Superior vena cava (SVC) resection and reconstruction is a technically demanding procedure associated with several concerns. During operation, continuous arterial and venous pressure measurements are essential to monitor and maintain the physiologic arterial-venous brain parenchymal gradient. Technical details mitigating this hemodynamic compromise include intraluminal shunt procedures, pharmacologic agents and fluid implementation, short venous clamping time, and anticoagulation therapy. SVC replacement is usually afforded using a normal or ringed polytetrafluoroethylene graft.