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Microsurgical anatomy of the lateral mesencephalic vein and its meaning for the deep venous outflow of the brain

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Abstract

The cerebral venous outflow consists of the superficial system and the deep draining system. The deep one drains the areas of the great vein of Galen, the two basal veins of Rosenthal, and their tributaries. Simultaneous obstruction of these veins can effect great harm. In the case of obstruction of the vein of Galen, the basal vein can ensure the venous outflow. Therefore, attention should be paid to anastomoses between the basal vein and the infratentorial venous system. The lateral mesencephalic vein (LMV) is the most important anastomosis between the supra- and infratentorial system linking the basal vein to the superior petrosal sinus. Since microanatomical studies concerning this vein have received less attention the aim of the present study was to visualize the course of this vein, its junction with the basal vein, its tributaries and its relationship with neural structures. Fifty-two cadaveric hemispheres were examined under the operating microscope. The LMV could be identified in all cases, with a mean diameter of 1.07 mm. Thorough understanding of the microanatomy of the LMV is crucial to avoid brain damage due to venous infarction during surgery, and its preservation could ensure deep venous outflow in the case of obstruction of the vein of Galen.

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Acknowledgement

We thank Florian Stingl for help in preparing the manuscript.

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Correspondence to Peter A. Winkler.

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Comment

Helder Tedeschi, Evandro de Oliveira, São Paulo, Brasil

Dr. Ardeshiri and his colleagues have conducted a very interesting study of the anatomical variations of the lateral mesencephalic vein. The study discusses the potential role of the lateral mesencephalic vein as an anastomotic alternative pathway to venous flow between the supra- and infratentorial venous system in the case of venous obstruction and thoroughly describes the anatomical variations of the vein in relation to the cerebral peduncle, the basal vein of Rosenthal, and to the superior petrosal sinus.

Pre-operative studies of the venous system are becoming an important tool in a variety of neurosurgical procedures. The authors study’ on the lateral mesencephalic vein will certainly add to the knowledge of the vein as a useful anatomic landmark in surgery of deep areas of the brain. In our practice the vein is usually used as a reference for the position of the lateral mesencephalic sulcus in the posterolateral aspect of the midbrain during surgery dedicated to cavernomas or certain tumours of the upper brain stem. It is also used as a guide for evaluating the intraoperative extent of resection of medial temporal lobe structures during intraventricular surgery in the temporal lobe in which the choroidal fissure is opened, as is the case with trans-sylvian selective amygdalohippocampectomy for the treatment of refractory mesial temporal lobe epilepsy.

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Ardeshiri, A., Ardeshiri, A., Tonn, JC. et al. Microsurgical anatomy of the lateral mesencephalic vein and its meaning for the deep venous outflow of the brain. Neurosurg Rev 29, 154–158 (2006). https://doi.org/10.1007/s10143-005-0016-2

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