The angioarchitecture of the vein of Labbé: a population-based-study of 200 Asian hemispheres

Objective: The superficial cerebral venous system demonstrates considerable anatomical variability. The inferior anastomotic vein, or vein of Labbé (VOL), is a key anastomotic channel between the superficial middle cerebral veins and the transverse sinus. However, the morphological characteristics of the VOL remain inadequately defined, particularly in East Asian populations. This study aimed to systematically analyze the angioarchitecture of the VOL. Methods: The VOL was evaluated using three-dimensional (3D) reconstructions derived from gadolinium-enhanced 3D T1-weighted turbo spin-echo sequences and validated against digital subtraction angiography (DSA). Key anatomical parameters – including number, diameter, lateralization, drainage entry points, and the relationship with the superior anastomotic vein – were assessed in 200 cerebral hemispheres from 100 healthy individuals (50 males, 50 females). Results: In the validation cohort (n = 20 hemispheres), 3D MRA demonstrated high concordance with DSA in identifying VOL anatomy and diameter. Among all 200 hemispheres analyzed, VOL duplication was identified in 2% and complete absence in 0.5%. The VOL drained into the transverse sinus in 61.3% of cases, into the SDA in 32.7%, and into the superior petrosal sinus in 4%. A lateralized drainage pattern was observed, with the VOL being more prominent than the superior anastomotic vein on the left hemisphere, whereas the superior anastomotic vein predominated on the right hemispheres (p = 0.022). Conclusions: This study represents the largest imaging-based analysis of VOL anatomy in an East Asian population. The VOL exhibits substantial interindividual variability in number, drainage pattern, and lateralization. Detailed knowledge of these anatomical nuances is crucial to minimize risk of venous infarction and enhance neurosurgical outcomes.