RT Journal Article
SR Electronic
T1 Incidence of Superficial Sylvian Vein Compromise and Postoperative Effects on CT Imaging after Surgical Clipping of Middle Cerebral Artery Aneurysms
JF American Journal of Neuroradiology
JO Am. J. Neuroradiol.
FD American Society of Neuroradiology
SP 2019
OP 2026
VO 26
IS 8
A1 Bruce L. Dean
A1 Robert C. Wallace
A1 Joseph M. Zabramski
A1 Alan M. Pitt
A1 C. Roger Bird
A1 Robert F. Spetzler
YR 2005
UL http://www.ajnr.org/content/26/8/2019.abstract
AB BACKGROUND AND PURPOSE: Dissection and retraction of the sylvian fissure can cause venous insufficiency and may be an important contributor to postoperative edema or hemorrhage after clipping of a middle cerebral artery (MCA) aneurysm. The incidence of changes in the superficial middle cerebral vein (SMCV) and adjacent veins and whether such changes increase the amount of edema or hemorrhage on postoperative CT is the focus of this study.METHODS: Pre- and postoperative angiograms of 100 consecutive patients with MCA aneurysms treated by craniotomy and clipping were compared to determine the postoperative incidence of changes involving the SMCV. CTs from the normal and abnormal postoperative venous groups were compared to determine the amount of edema or presence of parenchymal hemorrhage.RESULTS: Postoperatively, 31 (31%) SMCVs were altered, 20 to a minor or moderate degree. Eleven cases were pronounced. In 9 (9%) cases, the SMCV was completely obscured or failed to fill on postoperative angiography. More edema (observer 1, P < .0002; observer 2, P < .0006) and small brain parenchymal hemorrhages (observer 1, P < .00003; observer 2, P < .00001) were found on the postoperative CT images of the group whose SMCVs were altered than those that were unchanged.CONCLUSIONS: Neurosurgeons and neuroradiologists should be attentive to changes in the SMCV and adjacent venous structures to optimize outcomes of procedures involving the sylvian fissure.