2025 Poster Presentations
P457: USE OF JUGULAR VENOUS PRESSURE TO OPTIMIZE OUTCOMES OF VESTIBULAR SCHWANNOMA RESECTION: A REVIEW OF THE LITERATURE AND PROOF OF CONCEPT
Benjamin Brakel, BHSc1; Jessica Wang, MD2; Jeremy Kam, MBBS2; Henrik Huttunen, MD3; Bali Dhaliwal, MD3; Jon McEwen, MD3; Brian Westerberg, MD4; Serge Makarenko, MD2; Ryojo Akagami, MSc, MD2; 1Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; 2Division of Neurosurgery, Department of Surgery, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada; 3Division of Neuroanesthesia, Department of Anesthesiology, Pharmacology & Therapeutics, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada; 4Division of Otolaryngology, Department of Surgery, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
Background: Surgical resection of vestibular schwannoma (VS) is often curative if gross total resection is achieved, however, it is a delicate procedure with high risk to the facial nerve. With retrosigmoid approach for resection, the head is positioned to maximize lateral head rotation and neck flexion in order to optimize the surgical field. However, this may inadvertently occlude cerebral venous drainage, elevating intracranial pressure (ICP) and increasing intraoperative bleeding.
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 to traditional positioning.
Conclusion: This innovative approach offers promise in enhancing the safety and efficacy of intracranial surgery for VS and potentially other neurosurgical procedures.