A pitfall in the interhemispheric translamina terminalis approach for the removal of a craniopharyngioma. Significance of preserving draining veins. Part II. Experimental study

Surg Neurol. 1989 Aug;32(2):116-20. doi: 10.1016/0090-3019(89)90198-5.

Abstract

The authors have reported a case of a craniopharyngioma removed by the interhemispheric translamina terminalis approach, and the postoperative development of a subcortical hematoma. We suspected that the cause of the subcortical hematoma was dividing the bridging veins and applying a retractor over them. In this paper, we report our experimental study, using dogs and monkeys, to evaluate the effect of cutting the vein and applying a retractor over it. The incidence of a subcortical hematoma was highest (60%) when the veins were cut and the retraction was applied. Vein occlusion only did not cause hematoma to develop, and the retraction alone caused 13% of the hematomas. This clearly indicated that the clinical case reported in Part I developed the subcortical hematoma postoperatively because the frontal bridging vein was cut and a retractor was applied for 60 minutes over the cut vein.

MeSH terms

  • Action Potentials
  • Animals
  • Brain / blood supply*
  • Cerebrovascular Circulation
  • Craniopharyngioma / physiopathology
  • Craniopharyngioma / surgery*
  • Dogs
  • Macaca
  • Motor Neurons
  • Pituitary Neoplasms / physiopathology
  • Pituitary Neoplasms / surgery*
  • Veins / surgery*