Contemporary angiographic assessment and clinical implications of the vein of labbé in neurotologic surgery

Abstract

Background: To better understand the drainage patterns of the 3 largest superficial anastomotic veins (SAVs), namely, vein of Labbé (VL), the vein of Trolard (VT), and the superficial sylvian vein (SSV). To assess the dominance of the VL in the superficial cortical venous system, because this vein may be encountered in neurotologic surgery and its interruption may result in a venous infarct of the temporal lobe.

Methods: The database of the radiology department at the University of Cincinnati was used to identify all patients who underwent a diagnostic angiographic study between September 1, 2009, and January 1, 2010. Studies were excluded if there were intracranial masses or vascular lesions. Angiograms were assessed for the presence of the VL, VT, and SSV, as well as vessel dominance, determined by their relative calibers.

Results: A total of 101 patients (81%) underwent bilateral and 48 unilateral angiography, for a total of 250 studies. Mean age was 55 years (range, 16-83 yr). Seventy-seven patients (53%) were females. The most common pattern observed was the presence of all 3 SAVs (78%). The VL was absent or poorly developed in 34 studies (14%) and was the dominant superficial vein in 51 (20%), of which 28 (55%) occurred on the right.

Conclusion: Considerable variability is demonstrated in the drainage patterns of the SAVs. Care should be taken in neurotologic surgery to avoid injuring the VL because this may represent the single dominant drainage pathway of the lateral surface of the temporal lobe in a large number of patients.