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Is There a Risk of Clinical Consequences From Surgical Injury to the Superficial Middle Cerebral Vein? A Comparative

Michèle Yolande Moune1, Thomas Gaberel1,2

  • 1Department of Neurosurgery, Caen University Hospital, Caen, France.

Operative Neurosurgery (Hagerstown, Md.)
|July 29, 2026
PubMed
Abstract

Insights

Middle cerebral vein injury during middle cerebral artery aneurysm surgery is common but rarely causes severe symptoms. Sacrifice of this vein may be necessary and is not an absolute contraindication for surgery.

Area of Science:

  • Neurosurgery
  • Vascular Neurology
  • Cerebrovascular Surgery

Background:

  • Sacrificing the middle cerebral vein during middle cerebral artery aneurysm surgery raises concerns.
  • Previous studies suggest increased edema but no clinical symptoms with middle cerebral vein injury.

Purpose of the Study:

  • To evaluate the clinical impact of middle cerebral vein injury in patients undergoing middle cerebral artery aneurysm surgery.

Main Methods:

  • Retrospective cohort study of patients treated for unruptured middle cerebral artery aneurysms.
  • Inclusion criteria: microsurgery, pre/postoperative arteriography, complete hospitalization records.
  • Primary endpoint: postoperative clinical symptoms linked to parenchymal lesions suggesting cerebral venous thrombosis.

Main Results:

  • Middle cerebral vein injury occurred in 31.6% of 95 eligible patients.
  • Only 3.2% developed transient neurological symptoms potentially related to venous injury.
  • No significant association found between middle cerebral vein injury and clinical complications or radiological parenchymal lesions.

Conclusions:

  • Middle cerebral vein injury is frequent in middle cerebral artery aneurysm surgery.
  • Injury is not correlated with severe clinical events or cerebral venous thrombosis.
  • Vein preservation is ideal, but sacrifice is not an absolute contraindication if surgically necessary.
Keywords:
Cerebral vein thrombosisComplicationsMiddle cerebral veinSurgical injury

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