Morphological Pattern and Classification of the Superficial Middle Cerebral Vein by Cadaver Dissections: An Embryological Viewpoint

Abstract

In this study, we used 45 adult cadaveric cerebral hemispheres to investigate the anatomical classification of the superficial middle cerebral vein (SMCV) based on the number of stems, course, and anastomosis at the distal portion. We classified the SMCVs into five types based on embryological concept. Type A (18 cases, 40.0%) is that the frontosylvian veins (FSVs) merge with the vein of Trolard (VT) and the vein of Labbé (VL) at the distal portion of the sylvian fissure. Type B (5 cases, 11.1%) is that the temporosylvian veins (TSVs) merge with the VT and the VL at the distal portion. Type C (13 cases, 28.9%) is that no vein merge with the VT and the VL at the distal portion. The VT merges with the SMCV from the FSV and the VL merges with the SMCV from the TSV. They course along the sylvian fissure and merge at the proximal portion. In Type D (eight cases: 17.8%), the VT and the VL merge at the distal portion, and the SMCV from the FSV and the SMCV from the TSV join their confluence without merging. Type E (one case, 2.2%) show an undeveloped SMCV. Formation rate of intravenous anastomoses or bridging veins(BVs) at the distal portion between the frontosylvian trunk (FST) and the temporosylvian trunk (TST), between the FST and the temporal lobe, and between the TST and the frontal lobe was very low, because these formation may be difficult to occur during the embryological process in which the SMCV is formed from the telencephalic vein.

A New Classification of the Anatomical Variations of Labbé’s Inferior Anastomotic Vein

“…A carotid-cavernous fistula was approached through the LV–SV pathway [ 30 ]. As the drainage pattern of the SV is individually variable and does not mandatorily include the LV [ 12 , 13 , 31 , 32 , 33 ], the latter vein’s anatomy should be documented prior to any endovascular approach at the level of the skull base.…”

Dissection of the Sylvian Fissure in the Trans-sylvian Approach Based on the Morphological Classification of the Superficial Middle Cerebral Vein

“…Neurologia medico-chirurgica Advance Publication Date: October 14, 2021 the trans-sylvian approach. [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] Many neurosurgeons have conventionally made the trans-sylvian approach starting with dissection between the SMCV and the frontal lobe according to Yasargil. 22) Neurological deficits caused by sacrificing the BVs from the frontal base or temporal tip to the SMCV has been considered to be rare.…”

“…[1][2][3][4][5][6] Obtaining a wide operative field while preserving the venous structures in the trans-sylvian approach can be difficult because of various anastomoses of the superficial middle cerebral vein (SMCV). [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] Many neurosurgeons have conventionally dissected between the SMCV and the frontal lobe in the trans-sylvian approach. 22) However, this method of dissecting the SMCV can lead to sacrifice the bridging veins (BVs) with the frontal lobe in order to obtain a wide operative field, which may cause congestion and venous infarction.…”

“…Although the morphological patterns of the SMCV has been clarified mainly on outflow in the past, 11,13,15,21,[31][32][33] we have reported on the morphological classification of the SMCV from the number of stems, the course, and anastomoses present at the distal portion in cadaveric cerebral hemispheres. 14) The purpose of the present study was to investigate the best approach to dissect the SMCV based on the above classification, in order to obtain a wide operative field while preserving the venous structures in the trans-sylvian approach.…”

Surgical anatomy of the vein of Labbé

“…Повреждение вены Лаббе приводит к развитию венозного инфаркта и возникновению гематом височной доли, поэтому предотвращение ее травмы имеет первостепенное значение при осуществлении подвисочных и комбинированных латеральных доступов [6,7,11,16,17,18]. Места впадения дренирующих вен и вены Лаббе в синусы значительно варьируют [14,[19][20][21][22][23]. В связи с этим изучение хирургической анатомии вен, дренирующих височную долю, представляется важным для безопасного осуществления тракции височной доли и выбора места костной резекции в проекции венозных коллекторов, в частности в зоне, куда впадает вена Лаббе (каменистый синус, синодуральный угол (место соединения поперечного синуса с сигмовидным), пластины намета мозжечка, поперечный синус, вены средней черепной ямки).…”