Venous Infarction Resulting from Sacrifice of a Bridging Vein during Clipping of a Cerebral Aneurysm: Preoperative Evaluation Using Three-dimensional Computed Tomography Angiography - Case Report

Abstract

A 67-year-old woman presented with a ruptured aneurysm of the left internal carotid artery bifurcation. Three-dimensional computed tomography angiography (3D-CTA) demonstrated the first segment of the basal vein of Rosenthal passing in front of the internal carotid artery and the anastomosis with the cavernous sinus, the partially hypoplastic second segment, and the superficial sylvian vein entering the lateral side of the sphenoparietal sinus. Dissection of the sylvian fissure toward the distal direction enabled transfer of the superficial sylvian vein to the temporal side, but the bridging vein had to be sacrificed to secure adequate operating space. Postoperative CT demonstrated hemorrhagic infarction at the left caudate head and surrounding region. Postoperative venous infarction is not an uncommon complication of various approaches. 3D-CTA can provide important information about the venous anatomy indispensable for avoiding postoperative venous infarction.