Infarction of the lateral posterior choroidal artery territory after manipulation of the choroid plexus at the atrium: causal association with subependymal artery injury

Clinical article

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Object

The atrium of the lateral ventricle is often affected by tumors, and some patients with these tumors suffer neurological deficits, including hemiparesis after surgery. The authors of this study investigated the possible mechanisms causing the relatively high incidences of ischemic complications associated with surgery approaching the atrium of the lateral ventricle.

Methods

Clinical records and radiological images of 28 patients were retrospectively studied. These patients had their lateral ventricles opened at the atrium during the resection of gliomas as well as other nonbenign brain tumors, and were treated for gliomas at our tertiary referral center in the Tohoku district, Japan, between January 2008 and December 2010.

Results

Routine postoperative diffusion-weighted MR images obtained within 72 hours after surgery detected infarction in the periatrial/periventricular regions in 7 patients, presumably corresponding to the lateral posterior choroidal artery (LPChA) territory. Five of these 7 patients suffered neurological sequelae with varying severities. The choroid plexus at the atrium was coagulated to achieve hemostasis during the surgery in all of these patients. Detailed analysis of microangiograms revealed ventriculofugal arteries arising from the lateral ventricle. Damage of the subependymal artery that supplies the ventriculofugal arteries caused by coagulation of the choroid plexus at the atrium probably resulted in the infarction in these patients.

Conclusions

Neurosurgeons must be aware of the possibility of LPChA territory infarction during surgery in the atrial or periatrial regions caused by subependymal artery obstruction after manipulating or coagulating the choroid plexus near the atrium.

Abbreviations used in this paper:AChA = anterior choroidal artery; LPChA = lateral posterior choroidal artery; MMT = Manual Muscle Test.

Article Information

Address correspondence to: Toshihiro Kumabe, M.D., Ph.D., Department of Neurosurgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Miyagi, Japan. email: kuma@nsg.med.tohoku.ac.jp.

Please include this information when citing this paper: published online March 29, 2013; DOI: 10.3171/2013.2.JNS121221.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Coronal microangiogram (left) and illustration (right) demonstrating the subependymal artery. These images show ventriculofugal arteries in the periventricular region along the atrium of the lateral ventricle. From Takahashi S (ed): Intracranial arterial system: basal perforating arteries, in: Neurovascular Imaging: MRI & Microangiography. London: Springer-Verlag, 2010, pp 53–130. Reproduced with kind permission from Springer Science+Business Media B.V.

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    Case 1. Axial T1-weighted MR images with contrast enhancement before (A and B) and after (C and D) surgery. Diffusion-weighted images obtained within 72 hours of surgery (E–H) revealed high-intensity areas in the left cerebral peduncle, posterior lateral thalamus, posterior limb of the internal capsule, posterior periventricular region, and posterior hippocampus.

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    Case 2. Axial T1-weighted MR images with contrast enhancement obtained before (A) and after (B) surgery. Diffusionweighted images obtained within 72 hours of surgery (C–E) revealed high-intensity areas at the dorsolateral aspect of the right side of the thalamus.

  • View in gallery

    Case 3. Axial T1-weighted MR images with contrast enhancement before (A) and after (B) surgery. Diffusion-weighted images obtained within 72 hours of surgery (C–E) revealed high-intensity areas at the posterolateral thalamus and posterior parts of the caudate nucleus.

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