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

Benjamin Brakel; Jessica Wang; Jeremy Kam; Henrik Huttunen; Bali Dhaliwal; Jon McEwen; Brian Westerberg; Serge Makarenko; Ryojo Akagami

doi:10.1055/a-2324-9978

Journal of Neurological Surgery Part B: Skull Base, Table of Contents

J Neurol Surg B Skull Base 2025; 86(04): 403-408
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

¹Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada

,

Jessica Wang

²Division of Neurosurgery, Department of Surgery, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada

,

Jeremy Kam

²Division of Neurosurgery, Department of Surgery, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada

,

Henrik Huttunen

³Division of Neuroanesthesia, Department of Anesthesiology, Pharmacology and Therapeutics, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada

,

Bali Dhaliwal

³Division of Neuroanesthesia, Department of Anesthesiology, Pharmacology and Therapeutics, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada

,

Jon McEwen

³Division of Neuroanesthesia, Department of Anesthesiology, Pharmacology and Therapeutics, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada

,

Brian Westerberg

⁴Division of Otolaryngology, Department of Surgery, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada

,

Serge Makarenko

²Division of Neurosurgery, Department of Surgery, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada

,

Ryojo Akagami

²Division of Neurosurgery, Department of Surgery, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada

› Author Affiliations

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

Full Text

References

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