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Surgeons’ experience of venous risk with CPA surgery

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Abstract

The study aims to systematize neurosurgeons’ practical knowledge of venous sacrifice as applied to the posterior fossa region and to analyze the collected data to present and preserve relevant experience and expert knowledge for current and future practicing neurosurgeons. The venous structures assessed were the superior petrosal vein (SPV), sigmoid sinus (SS), and the tentorial veins (TV). The survey is constructed to obtain surgeons’ idea of assessed risk when sacrificing specific venous structures during posterior fossa surgery. They were asked how they prep for surgery, number of operations conducted, and their basis of knowledge. Collected data were mainly qualitative and analyzed with a mixed-method approach. A mean absolute deviation was calculated measuring rate of disagreement for a given substructure. Consensus existed among the participating surgeons that sacrificing the SPV and the TV was considered safe. Although, the risk of death when occluding major structures like the main trunk of the SPV, one of the SS’ and or a total occlusion of all TV yielded high risk of death. The risk of infarction was often too apparent to discredit even with low risk of death among an experienced class of surgeons. Our findings provide an overview of surgical risk associated with venous sacrifice. This will minimize cases where indispensable practical knowledge on safe handling veins in the cerebellopontine angle is either to be lost or taught among few when the neurosurgeons retire. This will lower the disagreement regarding risks and increase the quality of surgical decision-making.

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Acknowledgment

We thank the following neurosurgeons, who contributed with their surgical knowledge and experience to the survey that formed the basis of this paper:

  • Tiit Mathiesen, MD, Chief Professor, Department of Neurosurgery, Rigshospitalet

  • Jannick Brennum, MD, Chairman of the Neurocenter, Rigshospitalet

  • Jacob Bertram Springborg, MD, Associate professor, Department of Neurosurgery, Rigshospitalet

  • Vagn Eksesen, MD, Associate professor, Department of Neurosurgery, Rigshospitalet

  • Kåre Fugleholm, MD, Dr. Med, PhD, Clinical associate professor, Department of Neurosurgery, Rigshospitalet

  • Lars Bøgeskov, MD, Department of Neurosurgery, Rigshospitalet

  • Domenico D’Avella, MD, PhD, Professor, Director, Department of Neurosciences University of Padova Medical School

  • Thomas Santarius, MD PhD, Cambridge University Hospitals NHS Trust (Addenbrooke’s)

  • Marc Sindou, MD and Dumot Chloé MSc, University of Lyon

  • Evandro de Oliveira, MD PhD, Adjunct Professor of Neurological Surgery at the Mayo Clinic

  • Ulrich Sure, MD, Professor at University Hospital of Essen.

  • M. Necmettin Pamir, MD, Professor, President at Acibadem University

  • Andreas Raabe MD, Professor, Chairman of Neurosurgery at Bern University Hospital

  • Henry W. S. Schroeder, MD PhD, Dept. of Neurosurgery at the University Medicine Greifswald

  • Fady T. Charbel MD, Professor and Chief at University of Illinois Hospital

  • Marcos Soares Tatagiba, MD, Professor and Chief at University of Tübingen

  • Veit Rohde, MD, Professor and Chief at University Medical Center Göttingen

  • Jafri Malin Abdullah, MD, Professor and Chief at University of Sciences Malaysia, Dept. of NS

  • Basant Misra, MD, Professor and Head of Dept. of NS. at Hinduja National Hospital

  • William Couldwell, MD PhD, Professor and Chair of Dept. of NS. at University of Utah

  • Ioan Stefan Florian, MD PhD, Professor of Dept. of NS. at University of Cluj-Napoca

  • Peter Nakaji, MD, Dept. of Neurosurgery at Barrow Neurological Institute

  • Vladimir Benes, MD PhD, Professor and Chairman of Dept. of NS. at University Hospital Prague

  • Nejat Akalan, MD PhD, Professor of Dept. of Neurosurgery at Hacettepe University

  • Kazuhiro Hongo, MD, Professor of Department of Neurosurgery at Shinshu University

  • Helmut Bertalanffy, MD, Professor and Dir. for Neurosurgery, Int. Neurosc. Insitute Hannover

  • Takanori Fukushima, MD, Professor of Neurosurgery at Duke University

  • Juha Hernesemi, MD PhD, Professor emeritus in Neurosurgery at University of Helsinki

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Rigshospitalet, Copenhagen, Denmark

    Adam Alaoui-Ismaili, M. E. Krogager, L. Poulsgaard & T. Mathiesen

  2. Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg, Sweden

    A. S. Jakola

  3. Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden

    A. S. Jakola

  4. Department of Neurosurgery, University of Utah, Salt Lake City, UT, USA

    W. Couldwell

  5. IKM, University of Copenhagen, Copenhagen, Denmark

    T. Mathiesen

  6. Department of Clinical Neuroscience, Karolinska Institute, Solna, Sweden

    T. Mathiesen

Authors
  1. Adam Alaoui-Ismaili
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  2. M. E. Krogager
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  3. A. S. Jakola
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  4. L. Poulsgaard
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  5. W. Couldwell
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  6. T. Mathiesen
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Contributions

All authors contributed to the design of the study; Alaoui-Ismaili A and Mathiesen T undertook the literature review; Krogager ME collected and registered the data; Alaoui-Ismaili A and Mathiesen T drafted the paper; all authors contributed to the interpretation of data and revision of the paper; all have approved the final version.

Corresponding author

Correspondence to Adam Alaoui-Ismaili.

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No patients are directly involved. All questioned surgeons consented.

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Disclaimer

This is an expert opinion-based article. We strongly advice surgeons conducting CPA surgery to study venous circulation, keeping in mind the changing nature of these structures.

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Alaoui-Ismaili, A., Krogager, M.E., Jakola, A.S. et al. Surgeons’ experience of venous risk with CPA surgery. Neurosurg Rev 44, 1675–1685 (2021). https://doi.org/10.1007/s10143-020-01365-5

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