Kyoshima K, Oikawa S, Kobayashi S
Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan.
Neurosurgery. 2001 Feb;48(2):447-9. doi: 10.1097/00006123-200102000-00047.
Sacrifice of a bridging vein in the cranial base occasionally may cause significant postoperative morbidity. We report a simple method for preserving large bridging veins of the cranial base by reflecting the dura when a subtemporal or transsylvian approach is used.
In the subtemporal approach, when a larger bridging vein enters the dura attached to the bone of the temporal base before it empties into the dural sinus, the dura is dissected widely from the bone and is cut vertically toward the medial side of the temporal base in front of the entrance of the vein into the dura. The dura, which includes part of the entrance and interdural course of the vein, is reflected and retracted over the brain. In the transsylvian approach, when the bridging segment of the superficial sylvian vein becomes taut because of retraction of the temporal lobe, the dura is incised along the sphenoid ridge and is dissected and freed from the sphenoid bone.
This dura-reflecting technique facilitates brain retraction without exerting tension on the bridging vein of the cranial base and is expected to help avoid injury to bridging veins during neurosurgical procedures.
