Preoperative evaluation of superficial cortical venous drainage

Abstract

Objectives and methodology: The preoperative exact localization of superficial intracranial lesions and superficial cortical veins is often necessary for making craniotomy and evaluation of cortical veins. We developed a simple and cheap method for such localization using cod liver oil capsule during the preoperative MRI and MRV brain examination. With the help of MRV brain, 3DCEMRV and 2DTOF images were taken and superficial cortical veins studied in the marked area for comparison between both modalities of MRV and planning of surgery for avoiding venous injury. Results: Most of the cases were in the age group 16-60 years (91.6%). The most common clinical manifestation was headache (85.4%) and meningioma (60.4%) was found to be the most common pathology. Clear visualization (Grade 3) of the individual superficial cortical vein was observed in 48 cases (100%) in 3DCEMRV as compared to 2DTOF 22 cases (45.8%) P <0.001S. Clear visualization (Grade3) of superior sagittal sinus was observed in 48 cases (100%) in 3DCEMRV as compared to 2DTOF 33 cases (68.6%) P <0.001S. In post-operative CT Head, we found 4 (8.3%) cases were having venous infarction. 5 patients (10.4%) developed motor weakness postoperatively. In 3 cases, postoperative MRV were done and found no venous injury. Conclusion: This study showed that preoperative localization and evaluation of the tumoral area and cortical veins with the help of cod liver oil in MRI and MRV brain was very helpful in planning the surgery, making craniotomy and to avoid injury of the veins. This technique is easy to perform and the capsule is easily constructed and inexpensive. 3DCEMRV was found to be better modality than 2DTOF for delineation of veins. Final neurosurgical outcomes were better.

Keywords

• cod liver oil capsule
• 2DTOF
• 3DCEMRV
• MR venography
• midline lesions
• sagittal sinus