Surgical Strategy for Preventing Venous Brain Injury

The only way to prevent venous brain injury is to meticulously preserve the veins. In every surgical approach, there are various bridging veins blocking access to the subarachnoid space. It is necessary to understand venous anatomy, such as frontal bridging veins for the interhemispheric approach, sylvian veins for the pterional approach, and temporal bridging veins for the subtemporal approach. High-quality cerebral angiography is necessary for adequate pre-operative evaluation of venous anatomy. With the advent of new-generation CT scanning, 3D-CT angiograms using 64 slice scanners offer an alternative means of preoperative evaluation of the venous system. Indeed, CT venogram might be superior to conventional cerebral angiography in obtaining 3D anatomical information before surgery. Meticulous microsurgical technique is essential to preserve the venous structure during surgery, as are the appropriate use of high magnification and good illumination, moist operative field, careful dissection and minimized retraction. Vein preservation must be a critical part of surgical strategy, and perhaps the most important point in vein preservation is to keep the importance of those veins in mind at all times. To learn several techniques of vein preservation aids in the surgical strategy, and keeps the skills of the surgeon polished.