Kei Yamashiro1,2, Akira Wakako3,4, Tatsuo Omi3,4, Kazuhiro Murayama5, Daijiro Kojima3, Jun Muto3, Kazuhide Adachi3, Mitsuhiro Hasegawa3, Yuichi Hirose3. 1. Department of Neurosurgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-Cho, Toyoake, Aichi, 470-1192, Japan. keiyamashiro1577@gmail.com. 2. Department of Neurosurgery, Fujita Health University Okazaki Medical Center, Okazaki, Aichi, 444-0827, Japan. keiyamashiro1577@gmail.com. 3. Department of Neurosurgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-Cho, Toyoake, Aichi, 470-1192, Japan. 4. Department of Neurosurgery, Fujita Health University Okazaki Medical Center, Okazaki, Aichi, 444-0827, Japan. 5. Department of Radiology, Fujita Health University, Toyoake, Aichi, 470-1192, Japan.
Abstract
BACKGROUND: Diploic veins may act as collateral venous pathways in cases of meningioma with venous sinus invasion. Diploic vein blood flow should be preoperatively evaluated to consider preserving the veins. In this study, we evaluated the use of time-resolved whole-head computed tomography angiography (4D-CTA)-which is less patient-intensive than digital subtraction angiography (DSA)-for assessing diploic vein blood flow and the positional relationship between typical craniotomy approaches and diploic veins. METHODS: We retrospectively examined 231 patients who underwent surgery for intracranial meningioma. We performed contrast-enhanced magnetic resonance imaging (MRI) to evaluate diploic vein pathways and compared the visualization rates of diploic vein blood flow assessed using 4D-CTA and DSA. Subsequently, we evaluated the rates of the diploic veins transected during craniotomy by comparing the pre- and postoperative contrast-enhanced MRI. RESULTS: The diagnostic performance of 4D-CTA was assessed in 45 patients. Of the 320 diploic veins identified in these patients, blood flow in 70 (21.9%) diploic veins was identified by 4D-CTA and DSA, and both results were consistent. To assess the transection rates of the diploic veins, 150 patients were included. A trend towards a high transection rate of the diploic vein in the basal interhemispheric, frontotemporal, orbitozygomatic, combined transpetrosal, and convexity craniotomy approaches was observed. CONCLUSIONS: In patients with meningiomas, both 4D-CTA and DSA are useful in evaluating diploic vein blood flow. In meningiomas with venous sinus invasion, determining the extent of craniotomy after understanding the pathways and blood flow of diploic veins is recommended.
BACKGROUND: Diploic veins may act as collateral venous pathways in cases of meningioma with venous sinus invasion. Diploic vein blood flow should be preoperatively evaluated to consider preserving the veins. In this study, we evaluated the use of time-resolved whole-head computed tomography angiography (4D-CTA)-which is less patient-intensive than digital subtraction angiography (DSA)-for assessing diploic vein blood flow and the positional relationship between typical craniotomy approaches and diploic veins. METHODS: We retrospectively examined 231 patients who underwent surgery for intracranial meningioma. We performed contrast-enhanced magnetic resonance imaging (MRI) to evaluate diploic vein pathways and compared the visualization rates of diploic vein blood flow assessed using 4D-CTA and DSA. Subsequently, we evaluated the rates of the diploic veins transected during craniotomy by comparing the pre- and postoperative contrast-enhanced MRI. RESULTS: The diagnostic performance of 4D-CTA was assessed in 45 patients. Of the 320 diploic veins identified in these patients, blood flow in 70 (21.9%) diploic veins was identified by 4D-CTA and DSA, and both results were consistent. To assess the transection rates of the diploic veins, 150 patients were included. A trend towards a high transection rate of the diploic vein in the basal interhemispheric, frontotemporal, orbitozygomatic, combined transpetrosal, and convexity craniotomy approaches was observed. CONCLUSIONS: In patients with meningiomas, both 4D-CTA and DSA are useful in evaluating diploic vein blood flow. In meningiomas with venous sinus invasion, determining the extent of craniotomy after understanding the pathways and blood flow of diploic veins is recommended.
Authors: Ulises García-González; Daniel D Cavalcanti; Abhishek Agrawal; L Fernando Gonzalez; Robert C Wallace; Robert F Spetzler; Mark C Preul Journal: Neurosurg Focus Date: 2009-11 Impact factor: 4.047
Authors: I Hershkovitz; C Greenwald; B M Rothschild; B Latimer; O Dutour; L M Jellema; S Wish-Baratz; I Pap; G Leonetti Journal: Am J Phys Anthropol Date: 1999-03 Impact factor: 2.868
Authors: Abdullah Alarfaj; Tejas Sankar; Ravi Bhargava; Jonathan Tyler; Anil Walji; Richard Fox; Aziz Sagga; Abdullah Ishaque; Keith Aronyk Journal: Surg Neurol Int Date: 2021-05-31