Dos and Don’ts of Venous Accidents Around the Vein of Galen

Venous anatomy around the vein of Galen (VOG) is similar to any other venous regions. The fundamental concept being in the periphery they are small and multiple and as they approach the main vein they are large and single or paired. However, when analyzed with reference to tumors around the pineal region (some of which can be vascular and some others can engulf or push the nearby veins), we coin safe and dangerous zones. Safe maximal resection[1] being the key for pineal region tumors. This article is organized in such a way so as to describe the common anatomy first, followed by special arachnoid anatomy, pial/ependymal veins, and finally how to navigate through these branches while removing pineal region pathology and the common sites of bleed during the operation.