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J Neurol Surg B Skull Base
DOI: 10.1055/a-2324-9978
Original Article

Use of Jugular Venous Pressure to Optimize Outcomes of Vestibular Schwannoma Resection: A Review of the Literature and Proof of Concept

Benjamin Brakel
1   Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
,
Jessica Wang
2   Division of Neurosurgery, Department of Surgery, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
,
Jeremy Kam
2   Division of Neurosurgery, Department of Surgery, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
,
Henrik Huttunen
3   Division of Neuroanesthesia, Department of Anesthesiology, Pharmacology and Therapeutics, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
,
Bali Dhaliwal
3   Division of Neuroanesthesia, Department of Anesthesiology, Pharmacology and Therapeutics, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
,
Jon McEwen
3   Division of Neuroanesthesia, Department of Anesthesiology, Pharmacology and Therapeutics, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
,
Brian Westerberg
4   Division of Otolaryngology, Department of Surgery, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
,
Serge Makarenko
2   Division of Neurosurgery, Department of Surgery, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
,
Ryojo Akagami
2   Division of Neurosurgery, Department of Surgery, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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Abstract

Background Surgical resection of vestibular schwannoma (VS) and other benign posterior fossa tumors is often curative if gross total resection is achieved; however, these lesions pose unique challenges due to their intricate location and proximity to critical structures. Approaches for resection often utilize lateral head rotation and neck flexion to optimize the surgical field. However, this may inadvertently occlude cerebral venous drainage, elevating intracranial pressure (ICP) and increasing intraoperative bleeding, potentially increasing the operative risk to patients.

Methods We review relevant literature regarding the effects of head rotation and neck flexion on internal jugular vein (IJV) occlusion and ICP and highlight the notion that head rotation and flexion may occlude the ipsilateral IJV, increasing ICP. Subsequently, we propose a novel technique using continuous, real-time monitoring of jugular bulb pressure (JBP) to detect obstructions in jugular venous flow and guide optimal head positioning prior to VS resection.

Results As proof of concept, we present a single-patient case in which JBP monitoring was employed to optimize head positioning prior to a VS resection, which shows a significant reduction in JBP compared with traditional positioning.

Conclusion This innovative approach offers promise in enhancing the safety and efficacy of intracranial surgery for VS and other neurosurgical procedures.

Keywords

head positioning - intracranial pressure - jugular bulb - vestibular schwannoma

Previous Presentations

This material was presented as a poster presentation at the BC Cancer Summit in Vancouver, British Columbia, on November 17, 2023, and has been accepted for poster presentation at the 2024 Congress of the Canadian Neurological Sciences Federation in May 2024.


Study Ethics

Consent for publication was obtained from the patient involved in the study, and ethics approval was obtained from our institution's clinical research ethics board.


Statement of Authorship

The manuscript was written by B.B. with input from S.M. Figures were acquired and prepared by B.B., J.W., J.K., and S.M. The project was supervised by S.M. and conceptualized by B.B., S.M., and R.A. All authors reviewed the final submitted manuscript.




Publication History

Received: 31 March 2024

Accepted: 09 May 2024

Accepted Manuscript online:
13 May 2024

Article published online:
31 May 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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