Introduction The deep cerebral venous system plays a critical role in surgical approaches to the pineal and posterior third ventricular regions—areas that are particularly challenging in pediatric neurosurgery. While adult venous anatomy is well described, data on normal pediatric venous development remain scarce. Surgical planning in children often relies on extrapolating adult anatomy, which may not reflect age-related anatomical variations that occur during rapid brain growth. Methods We retrospectively analyzed high-resolution 3.0 T contrast-enhanced MRIs from 85 pediatric patients (aged 15 days–17 years) performed at a single tertiary center. Key venous angles (ICV–GV, GV–SS, SS–SSS, BV–GV) and distances (BV–BV, ICV–ICV, ICV–BV) were measured using multiplanar reconstruction. Correlations with age were assessed using Pearson correlation and linear regression. Patients were divided into three age groups (0–3 years, 4–12 years, 13–18 years), and group differences were evaluated with ANOVA and Bonferroni correction. Results Significant age-related variations were identified in the conformation of the deep venous system. The ICV–GV, GV–SS, and SS–SSS angles widened with age ( p < .001), while BV–GV angles decreased. BV–BV distance increased progressively from infancy to adolescence ( p < .001). The ICV–BV relationship remained stable across age groups. Group comparisons confirmed significant differences between the youngest (0–3 years) and oldest (13–18 years) cohorts for most parameters. Conclusion The venous anatomy of the pineal region evolves significantly with age. Understanding these changes can optimize preoperative planning and surgical strategies in pediatric patients. These data provide age-specific anatomical references that may support neurosurgeons worldwide, including those working in low-resource settings without routine access to neuronavigation.
Sáenz et al. (Fri,) studied this question.