Venous infarction following translabyrinthine access to the cerebellopontine angle

Between July 1988 and August 1992, 141 tumors of the cerebellopontine angle were surgically removed through a variety of transtemporal approaches. Superior petrosal sinus resection was performed in 44 of these patients with either large tumors in the vertical dimension or contracted mastoid anatomy, in an effort to enhance intradural tumor exposure and facial nerve identification. Three patients who underwent superior petrosal sinus resection developed early postoperative temporoparietal venous infarction with transient expressive aphasia. The ipsilateral cavernous sinus was entered and packed during tumor dissection in all three cases, and one patient also had sacrifice of the petrosal vein. This report reviews intradural cortical venous anatomy as it relates to transtemporal access to the cerebellopontine angle. Three cases of postoperative venous infarction are presented to emphasize the importance of the venous collateral circulation to the cavernous sinus in patients having undergone superior petrosal sinus resection.