Blood flow disturbance in perforating arteries attributable to aneurysm surgery.
OBJECTIVE
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.
Sasaki
Tatsuya
T
Department of Neurosurgery, Fukushima Medical University, Fukushima, Japan.
Kodama
Namio
N
Matsumoto
Masato
M
Suzuki
Kyouichi
K
Konno
Yutaka
Y
Sakuma
Jun
J
Endo
Yuji
Y
Oinuma
Masahiro
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017542:Aneurysm, Ruptured / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D020144:Basal Ganglia Cerebrovascular Disease / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D001783:Blood Flow Velocity; D001921:Brain / Q000098:blood supply / Q000503:physiopathology; D002536:Cerebral Arteries / Q000503:physiopathology; D002544:Cerebral Infarction / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D002560:Cerebrovascular Circulation / Q000502:physiology; D019054:Evoked Potentials, Motor / Q000502:physiology; D005260:Female; D006801:Humans; D007031:Hypothalamus / Q000098:blood supply / Q000503:physiopathology; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D007430:Intraoperative Care; D008297:Male; D008866:Microsurgery / Q000295:instrumentation; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods; D020656:Posterior Thalamic Nuclei / Q000098:blood supply / Q000503:physiopathology; D014057:Tomography, X-Ray Computed