2026 Poster Presentations
P439: THE ICONOGRAPHIC IMPACT IN MICRONEUROSURGERY: MASTERING THE INTRACRANIAL VENOUS SYSTEM
Fabio Torregrossa, MD1; Luciano Leonel, PhD1; Amedeo Piazza, MD1; Giovanni Grasso, MD, PhD2; Domenico Iacopino, MD, PhD2; Giuseppe Lanzino, MD1; Maria Peris-Celda, MD, PhD1; 1Mayo Clinic, Rochester, MN (USA); 2University of Palermo, Palermo, Italia
INTRODUCTION: The cerebral venous channels represent a major challenge in microneurosurgery, especially in the pineal region, where multiple veins drain into the great vein of Galen. Preserving the venous outflow is the most reliable strategy to prevent postoperative venous strokes or venous hypertension. Thus, a thorough understanding of the venous anatomy is crucial for minimizing risks and complications during surgery.
OBJECTIVE: This study aimed to provide a detailed description of the intracranial superficial and deep venous system through meticulous cadaveric dissection, highlighting its crucial role in mastering neuroanatomy.
METHODS: Four formalin-fixed, latex-injected anatomical specimens were dissected to analyze the relevant venous anatomy through a high-resolution photographic image acquisition technique. The deep cerebral veins and their surrounding neural structures were methodically dissected and documented, as well as the major superficial veins. A 3D anatomical model generated through the photogrammetry scanning technique was described.
RESULTS: The evaluated cerebral veins were displayed in a superficial to deep fashion. The SSS drains into the transverse sinus at the internal occipital protuberance through a plexiform confluent venous complex, known as the torcular herophili, which connects the superior sagittal, transverse, straight, and occipital sinuses (Fig 1).
The straight sinus begins behind the corpus callosum at the junction of the inferior sagittal sinus and the great vein of Galen (Fig 2).
In approaching the pineal region, several veins may obstruct the surgical route (Fig 3).
These include the superior vermian, draining into the posteroinferior aspect of the vein of Galen, as well as the tectal and pineal veins, draining into its anterosuperior aspect. The basal vein of Rosenthal represents the major anterolateral vein. The location of these veins and their drainage territories were carefully documented. The 3D anatomical model was dissected to highlight the anatomy of the cavernous sinus and its major tributaries (Fig 4).
CONCLUSION: This study provides a comprehensive and detailed description of the superficial and deep venous anatomy utilizing latex-injected cadaveric specimens. The presented images and descriptions offer valuable insights for planning and executing surgical approaches, especially to the pineal region, with the ultimate goal of minimizing potential risks and complications.