title: Intraoperative Visualization of Subependymal Arteries at the Atrium Supplying the Descending Motor Pathway.
abstract: OBJECTIVE
  We previously disclosed that damage to the subependymal arteries (SEAs) caused by coagulation of the choroid plexus at the atrium can result in infarction within the lateral posterior choroidal artery territory, followed by hemiparesis. The present study describes the intraoperative anatomical findings of the SEAs and choroid plexus at the atrium, which were verified only by a few cadaveric studies.
  
  
  METHODS
  Locations of the SEA and descending motor pathway were determined with the neuronavigation system and subcortical electrical stimulation in 8 cases of periatrial brain tumor. Indocyanine green videoangiography was performed to verify the blood flow in the choroid plexus and SEAs.
  
  
  RESULTS
  Intraoperative visualization of the SEAs was performed successfully in all patients. The neuronavigation system and subcortical electrical stimulation mapping demonstrated that these SEAs penetrated into the descending motor pathway. Indocyanine green depicted the blood flow of the SEAs entering the wall of the lateral ventricle and adjacent brain parenchyma. The blood flow directions between the SEAs and choroid plexus were not uniform, because the SEAs were filled ahead of the choroid plexus in 3 cases, whereas the choroid plexus was filled first in the other 2 cases.
  
  
  CONCLUSIONS
  Manipulations to the inner side of the choroid plexus at the transition from the atrium to the body of lateral ventricle can damage the SEAs. Not only coagulation of the SEAs themselves, but also coagulation of choroid plexus itself may reduce the blood flow in the SEAs, resulting in ischemic complications at descending motor pathway.
authors.affiliation: Department of Neurosurgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan; Department of Neurosurgery, University of Yamanashi Faculty of Medicine, Chuo, Yamanashi, Japan.
authors.forename: Mitsuto
authors.initials: M
authors.lastname: Hanihara
authors.affiliation: Department of Neurosurgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan.
authors.forename: Sumito
authors.initials: S
authors.lastname: Sato
authors.affiliation: Department of Neurosurgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan.
authors.forename: Ichiyo
authors.initials: I
authors.lastname: Shibahara
authors.affiliation: Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.
authors.forename: Ryuta
authors.initials: R
authors.lastname: Saito
authors.affiliation: Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Kanamori
authors.affiliation: Department of Neurosurgery, Yamagata University Faculty of Medicine, Yamagata, Yamagata, Japan.
authors.forename: Yukihiko
authors.initials: Y
authors.lastname: Sonoda
authors.affiliation: Department of Neurosurgery, University of Yamanashi Faculty of Medicine, Chuo, Yamanashi, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kinouchi
authors.affiliation: Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.
authors.forename: Teiji
authors.initials: T
authors.lastname: Tominaga
authors.affiliation: Department of Neurosurgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan. Electronic address: kuma@kitasato-u.ac.jp.
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Kumabe
mesh_terms: D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery; D002648:Child; D002831:Choroid Plexus / Q000098:blood supply* / Q000000981:diagnostic imaging* / Q000601:surgery; D005260:Female; D006801:Humans; D020547:Lateral Ventricles / Q000098:blood supply / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D011712:Pyramidal Tracts / Q000098:blood supply* / Q000000981:diagnostic imaging* / Q000601:surgery; D020535:Video-Assisted Surgery / Q000379:methods
keywords: Choroid plexus; Descending motor pathway; Lateral posterior choroidal artery; Subependymal artery