Management of a Persistent Oblique Occipital Sinus with Staged Ligation in a Case of Medulloblastoma: A Case Report

2021 ◽  
pp. 1-5
Author(s):  
Gaurav Tyagi ◽  
Gyani Jail Singh ◽  
Manish Beniwal ◽  
Dwarakanath Srinivas
Keyword(s):  
Case Report ◽  
Posterior Fossa ◽  
Tumor Resection ◽  
Female Child ◽  
Transverse Sinus ◽  
Venous Hypertension ◽  
Venous Outflow ◽  
Excessive Bleeding ◽  
Occipital Sinus ◽  
Suboccipital Craniotomy

<b><i>Introduction:</i></b> A patent persistent occipital sinus (OS) can be seen in 10% of adults. The presence of such a dominant draining OS can present as a challenge for posterior fossa surgeries. Occlusion or division of the sinus can cause venous hypertension, causing a cerebellar bulge or increased intra-op bleeding. <b><i>Case report:</i></b> A 3-and-a-half-year-old female child presented with a vermian medulloblastoma with hydrocephalus. MR venography (MRV) revealed a large patent OS draining from the torcula to the right sigmoid sinus. She underwent a left Frazier’s point VP shunt followed by a midline suboccipital craniotomy for the lesion. The OS was divided during a “Y”-shaped durotomy. Following the sinus ligation, there was a significant cerebellar bulge and excessive bleeding from the lesion. We released cisternal CSF and punctured the tumor cysts to allow the brain bulge to settle. Hemostasis was secured, and surgery was deferred, an augmented duroplasty was done, and bone flap was removed to allow for intracranial pressure decompression. The patient was electively ventilated for 24 h and weaned off gradually. A repeat MRV at 7 days showed the reorganization of the venous outflow at the torcula. Reexploration with tumor resection was done on post-op day 10. The patient recovered well from the surgery and was referred for adjuvant therapy. <b><i>Conclusion:</i></b> Surgeons should carefully analyze venous anatomy before posterior fossa surgeries. The persistent dominant OS, when present, should be taken care of while planning the durotomy. A hypoplastic but persistent transverse sinus allowed us to ligate and divide the OS. By doing a staged division of the sinus, reorganization of the venous outflow from the torcula can be allowed to occur, and the lesion can be resected.

scholarly journals Persistent Enlarged Occipital Sinus with Absent Unilateral Transverse Sinus

2019 ◽  
Vol 10 (03) ◽  
pp. 519-521
Author(s):  
Guru Dutta Satyarthee ◽  
Luis Rafael Moscote-Salazar ◽  
Amit Agrawal
Keyword(s):  
Rare Condition ◽  
Surgical Excision ◽  
Transverse Sinus ◽  
Venous Sinus ◽  
Occipital Sinus ◽  
Suboccipital Craniotomy ◽  
Acoustic Schwannoma ◽  
The Right ◽  
Dural Opening ◽  
Selection Of

AbstractThe occipital sinus may occasionally remain patent, but the incidence is extremely low and observed in less than 10% of cases. A persistent patent occipital sinus (POS) may be associated with other venous sinus abnormality. The absence of transverse sinus in association with POS is an extremely rare condition and not reported yet. The neuroradiologist, neurosurgeons, otolaryngologist, and neurologist must be aware of the possible existence of POS and other associated venous sinus anomaly, as its warrants very crucial modification of surgical planning, selection of appropriate approaches, and, additionally, may also critically limit the extent of surgical exposure of target, and may hinder intended extent of surgical excision of tumor and associated possibility of injury to POS, which may produce catastrophic hemorrhage, brain swelling, and neurosurgical morbidity. The authors report a 35-year-old male who underwent suboccipital craniotomy for right-side giant acoustic schwannoma. Following the raising bone flap, a markedly prominent, turgid, occipital sinus was observed, not placed exactly in the midline but deviated to the right side, causing further restraining of dural opening. Surgical nuances and intraoperative difficulty encountered along with pertinent literature is reviewed briefly.

scholarly journals “Drowning Brain in a Pool of CSF” — A Rare Complication of Periencephalic Subdural Panhygroma following Removal of a Posterior Fossa Tumor

2017 ◽  
Vol 07 (03) ◽  
pp. 223-226
Author(s):  
Bikash Behera ◽  
Ram Deo ◽  
Sanjib Mishra ◽  
Jyotirmayee Biswal ◽  
Deepak Das
Keyword(s):  
Posterior Fossa ◽  
Case Reports ◽  
Rare Complication ◽  
Tumor Resection ◽  
Foramen Magnum ◽  
Posterior Fossa Tumor ◽  
Subdural Hygroma ◽  
Posterior Fossa Tumors ◽  
Suboccipital Craniotomy ◽  
Pediatric Age Group

AbstractPosterior fossa tumors are commonly encountered in pediatric age group patients. Most of these tumors present with features of hydrocephalus in the child. Conventionally, these cases are managed by suboccipital craniotomy with decompression of the tumor mass to establish the free flow of cerebrospinal fluid (CSF) across fourth ventricle and aqueduct of Sylvius. Following resection of posterior fossa tumor, appearance of subdural hygroma is a rare phenomenon.Though few cases of subdural hygroma are reported in literature following foramen magnum decompression in Chiari's malformation, their appearance following posterior fossa tumor resection is alien to medical literature and limited to only two case reports. Here the authors present a patient with periencephalic subdural panhygroma (PSP) following posterior fossa tumor resection who was successfully treated with a ventriculoperitoneal shunt (VPS) to accomplish a symptomatic and radiologic remission.

Combined Transventricular and Supracerebellar Infratentorial Approach Preserving the Vermis in Giant Pediatric Posterior Fossa Midline Tumors

2008 ◽  
Vol 63 (suppl_1) ◽  
pp. ONS30-ONS37 ◽  
Author(s):  
Elvis J. Hermann ◽  
Marion Rittierodt ◽  
Joachim K. Krauss
Keyword(s):  
Posterior Fossa ◽  
Fourth Ventricle ◽  
Malignant Tumors ◽  
Tumor Resection ◽  
Venous Drainage ◽  
Foramen Magnum ◽  
Neurological Deficits ◽  
Low Grade ◽  
Suboccipital Craniotomy ◽  
Supracerebellar Infratentorial Approach

Abstract Objective: Giant pediatric midline tumors of the posterior fossa involving the fourth ventricle and the tectal region are difficult to approach and present a high risk of postoperative neurological deficits. Children with sequelae such as cerebellar mutism and ataxia experience a compromise in their quality of life. Here, we present our combined transventricular and supracerebellar infratentorial approach to avoid complications of vermian splitting. Methods: The combined transventricular and supracerebellar infratentorial approach described here was used in a total of four pediatric patients. A medial suboccipital craniotomy with opening of the foramen magnum and resection of the C1 lamina was performed with the patient in the semisitting position. The tumor mass filling the fourth ventricle was removed via a transventricular telovelar route through the foramen of Magendie, preserving the vermis. The rostral tumor portions in the peritectal region extruding up to the thalami were exposed and resected via an infratentorial supracere-bellar route to preserve the venous drainage of the cerebellum. Results: There were no new neurological deficits postoperatively. Two patients had low-grade astrocytomas, and two patients had malignant tumors. Complete tumor resection was achieved in two patients, and near-total tumor removal in the two others. CONCLUSION: The combined transventricular and supracerebellar infratentorial approach offers a unique possibility of safely removing giant pediatric midline tumors. Splitting of the cerebellar vermis is not necessary for removal of such tumors.

Endovascular Recanalization with Balloon Angioplasty and Stenting of an Occluded Occipital Sinus for Treatment of Intracranial Venous Hypertension: Technical Case Report

Neurosurgery ◽  
1999 ◽  
Vol 44 (4) ◽  
pp. 896-901 ◽  
Author(s):  
Adel M. Malek ◽  
Randall T. Higashida ◽  
Peter A. Balousek ◽  
Constantine C. Phatouros ◽  
Wade S. Smith ◽  
...  
Keyword(s):  
Case Report ◽  
Balloon Angioplasty ◽  
Venous Hypertension ◽  
Occipital Sinus ◽  
Endovascular Recanalization ◽  
Angioplasty And Stenting

scholarly journals PT-03 * PROLONGED VASOSPASM FOLLOWING POSTERIOR FOSSA TUMOR RESECTION- A CASE REPORT

2014 ◽  
Vol 16 (suppl 5) ◽  
pp. v175-v175
Author(s):  
N. Dalvi ◽  
C. Jacob ◽  
S. Karkare
Keyword(s):  
Case Report ◽  
Posterior Fossa ◽  
Tumor Resection ◽  
Posterior Fossa Tumor

Endovascular correction of an infantile intracranial venous outflow obstruction

2013 ◽  
Vol 12 (6) ◽  
pp. 660-663 ◽  
Author(s):  
Maryam Soltanolkotabi ◽  
Shahram Rahimi ◽  
Michael C. Hurley ◽  
Robin M. Bowman ◽  
Eric J. Russell ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Venous Pressure ◽  
Transverse Sinus ◽  
Venous Hypertension ◽  
Sigmoid Sinus ◽  
Dural Sinus ◽  
Stent Insertion ◽  
Outflow Obstruction ◽  
Venous Outflow ◽  
Venous Outflow Obstruction

The authors report on the case of a 7-year-old boy who presented with a reduced level of activity, macrocephaly, prominent scalp veins, and decreased left-sided visual acuity. Imaging workup demonstrated generalized cerebral volume loss, bilateral chronic subdural hematomas, absent left sigmoid sinus, hypoplastic left transverse sinus, and severe focal weblike stenosis of the right sigmoid sinus. Right sigmoid sinus angioplasty and stent insertion was performed, with an immediate reduction in the transduced intracranial venous pressure gradient across the stenosis (from 22 to 3 mm Hg). Postprocedural diminution of prominent scalp and forehead veins and spinal venous collateral vessels was followed by a progressive improvement in visual acuity and physical activity over a 1-year follow-up period, supporting the efficacy of angioplasty and stent insertion in intracranial venous outflow obstruction. There are multiple potential causes of intracranial venous hypertension in children. Development of dural sinus stenosis in infancy may be one such cause, mimicking the clinical presentation of other causes such as vein of Galen malformations. This condition can be ameliorated by early endovascular revascularization.

Endoscopic-Assisted Median Aperture Approach for Resection of Fourth Ventricular Tumor and Confirmation of Patency of Cerebral Aqueduct Using an Adjustable-Angle Endoscope: Technical Case Report

2017 ◽  
Vol 13 (2) ◽  
pp. 293-296 ◽  
Author(s):  
Ryan Austerman ◽  
Joshua Lucas ◽  
Alexandra Kammen ◽  
Gabriel Zada
Keyword(s):  
Case Report ◽  
Fourth Ventricle ◽  
Obstructive Hydrocephalus ◽  
Tumor Resection ◽  
Technical Note ◽  
Cerebral Aqueduct ◽  
Suboccipital Craniotomy ◽  
Cerebellar Retraction ◽  
Telovelar Approach ◽  
Operative Microscope

Abstract BACKGROUND AND IMPORTANCE: Open microsurgical approaches to the roof of the fourth ventricle via a telovelar approach typically require cerebellar retraction and/or splitting of the vermis and may be associated with postoperative neurological morbidities. In this case report and technical note, we describe the use of an adjustable-angle endoscope inserted into the median aperture via suboccipital craniotomy, resulting in enhanced visualization of the roof of the fourth ventricle and cerebral aqueduct and maximal safe tumor resection. CLINICAL PRESENTATION: A 49-yr-old woman with obstructive hydrocephalus and a fourth ventricular mass that was not fully visible with the use of an operative microscope. CONCLUSION: Direct visualization of the roof of the fourth ventricle, including the superior medullary velum and cerebral aqueduct, can be facilitated with an adjustable angle endoscope inserted into the median aperture via suboccipital craniotomy to minimize the degree of telovelar dissection and vermis splitting.

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