Acta Neurochirurgica

, Volume 159, Issue 10, pp 1913–1918 | Cite as

Technique for rerouting a bridging vein that hinders the anterior interhemispheric approach: a technical note

  • Kenta Ohara
  • Tomohiro Inoue
  • Hideaki Ono
  • Satoshi Kiyofuji
  • Akira Tamura
  • Isamu Saito
Technical Note - Vascular

Abstract

Background

The frontal bridging vein, which is the venous drainage route of the frontal cortex into the superior sagittal sinus (SSS), sometimes poses an obstacle in the anterior interhemispheric approach during surgery for anterior cerebral artery aneurysms. Although severe complications including venous infarction or edema due to damage to the bridging vein are well known, only a few reports have discussed how to avoid venous injury when we must sacrifice the bridging vein to obtain an appropriate surgical field. This report describes a microvascular technique performed in two patients who underwent rerouting of the bridging vein to obtain an appropriate anterior interhemispheric surgical corridor to treat a ruptured anterior cerebral artery aneurysm. The hindering bridging vein was resected from the entrance to the SSS and anastomosed toward the adjacent cortical vein.

Methods

A 65-year-old male and a 43-year-old male were admitted to our hospital for sudden headache. Computed tomography, magnetic resonance angiogram, or digital subtraction angiography demonstrated a subarachnoid hemorrhage and an anterior cerebral artery aneurysm in both patients. In both cases, a relatively robust bridging vein, which appeared problematic to sacrifice, was draining into the SSS, resulting in a limited surgical corridor. Thus, we performed cortical vein reconstruction, and the aneurysms were successfully clipped under a wider surgical view.

Results

We confirmed completed clipping without postoperative venous complications. One patient demonstrated patency of reconstructed venous flow by digital subtraction angiography. No apparent cognitive impairment was seen in either patient.

Conclusions

This technique may be useful for obtaining an appropriate surgical corridor when the frontal bridging vein may be damaged.

Keywords

Venous reconstruction Anterior interhemispheric approach Venous infarction Anterior cerebral artery aneurysm 

Supplementary material

701_2017_3285_MOESM1_ESM.mp4 (32 mb)
Video 1Surgical video of case 1 showing the procedure of bridging vein reconstruction (MP4 32,733 kb)

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Copyright information

© Springer-Verlag GmbH Austria 2017

Authors and Affiliations

  • Kenta Ohara
    • 1
  • Tomohiro Inoue
    • 1
  • Hideaki Ono
    • 1
  • Satoshi Kiyofuji
    • 1
  • Akira Tamura
    • 1
  • Isamu Saito
    • 1
  1. 1.Department of NeurosurgeryFuji Brain Institute and HospitalFujinomiya CityJapan

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