Microsurgical anatomy of the great cerebral vein of Galen and its tributaries

2003 ◽  
Vol 99 (6) ◽  
pp. 1028-1038 ◽  
Author(s):  
Patrick Chaynes
Keyword(s):  
Venous Drainage ◽  
Pineal Region ◽  
Surgical Approaches ◽  
Cerebral Vein ◽  
Cerebral Veins ◽  
Microsurgical Anatomy ◽  
Vein Of Galen ◽  
Content Type ◽  
Deep Cerebral Veins ◽  
Fine Print

Object. The deep cerebral veins may pose a major obstacle in operative approaches to deep-seated lesions, especially in the pineal region where multiple veins converge on the great cerebral vein of Galen. Because undesirable sequelae may occur from such surgery, the number of veins and branches to be sacrificed during these approaches should kept to a minimum. The purpose of this study was to examine venous drainage into the vein of Galen with a view to surgical approaches. If a vein hampering surgical access must be sacrificed, it can therefore be selected according to the smallest draining territory. Methods. The deep cerebral veins and their surrounding neural structures were examined in 50 cerebral hemispheres from 25 adult cadavers in which the arteries and veins had been perfused with red and blue silicone, respectively. Special consideration was given to the size and location of drainage of the vein of Galen and its tributaries. Conclusions. When a surgeon approaches the pineal region, several veins may hamper the access route. From posterior to anterior, these include the following: the superior vermian and the precentral or superior cerebellar veins, which drain into the posteroinferior aspect of the vein of Galen; and the tectal and pineal veins, which drain into its anterosuperior aspect. The internal occipital vein is the main vessel draining into the lateral aspect of the vein of Galen. It may be joined by the posterior pericallosal vein, and in that case has an extensive territory. To avoid intraoperative venous infarction, it is important to use angiography to determine the venous organization before surgery and to estimate the permeability and size of the branches of the deep venous system.

Microsurgical anatomy of the insula and the sylvian fissure

2004 ◽  
Vol 100 (5) ◽  
pp. 891-922 ◽  
Author(s):  
Necmettin Tanriover ◽  
Albert L. Rhoton ◽  
Masatou Kawashima ◽  
Arthur J. Ulm ◽  
Alexandre Yasuda
Keyword(s):  
Venous Drainage ◽  
Sylvian Fissure ◽  
Cerebral Vein ◽  
Microsurgical Anatomy ◽  
Venous Anatomy ◽  
Content Type ◽  
Important Landmark ◽  
Lenticulostriate Artery ◽  
The One ◽  
Fine Print

Object. The purpose of this study was to define the topographic anatomy, arterial supply, and venous drainage of the insula and sylvian fissure. Methods. The neural, arterial, and venous anatomy of the insula and sylvian fissure were examined in 43 cerebral hemispheres. Conclusions. The majority of gyri and sulci of the frontoparietal and temporal opercula had a constant relationship to the insular gyri and sulci and provided landmarks for approaching different parts of the insula. The most lateral lenticulostriate artery, an important landmark in insular surgery, arose 14.6 mm from the apex of the insula and penetrated the anterior perforated substance 15.3 mm medial to the limen insulae. The superior trunk of the middle cerebral artery (MCA) and its branches supplied the anterior, middle, and posterior short gyri; the anterior limiting sulcus; the short sulci; and the insular apex. The inferior trunk supplied the posterior long gyrus, inferior limiting sulcus, and limen area in most hemispheres. Both of these trunks frequently contributed to the supply of the central insular sulcus and the anterior long gyrus. The areas of insular supply of the superior and inferior trunks did not overlap. The most constant insular area of supply by the cortical MCA branches was from the prefrontal and precentral arteries that supplied the anterior and middle short gyri, respectively. The largest insular perforating arteries usually arose from the central and angular arteries and most commonly entered the posterior half of the central insular sulcus and posterior long gyrus. Insular veins drained predominantly to the deep middle cerebral vein, although frequent connections to the superficial venous system were found. Of all the insular veins, the precentral insular vein was the one that most commonly connected to the superficial sylvian vein.

Microsurgical anatomy of the sellar region

1975 ◽  
Vol 43 (3) ◽  
pp. 288-298 ◽  
Author(s):  
Wade H. Renn ◽  
Albert L. Rhoton
Keyword(s):  
Sphenoid Sinus ◽  
Carotid Arteries ◽  
Sella Turcica ◽  
Acute Angle ◽  
Surgical Approaches ◽  
Microsurgical Anatomy ◽  
Optic Nerves ◽  
Content Type ◽  
Sellar Floor ◽  
Fine Print

✓ Fifty adult sellae and surrounding structures were examined under magnification with special attention given to anatomical variants important to the transfrontal and transsphenoidal surgical approaches. The discovered variants considered disadvantageous to the transsphenoidal approach were as follows: 1) large anterior intercavernous sinuses extending anterior to the gland just posterior to the anterior sellar wall in 10%; 2) a thin diaphragm in 62%, or a diaphragm with a large opening in 56%; 3) carotid arteries exposed in the sphenoid sinus with no bone over them in 4%; 4) carotid arteries that approach within 4 mm of midline within the sella in 10%; 5) optic canals with bone defects exposing the optic nerves in the sphenoid sinus in 4%; 6) a thick sellar floor in 18%; 7) sphenoid sinuses with no major septum in 28% or a sinus with the major septum well off midline in 47%; and 8) a presellar type of sphenoid sinus with no obvious bulge of the sellar floor into the sphenoid sinus in 20%. Variants considered disadvantageous to the transfrontal approach were found as follows: 1) a prefixed chiasm in 10% and a normal chiasm with 2 mm or less between the chiasm and tuberculum sellae in 14%; 2) an acute angle between the optic nerves as they entered the chiasm in 25%; 3) a prominent tuberculum sella protruding above a line connecting the optic nerves as they entered the optic canals in 44%; and 4) carotid arteries approaching within 4 mm of midline within or above the sella turcica in 12%.

Anomalous duplication of the posterior part of the internal cerebral vein and the great vein of Galen

1972 ◽  
Vol 36 (5) ◽  
pp. 646-648 ◽  
Author(s):  
Alberto Calabro ◽  
A. Palmieri
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Posterior Part ◽  
Cerebral Vein ◽  
Vein Of Galen ◽  
Content Type ◽  
Internal Cerebral Vein ◽  
Great Vein ◽  
Fine Print

✓ The authors present a case of anomalous duplication of the posterior part of the internal cerebral vein and probably of the great vein of Galen, and hypothesize a relationship with subarachnoid hemorrhage.

Deep venous communication in vein of Galen malformations: incidence, Imaging, and Implications for treatment

2020 ◽  
pp. neurintsurg-2020-016224
Author(s):  
Hans Kortman ◽  
Ershad Navaei ◽  
Charles A Raybaud ◽  
Kartik Dev Bhatia ◽  
Manohar Shroff ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Venous Drainage ◽  
Cerebral Vein ◽  
Cerebral Veins ◽  
Vein Of Galen ◽  
Mri Imaging ◽  
Alternative Pathways ◽  
Sagittal Sinus ◽  
Drainage Patterns ◽  
Optimal Quality

BackgroundFailure to appreciate deep venous drainage pathways is a major cause of severe complications in the endovascular treatment of vein of Galen aneurysmal malformations (VOGMs).ObjectiveTo report deep venous drainage patterns in patients with VOGM, emphasizing the internal cerebral veins, and to describe the challenges in evaluating these.MethodsPatients with VOGM presenting to our institute between 2000 and 2018 were retrospectively analyzed. Patients with complete and good quality imaging datasets were included in the study. Three neuroradiologists with expertise in the subject independently analyzed the deep venous drainage patterns on multi-sequence MRI and digital subtraction angiography. Follow-up imaging studies were analyzed for alterations in deep venous drainage patterns that occurred following endovascular treatment. Descriptive statistics were used to report findings.ResultsTwenty-three patients had optimal quality MRI imaging and 25 had optimal quality DSA imaging available. In 14/23 (61%) patients, internal cerebral vein (ICV) communication could be reliably identified on MRI and in 8/25 (32%) patients on DSA. Deep venous communication with the VOGM was demonstrated in 8/26 (30.8%) patients. One (3.8%) patient demonstrated ICV communication with the VOGM only on postoperative imaging, while in 2 (8%) patients the ICV drainage route changed from VOGM to alternative pathways after the procedure. Other variant pathways included lateral mesencephalic vein, superior or inferior sagittal sinus, anterior mesencephalic vein, tentorial sinus, deep Sylvian vein, and superior vermian vein.ConclusionICV communication with the VOGM is not uncommon and requires dedicated preprocedural imaging to identify it. However, there are significant challenges in assessing this communication in the presence of high-flow fistulae, vessel tortuosity and size, and contrast limitations in this population.

Microsurgical Anatomy of the Venous Drainage of the Mesencephalodiencephalic Junction

Neurosurgery ◽  
2004 ◽  
Vol 54 (3) ◽  
pp. 678-686 ◽  
Author(s):  
Patrick Chaynes
Keyword(s):  
Third Ventricle ◽  
Posterior Part ◽  
Pineal Region ◽  
Pineal Body ◽  
Cerebral Vein ◽  
Cerebral Veins ◽  
Microsurgical Anatomy ◽  
Jugular Veins ◽  
Topographic Anatomy ◽  
Adjacent Structures

Abstract OBJECTIVE The veins draining the posterior wall of the third ventricle and its adjacent structures and the posterior part of the midbrain have been the most neglected of the intracranial vascular structures in both the anatomic and neurosurgical literature. During our dissections of the pineal region and the quadrigeminal cistern, we did not always encounter topographic anatomy as described in previous articles. The purpose of this study is to describe the topographic anatomy and normal variations of the specific veins that drain the collicular plate and the pineal body and their adjacent structures with a view to better defining neurosurgical approaches to the pineal region. METHODS The deep cerebral veins draining the pineal body, the collicular plate, and their surrounding neural structures were examined on both sides of 25 adult cadaveric brains. In all specimens, the carotid and vertebral arteries and the jugular veins were perfused with red or blue silicone, respectively, to facilitate dissection under ×3 to ×40 magnification. RESULTS The venous plexus on the dorsal aspect of the collicular plate drains via collicular veins according to three different patterns. These types of drainage are closely related to the existence or absence of the basal vein on one or both sides. CONCLUSION The veins draining the superior and inferior aspects of the pineal body form a superior and an inferior pineal vein that usually drain into the internal or great cerebral vein.

The transcallosal—transforaminal approach to the third ventricle with regard to the venous variations in this region

1997 ◽  
Vol 87 (5) ◽  
pp. 706-715 ◽  
Author(s):  
Uğur Türe ◽  
M. Gazi Yaşargil ◽  
Ossama Al-Mefty
Keyword(s):  
Third Ventricle ◽  
Anatomical Study ◽  
Surgical Approaches ◽  
Cerebral Vein ◽  
Foramen Of Monro ◽  
Content Type ◽  
The Third ◽  
Transforaminal Approach ◽  
Velum Interpositum ◽  
Fine Print

✓ Surgical approaches to lesions located in the anterior and middle portions of the third ventricle are challenging, even for experienced neurosurgeons. Various exposures involving the foramen of Monro, the choroidal fissure, the fornices, and the lamina terminalis have been advocated in numerous publications. The authors conducted a microsurgical anatomical study in 20 cadaveric brain specimens (40 hemispheres) to identify an exposure of the third ventricle that would avoid compromising vital structures. An investigation of the variations in the subependymal veins of the lateral ventricle in the region of the foramen of Monro was performed, as these structures are intimately associated with the surgical exposure of the third ventricle. In 16 (80%) of the brain specimens studied, 19 (47.5%) of the hemispheres displayed a posterior location of the anterior septal vein—internal cerebral vein (ASV—ICV) junction, 3 to 13 mm (average 6 mm) beyond the foramen of Monro within the velum interpositum, not adjacent to the posterior margin of the foramen of Monro (the classic description). Based on this finding, the authors advocate opening the choroidal fissure as far as the ASV—ICV junction to enlarge the foramen of Monro posteriorly. This technique achieves adequate access to the anterior and middle portions of the third ventricle without causing injury to vital neural or vascular structures. The high incidence of posteriorly located ASV—ICV junctions is a significant factor influencing the successful course of surgery. Precise planning of the surgical approach is possible, because the location of the junction is revealed on preoperative neuroradiological studies, in particular on magnetic resonance venography. It can therefore be determined in advance which foramen of Monro qualifies for posterior enlargement to gain the widest possible access to the third ventricle. This technique was applied in three patients with a third ventricular tumor, and knowledge of the venous variations in this region was an important resource in guiding the operative exposure.

Microsurgical anatomy of the pineal region

1980 ◽  
Vol 53 (2) ◽  
pp. 205-221 ◽  
Author(s):  
Isao Yamamoto ◽  
Naoki Kageyama
Keyword(s):  
Cranial Nerves ◽  
Pineal Region ◽  
Superior Cerebellar Artery ◽  
Cerebral Vein ◽  
Microsurgical Anatomy ◽  
Content Type ◽  
Cerebellar Artery ◽  
Bridging Vein ◽  
Tentorial Notch ◽  
Relationship Of

✓ Thirty cadaver brains were examined under × 6 to 16 magnification in order to define the microsurgical anatomy of the pineal region, particularly the relationship of the pineal body, posterior cerebral artery, superior cerebellar artery, vein of Galen, basal vein of Rosenthal, internal cerebral vein, straight sinus, bridging vein, the size of the tentorial notch, and the third and the fourth cranial nerves. The infratentorial and supratentorial approaches to the pineal region are compared from the viewpoint of microsurgical anatomy.

Surgical strategy for distal anterior cerebral artery aneurysms: microsurgical anatomy

2003 ◽  
Vol 99 (3) ◽  
pp. 517-525 ◽  
Author(s):  
Masatou Kawashima ◽  
Toshio Matsushima ◽  
Tomio Sasaki
Keyword(s):  
Cerebral Artery ◽  
Anterior Cerebral Artery ◽  
Parallel Line ◽  
Lower Half ◽  
Surgical Strategy ◽  
Surgical Approaches ◽  
Microsurgical Anatomy ◽  
Content Type ◽  
Distal Anterior Cerebral Artery ◽  
Fine Print

Object. Most distal anterior cerebral artery (ACA) aneurysms arise at the pericallosal—callosomarginal artery (PerA—CMA) junction, which is usually located in the A3 segment of the ACA around the genu of the corpus callosum. Aneurysms in the PerA—CMA junction are divided into two types according to their location: supracallosal and infracallosal. Infracallosal distal ACA aneurysms are defined as those located in the lower half of the A3 segment, which makes it more difficult to gain proximal control. In this study, the authors examined the microsurgical anatomy of the distal ACA region, focusing especially on the relationship between the PerA and CMA located in the lower half of the A3 (infracallosal) segment, and present a surgical strategy for dealing with distal ACA aneurysms. Methods. The microsurgical anatomy of the distal ACA region was examined in 22 adult cadaveric cerebral hemispheres after perfusion of the arteries and veins with colored silicone. The relationships of the infracallosal segment of the PerA to the CMA and the A2 segment of the PerA to the frontopolar artery were examined. The distance between the nasion and the site at which a parallel line directed along the long axis of the infracallosal PerA just proximal to the origin of the CMA artery crosses the forehead (which we have named the PC point) was also measured. Surgical approaches to distal ACA aneurysms were examined in stepwise dissections. Conclusions. The PerA—CMA junctions were located in the supracallosal and infracallosal segments of A3 in 36 and 55% of cases, respectively. In the infracallosal region, it was difficult to identify the proximal PerA and to establish proximal control of the vessel. The infracallosal part of the proximal PerA coursed almost parallel to the frontal cranial base, and the PC point was 42.2 ± 15.9 mm (mean ± standard deviation) from the nasion. These findings indicate that there is only a limited space in which to access an infracallosal distal ACA aneurysm below the PC point and establish proximal control by the anterior interhemispheric approach. When the approach is made above the PC point, an anterior callosotomy may be necessary to establish proximal control before final aneurysm dissection and clip placement are completed. The PC point is an important surgical landmark in planning the surgical strategy for infracallosal distal ACA aneurysms.

Occlusion of the great vein of Galen associated with a huge meningioma in the pineal region

1984 ◽  
Vol 61 (6) ◽  
pp. 1136-1140 ◽  
Author(s):  
Saburo Sakaki ◽  
Toshitaka Shiraishi ◽  
Sadanori Takeda ◽  
Kenzo Matsuoka ◽  
Kazuhiko Sadamoto
Keyword(s):  
Pineal Region ◽  
Neurological Deficits ◽  
Vein Of Galen ◽  
Content Type ◽  
Great Vein ◽  
Fine Print

✓ The authors report a case in which the great vein of Galen was occluded during removal of a huge meningioma in the pineal region. The patient recovered satisfactorily without any serious neurological deficits after the operation. Preoperative angiography had shown marked stenosis of the great vein of Galen and anastomoses between the deep and the superficial venous systems. Occlusion of the great vein of Galen may be well tolerated in particular cases if this vein is already compromised.

A proposed grading system for arteriovenous malformations

1986 ◽  
Vol 65 (4) ◽  
pp. 476-483 ◽  
Author(s):  
Robert F. Spetzler ◽  
Neil A. Martin
Keyword(s):  
Venous Drainage ◽  
Neurological Complications ◽  
Management Decision ◽  
Grading System ◽  
Content Type ◽  
Treatment Techniques ◽  
Clinical Series ◽  
Management Decision Making ◽  
Eloquent Cortex ◽  
Fine Print

✓ An important factor in making a recommendation for treatment of a patient with arteriovenous malformation (AVM) is to estimate the risk of surgery for that patient. A simple, broadly applicable grading system that is designed to predict the risk of morbidity and mortality attending the operative treatment of specific AVM's is proposed. The lesion is graded on the basis of size, pattern of venous drainage, and neurological eloquence of adjacent brain. All AVM's fall into one of six grades. Grade I malformations are small, superficial, and located in non-eloquent cortex; Grade V lesions are large, deep, and situated in neurologically critical areas; and Grade VI lesions are essentially inoperable AVM's. Retrospective application of this grading scheme to a series of surgically excised AVM's has demonstrated its correlation with the incidence of postoperative neurological complications. The application of a standardized grading scheme will enable a comparison of results between various clinical series and between different treatment techniques, and will assist in the process of management decision-making.

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