The Prevention of Postoperative Cerebral Venous Infarction(<SPECIAL ISSUE>Complication Avoidance: Anatomical Practice as Operative Training (2))

Abstract

There is a potential risk of sacrificing the cortical vein during neurosurgical operations, particularly in the interhemispheric or subtemporal approach. An impaired cortical vein might cause cerebral venous circulatory disturbances resulting in postoperative venous infarction. In this article, we reviewed the clinical features of venous infarction from our experiences, and describe how to prevent venous problems associated with the neurosurgery. We have encountered 8 cases (0.3%) with symptomatic postoperative venous infarction during the past 5 years. We found 2 types: severe onset (severe type; 5 cases) and gradual onset (mild type; 3 cases). The former needs immediate treatment from the intraoperative period onward, and the prevention of the ongoing venous thrombosis is essential in the latter. In order to prevent postoperative venous complications, we should take into account (1) the selection of surgical approach considering the cerebral venous system (especially dangerous venous structures), (2) the techniques required to preserve veins during the operation, (4) a safe method for vein the sacrifice, and (3) the treatment of postoperative venous infarction, in various operative strategies.