A New Classification of the Anatomical Variations of Labbé's Inferior Anastomotic Vein

Abstract

(1) Background: The inferior anastomotic vein of Labbé (LV) courses on the temporal lobe, from the sylvian fissure towards the tentorium cerebelli and finishes at the transverse sinus (TS). The importance of the LV topography is related to skull base neurosurgical approaches. Based on the hypothesis of the existence of as yet unidentified anatomical possibilities of the LV, we aimed through this research to document the superficial venous topographic patterns at the lateral and inferior surfaces of the temporal lobe. (2) Methods: A retrospective cohort of 50 computed tomography angiograms (CTAs) of 32 males and 18 females was documented. (3) Results: Absent (type 0) LVs were found in 6% of cases. Anterior (temporal, squamosal-petrosal-mastoid, type 1) LVs were found in 12% of cases. LVs with a posterior, temporoparietal course (type 2) were found to be bilateral in 46% of cases and unilateral in 36% of cases. Type 3 LVs (posterior, parietooccipital) were found to be bilateral in 8% and unilateral in 32% of cases. In 24% of cases, duplicate LVs were found that were either complete or incomplete. A quadruplicate LV was found in a male case. On 78 sides, the LV drained either into a tentorial sinus or into the TS. (4) Conclusions: The anatomy of the vein of Labbé is variable in terms of its course, the number of veins and the modality of drainage; thus, it should determine personalized neurosurgical and interventional approaches. A new classification of the anatomical variations of Labbé's vein, as detected on the CTAs, is proposed here (types 0-3).

Keywords: cerebral vein; computed tomography; superficial middle cerebral vein; tentorial sinus; tentorium cerebelli; vein of Labbé.

Figure 1

Right and left Labbé’s vein (LV) type 2 association.

Figure 2

Three-dimensional volume rendering, superomedial endocranial view, left side. Labbé’s vein was not emptying into the transverse sinus. 1. Labbé’s vein; 2. Dural vein; 3. Tentorial vein; 4. Transverse sinus; 5. Sigmoid sinus.

Figure 3

Three-dimensional volume rendering, endocranial anterosuperior view. Bilateral duplicated Labbé’s veins. 1. Left transverse sinus; 2. Tentorial sinuses; 3. Labbé’s vein type 3 (posterior, parieto-occipital), draining into tentorial sinuses; 4. Labbé’s vein type 1 (anterior, temporal), draining into tentorial sinuses but continuing and terminating in the confluence of dural sinuses.

Figure 4

Three-dimensional volume rendering, postero-supero-medial endocranial view, left side. Complete duplication of Labbé’s vein. Sinus of the lesser sphenoidal wing. 1. Complete duplication of Labbé’s vein, combination of types 2 and 3; 2. Lesser wing sinus (sphenoidal segment of the sinus of Breschet); 3. Ophtalmopetrosal sinus of Hyrtl; 4. Cavernous sinus.

Figure 5

Three-dimensional volume rendering, medial endocranial view, left side. Complete duplication of Labbé’s vein, combination of types 2 and 3. The posterior component appeared topographically as a sagittal parietooccipital vein. 1. Posterosuperior vein of Labbé (type 3); 2. Anteroinferior vein of Labbé (type 2); 3. Transverse sinus; 4. Sigmoid sinus.

Figure 6

Three-dimensional volume rendering, anteromedial endocranial view, right side. Partial or incomplete duplication of Labbé’s vein. 1. Labbé’s vein partially duplicated; 2. Sphenoparietal sinus of Breschet resulting from anatomical connection of a sagittal parietal vein to the sinus of the lesser sphenoidal wing; 3. Transverse sinus; 4. Sigmoid sinus.

Figure 7

Three-dimensional volume rendering, postero-supero-medial endocranial view, left side. Partial duplication of Labbé’s vein (types 3 + 3). 1. Sagittal parietal vein; 2. Lesser wing sinus; 3. Posterior duplicate of Labbé’s vein; 4. Anterior duplicate of Labbé’s vein, anastomosed with the sagittal parietal vein (arrowhead); 5. Transverse sinus; 6. Sigmoid sinus.

Figure 8

Three-dimensional volume rendering, medial endocranial view, left side. Complete duplication of Labbé’s vein, anterior component shows another duplication, albeit partial. 1. Posterior Labbé’s vein, type 3; 2. Anterior Labbé’s vein, type 2; 3. Proximal duplication of anterior Labbé’s vein; 4. Sigmoid sinus; 5. Tentorial sinus; 6. Transverse sinus.

Figure 9

Three-dimensional volume rendering, antero-medial endocranial view, right side. Quadruplicated Labbé’s vein. 1. Palisade of four veins corresponding to the course of Labbé’s vein; 2. Dural lacunae; 3. Tentorial sinus; 4. Transverse sinus; 5. Sigmoid sinus.