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Technique for rerouting a bridging vein that hinders the anterior interhemispheric approach: a technical note

  • Technical Note - Vascular
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Abstract

Background

The frontal bridging vein, which is the venous drainage route of the frontal cortex into the superior sagittal sinus (SSS), sometimes poses an obstacle in the anterior interhemispheric approach during surgery for anterior cerebral artery aneurysms. Although severe complications including venous infarction or edema due to damage to the bridging vein are well known, only a few reports have discussed how to avoid venous injury when we must sacrifice the bridging vein to obtain an appropriate surgical field. This report describes a microvascular technique performed in two patients who underwent rerouting of the bridging vein to obtain an appropriate anterior interhemispheric surgical corridor to treat a ruptured anterior cerebral artery aneurysm. The hindering bridging vein was resected from the entrance to the SSS and anastomosed toward the adjacent cortical vein.

Methods

A 65-year-old male and a 43-year-old male were admitted to our hospital for sudden headache. Computed tomography, magnetic resonance angiogram, or digital subtraction angiography demonstrated a subarachnoid hemorrhage and an anterior cerebral artery aneurysm in both patients. In both cases, a relatively robust bridging vein, which appeared problematic to sacrifice, was draining into the SSS, resulting in a limited surgical corridor. Thus, we performed cortical vein reconstruction, and the aneurysms were successfully clipped under a wider surgical view.

Results

We confirmed completed clip** without postoperative venous complications. One patient demonstrated patency of reconstructed venous flow by digital subtraction angiography. No apparent cognitive impairment was seen in either patient.

Conclusions

This technique may be useful for obtaining an appropriate surgical corridor when the frontal bridging vein may be damaged.

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Authors and Affiliations

  1. Department of Neurosurgery, Fuji Brain Institute and Hospital, 270-12 Sugita, Fu**omiya City, Shizuoka, 418-0021, Japan

    Kenta Ohara, Tomohiro Inoue, Hideaki Ono, Satoshi Kiyofuji, Akira Tamura & Isamu Saito

Authors
  1. Kenta Ohara
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  2. Tomohiro Inoue
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  3. Hideaki Ono
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  4. Satoshi Kiyofuji
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  5. Akira Tamura
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  6. Isamu Saito
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Corresponding author

Correspondence to Tomohiro Inoue.

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Funding

No funding was received for this research.

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For this type of retrospective study formal consent is not required.

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Comments

Ohara K. et al. have reported a unique but essential technique to preserve and reconstruct an important venous channel during surgery. This reviewer has reported reconstruction of the vein of Labbé using the saphenous vein graft after unintentional injury and brain edema (1). Venous injury can result in unpredictable sequelae, and techniques to reconstruct or preserve the venous system are very important (2). According to this report, preferably intentional reconstruction should be planned prior to injury rather than delayed reconstruction after injury. In this aspect, this technical report should be very fruitful. Nevertheless, reconstruction of the venous system requires a meticulous and precise technique because of its low flow and tendency to occlude easily. Enhanced visualization using pyocotanium blue dye to clarify the anastomosing layers should help make the technique more certain, and attention should be paid not to damage the intima of the venous wall.

Akio Morita,

Nippon, Tokyo.

(1) Morita A, Sekhar LN (1998) Reconstruction of the vein of Labbe by using a short saphenous vein bypass graft. Technical note. J Neurosurg 89:671–675.

(2) Morita A, Sekhar LN: Cerebral Veins and Dural Sinuses: Preservation and Reconstruction in Sekhar LN, Fessler RG (eds) Atlas of Neurosurgical Techniques. Brain Vol. 1, pp639–655, Thieme, New York, 2016.

Electronic supplementary material

Video 1

Surgical video of case 1 showing the procedure of bridging vein reconstruction (MP4 32,733 kb)

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Ohara, K., Inoue, T., Ono, H. et al. Technique for rerouting a bridging vein that hinders the anterior interhemispheric approach: a technical note. Acta Neurochir 159, 1913–1918 (2017). https://doi.org/10.1007/s00701-017-3285-y

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  • DOI: https://doi.org/10.1007/s00701-017-3285-y

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