Berker Berk Burak, Doğruel Yücel, Güngör Abuzer, Karataş Okumuş Seda Yağmur, Coşkun Mehmet Erdal, Türe Hatice, Türe Uğur
Departments of1Neurosurgery and.
2Department of Neurosurgery, Pamukkale University School of Medicine, Denizli; and.
J Neurosurg. 2023 Jul 14;140(1):260-270. doi: 10.3171/2023.5.JNS23657. Print 2024 Jan 1.
The objective of this study was to describe the distribution pattern of cerebellar hemispheric tentorial bridging (CHTB) veins on the tentorial surface in a case series of perimedian or paramedian supracerebellar approaches and to describe a novel technique to preserve these veins.
A series of 141 patients with various pathological processes in different locations was operated on via perimedian or paramedian supracerebellar approaches by the senior author from July 2006 through October 2022 and was retrospectively evaluated. During surgery, the number and locations of all CHTB veins were recorded to establish a distribution map on the tentorial surface, divided into nine zones. Patients were classified into four groups according to the surgical technique used to manage CHTB veins: 1) group 1 consisted of CHTB veins preserved without intervention during surgery or no CHTB veins found in the surgical route; 2) group 2 included CHTB veins coagulated during surgery; 3) group 3 included CHTB veins preserved with arachnoid and/or tentorial dissection from the cerebellar or tentorial surface, respectively; and 4) group 4 comprised CHTB veins preserved using a novel tentorial cut technique.
Overall, 141 patients were included in the study. Of these 141 patients, 38 were in group 1 (27%), 32 in group 2 (22.7%), 47 in group 3 (33.3%), and 24 in group 4 (17%). The total number of CHTB veins encountered was 207 during surgeries on one side. According to the distribution zones of the tentorium, zone 5 had the highest density of CHTB veins, while zone 7 had the lowest. Of the patients in group 4, 6 underwent the perimedian supracerebellar approach and 18 had the paramedian supracerebellar approach. There were 39 CHTB veins on the surface of the 24 cerebellar hemispheres in group 4. The tentorial cut technique was performed for 27 of 39 CHTB veins. Twelve veins were not addressed because they did not present any obstacles during approaches. During surgery, no complications were observed due to the tentorial cut technique.
Because there is no way to determine whether a CHTB vein can be sacrificed without complications, it is important to protect these veins in supracerebellar approaches. This new tentorial cut technique in perimedian or paramedian supracerebellar approaches makes it possible to preserve CHTB veins encountered during supracerebellar surgeries.
本研究的目的是描述一系列经小脑上近中线或旁中线入路病例中，小脑半球幕缘桥接（CHTB）静脉在小脑幕表面的分布模式，并描述一种保留这些静脉的新技术。
2006年7月至2022年10月，资深作者对一系列141例不同部位患有各种病理过程的患者采用经小脑上近中线或旁中线入路进行手术，并进行回顾性评估。手术过程中，记录所有CHTB静脉的数量和位置，以建立小脑幕表面的分布图，分为九个区域。根据处理CHTB静脉所采用的手术技术，将患者分为四组：1）第1组包括手术中未干预而保留的CHTB静脉或手术路径中未发现CHTB静脉；2）第2组包括手术中凝固的CHTB静脉；3）第3组包括分别从小脑表面或小脑幕表面进行蛛网膜和/或小脑幕分离后保留的CHTB静脉；4）第4组包括采用一种新的小脑幕切开技术保留的CHTB静脉。
总体而言，141例患者纳入本研究。在这141例患者中，第1组38例（27%），第2组32例（22.7%），第3组47例（33.3%），第4组24例（17%）。一侧手术中遇到的CHTB静脉总数为207条。根据小脑幕的分布区域，第5区CHTB静脉密度最高，第7区最低。第4组患者中，6例行经小脑上近中线入路，18例行经小脑上旁中线入路。第4组24个小脑半球表面有39条CHTB静脉。39条CHTB静脉中有27条采用了小脑幕切开技术。12条静脉未作处理，因为在入路过程中未造成任何阻碍。手术过程中，未观察到因小脑幕切开技术导致的并发症。
由于无法确定牺牲一条CHTB静脉是否会引发并发症，因此在小脑上入路中保护这些静脉很重要。这种在经小脑上近中线或旁中线入路中采用的新的小脑幕切开技术，使得在小脑上手术中遇到的CHTB静脉得以保留成为可能。
