Table Of ContentWolfgang Seeger
Microsurgery
of
Cerebral Veins
Springer-Verlag Wien NewY ork
Prof. Dr. med. WOLFGANG SEEGER
Medical Director of the Department of General Neurosurgery
and Chairman of Neurosurgery of the Neurosurgical Clinic,
University of Freiburg i. Br., Federal Republic of Germany
ISBN-13: 978-3-7091-7020-5 e-ISBN-13: 978-3-7091-7018-2
DOl: 10.1007/978-3-7091-7018-2
With 201 Figures
This work is subject to copyright
All rights are reserved, whether the whole or part of the material is concerned, specifically those of translation, reprinting,
re-use of illustrations, broadcastin'g, reproduction by photocopying machine or similar means, and storage in data banks
© 1984 by Spril)ger-VerlaglWien
Softcover reprint of the hardcover I st edition 1984
Design: Hans Joachim Boning, Wien
Library of Congress Cataloging in Publication Data. Seeger, Wolfgang, 1929 - . Microsurgery of cerebral veins. Includes bibliographies.
1. Cerebral veins-Surgery. 2. Microsurgery. I. Title. [DNLM: 1. Brain-blood supply-atlases. 2. Veins-sut:.gery-atlases. 3. Microsurgery
atlases. WL 17 S4S1mb]. RDS94.2.S44 1984. 617' .481. 84-20297.
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PREFACE~I ~IV
Preface
A description of cerebral veins under operative versely, where there are large arterial vessel stems (at
technical aspects is practically a description of opera the base of the brain) the veins somewhat lose their
tive approaches and their obstruction by cerebral significance. They become important again in the
veins. It is this which constitutes the major difference region of the basal Dura, the Tentorium, and the Falx
between arteries and veins. The arteries of the brain but (with the exception of the region of the Sinus
originate from only four large vessel stems, which cavernosus) away from the large arterial stems. This
bridge the CSF space and then run along the surface justifies writing a microneurosurgical textbook exclu
of the brain or inside the brain. Arterial vessels hardly sively under the aspect of the cerebral veins.
interfere with operative approaches, even in the deep That we know so much about cerebral veins is due
CSF spaces such as the Sylvian fissure, the Tentorium primarily to the work of neuroradiologists. It is not
fissure, and the ventricle system. Veins, on the other the objective of the present volume to provide a
hand, can appear in almost every location of the brain compreherisive and comparative survey of the large
as so-called bridging veins. They are extremely vari number of individual results of attempts at establish
able and can bloc~ the approach to deep CSF spaces ing vein types. Such an endeavor might be of some
almost anywhere. Today, most sites of the brain are historical and developmental interest, however, it is
micro surgically accessible, thanks to the fact that the of little relevance for the surgeon, who is confronted
deep CSF spaces are now being used where they were with at times extreme variants in the individual case.
once avoided because they were so rich in vessels. It is Theref.ore, some interesting details had to be left out
therefore all the more important to know the veins of the book. Instead, the "typical" courses of the
and their variants. The last point alone justifies carry veins are contrasted with the extreme deviations in
ing out angiography prior to intracranial operations, if order to illustrate the range of variation the surgeon
only as an additional safety measure, although an has to reckon with. The veins are represented in
giograms do not always reliably show how the veins relation to the surrounding structures; first, in an
might block the operative approach. anatomical model, then in the microsurgical topogra
In contrastio the Fissura longitudinalis, in the region phy. Typical operations and modifications of ap
of the posterior cranial Fossa it is difficult to assess the proaches depending on atypical courses of the veins
veins and their blocking potential when the quad are described. As in the preceding volumes of this
rigemina or the Fissura horizontalis cerebelli are be series, the same maxim holds true here: problematic
ingapproached. Such an evaluation is also problem operations on the brain should first be simulated on a
atic at other sites near the midline (e.g., the afferent brain which has been preserved in formalin. A book
vessels of the V. magna Galeni and their connections may draw attention to certain structural peculiarities,
to-the Sinus petrosus sup.). Fortunately, these veins however, it cannot provide the true spatial dimen
have courses which are more regular than those of the sions that only the natural organ can. Furthermore,
veins in the convexity of the cerebrum and the cere for this work, too, the drawings were done not by a
bellum. Thus in a surgical textbook the veins cannot professional draftsman but by a surgeon, on the basis
be depicted in isolation as they are in a neuroradiolog of his operations and those of his coworkers. There
ical presentation. Special attention must be paid to are no professional draftsmen who possess the neces
the relationships between the veins and other struc sary anatomical and technical surgical knowledge. I
tures, particularly the cerebral structures, the ar therefore have to apologize for the shortcomings of
teries, the Tentorium, and the Falx. In the areas my drawings, which have to be expected of someone
where the largest veins flow (e.g., <l;t the edge of the who has spent most of his life not at the drawing table
hemisphere), mostly small arteries are found. Con- but at the operating table.
VI~I- -------------------------------------------______~ lpREFACE
It remains for me to acknowledge my indebtedness to the Neuropathological Institute of Freiburg Universi
those who have assisted me in the preparation of this ty and Prof. Staubesand, Director of the Anatomical
book. I should especially like to mention Prof. J. Institute of Freiburg University, who provided the
Bonnal, Liege, for his description of the Sinus sagit anatomical preparations. Virginia Sonntag-O'Brien
talis sup. and its plastic' reconstruction, and Prof. J. translated the text and Ermy Hilsenbeck-Hotteck
Baumgartner, Colmar, for his work on the quad typed the manuscript.
rigemina. The present volume - just as the previous In conclusion I should like to particularly thank
ones - is based on practical clin~cal work. I want to Springer Verlag Wien-New York for their coopera
express my gratitude to my co-workers, Prof. J. M. tion which was excellent as usual.
Gilsbach, PD Dr. H. R. Eggert, Dr. W. Hassler, and
Dr. A. Harders for many valuable and stimulating Freiburg, October 1984 Wolfgang Seeger
discussions. My appreciation goes to Prof. B. Volk of
CONTENTS VII
L...l_ _______________________- ---Jl
Contents
Part I
General Remarks (Figs.1 to 6)
Chapter 1
(Figs. 1 to 6) 2
Part II
Special Microsurgical Aspects (Figs. 7 to 201)
Chapter 2
Sinus sagittalis sup. (Figs 7 to 84) 16
Sinus sagittalis sup., Venous Collateral Circulation (Figs. 7 to 12) 16
Sinus sagittalis sup., Frontal (Figs. 13 to 21) 28
Sinus sagittalis sup., Parietal (Figs. 22 to 41) 46
Addendum: Reconstruction of the Sinus (Figs. 42 to 48) 86
Sinus sagittalis sup., Parieto-occipital (Figs. 49 to 84) 100
Chapter 3
Galenic Vein System (Figs. 85 to 153) 172
Veins of the Fissura transversa cerebri (Figs. 85 to 114) 172
Veins of the Lateral Ventricle (Figs. 115 to 143) 232
Veins of the Cisterna tecti ("quadrigemina") (Figs. 144 to 153) 290
Chapter 4
Infratentorial Veins (Including Caudal Veins of the Galenic System) (Figs. 154 to 179) 310
Chapter 5
Draining Veins on the Cranial Base and Superficial Veins of the Cortex (Figs. 180 to 201) 362
References 407
Subject Index 417
Part I
General Remarks
(Figs. 1 to 6)
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GENERALREMARKS~I ~12
Chapter 1
General Remarks
(Figs. 1 to 6)
Fig. 1. Electrocoagulation stretches the venous (and
the arterial) vessels. Lumen not completely occluded,
as stretching keeps the vessel open
A Example of vessel stretched between brain sur
face and tumor
B Coagulation of the vessel
C Vessel lumen not completely occluded
strai.n ed vesse \ after shrinki.n g by coagulation CD
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GENERALREMARKS~I ~14
Fig. 2
A The vessel is cut
B Vessel stumps are retracted after coagulation
C After some time, the narrow lumen becomes
dilated due to intravasal pressure
D Rupture of vessel stumps
