Identification and Protective Strategies for "Cortical Dangerous Veins" in Neurosurgical Craniotomies

To investigate the identification and management techniques and strategies for cortical dangerous veins during neurosurgical craniotomies.

We retrospectively analyzed 37 patients who underwent craniotomies involving the intraoperative protection of cortical dangerous veins between July 2022 and June 2024. Preoperatively, high-resolution magnetic resonance imaging data were used for three-dimensional visualization to delineate the resection margins and plan the management of related cortical dangerous veins, including bridging veins, superficial Sylvian veins, anastomotic veins, and veins in the eloquent cortex. Intraoperatively, attention was paid to preserving the cortical dangerous veins. Postoperatively, venous flow disturbances were assessed on the basis of symptoms, imaging findings, physical examinations, and other clinical findings.

Preoperative three-dimensional visualization of the cerebral structures and veins corresponded to the intraoperative observations in all 37 patients. Forty-seven cortical dangerous veins were dissected and protected intraoperatively, including 14 bridging veins, five superficial Sylvian veins, eight anastomotic veins, and 20 veins involving the central lobe. Six patients experienced intraoperative venous injury, which was managed by suturing or pressure hemostasis. No patient exhibited definite postoperative symptoms or radiological changes attributable to venous infarction.

This study highlights the importance of integrating cortical dangerous vein protection into surgical planning and lesion resection. Employing three-dimensional visualization to advance identification of cortical dangerous veins and preserve vein integrity during resection may mitigate postoperative venous infarction-related deficits without adversely affecting the treatment efficacy.