Importance of Veins for Neurosurgery as Landmarks Against Brain Shifting Phenomenon: An Anatomical and 3D-MPRAGE MR Reconstruction of Superficial Cortical Veins

Abstract

Modern neurosurgery uses preoperative imaging daily. Three-dimensional reconstruction of the cortical anatomy and of the superficial veins helps the surgeons plan and perform neurosurgical procedures much more safely. The target is always to give the patient maximum benefit in terms of outcome and minimize intraoperative and postoperative complications. This study aims to develop a method for the combined representation of the cerebral cortex anatomy and the superficial cerebral veins, whose integration is beneficial in daily practice. Only those patients who underwent surgical procedures with craniotomy and a large opening of the dura mater were included in this study, for a total of 23 patients, 13 females (56.5%) and 10 males (43.5%). The average age was 50.1 years. We used a magnetic resonance tomograph Magnetom Vision® 1.5T (Siemens AG). Two sequences were applied: a strongly T1-weighted magnetization-prepared rapid acquisition with gradient echo (MPRAGE) sequence to visualize cerebral anatomical structures, and a FLASH-2D-TOF angiography sequence to visualize the venous vessels on the cortical surface after the administration of a paramagnetic contrast agent. The two data sets were superimposed manually, co-registered in an interactive process, and merged to create a combined data set, segmented and visualized as a three-dimensional reconstruction. Furthermore, we present our method for visualizing superficial veins, which helps manage brain shift (BS). We also performed anatomical observations on the reconstructions. The reconstructions of the cortical and venous anatomy proved to be a valuable tool in surgical planning and positively influenced the surgical procedure. Due to the good correlation with the existing surgical site, this method should be validated on a larger cohort or in a multicentric study.

Navigated Transcranial Magnetic Stimulation Motor Mapping Usefulness in the Surgical Management of Patients Affected by Brain Tumors in Eloquent Areas: A Systematic Review and Meta-Analysis

“…Function MRI is a valuable tool, which helps to obtain visuo-spatial data of motor and language functions, which can be merged with the anatomic multiplanar MRI study in navigation planning (22,(33)(34)(35). fMRI offers 59-100% sensitivity, with 0-97% specificity, which although a drawback offers a great variability operator dependent of language mapping, while tractography representation does not offer functional data (36)(37)(38)(39). TMS mapping is not a novelty by itself, introduced in 1985 (40), it has been reported to be a valuable tool in risk stratification and the mapping of motor and language areas for surgical planning (41)(42)(43)(44)(45)(46)(47)(48)(49)(50).…”

Perforating Arteries of the Lemniscal Trigone: A Microsurgical Neuroanatomic Description

“…However, in our dissections, we did not find any perforators originating directly from the collicular artery or accessory collicular artery. The veins in this anatomical region have received considerable attention in neuroradiological (Hochstetter, 1938;Scheinker, 1945;Cannon, 1951;Huang and Wolf, 1965;Babin and Megret, 1973;Tamaki et al, 1976;Suzuki et al, 2001;Ardeshiri et al, 2007;Wackenheim and Braun, 2013) and anatomical studies (Stephens and Stilwell, 1969;Duvernoy, 1974Duvernoy, , 1978Lang et al, 1981;Matsushima et al, 1983;Ono et al, 1984;Graham, 1996;Tomasi et al, 2020). However, not much data about the course, origin, anatomical variations, and frequency of the dorsal perforating arteries could be found in the literature, especially concerning the lemniscal trigone.…”

Surgery for Epilepsy Involving Rolandic and Peri-Rolandic Cortex

“…We can not rely on neuro-navigations to identify surgical boundaries if we could not correct brain shift related problems. 'Surface navigation' based on relative anatomical structures, such as vessels, bones, and gyrus, could supplement the current navigation system [35].…”