Wang Mengyang, Wang Jiajing, Zhang Xiuling, Chai Songshan, Cai Yuankun, Dai Xuan, Yang Bangkun, Liu Wen, Lu Taojunjin, Mei Zhimin, Zheng Zhixin, Zhou YiXuan, Yang Jingyi, Shen Lei, Zhao Jingwei, Ho Joshua, Cai Meng, Chen Jincao, Xiong Nanxiang
Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China.
Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Front Surg. 2022 Jun 10;9:921589. doi: 10.3389/fsurg.2022.921589. eCollection 2022.
This study aims to evaluate the impact of the inferior petrosal veins (IPVs) on operational exploration and to analyze related anatomic features.
A total of 317 patients were retrospectively studied. Surgical outcomes and postoperative complications were analyzed, and patients were divided into two groups according to whether the IPV was sacrificed or preserved. The diameter of the IPV was also recorded during operation. Furthermore, the position where the IPV drained into the jugular bulb was recorded in each patient, and the influence of different injection points on the operation was analyzed.
IPVs were conclusively identified in 242/317 (76.3%) of patients, with 110/242 (45.5%) of patients categorized as "IPV sacrifice" versus 132/242 (54.5%) categorized as "IPV preservation." IPV diameter was observed to be <0.5 mm in 58 cases (23.9%), 0.5 mm-1.0 mm (≥0.5 mm and ≤1.0 mm) in 145 cases (59.9%), and >1 mm in 39 cases (16.2%). The position of IPV drainage into the jugular bulb was at the level of the accessory nerve in 163 cases (67.3%), the level of the vagus nerve in 42 cases (17.4%), and the level of the glossopharyngeal nerve or above in 37 cases (15.3%). The diameters of IPV in the sacrifice group were mainly less than 1 mm (94.5% vs. 75%, < 0.01), and the cases with draining points near the glossopharyngeal nerve were more than that in the preservation group (27.3% vs. 5.3%, < 0.01).
IPV is an obstructive structure in MVD for HFS, with considerable variations in diameters and draining points. IPV near the glossopharyngeal nerve significantly impacts surgical exposure and is often sacrificed for a better view of the operation field. Meanwhile, it is feasible to maintain IPVs with a diameter >1 mm.
本研究旨在评估岩下静脉（IPV）对手术探查的影响并分析相关解剖学特征。
对317例患者进行回顾性研究。分析手术结果及术后并发症，根据IPV是否被牺牲或保留将患者分为两组。术中还记录了IPV的直径。此外，记录每位患者IPV汇入颈静脉球的位置，并分析不同汇入点对手术的影响。
在317例患者中的242例（76.3%）明确识别出IPV，其中110例（45.5%）患者被归类为“IPV牺牲”，132例（54.5%）患者被归类为“IPV保留”。观察到IPV直径<0.5 mm的有58例（23.9%），0.5 mm - 1.0 mm（≥0.5 mm且≤1.0 mm）的有145例（59.9%），>1 mm的有39例（16.2%）。IPV汇入颈静脉球的位置在副神经水平的有163例（67.3%），迷走神经水平的有42例（17.4%），舌咽神经水平及以上的有37例（15.3%）。牺牲组IPV的直径主要小于1 mm（94.5%对75%，<0.01），且汇入点靠近舌咽神经的病例比保留组更多（27.3%对5.3%，<0.01）。
IPV是面肌痉挛微血管减压术中的一个阻碍结构，其直径和汇入点存在相当大的变异。靠近舌咽神经的IPV显著影响手术暴露，常为获得更好的术野视野而被牺牲。同时，保留直径>1 mm的IPV是可行的。
