Abstract
BackgroundWe investigated the understudied anatomical variations of the superior petrosal vein (SPV) complex (SPVC), which may play some role in dictating the individual complication risk following SPVC injury.MethodsMicrovascular decompressions of the trigeminal nerve between September 2012 and July 2016. All operations utilized an SPVC preserving technique. Preoperative balanced fast field echo (bFFE) magnetic resonance imaging, or equivalent sequences, and operative videos were studied for individual SPVC anatomical features.ResultsApplied imaging and operative SPVC anatomy were described for fifty patients (mean age, 67.18 years; female sex and right-sided operations, 58% each). An SPVC component was sacrificed intentionally in 6 and unintentionally in only 7 cases. Twenty-nine different individual variations were observed; 80% of SPVCs had either 2 SPVs with 3 or 1 SPV with 2, 3, or 4 direct tributaries. Most SPVCs had 1 SPV (64%) and 2 SPVs (32%). The SPV drainage point into the superior petrosal sinus was predominantly between the internal auditory meatus and Meckel cave (85.7% of cases). The vein of the cerebellopontine fissure was the most frequent direct tributary (86%), followed by the pontotrigeminal vein in 80% of SPVCs. Petrosal-galenic anastomosis was detected in at least 38% of cases. At least 1 SPV in 54% of the cases and at least 1 direct tributary in 90% disturbed the operative field. The tributaries were more commonly sacrificed.ConclusionsThe extensive anatomical variation of SPVC is depicted. Most SPVCs fall into 4 common general configurations and can usually be preserved. BFFE or equivalent sequences remarkably facilitated the intraoperative understanding of the individual SPVC in most cases.
Highlights
IntroductionIntroduction structures in thecerebellopontine angle (CPA) cistern [3, 4, 7, 29, 35]. We collectively referred to these sequences as balanced fast field echo (bFFE)
Introduction structures in thecerebellopontine angle (CPA) cistern [3, 4, 7, 29, 35]
BFFE balanced fast field echo, fast imaging employing steadystate acquisition (FIESTA) fast imaging employing steady-state acquisition, MRI magnetic resonance imaging, 3D CISS three-dimensional constructive interference in steady state 1 Data were missing in 21 of 50 cases (42%)
Summary
Introduction structures in theCPA cistern [3, 4, 7, 29, 35]. We collectively referred to these sequences as bFFE. We aimed to evaluate the individual anatomical variations of the SPVC by examining preoperative bFFE and intraoperative findings. The superior petrosal vein (SPV) complex is a major draining system in the posterior fossa and a consistent landmark within the cerebellopontine angle (CPA) [18, 26]. Injury of a part of the SPV complex (SPVC) has been frequently reported in large case series, with an incidence ranging from 55 to 84% of cases [16, 25, 34]. Identifying patients who are at risk of developing major complications a priori is currently impossible, because anatomical features rendering patients prone to such adverse events are unknown. We investigated the understudied anatomical variations of the superior petrosal vein (SPV) complex (SPVC), which may play some role in dictating the individual complication risk following SPVC injury
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