Craniometric guidance for the Sylvian vein.

Area of Science:

• Neurosurgery
• Neuroanatomy
• Medical Imaging

Background:

• The Sylvian vein (SV) is a critical landmark for lateral brain surface neurosurgical approaches.
• Minimally invasive surgery necessitates precise anatomical localization, making SV identification crucial.
• Previous linear guidance methods for the SV were complex and unclear.

Purpose of the Study:

• To develop a novel, clear, and accurate anatomical guidance for the Sylvian vein (SV).
• To enhance neurosurgical planning and intraoperative approaches through improved SV localization.

Main Methods:

• Thirty-seven patients' Sylvian veins (SVs) were analyzed on venous phase angiographic images.
• Images were fused, and lateral skull outlines were realigned using landmarks like coronal sutures.
• A Sylvian circle (SC) was constructed using the external ear canal (EAC) and glabella, and its accuracy in representing the SV was measured.

Main Results:

• The Sylvian circle (SC) accurately represented the Sylvian vein (SV) contour in 79% of patients (within 5 mm).
• Five SVs were above the SC, and two were below, with seven cases showing less than 80% of the SV trajectory within 5 mm of the SC.
• The SC demonstrated a more accurate representation of the SV compared to linear methods.

Conclusions:

• The Sylvian circle (SC) provides a more accurate contour of the Sylvian vein (SV) than linear representations.
• The SC is a prompt and instinctively applicable tool for pre- and intra-operative neurosurgical practice.
• This new guidance enhances the reliability of neurosurgical planning and approach for SV localization.