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Sylvian Vein

vena cerebri media superficialis

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.

Region: Head & Skull

Clinical Relevance

Clinical Notes

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.

Pathology

Common Injuries & Conditions

Sylvian Vein Sacrifice in MCA Aneurysm Surgery

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.