The Research On DSA Venous Phase Of The Cerebral Deep Venous System And Its Clinical Significance

Objective: The characteristics of the cerebral deep venous system on the DSA venous phase were researched to understand the anatomical variations and normal contorts of major related venous drainage in the cerebral deep venous system.To provide guidance for individualized treatment strategy of intracranial lesions,especially when intracranial tumors were deep-seated,such as the lateral or the third ventricular tumors.Removing tumors as much as possible at the premise of avoiding damage of its surrounding venous drainage to achieve the goal of increasing the success rate of surgery,reducing the patients’ complications,as well as improving their prognosis and quality of life.Methods: This research included two parts.Part 1: The DSA venous phase imaging data of 100 patients(intracranial arteriovenous malformation and venous malformations venous related diseases were excluded)in our neurosurgical department from September 2014 to December 2015 were collected to analyze the visualizations of Galen vein(GV),Internal cerebral vein(ICV),Basilar vein(BV),Thalamostriate vein(TV),Anterior ternimal vein(ATV),the lengths and diameters of GV,ICV,BV and the angle between GV and straight sinus were measured with correlative imaging software retrospectively,additionally,the anastomoses between deep cerebral vein and superficial cerebral vein,the variations of the venous drainage were analyzed.Part 2: From September 2013 to December 2015,12 patients with the lateral or the third ventricular lesions were operated by trans callosal-septum pellucidum-interforniceal approach in our neurosurgical department.All patients had the symptoms of intracranial hypertension.The course of disease was from 1 to 3 months.There were seven males and five females,and the average age was 24.8±5.4(from 17 to 36 years old).Determine whether radiochemotherapy or ventriculoperitoneal shunt was needed according to the pathological results and patients with hydrocephalus or not,postoperative follow-up ranged from 1 to 14 months.Then analyzed of the effects of surgical therapy,and summarized the influence of its related venous drainage on callosal-septum pellucidum-interforniceal approach.Results: Part 1: The visualizations of GV,ICV,BV and TV on the venous phase of DSA were one hundred percent,while that of ATV was only 96 percent.The diameter of GV was(4.43±0.73)mm,and its length was(13.10±1.77)mm,the diameter of ICV(2.48±0.53)mm,and its length was(35.37±1.85)mm,the diameter of BV is(2.10±0.43)mm,and its length was(35.24±4.22)mm.The angle between GV and straight sinus was divided into an acute angle and an obtuse angle,the probability of acute angle was 94%(94/100),the latter was 6%(6/100),and the average angle was(73.8±16.6)o.Anastomoses between deep cerebral vein and superficial cerebral vein was abundant,it was obvious especially when in BV and its tributaries,while which in ICV and its tributaries was scanty.Part 2: In all patients,total resection was achieved in 7 patients,3 cases(the tumor resection rate was more than 90%,with only a few residual tumors adherent to important vessels or nerve)were subtotal and 2 cases(the relationship between tumor and thalamus or other important structures was closely related)were partial resected,respectively.The results of pathological examination suggested that 4 cases were ependymoma,3 cases goniolma,2 cases astrocytoma,1 case inflammatory granuloma,1 case Epidermoid cyst and 1 case was arachnoid cyst.Complications included one case of transient hemiplegia and one case of affective disorder.All the patients’ symptoms were significantly improved after operation,and they were able to return to their regular life with no or minimal neurological sequelae.After 1 to 14 months follow-up,the reviews of the MRI confirmed that 1 case was recurrent,3 were residual while the tumor volume did not increase obviously,other cases had no signs of tumor recurrence.Conclusion: Part 1: There are a reasonable number of anatomical variations in the deep cerebral venous system.The visualizations of cerebral deep vein drainage vessels on the DSA venous phase were clear,and anastomoses between deep cerebral vein and superficial cerebral vein were clearly visualized,the acute angle between GV and straight sinus at the abouchement was common.DSA or other imaging examinations may be necessary for us to understand the anatomical variations and normal contorts of major related venous drainage in the cerebral deep venous system,as well as to be familiar with the relationship between lesions and the relevant venous drainage,and then choose the most suitable surgical approach for treatment of deep midline lesions such as the lateral or the third ventricular tumors according to the patient’s individual situation.Part 2: The trans callosal-septum pellucidum-interforniceal approach was peformed in cerebral tissue gap,which had the advantages of short working distance,satisfactory operative field exposure,less damage of cerebral tissue,less complications and so on,its main obstacle was ICV and its tributaries,partial tumor removal may be necessary in some cases.