Internal cerebral vein sacrifice during pineal region epidermoid cyst resection: illustrative case

Sacrifice of the internal cerebral vein (ICV) during neurosurgical procedures is exceedingly rare and poorly characterized in the literature. We report the case of a 14-year-old male who sustained an intraoperative right ICV sacrifice during resection of a pineal region epidermoid cyst.

Postoperatively, the patient developed bilateral thalamic infarcts and transient neurological deficits, including left hemiparesis, mutism, and dysphagia. Despite these initial postoperative findings, he experienced significant recovery with supportive care and rehabilitation. Three months after the procedure, he had returned to school with no deficits other than trace triceps weakness, which was completely resolved by 8 months after the procedure.

This case provides rare insight into the natural history of ICV infarction and suggests that meaningful recovery may be possible under select conditions. https://thejns.org/doi/10.3171/CASE2686.