Incidence, Pathophysiology, and Prevention Strategies for Cerebral Venous Complications after Neurologic Surgery: A Systematic Review of the Literature

• Published in: World neurosurgery 2018-11, Vol.119, p.294-299
• Main Authors: Savardekar, Amey R., Patra, Devi P., Narayan, Vinayak, Thakur, Jai D., Nanda, Anil
• Format: Article
• Language: English
• Subjects: Brain Edema - etiology; Brain Edema - prevention & control; Brain Infarction - etiology; Brain Infarction - prevention & control; Cerebral edema; Cerebral veins; Cerebral Veins - injuries; Cerebral Veins - surgery; Cerebrovascular Disorders - etiology; Cerebrovascular Disorders - prevention & control; Complications; Humans; Neurosurgery; Neurosurgical Procedures - adverse effects; Neurosurgical Procedures - methods; Organ Sparing Treatments - methods; Postoperative Complications - etiology; Postoperative Complications - prevention & control; Tomography, X-Ray Computed; Vascular Surgical Procedures - adverse effects; Vascular Surgical Procedures - methods; Venous injury; Venous occlusion/sacrifice; Venous preservation
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2018.06.231

Complications arising from cerebral venous occlusion/sacrifice during neurosurgical procedures have received comparatively less attention in the neurosurgical literature. Consequently, cerebral venous complications are not given due recognition, even though most practicing neurosurgeons would agree that they are not uncommon. We present a review of complications arising from venous sacrifice/occlusion during neurosurgery and discuss strategies described in the literature to prevent such occurrences. We conducted a systematic review of the literature to provide a synopsis of the current evidence regarding cerebral venous injury after a neurosurgical procedure. The objectives of this review were to assess the incidence of venous injuries after a neurosurgical procedure with their clinical outcome and to evaluate current strategies and technical advances for their prevention. Complications related to dural venous sinuses were not considered in this review. Twenty-six relevant articles were identified and reviewed. Complications from cerebral venous occlusion/sacrifice are being increasingly recognized, and venous preservation strategies are being promoted in the neurosurgical literature. Based on our review of literature, the incidence of venous injury can range from 2.6% to 30%. We discuss the pathophysiology after venous injury and factors affecting outcome after cerebral venous injury. An overview of surgical techniques described to prevent or manage venous injury during neurosurgical procedures is presented. The unpredictable response of the brain to venous injury causes catastrophic complications in a few patients. To avoid these complications, meticulous venous preservation should be a goal in all neurosurgical procedures. Increased recognition of cerebral venous complications over the last 2 decades has resulted in the increasing recognition among neurosurgeons that venous preservation is an essential tenet of neurosurgery. •Complications from venous occlusion/sacrifice have received comparatively lesser attention in neurosurgical literature.•“Unpredictable” postoperative complications may be due to lack of prevention and recognition of venous compromise.•A systematic literature review was conducted to summarize evidence about cerebral venous injury after cranial surgery.•We assessed incidence/clinical outcome of injury post cranial surgery and preventative strategies and technical advances.•To avoid catastrophic complications, meticulous venous preser