Anatomic variations of the deep cerebral veins: a susceptibility-weighted imaging study in a population of Côte d’Ivoire and surgical implications

Anatomic variations of the deep cerebral veins: a susceptibility-weighted imaging study in a population of Côte d’Ivoire and surgical implications | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Anatomic variations of the deep cerebral veins: a susceptibility-weighted imaging study in a population of Côte d’Ivoire and surgical implications Kessé Marc-Antoine BROU, N'guessan Judicaël AHOURY, Seydou TRAORE, and 6 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8090541/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Purpose A precise understanding of the anatomic variations of the deep cerebral veins is a prerequisite for safe neurosurgical intervention in the third ventricular region. This study aimed to delineate the anatomy and prevalence of variations of the deep cerebral veins using Susceptibility-Weighted Imaging (SWI) in a population of Côte d’Ivoire. Methods In this retrospective study, 303 normal brain magnetic resonance imaging (MRI) examinations (606 cerebral hemispheres) performed on a 3 Tesla system were analyzed. SWI sequences were evaluated to determine the visualization rates of eight deep cerebral veins, assess inter-hemispheric symmetry, and classify anatomic variants of the thalamostriate (TSV), anterior septal (ASV), and anterior caudate (ACNV) veins. Results The lateral direct thalamic vein demonstrated the highest visualization rate (99.33%), while the superior choroidal vein demonstrated the lowest (41.66%). The deep venous network was asymmetric in 76.57% of subjects. The TSV-ASV junction was most frequently Type IA (57.5%). A statistically significant lateralization was observed, with Type IIA being more prevalent in the right hemisphere (p = 0.015). The ACNV drained predominantly into the TSV (78.7%), with significant inter-hemispheric differences in its drainage pattern (p < 0.001). Conclusion SWI provides excellent visualization of the deep cerebral venous system. The high prevalence of anatomic variations and inter-hemispheric asymmetries documented herein, including the significant lateralization of the Type IIA TSV-ASV junction, provides crucial anatomic data for preoperative planning, potentially minimizing vascular risk during transcallosal-transforaminal approaches to the third ventricle. Cerebral Veins Anatomic Variation Magnetic Resonance Imaging Susceptibility-Weighted Imaging Third Ventricle Neuroanatomy Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 1. Introduction The deep cerebral veins represent the principal drainage system for the deep grey nuclei, thalami, and periventricular white matter [ 1 ]. Their complex and highly variable anatomy is of paramount clinical significance, not only for the diagnosis of vascular pathologies such as cerebral venous thrombosis but, critically, for the planning and execution of neurosurgical procedures within the confined space of the third ventricle [ 2 , 3 ]. The thalamostriate vein (TSV) and anterior septal vein (ASV) are key components of this deep venous system. The anatomic relationship between the TSV and ASV forms a critical landmark—the venous angle—which is instrumental in defining the surgical corridor for the transcallosal-transforaminal approach [ 3 , 4 ]. The anterior caudate nucleus vein (ACNV) is a tiny branch that only has few studies about its variants especially in Africa. Susceptibility-Weighted Imaging (SWI), a magnetic resonance imaging (MRI) technique that exploits the magnetic susceptibility of deoxygenated hemoglobin, has emerged as a superior modality for high-resolution, non-contrast venography [ 3 , 5 ]. It provides unparalleled visualization of small-caliber venous structures, making it ideal for detailed anatomic studies. While previous investigations have utilized SWI to characterize these veins in various populations [ 2 , 6 ], data from sub-Saharan African cohorts are very rare. This study, therefore, sought to systematically analyze the anatomy and anatomic variations of the deep cerebral veins using SWI in a population of Côte d’Ivoire by quantifying the visualization rates of the main deep cerebral veins, assessing the symmetry of this venous network between the cerebral hemispheres, and establishing the prevalence of anatomical variants of the TSV-ASV junction and the drainage pattern of the ACNV. 2. Materials and Methods 2.1. Study Design and Population This retrospective, cross-sectional study was conducted at the Abidjan Institute of Radiology and Medical Imaging (IRIMA). The study protocol received formal approval from the institution's Ethics Committee. Consecutive brain MRI examinations performed between January and December 2024 were screened. The inclusion criteria were: availability of a diagnostic-quality SWI sequence and a final radiological report concluding a normal study. Examinations compromised by significant motion artifact or incomplete sequences were excluded. A final cohort of 303 patients, representing 606 cerebral hemispheres, was constituted for analysis. 2.2. MRI Protocol and SWI Acquisition All imaging was performed on a 3 Tesla Philips ELITION 3.0 T X system. The SWI sequence was acquired using a three-dimensional, velocity-compensated gradient-echo sequence. The acquisition parameters were standardized as follows: Repetition Time (TR) = 30 ms; Echo Time (TE) = 20 ms; flip angle = 15°; slice thickness = 1.5 mm; field of view = 230 x 230 mm; matrix size = 352 x 352. 2.3. Image Analysis A single radiologist, performed all analyses on a dedicated Philips post-processing workstation. The following deep cerebral veins were assessed for visualization in each hemisphere: Great Cerebral Vein (GCV), Internal Cerebral Vein (ICV), Thalamostriate Vein (TSV), Anterior Septal Vein (ASV), Anterior Caudate Vein (ACNV), Medial Atrial Vein (MAV), Lateral Direct Thalamic Vein (LDV), and Superior Choroidal Vein (CV). A vein was deemed adequately visualized if its course was continuously apparent without interruption within the anatomic region of interest, defined as the space between two vertical lines tangential to the lateral walls of the anterior horns of the lateral ventricles. The configuration of the TSV-ASV junction was classified according to the system established by Türe et al. [11]: Type I (junction anterior to the foramen of Monro) and Type II (junction posterior to the foramen of Monro), with each type subdivided into Subtype A (true venous angle) and Subtype B (false venous angle). The terminal drainage of the ACNV was cataloged as terminating into the TSV, ASV, or ICV. 2.4. Statistical Analysis Data were collated and analyzed using IBM SPSS Statistics (Version 28). Descriptive statistics were computed for all variables. Frequencies were compared using the Chi-square test of independence or the multivariate Chi-square test for inter-hemispheric comparisons. The Mann-Whitney U test was employed to compare visualization rates between anatomic vein groups. A p-value of less than 0.05 was considered statistically significant. 3. Results 3.1. Study Population Demographics The study population consisted of 303 individuals (172 male, 131 female), corresponding to 606 cerebral hemispheres. The demographic distribution by age was as follows: 0–15 years (20.79%), 15–30 years (26.40%), 30–45 years (31.68%), 45–60 years (10.90%), and > 60 years (10.23%). 3.2. Visualization of Deep Cerebral Veins The visualization rates for the eight deep cerebral veins are summarized in Table 1 . The lateral direct thalamic vein was the most consistently identified structure (99.33%), whereas the superior choroidal vein demonstrated the lowest rate of consistent visualization (41.66%). No statistically significant associations were found between visualization rates and patient gender (p = 1.000) or age group (p = 0.885). 3.3. Inter-hemispheric Symmetry An asymmetric configuration of the deep venous network was observed in 76.57% of subjects (232/303). The prevalence of asymmetry did not differ significantly between male (78.53%) and female (73.81%) patients (p = 0.983). No significant difference was detected in the overall visualization rates of veins between the right and left hemispheres (p = 0.999). 3.4. Anatomic Variations TSV-ASV Junction : Analysis of 593 analyzable hemispheres revealed the following distribution: Type IA (57.5%), Type IB (24.12%), Type IIB (11.80%), and Type IIA (6.58%). This distribution was statistically significant (p < 0.0001). A significant lateralization was observed (p = 0.015), attributable to a higher prevalence of Type IIA junctions in the right hemisphere (29 right vs. 10 left). ACNV Drainage : Among 507 analyzable hemispheres, the ACNV terminated into the TSV in 78.7% of cases, the ASV in 15.19%, and directly into the ICV in 6.11%. This distribution was statistically significant (p < 0.0001). The drainage pattern demonstrated significant lateralization (p < 0.001), with termination into the ICV being more frequent on the right. Table 1 Visualization frequency of the studied deep cerebral veins VEINS Count Percentage % GCV 260 85,80 ICV 554 91,72 TSV 579 95,70 ASV 567 93,71 ACNV 506 83,63 MAV 579 95,70 LDV 601 99,33 id CV 252 41,66 N = 606 4. Discussion This study provides a detailed analysis of deep cerebral venous anatomy based on SWI in a West African population and represents one of the most significant series in this scientific field according to the literature available to us. Our findings confirm the high efficacy of SWI for delineating this complex vascular network. The visualization rates for major veins like the TSV and ICV exceed 90%, aligning with prior literature [ 2 , 6 ]. The relatively low visualization rate of the superior choroidal vein (41.66%) is consistent with its known anatomic variability and small caliber. A principal finding is the high prevalence of inter-hemispheric asymmetry (76.57%), underscoring the substantial anatomic variability that must be meticulously accounted for in preoperative planning. The predominance of the Type IA TSV-ASV junction (anterior venous angle) is consistent with the findings of Türe et al. in cadaveric dissections [ 3 ] and subsequent MR imaging studies [ 2 , 6 ]. The observed disparities in the frequencies of less common variants (e.g., Types IB and IIA) compared to other populations may suggest ethnogeographic variations in venous anatomy, a hypothesis that warrants further investigation. The most notable finding is the significant lateralization of the Type IIA junction to the right hemisphere. This has not been prominently reported in the studies considered in our review. From a surgical perspective, the position of the TSV-ASV junction is a critical determinant of the safe working corridor in the transcallosal-transforaminal approach [ 3 , 4 ]. A Type I junction, being situated anteriorly, is considered to be at greater risk during posterior enlargement of the foramen of Monro. The high frequency of this configuration in our population necessitates its precise preoperative identification. The lateralization of the Type IIA variant could inform the strategic selection of the operative side. The detailed mapping of ACNV drainage patterns further enriches the topographic understanding of the regional venous architecture as the works about this tributary are rare. We can cite the publication by Wang et al., which provides a good overview of ACNV variants. [ 4 ]. 4.1. Limitations This study has limitations inherent to its retrospective and monocentric design. The single-observer analysis, while ensuring internal consistency, precludes the assessment of inter-observer variability. Furthermore, the focus on a radiologically normal population establishes a robust anatomic baseline but does not address potential alterations in pathologic states. 5. Conclusion Susceptibility-Weighted Imaging is a superior modality for the non-invasive delineation of the deep cerebral venous system. This study provides foundational data on the anatomic variations and asymmetries prevalent in an Ivorian population, including the significant lateralization of the Type IIA TSV-ASV junction. These results emphasize the indispensability of incorporating SWI into the preoperative workflow for third ventricle surgery. Such detailed venographic mapping is crucial for anticipating individual anatomic patterns and is instrumental in mitigating the risk of iatrogenic venous injury. Future prospective, multicenter studies across diverse populations are recommended to further elucidate the full spectrum of neurovascular anatomic diversity. Declarations Compliance with Ethical Standards Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Conflict of Interest: All authors declare that they have no conflict of interest. Ethical Approval: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required. Informed Consent: Informed consent was waived by the Institutional Review Board due to the retrospective nature of the study. Author Contributions All authors contributed to the study conception and design. The following specific contributions were made using the CRediT (Contributor Roles Taxonomy) model: BROU Kessé Marc-Antoine: Conceptualization, Methodology, Software, Validation, Formal Analysis, Investigation, Data Curation, Writing – Original Draft, Writing – Review & Editing, Visualization, Project Administration. Email: [email protected] AHOURY N'guessan Judicaël: Conceptualization, Methodology, Validation, Writing – Review & Editing. E-mail: [email protected] TRAORÉ Seydou: Investigation, Data Curation. E-mail : [email protected] KONAN Landry Melaine : Validation, Writing – Review & Editing E-mail: [email protected] DJONDÉ Grâce: Conceptualization (Neuroanatomy and Surgical Implications). E-mail: [email protected] DIABY Raïssa: Conceptualization (Neuroanatomy and Surgical Implications). E-mail: [email protected] GBAZI Marc: Conceptualization (Neuroanatomy and Surgical Implications). E-mail: [email protected] DIABATE Aboubacar Sidiki: Conceptualization, Resources, Supervision, Ethics Acquisition. [email protected] ZAHREDDINE Walid: Resources, Supervision, Ethics Acquisition. All authors read and approved the final manuscript. Email: [email protected] References Schlesinger B (1939) The venous drainage of the brain, with special reference to the Galenic system. Brain 62:274–291 Timurkaynak E, Rhoton AL, Barry M (1986) Microsurgical anatomy and approaches to the lateral ventricles. Neurosurgery 19(5):685–723 Türe U, Yaşargil MG, Al-Mefty O (1997) The transcallosal-transforaminal approach to the third ventricle with regard to the venous variations in this region. J Neurosurg 87(5):706–715 Wang J, Wang J, Sun J, Gong X (2010) Evaluation of the anatomy and variants of internal cerebral veins with phase-sensitive MR imaging. Surg Radiol Anat 32(7):669–674 Cagatay Cimsit N, Türe U, Ekinci G et al (2003) Venous variations in the region of the third ventricle: the role of MR venography. Neuroradiology 45(12):900–904 Zhang XF, Li JC, Wen XD, Ren CG, Cai M, Chen CC (2015) Susceptibility-Weighted Imaging of the Anatomic Variation of Thalamostriate Vein and Its Tributaries. PLoS ONE 10(10):e0141513 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8090541","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":544070388,"identity":"fa986681-3f00-4903-97b7-1e7892c0cf8f","order_by":0,"name":"Kessé Marc-Antoine 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1","display":"","copyAsset":false,"role":"figure","size":26652,"visible":true,"origin":"","legend":"\u003cp\u003eSWI axial MRI slice from our study showing the deep cerebral veins we investigated\u003c/p\u003e","description":"","filename":"figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8090541/v1/12bf277797a95ccb15280468.jpg"},{"id":95810025,"identity":"0f0a8384-710a-45b7-9b14-5fbfb386786b","added_by":"auto","created_at":"2025-11-13 08:51:40","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":419619,"visible":true,"origin":"","legend":"\u003cp\u003eSWI axial MRI slices from our study showing the ASV-TSV branching giving types IA (left side) and IB (right side) in image A, as well as a bilateral type IIB in image B.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-8090541/v1/b57e4f496a7fdbcfe68dbe4c.png"},{"id":95810224,"identity":"68b87a30-b2dd-450e-9610-47cae0701511","added_by":"auto","created_at":"2025-11-13 08:52:02","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":30594,"visible":true,"origin":"","legend":"\u003cp\u003eDifferences in ASV-TSV branching type distribution residues according to cerebral hemisphere based on the Chi-square test\u003c/p\u003e","description":"","filename":"Figure3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8090541/v1/2b723e6ac42585278b5d9d21.jpg"},{"id":95810092,"identity":"67373d54-745f-4619-88bc-a66b6718830f","added_by":"auto","created_at":"2025-11-13 08:51:46","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":345988,"visible":true,"origin":"","legend":"\u003cp\u003eSWI axial MRI slices from our study showing ACNV draining into TSV (Image A, right side), into ASV (Image A, left side) and into ICV (Image B, left side) as well as a ASV-TSV branching type IIA (Image B, right side)\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-8090541/v1/dd25a60bb443321153a4c423.png"},{"id":95819002,"identity":"6706a7f6-77ac-4fa6-8771-695849a43cf7","added_by":"auto","created_at":"2025-11-13 10:37:13","extension":"jpg","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":31278,"visible":true,"origin":"","legend":"\u003cp\u003eDifferences in ACNV drainage vein distribution residues according to cerebral hemisphere based on the Chi-square test\u003c/p\u003e","description":"","filename":"Figure5.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8090541/v1/249fc3ffe9a9e6fb015b9d19.jpg"},{"id":97672183,"identity":"4891427a-faa4-4dbe-961d-170a7e925aba","added_by":"auto","created_at":"2025-12-08 09:34:34","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1822413,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8090541/v1/e94e3d35-181a-499d-aeec-0d1a92dd3556.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Anatomic variations of the deep cerebral veins: a susceptibility-weighted imaging study in a population of Côte d’Ivoire and surgical implications","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eThe deep cerebral veins represent the principal drainage system for the deep grey nuclei, thalami, and periventricular white matter [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Their complex and highly variable anatomy is of paramount clinical significance, not only for the diagnosis of vascular pathologies such as cerebral venous thrombosis but, critically, for the planning and execution of neurosurgical procedures within the confined space of the third ventricle [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe thalamostriate vein (TSV) and anterior septal vein (ASV) are key components of this deep venous system. The anatomic relationship between the TSV and ASV forms a critical landmark\u0026mdash;the venous angle\u0026mdash;which is instrumental in defining the surgical corridor for the transcallosal-transforaminal approach [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. The anterior caudate nucleus vein (ACNV) is a tiny branch that only has few studies about its variants especially in Africa.\u003c/p\u003e\u003cp\u003eSusceptibility-Weighted Imaging (SWI), a magnetic resonance imaging (MRI) technique that exploits the magnetic susceptibility of deoxygenated hemoglobin, has emerged as a superior modality for high-resolution, non-contrast venography [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. It provides unparalleled visualization of small-caliber venous structures, making it ideal for detailed anatomic studies.\u003c/p\u003e\u003cp\u003eWhile previous investigations have utilized SWI to characterize these veins in various populations [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], data from sub-Saharan African cohorts are very rare. This study, therefore, sought to systematically analyze the anatomy and anatomic variations of the deep cerebral veins using SWI in a population of C\u0026ocirc;te d\u0026rsquo;Ivoire by quantifying the visualization rates of the main deep cerebral veins, assessing the symmetry of this venous network between the cerebral hemispheres, and establishing the prevalence of anatomical variants of the TSV-ASV junction and the drainage pattern of the ACNV.\u003c/p\u003e"},{"header":"2. Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003e2.1. Study Design and Population\u003c/h2\u003e\u003cp\u003eThis retrospective, cross-sectional study was conducted at the Abidjan Institute of Radiology and Medical Imaging (IRIMA). The study protocol received formal approval from the institution's Ethics Committee.\u003c/p\u003e\u003cp\u003eConsecutive brain MRI examinations performed between January and December 2024 were screened. The inclusion criteria were: availability of a diagnostic-quality SWI sequence and a final radiological report concluding a normal study. Examinations compromised by significant motion artifact or incomplete sequences were excluded. A final cohort of 303 patients, representing 606 cerebral hemispheres, was constituted for analysis.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\u003ch2\u003e2.2. MRI Protocol and SWI Acquisition\u003c/h2\u003e\u003cp\u003eAll imaging was performed on a 3 Tesla Philips ELITION 3.0 T X system. The SWI sequence was acquired using a three-dimensional, velocity-compensated gradient-echo sequence. The acquisition parameters were standardized as follows: Repetition Time (TR)\u0026thinsp;=\u0026thinsp;30 ms; Echo Time (TE)\u0026thinsp;=\u0026thinsp;20 ms; flip angle\u0026thinsp;=\u0026thinsp;15\u0026deg;; slice thickness\u0026thinsp;=\u0026thinsp;1.5 mm; field of view\u0026thinsp;=\u0026thinsp;230 x 230 mm; matrix size\u0026thinsp;=\u0026thinsp;352 x 352.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003e2.3. Image Analysis\u003c/h2\u003e\u003cp\u003eA single radiologist, performed all analyses on a dedicated Philips post-processing workstation. The following deep cerebral veins were assessed for visualization in each hemisphere: Great Cerebral Vein (GCV), Internal Cerebral Vein (ICV), Thalamostriate Vein (TSV), Anterior Septal Vein (ASV), Anterior Caudate Vein (ACNV), Medial Atrial Vein (MAV), Lateral Direct Thalamic Vein (LDV), and Superior Choroidal Vein (CV).\u003c/p\u003e\u003cp\u003eA vein was deemed adequately visualized if its course was continuously apparent without interruption within the anatomic region of interest, defined as the space between two vertical lines tangential to the lateral walls of the anterior horns of the lateral ventricles.\u003c/p\u003e\u003cp\u003eThe configuration of the TSV-ASV junction was classified according to the system established by T\u0026uuml;re et al. [11]: Type I (junction anterior to the foramen of Monro) and Type II (junction posterior to the foramen of Monro), with each type subdivided into Subtype A (true venous angle) and Subtype B (false venous angle). The terminal drainage of the ACNV was cataloged as terminating into the TSV, ASV, or ICV.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\u003ch2\u003e2.4. Statistical Analysis\u003c/h2\u003e\u003cp\u003eData were collated and analyzed using IBM SPSS Statistics (Version 28). Descriptive statistics were computed for all variables. Frequencies were compared using the Chi-square test of independence or the multivariate Chi-square test for inter-hemispheric comparisons. The Mann-Whitney U test was employed to compare visualization rates between anatomic vein groups. A p-value of less than 0.05 was considered statistically significant.\u003c/p\u003e\u003c/div\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003e3.1. Study Population Demographics\u003c/h2\u003e\u003cp\u003eThe study population consisted of 303 individuals (172 male, 131 female), corresponding to 606 cerebral hemispheres. The demographic distribution by age was as follows: 0\u0026ndash;15 years (20.79%), 15\u0026ndash;30 years (26.40%), 30\u0026ndash;45 years (31.68%), 45\u0026ndash;60 years (10.90%), and \u0026gt;\u0026thinsp;60 years (10.23%).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\u003ch2\u003e3.2. Visualization of Deep Cerebral Veins\u003c/h2\u003e\u003cp\u003eThe visualization rates for the eight deep cerebral veins are summarized in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The lateral direct thalamic vein was the most consistently identified structure (99.33%), whereas the superior choroidal vein demonstrated the lowest rate of consistent visualization (41.66%). No statistically significant associations were found between visualization rates and patient gender (p\u0026thinsp;=\u0026thinsp;1.000) or age group (p\u0026thinsp;=\u0026thinsp;0.885).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\u003ch2\u003e3.3. Inter-hemispheric Symmetry\u003c/h2\u003e\u003cp\u003eAn asymmetric configuration of the deep venous network was observed in 76.57% of subjects (232/303). The prevalence of asymmetry did not differ significantly between male (78.53%) and female (73.81%) patients (p\u0026thinsp;=\u0026thinsp;0.983). No significant difference was detected in the overall visualization rates of veins between the right and left hemispheres (p\u0026thinsp;=\u0026thinsp;0.999).\u003c/p\u003e\u003cp\u003e\u003cb\u003e3.4. Anatomic Variations\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eTSV-ASV Junction\u003c/b\u003e: Analysis of 593 analyzable hemispheres revealed the following distribution: Type IA (57.5%), Type IB (24.12%), Type IIB (11.80%), and Type IIA (6.58%). This distribution was statistically significant (p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001). A significant lateralization was observed (p\u0026thinsp;=\u0026thinsp;0.015), attributable to a higher prevalence of Type IIA junctions in the right hemisphere (29 right vs. 10 left).\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eACNV Drainage\u003c/b\u003e: Among 507 analyzable hemispheres, the ACNV terminated into the TSV in 78.7% of cases, the ASV in 15.19%, and directly into the ICV in 6.11%. This distribution was statistically significant (p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001). The drainage pattern demonstrated significant lateralization (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), with termination into the ICV being more frequent on the right.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eVisualization frequency of the studied deep cerebral veins\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVEINS\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCount\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePercentage %\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGCV\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003e260\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e85,80\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eICV\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003e554\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e91,72\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTSV\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e579\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e95,70\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eASV\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e567\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e93,71\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eACNV\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e506\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e83,63\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMAV\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e579\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e95,70\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eLDV\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e601\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e99,33\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eid CV\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e252\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e41,66\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"3\"\u003e\u003cb\u003eN\u0026thinsp;=\u0026thinsp;606\u003c/b\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eThis study provides a detailed analysis of deep cerebral venous anatomy based on SWI in a West African population and represents one of the most significant series in this scientific field according to the literature available to us. Our findings confirm the high efficacy of SWI for delineating this complex vascular network. The visualization rates for major veins like the TSV and ICV exceed 90%, aligning with prior literature [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. The relatively low visualization rate of the superior choroidal vein (41.66%) is consistent with its known anatomic variability and small caliber.\u003c/p\u003e\u003cp\u003eA principal finding is the high prevalence of inter-hemispheric asymmetry (76.57%), underscoring the substantial anatomic variability that must be meticulously accounted for in preoperative planning. The predominance of the Type IA TSV-ASV junction (anterior venous angle) is consistent with the findings of T\u0026uuml;re et al. in cadaveric dissections [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e] and subsequent MR imaging studies [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. The observed disparities in the frequencies of less common variants (e.g., Types IB and IIA) compared to other populations may suggest ethnogeographic variations in venous anatomy, a hypothesis that warrants further investigation.\u003c/p\u003e\u003cp\u003eThe most notable finding is the significant lateralization of the Type IIA junction to the right hemisphere. This has not been prominently reported in the studies considered in our review. From a surgical perspective, the position of the TSV-ASV junction is a critical determinant of the safe working corridor in the transcallosal-transforaminal approach [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. A Type I junction, being situated anteriorly, is considered to be at greater risk during posterior enlargement of the foramen of Monro. The high frequency of this configuration in our population necessitates its precise preoperative identification. The lateralization of the Type IIA variant could inform the strategic selection of the operative side. The detailed mapping of ACNV drainage patterns further enriches the topographic understanding of the regional venous architecture as the works about this tributary are rare. We can cite the publication by Wang et al., which provides a good overview of ACNV variants. [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003e4.1. Limitations\u003c/h2\u003e\u003cp\u003eThis study has limitations inherent to its retrospective and monocentric design. The single-observer analysis, while ensuring internal consistency, precludes the assessment of inter-observer variability. Furthermore, the focus on a radiologically normal population establishes a robust anatomic baseline but does not address potential alterations in pathologic states.\u003c/p\u003e\u003c/div\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eSusceptibility-Weighted Imaging is a superior modality for the non-invasive delineation of the deep cerebral venous system. This study provides foundational data on the anatomic variations and asymmetries prevalent in an Ivorian population, including the significant lateralization of the Type IIA TSV-ASV junction. These results emphasize the indispensability of incorporating SWI into the preoperative workflow for third ventricle surgery. Such detailed venographic mapping is crucial for anticipating individual anatomic patterns and is instrumental in mitigating the risk of iatrogenic venous injury. Future prospective, multicenter studies across diverse populations are recommended to further elucidate the full spectrum of neurovascular anatomic diversity.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eCompliance with Ethical Standards\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.\u003cbr\u003e \u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of Interest:\u003c/strong\u003e All authors declare that they have no conflict of interest.\u003cbr\u003e \u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Approval:\u003c/strong\u003e All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.\u003cbr\u003e \u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInformed Consent:\u003c/strong\u003e Informed consent was waived by the Institutional Review Board due to the retrospective nature of the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors contributed to the study conception and design. The following specific contributions were made using the CRediT (Contributor Roles Taxonomy) model:\u003c/p\u003e\n\u003cul\u003e\n\u003cli\u003e\u003cstrong\u003eBROU Kessé Marc-Antoine:\u003c/strong\u003e Conceptualization, Methodology, Software, Validation, Formal Analysis, Investigation, Data Curation, Writing – Original Draft, Writing – Review \u0026amp; Editing, Visualization, Project Administration. Email: [email protected] \u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eAHOURY N'guessan Judicaël:\u003c/strong\u003e Conceptualization, Methodology, Validation, Writing – Review \u0026amp; Editing. \u003cu\u003eE-mail:\u003c/u\u003e [email protected] \u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eTRAORÉ Seydou:\u003c/strong\u003e Investigation, Data Curation. \u003cu\u003eE-mail :\u003c/u\u003e [email protected] \u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eKONAN Landry Melaine :\u003c/strong\u003e Validation, Writing – Review \u0026amp; Editing \u003cu\u003eE-mail: \u003c/u\[email protected]\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eDJONDÉ Grâce:\u003c/strong\u003e Conceptualization (Neuroanatomy and Surgical Implications). \u003cu\u003eE-mail: \u003c/u\[email protected]\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eDIABY Raïssa:\u003c/strong\u003e Conceptualization (Neuroanatomy and Surgical Implications). \u003cu\u003eE-mail: \u003c/u\[email protected]\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eGBAZI Marc:\u003c/strong\u003e Conceptualization (Neuroanatomy and Surgical Implications). \u003cu\u003eE-mail: \u003c/u\[email protected]\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eDIABATE Aboubacar Sidiki:\u003c/strong\u003e Conceptualization, Resources, Supervision, Ethics Acquisition. [email protected] \u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eZAHREDDINE Walid:\u003c/strong\u003e Resources, Supervision, Ethics Acquisition.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eAll authors read and approved the final manuscript. \u003cu\u003eEmail:\u003c/u\u003e [email protected]\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSchlesinger B (1939) The venous drainage of the brain, with special reference to the Galenic system. Brain 62:274\u0026ndash;291\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTimurkaynak E, Rhoton AL, Barry M (1986) Microsurgical anatomy and approaches to the lateral ventricles. Neurosurgery 19(5):685\u0026ndash;723\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eT\u0026uuml;re U, Yaşargil MG, Al-Mefty O (1997) The transcallosal-transforaminal approach to the third ventricle with regard to the venous variations in this region. J Neurosurg 87(5):706\u0026ndash;715\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWang J, Wang J, Sun J, Gong X (2010) Evaluation of the anatomy and variants of internal cerebral veins with phase-sensitive MR imaging. Surg Radiol Anat 32(7):669\u0026ndash;674\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCagatay Cimsit N, T\u0026uuml;re U, Ekinci G et al (2003) Venous variations in the region of the third ventricle: the role of MR venography. Neuroradiology 45(12):900\u0026ndash;904\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZhang XF, Li JC, Wen XD, Ren CG, Cai M, Chen CC (2015) Susceptibility-Weighted Imaging of the Anatomic Variation of Thalamostriate Vein and Its Tributaries. PLoS ONE 10(10):e0141513\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Cerebral Veins, Anatomic Variation, Magnetic Resonance Imaging, Susceptibility-Weighted Imaging, Third Ventricle, Neuroanatomy","lastPublishedDoi":"10.21203/rs.3.rs-8090541/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8090541/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePurpose\u003c/h2\u003e\u003cp\u003eA precise understanding of the anatomic variations of the deep cerebral veins is a prerequisite for safe neurosurgical intervention in the third ventricular region. This study aimed to delineate the anatomy and prevalence of variations of the deep cerebral veins using Susceptibility-Weighted Imaging (SWI) in a population of C\u0026ocirc;te d\u0026rsquo;Ivoire.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eIn this retrospective study, 303 normal brain magnetic resonance imaging (MRI) examinations (606 cerebral hemispheres) performed on a 3 Tesla system were analyzed. SWI sequences were evaluated to determine the visualization rates of eight deep cerebral veins, assess inter-hemispheric symmetry, and classify anatomic variants of the thalamostriate (TSV), anterior septal (ASV), and anterior caudate (ACNV) veins.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eThe lateral direct thalamic vein demonstrated the highest visualization rate (99.33%), while the superior choroidal vein demonstrated the lowest (41.66%). The deep venous network was asymmetric in 76.57% of subjects. The TSV-ASV junction was most frequently Type IA (57.5%). A statistically significant lateralization was observed, with Type IIA being more prevalent in the right hemisphere (p\u0026thinsp;=\u0026thinsp;0.015). The ACNV drained predominantly into the TSV (78.7%), with significant inter-hemispheric differences in its drainage pattern (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eSWI provides excellent visualization of the deep cerebral venous system. The high prevalence of anatomic variations and inter-hemispheric asymmetries documented herein, including the significant lateralization of the Type IIA TSV-ASV junction, provides crucial anatomic data for preoperative planning, potentially minimizing vascular risk during transcallosal-transforaminal approaches to the third ventricle.\u003c/p\u003e","manuscriptTitle":"Anatomic variations of the deep cerebral veins: a susceptibility-weighted imaging study in a population of Côte d’Ivoire and surgical implications","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-13 08:32:45","doi":"10.21203/rs.3.rs-8090541/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"00512f34-bc60-4663-8aee-b1b0265adace","owner":[],"postedDate":"November 13th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-12-06T09:38:44+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-13 08:32:45","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8090541","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8090541","identity":"rs-8090541","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}