Postoperative cortical venous infarction in tumours firmly adherent to the cortex

It is sometimes difficult to separate extra-axial tumours from the cortical veins in case of tumours attaching tightly to the cortex and the cortical veins. We present two patients having a postoperative cortical venous infarction. A 59 year old female had convexity meningioma above the motor cortex where abnormal cortical anastomotic veins developed. Transient hemiparesis occurred after total removal of the tumour because of venous infarction and cyst formation resulting from sacrifice of these veins which were tightly adherent to the tumour surface. A 15 year old boy with immature teratoma of the pineal region, showing several draining veins around the vascular-rich tumour, presented transient drowsiness, diplopia and partial impairment of bilateral visual acuity postoperatively because of localised cortical brain and venous damage. It is important to make an effort to preserve main cortical veins during operation as much as possible, even if the tumour adheres to the cortical surface.