BACKGROUND We investigated the understudied anatomical variations of the superior petrosal vein (SPV) complex (SPVC), which may play some role in dictating the individual complication risk following SPVC injury. METHODS Microvascular decompressions of the trigeminal nerve between September 2012 and July 2016. All operations utilized an SPVC preserving technique. Preoperative balanced fast field echo (bFFE) magnetic resonance imaging, or equivalent sequences, and operative videos were studied for individual SPVC anatomical features. RESULTS Applied imaging and operative SPVC anatomy were described for fifty patients (mean age, 67.18 years; female sex and right-sided operations, 58% each). An SPVC component was sacrificed intentionally in 6 and unintentionally in only 7 cases. Twenty-nine different individual variations were observed; 80% of SPVCs had either 2 SPVs with 3 or 1 SPV with 2, 3, or 4 direct tributaries. Most SPVCs had 1 SPV (64%) and 2 SPVs (32%). The SPV drainage point into the superior petrosal sinus was predominantly between the internal auditory meatus and Meckel cave (85.7% of cases). The vein of the cerebellopontine fissure was the most frequent direct tributary (86%), followed by the pontotrigeminal vein in 80% of SPVCs. Petrosal-galenic anastomosis was detected in at least 38% of cases. At least 1 SPV in 54% of the cases and at least 1 direct tributary in 90% disturbed the operative field. The tributaries were more commonly sacrificed. CONCLUSIONS The extensive anatomical variation of SPVC is depicted. Most SPVCs fall into 4 common general configurations and can usually be preserved. BFFE or equivalent sequences remarkably facilitated the intraoperative understanding of the individual SPVC in most cases.

中文翻译：

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50例三叉神经微血管减压术中，上睑静脉复合体的个体变异及其显微外科意义。

背景技术我们调查了未充分研究的岩上静脉（SPV）复合体（SPVC）的解剖学变异，这些变异可能在指示SPVC损伤后的个体并发症风险中起一定作用。方法在2012年9月至2016年7月之间对三叉神经进行微血管减压。所有手术均采用SPVC保存技术。术前平衡快速场回波（bFFE）磁共振成像或等效序列和手术录像被研究用于个体SPVC解剖特征。结果描述了50例患者（平均年龄67.18岁；女性和右侧手术，分别占58％）的应用成像和SPVC解剖结构。SPVC组件有意牺牲了6例，无意中牺牲了7例。观察到二十九个不同的个体变异。80％的SPVC具有2个带有3个SPV或1个带有2个，3个或4个直接支流的SPV。大多数SPVC具有1个SPV（64％）和2个SPV（32％）。SPV排入上睑窦的引流点主要位于内耳道和Meckel洞穴之间（占病例的85.7％）。小脑桥脑裂孔的静脉是最常见的直接支流（86％），其次是80％的SPVC中的桥三叉静脉。至少有38％的病例检出了Petrosal-galenic吻合。在54％的病例中至少有1个SPV，在90％的病例中至少有1个直接支流干扰了手术视野。朝贡通常被牺牲。结论描述了SPVC的广泛解剖变化。大多数SPVC属于4种常见的常规配置，通常可以保留。