Acute cerebral venous outflow obstruction during convexity meningioma resection

Abstract

Background

Cerebral venous outflow obstruction involves idiopathic intracranial hypertension, and the most common related condition is dural venous sinus stenosis or, in other words, an obstruction of the dural venous sinuses. In these cases, the pathological process is often chronic, displays only mild symptoms, and rarely requires urgent surgical intervention. In this study, we present a unique case involving an acute cerebral venous outflow obstruction that occurred during meningioma resection that ultimately had catastrophic consequences.

Materials and methods

The patient's preoperative imaging only revealed an unremarkable frontal convexity meningioma with an average diameter exceeding 8 cm. She was admitted for a scheduled right frontoparietal craniotomy for lesion resection.

Results

The patient's unique congenital dural venous sinus structure along with a non-surgical epidural hematoma both contributed to a catastrophic outcome, causing a progressive hemispheric encephalocele, significant blood loss, and wound closure difficulties.

Conclusion

Neurosurgeons should place an additional focus on cerebral venous outflow patency during tumor resection, even if the tumor does not involve the transverse or sigmoid sinuses. It is well known that the tacking sutures play an essential role in preventing an epidural hematoma, but the procedure to mitigate hematomas occurring outside the surgical field of view is not fully recognized by neurosurgeons. If dural tacking sutures are placed after complete tumor resection, the prophylactic effect for preventing EDH in the non-surgical areas may not be guaranteed. Therefore, we strongly advocate for the tacking sutures to be accurately placed before dural incisions are made.

Keywords:

• Cerebral venous outflow obstruction
• encephalocele
• epidural hematoma
• meningioma
• tacking suture

Acknowledgment

The authors respectfully thank the patient and her family for their trust and agreement on the publication of this case. We are grateful to all the medical staff involved in the rescue of the patient, including those in the department of blood transfusion, the operating room and NICU. We also thank Dr. Xiufeng Zhang for his help in image processing.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Ethics statement

This study was carried out in accordance with the recommendations of the guidelines of the International Committee of Medical Journal Editors, the ethics committee of the Shanxi Provincial People's Hospital with written informed consent from this subject. The subject gave written informed consent in accordance with the Declaration of Helsinki.

Informed consent

Considering that the patient was in a state of disturbance of consciousness at that time, her immediate relatives received a detailed description of the research protocol and gave written informed consent. Prior to this submission, the publication informed consent signed by the patient has been obtained.