Fatima Nida, Barnard Zachary R, Maxwell Anne K, Muelleman Tommy J, Slattery William H, Mehta Gautam U, Wagner Willis, Lekovic Gregory P
Division of Neurosurgery, House Institute, Los Angeles, California, United States.
Department of Otolaryngology, House Institute, Los Angeles, California, United States.
Front Surg. 2022 Apr 28;9:853704. doi: 10.3389/fsurg.2022.853704. eCollection 2022.
Sigmoid sinus (SS) stenosis is a complication of translabyrinthine approach. Velocity changes in the SS measured by intra-operative doppler ultrasound may help in identifying patients at risk for sinus occlusion.
SS velocity was measured using doppler ultrasound prior to opening dura and again prior to placement of the abdominal fat graft.
Data collected included: patient age, surgical side, sinus dominance, tumor volume, intra-operative doppler ultrasound measurements, post-operative venous sinus imaging, anticoagulation, and morbidities and mortalities.
SS patency and velocity.
Eight patients were included in the analysis (22 to 69 years). Four had left-sided and four had right-sided craniotomies. Sigmoid sinuses were either right-side dominant or co-dominant. The mean velocity ± standard deviation (SD) prior to dura opening and abdominal fat packing was 23.2 ± 11.3 and 25.5 ± 13.9 cm/s, respectively, = 0.575. Post-operative Magnetic Resonance Venography (MRV) imaging showed four sigmoid sinus occlusions; seven patients showed sigmoid sinus stenosis, and one internal jugular vein occlusion. One patient had post-operative Computed Tomography Venography (CTV) only. Of the four patients with MRV occlusions, CTVs were performed with three showing occlusion and all four-showing stenosis. One patient with internal jugular vein occlusion on MRV received warfarin anticoagulation. There was one cerebrospinal fluid leak requiring ear closure, one small cerebellar infarct, and one with facial nerve palsy (House-Brackman Grade 3).
SS velocity changes before and after tumor resection were not predictive of sinus occlusion. We hypothesize that sinus occlusion may be caused by related factors other than thrombosis, such as external compression of the sinus secondary to abdominal fat grafting.
乙状窦（SS）狭窄是经迷路入路的一种并发症。术中多普勒超声测量的乙状窦速度变化可能有助于识别有窦闭塞风险的患者。
在打开硬脑膜前及植入腹部脂肪移植物前，使用多普勒超声测量乙状窦速度。
收集的数据包括：患者年龄、手术侧、窦优势、肿瘤体积、术中多普勒超声测量结果、术后静脉窦成像、抗凝情况以及发病率和死亡率。
乙状窦通畅情况和速度。
8例患者纳入分析（年龄22至69岁）。4例行左侧开颅手术，4例行右侧开颅手术。乙状窦以右侧优势或双侧优势为主。打开硬脑膜和植入腹部脂肪前的平均速度±标准差（SD）分别为23.2±11.3和25.5±13.9cm/s，P = 0.575。术后磁共振静脉血管造影（MRV）成像显示4例乙状窦闭塞；7例患者显示乙状窦狭窄，1例颈内静脉闭塞。1例患者仅行术后计算机断层扫描静脉血管造影（CTV）。在4例MRV闭塞患者中，行CTV检查，3例显示闭塞，4例均显示狭窄。1例MRV显示颈内静脉闭塞的患者接受了华法林抗凝治疗。有1例脑脊液漏需行耳部封闭术，1例小脑小梗死，1例面神经麻痹（House-Brackman 3级）。
肿瘤切除前后乙状窦速度变化不能预测窦闭塞。我们推测窦闭塞可能由血栓形成以外的相关因素引起，如腹部脂肪移植继发的窦外部压迫。
