Vascular Complications in Glioma Surgery: insights from a Case-Based Analysis

Purpose The modern paradigm of maximal safe resection has improved oncological outcomes but has also increased the risk of vascular complications due to closer dissection near eloquent and vascular-rich brain regions. This study presents a comprehensive case-based analysis of vascular injuries encountered during glioma surgery, focusing on their mechanisms, clinical impact, and preventive strategies. Methods We retrospectively reviewed intraoperative videos, surgical reports and charts of patients undergoing brain glioma surgery. Results We identified 4 possible scenarios: damage to capillaries arising from parent vessels; damage to “en passage” vessels; damage to large caliber vessels; damage to perforators. Conclusions Understanding the complex vascular anatomy surrounding gliomas, integrating advanced preoperative imaging, and adopting meticulous microsurgical techniques are essential to minimize ischemic morbidity. Ultimately, sound intraoperative judgment—prioritizing vascular preservation over radicality when planes are unfavorable—remains critical for optimizing functional outcomes.