title: Medial posterior choroidal artery territory infarction associated with tumor removal in the pineal/tectum/thalamus region through the occipital transtentorial approach.
abstract: OBJECTIVE
  Damage to the deep venous system, occipital lobe, and/or corpus callosum is well known to cause complications associated with the occipital transtentorial approach (OTA), but ischemic complications are not well documented. The authors investigated the high incidences of ischemic complications associated with removal of pineal/tectal/thalamic tumors through the OTA.
  
  
  METHODS
  Clinical records of 29 patients who underwent 31 surgeries using the OTA from December 2001 to May 2011 were retrospectively studied. Tumor locations were the pineal/tectal/thalamic region for 19, cerebellum for 7, and medial temporal lobe for 3.
  
  
  RESULTS
  Postoperative diffusion-weighted magnetic resonance images obtained within 72 h after surgery detected infarction in the tectal/splenial/thalamic region, presumably representing the medial posterior choroidal artery (MPChA) territory, in 10 patients. All these patients had tumor in the pineal/tectal/thalamic region. Deteriorated or newly developed eye symptoms including vertical gaze palsy tended to persist in these patients compared to those without ischemic complications.
  
  
  CONCLUSIONS
  A relatively high incidence of MPChA territory infarction was associated with removal of tumors in the pineal/tectal/thalamic region through the OTA. Eye symptoms often occurred post-surgery and tended to persist in these patients. Neurosurgeons must be aware of the possibility of MPChA territory infarction to further increase the safety of the OTA.
authors.affiliation: Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.
authors.forename: Ryuta
authors.initials: R
authors.lastname: Saito
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Kumabe
authors.forename: Masayuki
authors.initials: M
authors.lastname: Kanamori
authors.forename: Yukihiko
authors.initials: Y
authors.lastname: Sonoda
authors.forename: Shunji
authors.initials: S
authors.lastname: Mugikura
authors.forename: Shoki
authors.initials: S
authors.lastname: Takahashi
authors.forename: Teiji
authors.initials: T
authors.lastname: Tominaga
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002545:Brain Ischemia / Q000209:etiology; D001932:Brain Neoplasms / Q000601:surgery*; D002544:Cerebral Infarction / Q000209:etiology* / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D038524:Diffusion Magnetic Resonance Imaging; D018572:Disease-Free Survival; D005128:Eye Diseases / Q000453:epidemiology / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006261:Headache / Q000209:etiology; D006801:Humans; D007223:Infant; D017567:Karnofsky Performance Status; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009325:Nausea / Q000209:etiology; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D009777:Occipital Bone / Q000601:surgery*; D010871:Pinealoma / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology* / Q000473:pathology; D012189:Retrospective Studies; D013285:Strabismus / Q000209:etiology; D016019:Survival Analysis; D003336:Tectum Mesencephali / Q000601:surgery*; D014549:Urinary Incontinence / Q000209:etiology; D055815:Young Adult