Blood flow disturbance in perforating arteries attributable to aneurysm surgery

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Object

The object of this study was to investigate patients with cerebral infarction in the area of the perforating arteries after aneurysm surgery.

Methods

The authors studied the incidence of cerebral infarction in 1043 patients using computed tomography or magnetic resonance imaging and the affected perforating arteries, clinical symptoms, prognosis, and operative maneuvers resulting in blood flow disturbance.

Results

Among 46 patients (4.4%) with infarction, the affected perforating arteries were the anterior choroidal artery (AChA) in nine patients, lenticulostriate artery (LSA) in nine patients, hypothalamic artery in two patients, posterior thalamoperforating artery in five patients, perforating artery of the vertebral artery (VA) in three patients, anterior thalamoperforating artery in nine patients, and recurrent artery of Heubner in nine patients. Sequelae persisted in 21 (45.7%) of the 46 patients; 13 (28.3%) had transient symptoms and 12 (26.1%) were asymptomatic. Sequelae developed in all patients with infarctions in perforating arteries in the area of the AChA, hypothalamic artery, or perforating artery of the VA; in four of five patients with posterior thalamoperforating artery involvement; and in two of nine with LSA involvement. The symptoms of anterior thalamoperforating artery infarction or recurrent artery of Heubner infarction were mild and/or transient. The operative maneuvers leading to blood flow disturbance in perforating arteries were aneurysmal neck clipping in 21 patients, temporary occlusion of the parent artery in nine patients, direct injury in seven patients, retraction in five patients, and trapping of the parent artery in four patients.

Conclusions

The patency of the perforating artery cannot be determined by intraoperative microscopic inspection. Intraoperative motor evoked potential monitoring contributed to the detection of blood flow disturbance in the territory of the AChA and LSA.

Abbreviations used in this paper:ACA = anterior cerebral artery; AChA = anterior choroidal artery; ACoA = anterior communicating artery; BA = basilar artery; CT = computed tomography; ICA = internal carotid artery; LSA = lenticulostriate artery; MCA = middle cerebral artery; MEP = motor evoked potential; MR = magnetic resonance; PCoA = posterior communicating artery; PICA = posterior inferior cerebellar artery; SSEP = somatosensory evoked potential; VA = vertebral artery.

Article Information

Address reprint requests to: Namio Kodama, M.D., Ph.D., Department of Neurosurgery, Fukushima Medical University, 1 Hikarigaoka, Fukushima 960-1295, Japan. email: nkodama@fmu.ac.jp.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    Postoperative T2-weighted MR images (VA-PA center right of panel) and CT scans show examples of cerebral infarction in the territory of various perforating arteries. Each set are two different postoperative images of one patient. ATPA = anterior thalamoperforating artery; HA = hypothalamic artery; PTPA = posterior thalamoperforating artery; RAH = recurrent artery of Heubner; VA-PA = perforating artery of the VA.

  • View in gallery

    Graph showing the occluded artery, occlusion time (minutes), and territory of the cerebral infarction in nine cases of infarction attributable to temporary occlusion of the parent artery. None of these patients experienced infarction in the territory of cortical branches of a major cerebral artery. Asterisk indicates temporary occlusion of the bilateral A1 portion of the ACA.

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