Department of Neurosurgery, Rigshospitalet, Copenhagen, Denmark.
Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg, Sweden.
Neurosurg Rev. 2021 Jun;44(3):1675-1685. doi: 10.1007/s10143-020-01365-5. Epub 2020 Aug 8.
The study aims to systematize neurosurgeons' practical knowledge of venous sacrifice as applied to the posterior fossa region and to analyze the collected data to present and preserve relevant experience and expert knowledge for current and future practicing neurosurgeons. The venous structures assessed were the superior petrosal vein (SPV), sigmoid sinus (SS), and the tentorial veins (TV). The survey is constructed to obtain surgeons' idea of assessed risk when sacrificing specific venous structures during posterior fossa surgery. They were asked how they prep for surgery, number of operations conducted, and their basis of knowledge. Collected data were mainly qualitative and analyzed with a mixed-method approach. A mean absolute deviation was calculated measuring rate of disagreement for a given substructure. Consensus existed among the participating surgeons that sacrificing the SPV and the TV was considered safe. Although, the risk of death when occluding major structures like the main trunk of the SPV, one of the SS' and or a total occlusion of all TV yielded high risk of death. The risk of infarction was often too apparent to discredit even with low risk of death among an experienced class of surgeons. Our findings provide an overview of surgical risk associated with venous sacrifice. This will minimize cases where indispensable practical knowledge on safe handling veins in the cerebellopontine angle is either to be lost or taught among few when the neurosurgeons retire. This will lower the disagreement regarding risks and increase the quality of surgical decision-making.
本研究旨在系统整理神经外科医生在处理后颅窝区域时对静脉牺牲的实践知识，并对收集到的数据进行分析，为当前和未来的神经外科医生呈现和保存相关经验和专家知识。评估的静脉结构包括岩上窦（SPV）、乙状窦（SS）和天幕静脉（TV）。该调查旨在了解外科医生在进行后颅窝手术时牺牲特定静脉结构的评估风险观念。询问他们如何为手术做准备、进行了多少次手术以及他们的知识基础。收集的数据主要是定性的，并采用混合方法进行分析。通过计算给定子结构的不一致率来计算平均绝对偏差。参与调查的外科医生一致认为牺牲 SPV 和 TV 是安全的。然而，当阻塞像 SPV 的主要干、SS 的一条或所有 TV 的总阻塞这样的主要结构时，死亡的风险很高。梗塞的风险往往太明显，即使在经验丰富的外科医生中，死亡的风险很低，也无法被忽视。我们的研究结果提供了与静脉牺牲相关的手术风险概述。这将最大限度地减少因神经外科医生退休而导致在后脑桥小脑角安全处理静脉方面不可或缺的实用知识丢失或仅在少数人中传授的情况。这将降低风险方面的分歧，并提高手术决策的质量。
