Operative neurosurgery (Hagerstown, Md.) · 2026
Is There a Risk of Clinical Consequences From Surgical Injury to the Superficial Middle Cerebral Vein? A Comparative Cohort Study.
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Moune Michèle Yolande, Gaberel Thomas
Аннотация
BACKGROUND AND OBJECTIVES: Surgical management of unruptured middle cerebral artery (MCA) aneurysms may lead to the sacrifice of the middle cerebral vein, raising concerns about potential clinical consequences. Previous studies have reported increased postoperative edema with middle cerebral vein injury but without associated clinical symptoms. The aim of this study was to evaluate the clinical impact of middle cerebral vein injury in a homogeneous cohort of patients undergoing MCA aneurysm surgery.
METHODS: A retrospective cohort study was conducted, including patients treated for unruptured MCA aneurysms by microsurgery between January 2013 and May 2023. Inclusion required available pre- and postoperative arteriography and complete hospitalization records. The primary end point was the occurrence of postoperative clinical symptoms attributable to radiological parenchymal lesions suggestive of cerebral venous thrombosis.
RESULTS: Of 151 patients, 95 met inclusion criteria. Middle cerebral vein injury was identified in 30 of 95 cases (31.6%). Only 3 patients (3.2%) developed neurological symptoms potentially related to venous injury, all of which were resolved without unfavorable outcomes. No association was found between middle cerebral vein injury and clinical complications: 1 of 3 (33.3%) in the complication group had a vein injury vs 29 of 92 (31.5%) in the group without complications ( P = .6). The risk of parenchymal lesion on computed tomography without clinical signs was 6 of 65 (9.2%) in patients without vein injury and 5 of 30 (16.6%) in those with vein injury ( P = .3).
CONCLUSION: Middle cerebral vein injury during unruptured MCA aneurysm surgery is frequent. The presence of such injury is not correlated with the occurrence of severe clinical events related to cerebral venous thrombosis. Preservation of the middle cerebral vein remains preferable, but sacrifice should not be considered an absolute contraindication if required by the surgical procedure.
METHODS: A retrospective cohort study was conducted, including patients treated for unruptured MCA aneurysms by microsurgery between January 2013 and May 2023. Inclusion required available pre- and postoperative arteriography and complete hospitalization records. The primary end point was the occurrence of postoperative clinical symptoms attributable to radiological parenchymal lesions suggestive of cerebral venous thrombosis.
RESULTS: Of 151 patients, 95 met inclusion criteria. Middle cerebral vein injury was identified in 30 of 95 cases (31.6%). Only 3 patients (3.2%) developed neurological symptoms potentially related to venous injury, all of which were resolved without unfavorable outcomes. No association was found between middle cerebral vein injury and clinical complications: 1 of 3 (33.3%) in the complication group had a vein injury vs 29 of 92 (31.5%) in the group without complications ( P = .6). The risk of parenchymal lesion on computed tomography without clinical signs was 6 of 65 (9.2%) in patients without vein injury and 5 of 30 (16.6%) in those with vein injury ( P = .3).
CONCLUSION: Middle cerebral vein injury during unruptured MCA aneurysm surgery is frequent. The presence of such injury is not correlated with the occurrence of severe clinical events related to cerebral venous thrombosis. Preservation of the middle cerebral vein remains preferable, but sacrifice should not be considered an absolute contraindication if required by the surgical procedure.