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ACCOMPANYING ARTICLE DOI: 10.3171/2018.4.FOCUS18120. INCLUDE WHEN CITING DOI: 10.3171/2018.4.FOCUS18207. It is an old neurosurgical adage to state, “The carotid artery is a terrible thing to lose.” For all too long, the field of cerebrovascular surgery has indeed been synonymous with arteries. After all, that is where most of the neurosurgical drama, triumphs, and disasters really reside. Veins have been “surgical orphans” until quite recently. It is most fitting that the cerebral venous system be “celebrated” in a dedicated journal issue such as this one. It is also most fitting to include in this issue an article describing the results of careful observation of cerebral venous flow, in health and disease states, through the window of semiquantitation. What is our relationship to cerebral veins in general? Is it amicable or antagonistic? It could be either. Cerebral veins play a complex role in surgical practice, and the senior author (J.J.M.) has always thought of the neurosurgeon’s relationship to them as falling into one of two groupings: friend or foe, with a total of 5 categories.