Complications due to venous injury have been observed in the vein of Labbé or other bridging veins. In this paper, we present surgical techniques for the preservation of the sylvian vein when approaching skull base lesions.
Using the orbitofrontomalar approach with preserving the superficial sylvian vein, we approached 32 skull base lesions: nine aneurysms, four arteriovenous malformations and 19 skull base tumors.
The following surgical procedures were used;(1) Orbitofrontomalar approach a) Frontotemporal craniotomy b) Superolateral orbitotomy c) Removal of malar flap
(2) Combined epi- and subdural approach a) Removal of anterior clinoid process and optic strut, followed by unroofing of optic canal.
b) Dural incision along the sylvian fissure down to the cavernous sinus, opening of the dura of the superior orbital fissure and carotid fibrous ring, and finally cutting the falciform ligament and optic sheath.
c) The sphenoparietal sinus, superficial sylvian vein and internal carotid artery are mobilized. Thus, a sufficient operative field can be obtained.
With these procedures, we could approach skull base lesions while preserving the superficial sylvian vein without any complications.
