頭蓋底部病変へのアプローチにおける Labbé 静脈温存法

Abstract

Preservation of large draining veins bridging the cortex and sinuses is extremely important for prevention of postoperative intracerebral hemorrhage. The vein of Labbé is also important and has been preserved during subtemporal approach using the arachnoid dissecting technique, partial cortex removing technique and intermittent retraction technique. But these techniques have absolute limitations because the subtemporal approach passes through a space between the tentorium and the temporal cortex.We have performed the presigmoidal transpetrosal transtentorial approach preserving the vein of Labbé by the following technique. After completion of lateral suboccipital craniectomy and temporal craniotomy, the sigmoid sinus has been completely exposed to the jugular bulb epidurally. The superior petrosal sinus has been ligated and cut between two ligatures. The tentorium has been completely cut.In some instances, there are small bridging veins draining into the tentorium. In these cases, tentoriotomy is performed in front of the entrance of these veins. After cutting the tentorium, the sigmoid sinus has been mobilized posteriorly and the tentorium, the transverse sinus, the vein of Labbé and the temporal lobe superiorly. In this technique, the vein of Labbé and the temporal cortex can be mobilized together in the same direction and there is no traction force between them. This technique is quite important and useful for preservation of the vein of Labbéduring skull base surgery.