Surgical anatomy of the vein of Labbé

Abstract

The objective is to study surgical anatomy of the vein of Labbé (inferior anastomotic vein) and venous drainage of the mediobasal surface of the temporal lobe, as well as to identify the most common variants of drainage of the lateral and basal parts of the temporal lobe which are necessary to take into account during surgical approach. Materials and methods . The study was conducted on 50 non-preserved human brain hemispheres with homolateral surface of the base of the skull. Surgical part of the study was conducted on 25 cadavers. Anterior and posterior petrosal subtemporal transtentorial approaches were modelled. Standard neurosurgical set of microinstruments, surgical microscope and high-speed neurosurgical drills were used. At the intradural stage of the approach, the vein of Labbé was identified, its anastomotic type and the character of outflow into the venous collectors were determined. Results . In total, 115 groups of veins draining the brain were identified. Venous drainage of the transversal group was identified in 100 % of cases, of the tentorial group – in 72 % of cases, of the petrosal group – in 58 % of cases. No significant differences between the locations of vein inflow were identified on the right and left. Three (3) variants of drainage of the lateral and basal parts of the temporal lobe were identified: 1) inflow of venous drainage groups into the sinodural angle, posterior third of the petrosa; sinus and anterior parts of the transverse sinus – 14 (28 %) cases; 2) inflow into the sinodural angle, anterior parts of the transverse sinus and tentorial surface – 21 (42 %) cases; 3) inflow into all of the venous collectors (sinodural angle, petrosal, transverse, tentorial sinuses) – 15 (30 %) cases. Two (2) anastomotic types of the vein of Labbé were identified: with direct (12 %) and indirect (88 %) outflow into the venous collectors of the base of the skull. In the indirect type, “venous star” was observed comprised of several venous trunks which converged near the sinodural angle. The veins of Labbé with indirect type of outflow entered the petrosal sinus (4 % of cases), sinodural angle (14 %), tentorium (10 %) and transverse sinus (60 %) through the posterior inferior superficial temporal vein (8 %), medial inferior superficial temporal vein (26 %) and posterior inferior superficial temporal vein (54 %). The vein of Labbé with direct type of drainage entered only the transverse sinus. In most cases, the vein of Labbé entered the transverse sinus 10 mm behind the sinodural angle. Large diameter veins (dominant veins) were observed in 38 % of cases, all of them entered the transverse sinus. Conclusion . The identified variants of venous drainage of the lateral and basal parts of the temporal lobe and anastomotic variants of the vein of Labbé allow to select the optimal surgical approach and correct its direction, refine the character of temporal lobe traction and predict technical difficulties during supratemporal approach.