PDF herunterladen
CC BY-NC-ND 4.0 · Asian J Neurosurg 2020; 15(03): 777-780
DOI: 10.4103/ajns.AJNS_370_19
Case Report

Artery of percheron and endoscopic endonasal surgery: Case report and review of the literature

Marta Pereira
Department of Neurosurgery, Sant Pau Hospital, Barcelona
,
Fernando Hernández
Department of Neurosurgery, Sant Pau Hospital, Barcelona
,
Carlos Cortés
Department of Neurosurgery, Sant Pau Hospital, Barcelona
› Institutsangaben
› Weitere Informationen
Auch verfügbar auf
  Lizenzen und Reprints

Artery of Percheron (AOP) is a rare anatomical variant in which a single perforating artery arising from the P1 segment of the posterior cerebral artery supplies paramedian thalami and rostral midbrain. The occlusion of AOP produces bilateral thalamic ischemia and may be a rare complication in relation to an extended endoscopic endonasal approach. We report the case of a patient who developed AOP damage during endoscopic endonasal surgery (EES); to our knowledge, this complication has been previously reported only in one case, in relation to a second surgery. We also review the anatomical variants in thalamic vascularization and the factors that may be involved in this complication. A 52-year-old female underwent an extended endoscopic endonasal approach with intraoperative neurophysiological monitoring. In the postoperative period, she presented with a decreased level of consciousness and bilateral mydriasis. Magnetic resonance imaging showed rostral midbrain and paramedian thalami ischemia congruent with AOP infarction. AOP infarction may be associated with extended EES when treating lesions with retrosellar extension. Every effort should be made to preserve the small perforating arteries. Intraoperative neurophysiological monitoring of the motor and sensory pathways may not detect damage to the AOP.

Key-words:

Artery of Percheron - endoscopic approach - pituitary - skull base - thalamic infarct

Financial support and sponsorship

Nil.




Publikationsverlauf

Eingereicht: 23. Dezember 2019

Angenommen: 25. Februar 2020

Artikel online veröffentlicht:
16. August 2022

© 2020. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Ammirati M, Wei L, Ciric I. Short-term outcome of endoscopic versus microscopic pituitary adenoma surgery: A systematic review and meta-analysis. J Neurol Neurosurg Psychiatry 2013;84:843-9.
  • 2 Chin OY, Ghosh R, Fang CH, Baredes S, Liu JK, Eloy JA. Internal carotid artery injury in endoscopic endonasal surgery: A systematic review. Laryngoscope 2016;126:582-90.
  • 3 Romero AD, Lal Gangadharan J, Bander ED, Gobin YP, Anand VK, Schwartz TH. Managing arterial injury in endoscopic skull base surgery: Case series and review of the literature. Oper Neurosurg (Hagerstown) 2017;13:138-49.
  • 4 Rowan NR, Turner MT, Valappil B, Fernandez-Miranda JC, Wang EW, Gardner PA, et al. Injury of the carotid artery during endoscopic endonasal surgery: Surveys of skull base surgeons. J Neurol Surg B Skull Base 2018;79:302-8.
  • 5 Garcia-Grimshaw MA, Peschard-Franco M, Gutierrez-Manjarrez F. Bilateral thalamic ischemic stroke second. Coreus 2018;10:E2676.
  • 6 Lazzaro NA, Wright B, Castillo M, Fischbein NJ, Glastonbury CM, Hildenbrand PG, et al. Artery of Percheron infarction: Imaging patterns and clinical spectrum. AJNR Am J Neuroradiol 2010;31:1283-9.
  • 7 Sankar T, Souster J, Steinke DE. Bilateral thalamic infarction following transsphenoidal surgery. Can J Neurol Sci 2008;35:522-5.
  • 8 Thurtell MJ, Halmagyi GM. Complete ophthalmoplegia: An unusual sign of bilateral paramedian midbrain-thalamic infarction. Stroke 2008;39:1355-7.
  • 9 Raut TP, Baheti G, Hinduja A, Makhija P, Ansari K, Sharma V, et al. Sudden onset altered sensorium: Artery of Percheron infarct. J Neurol Neurosci 2017;8:212.
  • 10 Kumral E, Evyapan D, Balkir K, Kutluhan S. Bilateral thalamic infarction. Clinical, etiological and MRI correlates. Acta Neurol Scand 2001;103:35-42.
  • 11 Reilly M, Connolly S, Stack J, Martin EA, Hutchinson M. Bilateral paramedian thalamic infarction: A distinct but poorly recognized stroke syndrome. Q J Med 1992;82:63-70.
  • 12 Rangel-Castilla L, Gasco J, Thompson B, Salinas P. Bilateral paramedian thalamic and mesencephalic infarcts after basilar tip aneurysm coiling: Role of the artery of Percheron. Neurocirugia (Astur) 2009;20:288-93.
  • 13 Roitberg BZ, Tuccar E, Alp MS. Bilateral paramedian thalamic infarct in the presence of an unpaired thalamic perforating artery. Acta Neurochir (Wien) 2002;144:301-4.
  • 14 Matheus MG, Castillo M. Imaging of acute bilateral paramedian thalamic and mesencephalic infarcts. AJNR Am J Neuroradiol 2003;24:2005-8.
  • 15 Graff-Radford NR, Damasio H, Yamada T, Eslinger PJ, Damasio AR. Nonhaemorrhagic thalamic infarction. Clinical, neuropsychological and electrophysiological findings in four anatomical groups defined by computerized tomography. Brain 1985;108(Pt 2):485-516.
  • 16 Aryan S, Thakar S, Hegde AS. Artery of Percheron infarction after endoscopic pituitary surgery. Acta Neurochir (Wien) 2016;158:1973-5.
  • 17 Arauz A, Patiño-Rodríguez HM, Vargas-González JC, Arguelles-Morales N, Silos H, Ruiz-Franco A, et al. Clinical spectrum of artery of Percheron infarct: Clinical-radiological correlations. J Stroke Cerebrovasc Dis 2014;23:1083-8.
  • 18 Khanni JL, Casale JA, Koek AY, Espinosa Del Pozo PH, Espinosa PS. Artery of Percheron infarct: An acute diagnostic challenge with a spectrum of clinical presentations. Cureus 2018;10:e3276.
  • 19 Lepore FE, Gulli V, Miller DC. Neuro-ophthalmological findings with neuropathological correlation in bilateral thalamic-mesencephalic infarction. J Clin Neuroophthalmol 1985;5:224-8.
  • 20 Raphaeli G, Liberman A, Gomori JM, Steiner I. Acute bilateral paramedian thalamic infarcts after occlusion of the artery of Percheron. Neurology 2006;66:E7.