Venous Preservation: A Novel Technique for Vein of the Labbe Preservation in a Subtemporal Approach to a Midbrain Metastasis

The vein of Labbe is the largest superficial cerebral vein that drains the temporal lobe. It courses across the temporal lobe between the Sylvian fissure and the transverse sinus. Rupture of this vein has been known to cause serious complications such as temporal lobe ischemia, hemorrhagic infarction, and significant edema. Here we describe a technique for safe preservation of the vein of Labbe with an aberrant course via a posterior subtemporal approach to the midbrain on the dominant temporal lobe.

A left temporal craniotomy and subtemporal approach were performed. After the dura was opened, microscopic dissection was used. A large superficial temporal vein was identified coursing over the inferior temporal lobe but entering the dura more anteriorly than normal. The dural incision was extended anteriorly to identify an area of the temporal lobe that could be safely retracted without tearing or thrombosing the vein; however, there was no such corridor available. Dura parallel and just lateral to the venous entrance on the mastoid roof was incised and followed anteriorly and posteriorly. A similar cut was made medial to the venous course. This dural sleeve was then retracted. Using a lumbar drain for brain relaxation, a subtemporal approach to the incisura was performed. The field of view was widened via a tentorial incision. The midbrain lesion coursing over the temporal lobe was identified and decompressed.

The patient recovered well from surgery with improvement in observed symptoms. Pathology was nonsmall cell lung cancer and the patient underwent postoperative radiation.

Venous preservation is critical to safe surgery. This case illustrates a novel technique for preserving the vein of Labbe and its tributaries. It also allows for the protection of any large veins when aberrant, while retracting the temporal lobe. A careful review of preoperative imaging can help prepare for this challenge.

Publication History

Article published online:
12 February 2021