neurorehabilitation, he was able to walk with support but had a tracheostomy, required a feeding tube, and voided with a urinary catheter. Such a catastrophic outcome after an apparently trivial nondominant transverse sinus injury during resection of a tentorial meningioma raises the question whether reconstruction of the sinus wall with preservation of its patency might have prevented this complication in our patient.
Insights
Tentorial meningioma resection can lead to severe complications, even with minor venous sinus injury. This case highlights the potential need for sinus reconstruction to prevent devastating outcomes like hemorrhagic venous infarction.
Area of Science:
- Neurosurgery
- Neurology
- Vascular Neurosurgery
Background:
- Tentorial meningiomas can cause significant neurological deficits due to mass effect and infratentorial extension.
- Surgical resection is the primary treatment, but proximity to major venous sinuses poses risks.
Observation:
- A 52-year-old man with a tentorial meningioma experienced acute deterioration 48 hours post-surgery.
- This was due to hemorrhagic venous infarction of the cerebellum and brainstem following a minor injury to the transverse-sigmoid sinus junction.
Findings:
- Despite successful tumor removal, the patient suffered a severe neurological deficit, including prolonged coma and permanent disability.
- The complication arose from an apparently minor injury to the nondominant transverse sinus during tumor dissection.
Implications:
- This case questions whether sinus wall reconstruction and patency preservation could prevent such catastrophic outcomes.
- It emphasizes the critical importance of meticulous surgical technique and potentially advanced reconstructive methods when operating near venous sinuses.
