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

Chaynes, Patrick

doi:10.3171/jns.2003.99.6.1028

Cited by 52 publications

(37 citation statements)

References 34 publications

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“…Using the sitting position, gravity reduces the venous pressure, which makes the dissection of veins from the tumor easier. It has been generally reported that the precentral cerebellar vein can be sacrificed without any clinical symptoms (18,22,30). However, Kanno reported a case with thrombosis of the basal veins of Rosenthal and internal cerebral veins, which were initiated by division of the precentral cerebellar vein and followed by fatal hemorrhagic infarction (31).…”

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confidence: 99%

Neurosurgical venous considerations for tumors of the pineal region resected using the infratentorial supracerebellar approach

Kodera

Bozinov

Sürücü

et al. 2011

Journal of Clinical Neuroscience

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The authors present a microsurgical technique for the resection of a heterogeneous group of pineal-region tumors and discuss the key points for successfully performing this surgery. Twenty-six consecutive patients with pineal-region tumors were resected by the senior author (H.B.) and analyzed retrospectively. For all 26 patients, the operation was conducted using the infratentorial supracerebellar (ITSC) approach in the sitting (23 patients) or Concorde (three patients) positions. Twenty-five patients had symptomatic obstructive hydrocephalus and were treated with ventricular drainage, a previously inserted ventriculoperitoneal shunt, or an endoscopic third ventriculostomy before undergoing resection of the pineal-region tumor. The gross total removal of the tumor was achieved in 23 patients and subtotal removal was achieved in three patients. The tumors were pathologically diagnosed mainly as pineocytomas (10), pilocytic astrocytomas (6), or pineal cysts (4). Twenty-five of the patients clinically improved after surgery, and there was no mortality. Two patients experienced transient postoperative neurological deterioration: one patient developed Parinaud syndrome, and one patient developed intermittent diplopia. Successful surgery and patient outcome when treating tumors of the pineal region using the ITSC approach requires: (i) preservation of the venous flow of the Galenic draining system; (ii) preservation of the thick bridging veins of the tentorial surface of the cerebellum, especially the hemispheric bridging veins; and (iii) minimizing retraction of the cerebellum during surgery to avoid adverse effects caused by both direct cerebellar compression and disturbance of the venous circulation.

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confidence: 99%

Neurosurgical venous considerations for tumors of the pineal region resected using the infratentorial supracerebellar approach

Kodera

Bozinov

Sürücü

et al. 2011

Journal of Clinical Neuroscience

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“…Chaynes [1] described the anatomy of the ICVs in considerable detail. The ICVs run dorsally within the roof of the third ventricle with a mean maximal diameter of 2.7 mm.…”

Section: Discussionmentioning

confidence: 99%

“…During neurosurgical procedures, injury to the cerebral venous system can be caused by tears in the venous sinuses at craniotomy, brain retraction interfering with venous outflow, obliteration of veins or sinuses, and hemodynamic changes after extensive lesion removal [1,9] . Chaynes [1] described the anatomy of the ICVs in considerable detail.…”

Section: Discussionmentioning

confidence: 99%

“…Occlusion of the deep cerebral venous system can lead to a variety of clinical symptoms and signs including headache, vomiting, lethargy, pyrexia, hemiparesis, behavioral anomalies, decreased level of consciousness, coma, and death [2,3,[10][11][12][13] . However, deep cerebral venous system thrombosis is usually associated with thrombosis of the superficial veins and sinuses [1,3,11] and can be caused by the use of birth control pills, malignancies, and chronic illness [3] .…”

Section: Discussionmentioning

confidence: 99%

“…The ICVs course posteriorly within the roof of the third ventricle and drain into the great cerebral vein of Galen [1] . The proximity of the ICVs to the midline and their position between the lateral ventricles and both thalami make them vulnerable to injury during neurosurgical approaches to the lateral or third ventricle.…”

Section: Introductionmentioning

confidence: 99%

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Unilateral Postoperative Deep Cerebral Venous Thrombosis with Complete Recovery: A Report of 2 Cases

Benifla

Laughlin²,

Tovar-Spinoza³

et al. 2017

Pediatr Neurosurg

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Postsurgical deep brain venous thrombosis has not been well described in children before. When approaching thalamic or intraventricular lesions, extra care should be taken to prevent injury to the internal cerebral veins (ICVs) and the vein of Galen. However, even when they are well preserved during surgery, postoperative hemodynamic changes, mainly in the first 24 h, or surgical manipulation can cause thrombosis of these veins. We report 2 children with unilateral postoperative ICV thrombosis; in 1 of the patients the vein of Galen was also thrombosed. Although both patients had altered sensorium initially, no anticoagulation therapy was given, and they both recovered well. When approaching thalamic or intraventricular lesions, extra care should be taken to prevent injury to the ICV and the vein of Galen. The surgeon should respect the deep brain venous system when approaching midline structures. Both the neurosurgeon and the neuroradiologist should be aware of this possible complication in order to make a prompt diagnosis and to offer proper treatment if needed.

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Life without the vein of Galen: Clinical and radiographic sequelae

Youssef¹,

Downes²,

Agazzi³

et al. 2011

Clinical Anatomy

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A thorough understanding of the anatomy of the pineal region, particularly venous drainage, is critical for gaining open surgical access to the pineal gland. The adverse sequelae after intraoperative venous occlusion are assumed to be catastrophic but have been scarcely reported. We report a case of pineocytoma in which the vein of Galen was ligated without postoperative adverse sequelae. Pineal region anatomy with emphasis on deep veins was reviewed in large anatomical studies. There are tremendous anatomical variations in the vein of Galen and its tributaries. Several confounding factors can be encountered during surgery and may lead to accidental sacrifice of the vein of Galen. Survival after focal occlusion of a major deep vein depends on the development of collateral circulation as shown in our case report. Venous drainage remains the cornerstone in the surgical planning of the pineal region. Anatomical variations and venous collaterals undoubtedly contributed to the mixed reports of adverse sequelae after venous sacrifice. Vein of Galen ligation may be survivable but consequences cannot be predicted without a thorough pre-ligation assessment of regional venous collateral drainage. Thorough understanding of the venous anatomy, meticulous planning of the surgical approach and avoidance of the occlusion of the vein of Galen and its major tributaries are key factors to successful pineal region surgery.

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

Cited by 52 publications

References 34 publications

Neurosurgical venous considerations for tumors of the pineal region resected using the infratentorial supracerebellar approach

Neurosurgical venous considerations for tumors of the pineal region resected using the infratentorial supracerebellar approach

Unilateral Postoperative Deep Cerebral Venous Thrombosis with Complete Recovery: A Report of 2 Cases

Life without the vein of Galen: Clinical and radiographic sequelae

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