Title

Venous Sinus Compromise After Pre-Sigmoid, Transpetrosal Approach For Skull Base Tumors: A Study On The Asymptomatic Incidence and Report Of A Rare Dural Arteriovenous Fistula As Symptomatic Manifestation.

Document Type

Journal Article

Publication Date

5-1-2017

Journal

Journal of Clinical Neuroscience : Official Journal of the Neurosurgical Society of Australasia

Volume

39

DOI

10.1016/j.jocn.2016.12.040

Keywords

Central Nervous System Vascular Malformations; Cranial Sinuses; Humans; Incidence; Neurosurgical Procedures; Postoperative Complications; Skull Base Neoplasms

Abstract

The sigmoid sinus is routinely exposed and manipulated during pre-sigmoid, transpetrosal approaches to the skull base, but there is scant data available on the incidence of venous sinus compromise after surgery. We encountered a dural arteriovenous fistula as a result of sigmoid sinus occlusion and examined the incidence of venous sinus thrombosis or narrowing after transpetrosal surgeries. We performed a retrospective analysis of a series of patients treated by the senior surgeons (WCJ, MH, HJK), who underwent either a posterior petrosectomy or translabyrinthine approach for various skull base tumors. All available clinical and radiographic data were thoroughly examined in each patient to determine the post-operative fate of the venous sinuses. Of the 52 available patients, five patients were discovered post-operatively to have a narrowed or constricted sigmoid sinus ipsilateral to the surgery, whereas another five patients were diagnosed with asymptomatic sinus thrombosis either in the transverse or sigmoid or both. None of these patients experienced symptoms, nor were there any instance of ischemic or hemorrhagic complications. However, there was one additional patient who presented with pulsatile tinnitus 2years after surgery. His angiogram showed an occlusion of the ipsilateral sigmoid sinus and a posterior fossa dural arteriovenous fistula. A two-stage transvenous and transarterial embolization was successful in eliminating the fistula. Technical considerations to avoid sinus injuries during pre-sigmoid, transpetrosal surgery are discussed.

Peer Reviewed

1