Division of Neurosurgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wang Lang Road, Siriraj, Bangkok Noi, Bangkok, 10700, Thailand.
Department of Neurosurgery, Neurological Institute of Thailand, Bangkok, Thailand.
Neurosurg Rev. 2024 Aug 9;47(1):415. doi: 10.1007/s10143-024-02547-1.
Chronic occlusion of the superior sagittal sinus (SSS) by tumors in the midsagittal region causes the collateral venous pathway (CVP). Understanding common patterns of CVP is helpful in reducing surgical complications. This study aimed to investigate the CVP found in patients with SSS-invading tumors, and to provide information on the prevention of operative venous complications. From January 2015 to December 2022, this retrospective study collected patients with tumors that invaded the SSS and underwent digital subtraction angiography of intracranial vessels. Data collected included sex, age, tumor pathology, tumor location along the SSS, tumor side, degree of obstruction of the SSS, types and route patterns of the CVP, and the distance between the tumor and the diploic vein (DV). Twenty patients (6 males, 14 females) were recruited. The prevalence of CVP types was 90% for DV, 35% for end-to-end anastomosis of superficial cortical vein, 15% for meningeal vein, and 20% for other types of CVP. The pteriofrontoparietal and occipitoparietal diploic routes were found on the cerebral hemisphere contralateral to the tumor significantly more than in the cerebral hemisphere ipsilateral to the tumor. Of all patients with presence of collateral DV, 61% had a very close (less than 1 cm) distance between the nearest DV and tumor attachment in the SSS. DV in the cerebral hemisphere contralateral to the tumor was the most common type of CVP found in patients with tumor-induced SSS obstruction. Most of the collateral DV was located very close to the SSS tumor attachment. Neurosurgeons should realize these findings when planning a craniotomy.
上矢状窦（SSS）慢性闭塞由中矢状区肿瘤引起，导致侧支静脉通路（CVP）。了解 CVP 的常见模式有助于减少手术并发症。本研究旨在调查 SSS 侵袭性肿瘤患者的 CVP，并提供有关预防手术静脉并发症的信息。从 2015 年 1 月至 2022 年 12 月，这项回顾性研究收集了 SSS 受侵犯且接受颅内血管数字减影血管造影的肿瘤患者的数据。收集的数据包括性别、年龄、肿瘤病理学、SSS 沿线肿瘤位置、肿瘤侧、SSS 阻塞程度、CVP 的类型和路径模式以及肿瘤与硬脑膜静脉（DV）之间的距离。共纳入 20 名患者（6 名男性，14 名女性）。DV 类型的 CVP 发生率为 90%，浅皮质静脉端对端吻合为 35%，脑膜静脉为 15%，其他类型的 CVP 为 20%。在肿瘤对侧大脑半球发现翼额顶枕骨和枕顶枕骨硬脑膜静脉通路明显多于同侧大脑半球。所有存在侧支 DV 的患者中，61%的患者在 SSS 中最靠近肿瘤的最近硬脑膜静脉与肿瘤之间的距离小于 1cm。肿瘤引起的 SSS 阻塞患者中，最常见的 CVP 类型是肿瘤对侧大脑半球的 DV。大多数侧支 DV 非常靠近 SSS 肿瘤附着处。神经外科医生在计划开颅手术时应认识到这些发现。
