The superficial middle cerebral vein (Sylvian vein) drains the lateral cortex of the brain around the sylvian fissure, running in the sylvian fissure from the MCA territory to drain into the cavernous sinus or the sphenoparietal sinus. It connects superiorly with the superior sagittal sinus via the vein of Trolard and inferiorly with the transverse sinus via the vein of Labbe.
| Origin | Cortical veins around the lateral sulcus |
|---|---|
| Course | Runs forward and downward along the lateral sulcus and around the temporal pole to drain into the cavernous or sphenoparietal sinus |
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The Sylvian vein must be preserved during pterional craniotomy and temporal approaches to the sylvian fissure. It is at particular risk during aneurysm surgery and MCA aneurysm clipping when the sylvian fissure is widely split. Its sacrifice produces venous infarction of the temporal and frontal opercula with significant functional deficit. The Sylvian vein varies considerably. Some individuals have a dominant superior drainage (via Trolard) while others have dominant inferior drainage (via Labbe), which affects the approach strategy.
Inadvertent coagulation of the Sylvian vein during pterional craniotomy and sylvian fissure splitting for MCA aneurysm clipping produces venous congestion of the lateral frontal and temporal cortex with post-operative aphasia, hemiparesis, and brain swelling; the vein must be identified at the beginning of sylvian fissure opening and protected throughout.
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