Morphometric analysis and classification of the brain superficial venous system on digital subtraction angiographic images

In the literature, there is not enough study on cerebral venous anatomy, and the veins are not considered significant as arteries. The brain venous system has a complex anatomy and significant variability. Normal variations of the venous system include the presence of embryological residues such as aplasia and hypoplasia of certain regions, multiple presences, fenestrations. Knowing these changes may be necessary to evaluate the follow-up and surgical management of some diseases. Venous drainage of the brain is connected to the systemic circulation from the cerebral veins to the dural sinuses and then to the internal jugular vein. Brain veins mainly can be divided into two groups as cerebral veins and cerebellar veins. Cerebral veins, according to the anatomical position, are divided as superficial cerebral and deep venous system. Cerebral veins were not given priority in the studies due to their frequent high variations. However, damage to venous structures may have serious consequences, including hemiplegia, coma, and death. Therefore, care should be taken to protect the veins in surgical procedures. In this study, the features of the venous system, the relationship of the veins with each other, the most common locations and variations were discussed. The study aimed to classify the superficial veins of the brain and to determine their morphological characteristics. In this study, 1302 patients underwent digital subtraction angiography (DSA) images in the archives of Bursa Uludag University Radiology Department. The numerical parameters examined in the study are as follows. Superior sagittal sinus, Labbe's vein (inferior anastomotic vein), Trolard's vein (superior anastomotic vein), transverse sinus, sigmoid sinus, and medial cerebral vein diameters, sigmoid sinus, internal jugular vein, and superior cerebral veins are numbers. Angular measurement parameters are between transverse sinus and superior sagittal sinus, straight sinus and superior sagittal sinus, medial cerebral vein and Trolard's vein, medial cerebral veins and Labbe's vein, transverse sinus and Labbe's vein, Trolard's vein and superior sagittal sinus, superior cerebral veins and superior sagittal sinus, straight sinus sinus and transverse sinus. The parameters examined under the title of morphological typing are the presence of the Labbe's and Trolard's veins and their relationship with each other, and the dominant side of the transverse sinus. In the evaluation of the data, the examination images and reports of Centricity RIS-i Plus® 4.2 and Centricity PACS® (GE, Fairfield, Connecticut, USA) programs installed in workstations in Bursa Uludag University Faculty of Medicine Radiology Department were used. The results were analyzed with IBM SPSS 23 (Statistical Package for the Social Sciences). The mean age of the patients was 54.5 ± 18.382. 528 (52.54%) were female, and 477 (47.46%) were male. Both anastomotic veins were present in 439 patients in the examination of the relationship between the medial cerebral vein and the classification of superficial veins of the brain. In our study, the mean diameter of the superior sagittal sinus was 6.65 mm. The average number of superior cerebral veins was determined as eight. When planning an intracranial surgery, knowledge of anatomical variations of the cerebrovascular system and preoperative recognition is critical. Variations of venous anatomy may contribute to chronic pathological conditions in the brain or cause complications during procedures. We think that the study of superficial venous anatomy of the brain in detail will make an essential contribution to the literature.