Abstract：
BACKGROUND/OBJECT:Ligation and division of anterior third (AT) of superior sagittal sinus (SSS) is presumed to be safe and is commonly used for approaching anterior skull base tumors and distal anterior cerebral artery aneurysms (DACA). Contrary to this belief we found complications secondary to this procedure more often than described and we have described them along with probable etiology. MATERIALS AND METHODS:A total of 62 patients who underwent bifrontal or extended bifrontal craniotomies with ligation and division of the proximal end of SSS were studied retrospectively. The clinical profiles and postoperative CT scans were studied to look for venous edema and hemorrhages. Venogram (digital subtraction) was done in one of the patients who had developed this complication. RESULTS:Five patients developed bifrontal venous hemorrhagic infarcts (4 patients with anterior skull base tumors and 1 with DACA aneurysm). These patients had a morbid postoperative hospital stay with memory disturbances and urinary incontinence in the follow up period. Two patients died. The venogram done in one patient revealed complete occlusion of the AT-SSS. The morbidity and mortality that can be attributed to ligation of AT-SSS was 8.06% and 1.6% respectively. CONCLUSIONS:The safety of ligation and division of the AT-SSS is questionable, contrary to traditional teaching. Though only the proximal end of SSS is ligated, the occlusion extends upto the distal craniotomy edge possibly due to reflection of the dural leaf with AT-SSS that causes kinking and thrombosis. It is more often seen in patients with anterior skull base lesions, probably because of already compromised basal venous drainage. A preoperative venogram could possibly predict the safety of this procedure.
journal_name
Clin Neurol Neurosurgjournal_title
Clinical neurology and neurosurgeryauthors
Salunke P,Sodhi HB,Aggarwal A,Ahuja CK,Dhandapani SS,Chhabra R,Gupta SKdoi
10.1016/j.clineuro.2013.06.003subject
Has Abstractpub_date
2013-10-01 00:00:00pages
1998-2002issue
10eissn
0303-8467issn
1872-6968pii
S0303-8467(13)00211-4journal_volume
115pub_type
杂志文章abstract：:A 44-year-old man presented with symptoms of periodic ataxia, dysarthria, nausea and excessive sweating during the last twenty years. These symptoms could be provoked by physical or emotional stress and disappeared after bedrest for several hours. No other members of his family were known to have such complaints. Acet...
journal_title：Clinical neurology and neurosurgery
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journal_title：Clinical neurology and neurosurgery
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journal_title：Clinical neurology and neurosurgery
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journal_title：Clinical neurology and neurosurgery
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journal_title：Clinical neurology and neurosurgery
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journal_title：Clinical neurology and neurosurgery
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更新日期：2013-10-01 00:00:00
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pub_type： 杂志文章
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更新日期：1983-01-01 00:00:00
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更新日期：2013-08-01 00:00:00
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更新日期：2004-03-01 00:00:00
