Blood flow disturbance in perforating arteries attributable to aneurysm surgery

2007 ◽  
Vol 107 (1) ◽  
pp. 60-67 ◽  
Author(s):  
Tatsuya Sasaki ◽  
Namio Kodama ◽  
Masato Matsumoto ◽  
Kyouichi Suzuki ◽  
Yutaka Konno ◽  
...  
Keyword(s):  
Blood Flow ◽  
Cerebral Infarction ◽  
Clinical Symptoms ◽  
Motor Evoked Potential ◽  
Parent Artery ◽  
Aneurysm Surgery ◽  
Flow Disturbance ◽  
Perforating Artery ◽  
Evoked Potential Monitoring ◽  
Perforating Arteries

Object 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.

Confirmation of blood flow in perforating arteries using fluorescein cerebral angiography during aneurysm surgery

2007 ◽  
Vol 107 (1) ◽  
pp. 68-73 ◽  
Author(s):  
Kyouichi Suzuki ◽  
Namio Kodama ◽  
Tatsuya Sasaki ◽  
Masato Matsumoto ◽  
Tsuyoshi Ichikawa ◽  
...  
Keyword(s):  
Fluorescein Angiography ◽  
Cerebral Artery ◽  
Cerebral Angiography ◽  
Clinical Symptoms ◽  
Posterior Inferior Cerebellar Artery ◽  
Parent Artery ◽  
Aneurysm Surgery ◽  
Aneurysm Clip ◽  
Perforating Artery ◽  
Perforating Arteries

Object The authors performed fluorescein cerebral angiography in patients after aneurysm clip placement to confirm the patency of the parent artery, perforating artery, and other arteries around the aneurysm. Methods Twenty-three patients who underwent aneurysm surgery were studied. Aneurysms were located in the internal carotid artery in 12 patients, middle cerebral artery in six, anterior cerebral artery in three, basilar artery bifurcation in one, and junction of the vertebral artery (VA) and posterior inferior cerebellar artery in one. After aneurysm clip placement, the target arteries were illuminated using a beam from a blue light-emitting diode atop a 7-mm diameter pencil-type probe. In all patients, after intravenous administration of 5 ml of 10% fluorescein sodium, fluorescence in the vessels was clearly observed through a microscope and recorded on videotape. Results The excellent image quality and spatial resolution of the fluorescein angiography procedure facilitated intra-operative real-time assessment of the patency of the perforating arteries and branches near the aneurysm, including: 12 posterior communicating arteries; 12 anterior choroidal arteries; four lenticulostriate arteries; three recurrent arteries of Heubner; three hypothalamic arteries; one ophthalmic artery; one perforating artery arising from the VA; and one posterior thalamoperforating artery. All 23 patients experienced an uneventful postoperative course without clinical symptoms of perforating artery occlusion. Conclusions Because the fluorescein angiography procedure described here allows intraoperative confirmation of the patency of perforating arteries located deep inside the surgical field, it can be practically used for preventing unexpected cerebral infarction during aneurysm surgery.

scholarly journals Cerebral Infarction Along the Distribution of Perforating Arteries During Aneurysm Surgery in a Patient With Pheochromocytoma

2011 ◽  
Vol 51 (1) ◽  
pp. 72-75
Author(s):  
Nobusuke TSUZUKI ◽  
Hiroshi NAWASHIRO ◽  
Terushige TOYOOKA ◽  
Hideo OSADA ◽  
Naoki OTANI ◽  
...  
Keyword(s):  
Cerebral Infarction ◽  
Aneurysm Surgery ◽  
Perforating Arteries

scholarly journals Motor-Evoked Potential Monitoring during Cerebral Aneurysm Surgery

2005 ◽  
Vol 25 (1) ◽  
pp. 51-59
Author(s):  
Kyouichi SUZUKI ◽  
Masato MATSUMOTO ◽  
Tatsuya SASAKI ◽  
Namio KODAMA ◽  
Masaki NAKANE ◽  
...  
Keyword(s):  
Cerebral Aneurysm ◽  
Evoked Potential ◽  
Motor Evoked Potential ◽  
Aneurysm Surgery ◽  
Evoked Potential Monitoring ◽  
Potential Monitoring

Assessment of Flow in Perforating Arteries During Intracranial Aneurysm Surgery Using Intraoperative Near-Infrared Indocyanine Green Videoangiography

2007 ◽  
Vol 61 (suppl_3) ◽  
pp. ONS-63-ONS-73 ◽  
Author(s):  
Jean G. de Oliveira ◽  
Jürgen Beck ◽  
Volker Seifert ◽  
Manoel J. Teixeira ◽  
Andreas Raabe
Keyword(s):  
Indocyanine Green ◽  
Visual Information ◽  
Intracranial Aneurysms ◽  
Near Infrared ◽  
Aneurysm Surgery ◽  
Indocyanine Green Videoangiography ◽  
Small Arteries ◽  
Perforating Artery ◽  
Clip Application ◽  
Perforating Arteries

Abstract Objective: Perforating arteries are commonly involved during the surgical dissection and clipping of intracranial aneurysms. Occlusion of perforating arteries is responsible for ischemic infarction and poor outcome. The goal of this study is to describe the usefulness of near-infrared indocyanine green videoangiography (ICGA) for the intraoperative assessment of blood flow in perforating arteries that are visible in the surgical field during clipping of intracranial aneurysms. In addition, we analyzed the incidence of perforating vessels involved during the aneurysm surgery and the incidence of ischemic infarct caused by compromised small arteries. Methods: Sixty patients with 64 aneurysms were surgically treated and prospectively included in this study. Intraoperative ICGA was performed using a surgical microscope (Carl Zeiss Co., Oberkochen, Germany) with integrated ICGA technology. The presence and involvement of perforating arteries were analyzed in the microsurgical field during surgical dissection and clip application. Assessment of vascular patency after clipping was also investigated. Only those small arteries that were not visible on preoperative digital subtraction angiography were considered for analysis. Results: The ICGA was able to visualize flow in all patients in whom perforating vessels were found in the microscope field. Among 36 patients whose perforating vessels were visible on ICGA, 11 (30%) presented a close relation between the aneurysm and perforating arteries. In one (9%) of these 11 patients, ICGA showed occlusion of a P1 perforating artery after clip application, which led to immediate correction of the clip confirmed by immediate reestablishment of flow visible with ICGA without clinical consequences. Four patients (6.7%) presented with postoperative perforating artery infarct, three of whom had perforating arteries that were not visible or distant from the aneurysm. Conclusion: The involvement of perforating arteries during clip application for aneurysm occlusion is a usual finding. Intraoperative ICGA may provide visual information with regard to the patency of these small vessels.

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