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Venous Drainage Pattern Analysis of Medial Sphenoid Wing Meningiomas Related to Surgical Planning

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Venous Drainage Pattern Analysis of Medial Sphenoid Wing Meningiomas Related to Surgical Planning ORIGINAL ARTICLE Indonesian Journal of Neurosurgery (IJN) 2020, Volume 3, Number 2: 63-67 P-ISSN.2089-1180, E-ISSN.2302-2914 Venous drainage pattern analysis of medial sphenoid wing meningiomas related to surgical planning Muhammad Adam Pribadi1, Muhammad Wildan Hakim2, Nur Setiawan Suroto2*, Rahadian Indarto Susilo2, Irwan Barlian Immadoel Haq2 ABSTRACT Background: Medial sphenoid wing meningiomas involved to the postoperative complication were retrospectively reviewed using anterior clinoid process (APC) and located medial on the lesser and the patient’s medical and surgical records. greater wing of the sphenoid. Surgical planning of medial sphenoid Results: Based on the 7 surgical cases, 5 cases found as cortical wing meningiomas must be carefully considered, which in skull type, sphenobasal type was found in 2 cases and did not find base surgery has emphasized the essential of venous preserving the cavernous type. The average tumor volume of cortical and and the morbidity when accidentally sacrificed. sphenobasal type was 47,7 cm3, 36 cm3 respectively. In this study, Objective: This study aimed to understand the characteristic one surgical complication was identified, frontal intracerebral venous drainage pattern of medial sphenoid wing meningiomas hemorrhage (ICH) from postoperative computed tomography (CT) and correlate with surgical planning scan evaluation in patients who diagnosed with sphenobasal type. Methods: A retrospective analysis evaluation was performed on Conclusion: Complication because venous damage in cases of 7 patients with medial sphenoid wing meningiomas using digital Medial sphenoid wing meningiomas was rare. However, surgical subtraction angiography (DSA) to determine the venous drainage strategies that aimed to avoid venous complications influenced system characteristics before surgery. Classification of the venous by venous preservation and a good understanding of venous drainage pattern from sylvian veins was divided into cortical type, characteristics. sphenobasal type and cavernous type. Clinical information and Keywords: Meningioma, Medial sphenoid wing meningioma, Skull base surgery, Venous drainage Cite This Article: Pribadi, M.A., Hakim, M.W., Suroto, N.S., Susilo, R.I., Haq, I.B.I. 2020. Venous Drainage Pattern Analysis of Medial Sphenoid Wing Meningiomas Related to Surgical Planning. Indonesian Journal of Neurosurgery 3(2): 63-67. DOI: 10.15562/ijn.v3i2.124 1Dr. Achmad Mochtar General INTRODUCTION anterior clinoidal meningiomas as globular tumors Hospital, Bukittinggi, Indonesia with a maximum diameter of 5 cm or larger, cantered 2 Department of Neurosurgery, The most common primary brain tumoraround the ACP, which is usually hyperostotic. Faculty of Medicine, Universitas is meningiomas. Arachnoidal cells of the Surgical procedure must be considered carefully, Airlangga, Dr. Soetomo Academic leptomeninges are the origin of meningiomas and because of many essential structures around Medical Center Hospital, Surabaya, may arise wherever the cells are.1 In the United Indonesia the anterior clinoid process, such as the artery States between 2002 and 2006, it was reported that of internal carotid, nerve of optic, its branches, meningiomas were the primary brain tumor which perforators, and the system of diencephalic.4 Al- has the most cases of all primary brain and central Mefty’s study for clinoidal meningiomas resulted in nervous system tumors, with percentage 33.8%. *Corresponding Author: a classification based on advances in microsurgical Data from the Central Brain Tumor Registry of anatomy that are widely accepted.5 Nur Setiawan Suroto; Department the United States (CBTRUS) reported that females of Neurosurgery, Faculty of The communication patterns between the have a twofold higher incidence.2 Sphenoid ridge Medicine, Universitas Airlangga, cavernous sinus and the Superficial middle cerebral Dr. Soetomo Academic Medical meningiomas represent approximately 20% of vein (SMCV) from Tanoue’s study were classified Center Hospital, Surabaya, supratentorial meningiomas, among which less than into 4 types: Type A was defined as SMCV connects Indonesia; half arise from the medial ridge of the sphenoid. The with the sphenoparietal sinus proximal and flows nur.setiawan.suroto-2016@ tumor was first described in 1910 by Frotscher into the frontal aspect of the cavernous sinus. Type fk.unair.ac.id and Becker as an autopsy finding in a 72-year- B, SMCV connects with the cavernous sinus at old man. Medial sphenoid wing meningiomas the lateral aspect independently. Type C, SMCV Received: 2020-04-13 involved in the anterior clinoid process (APC), connects with the pterygoid plexus via the middle Accepted: 2020-06-28 located medially on the lesser and greater wing of Published: 2020-08-01 3 cranial fossa while moving downward. Type D, the sphenoid and represent a distinct entity. Giant SMCV connects with the superior petrosal sinus or PublishedOpen access: by DiscoverSyshttps://ina-jns.org/ | IJN 2020; 3(2): 63-67 | doi: 10.15562/ijn.v3i2.124 63 ORIGINAL ARTICLE transverse sinus through the tentorial sinus.6 imaging was analyzed from the location and size of The majority of published studies on Medial the tumor found in the database. Digital subtraction sphenoid wing meningiomas concern the results angiography (DSA) was used to analyze the pattern of the surgical treatment of the tumors. No much of venous drainage according to the classification information is available on the importance of described previously. The pattern of venous venous drainage patterns in Medial sphenoid drainage was examined in 13 patients only, but 6 wing meningiomas for patients who will undergo patients refused to perform surgery. 115 patients surgical intervention. Many articles discussed who did not perform surgery either DSA were about anatomical consideration and classification excluded. The classification of venous drainage was of venous drainage, while study whether there categorized according to the drainage pattern of the is a relationship between the classification of a Sylvian vein into the major draining vein, whether venous drainage system and surgical strategy is not cortical, sphenobasal, or cavernous type. Clinical available yet. The latest article, Nagata, classified information and postoperative complication were the venous drainage pattern from the sylvian veins retrospectively reviewed using the patient’s medical into three groups, cortical type, sphenobasal type, and surgical records. or cavernous type, to consider appropriate surgical Skull base surgery of temporofrontal or strategy. Cortical venous drainage classification orbitozygomatic approach was used to this group of was defined when the Sylvian vein drains out medial sphenoid meningioma patients. The extent directly into the cortical vein direction, not into the of resection was based on a subjective surgical sphenoparietal, sphenobasal, and cavernous vein impression of gross total resection (GTR), subtotal direction (Figure 1A). Sphenobasal venous drainage resection (STR), and partial resection (PR) obtained classification was defined when the Sylvian vein from a surgeon’s surgical record. Postoperative drains its flows from the pterygoid plexus to the computed tomography (CT) scan was also reviewed foramen ovale (Figure 1B). And cavernous venous to confirm tumor removal. drainage classification was defined when the Sylvian vein drains its flows directly into the cavernous RESULTS sinus via sphenoparietal sinus (Figure 1C). 7 The skull base surgery technique explains the This study included 7 patients from April 2012 importance of venous preserving and the morbidity to March 2019 with medial sphenoid wing when this venous accidentally sacrificed during meningiomas who underwent preoperative DSA to surgery. Some papers reported complication of examine the characteristics of the venous drainage venous can occurr whenever the pattern of venous system and operated at Dr. Soetomo Academic drainage is changed or obstructed by the tumor. Medical Center Hospital, Surabaya, Indonesia. This study aimed to find the characteristic of Medial The patient’s demographic data were described in sphenoid wing meningiomas vein in Indonesia, Table 1. Patient’s ages ranged from 38-65 years, with an average of 47 years. The average of tumor especially East Java, which is expected to have 3 3 benefits in determining the surgical strategy to get volume was 47,7 cm for cortical type, 36 cm for a better result. sphenobasal type. The most common presenting symptoms were visual deterioration and headaches. METHODS Analysis from the total of 7 cases, 5 cases showed the cortical type of sylvian venous drainage (71,4%) This retrospective analysis study from 122 patients with four cases invasion to the cavernous sinus, with medial sphenoid wing meningioma in an then 2 other cases showed the sphenobasal type outpatient clinic at Dr. Soetomo Academic Medical (28,6%) with no invasion to the cavernous sinus Center Hospital, Surabaya, Indonesia during period and did not found type of cavernous. The average April 2012 until March 2019. The preoperative tumor volume of the cortical type was 47,7 cm3 and the sphenobasal type tumor was 36 cm3, see Table 2. A large operative view was obtained in cortical type patients. There is a surgical complication, headache, and prolonged length of stay, that happened. Frontal ICH was found from postoperative CT scan evaluation in the sphenobasal type patients. Gross total removal was obtained by 40% (2/5) in the cortical type. Subtotal removal was
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