Corrigendum: Perforating Arteries of the Lemniscal Trigone: A Microsurgical Neuroanatomic Description

Abstract Background Treatment of perforator involving aneurysm (piAN) remains a challenge to open and endovascular neurosurgeons. Our aim is to demonstrate a primary outcome of endovascular therapy for piANs with the use of perforator preservation technologies (PPT) based on a new neuro-interventional classification. Methods The piANs were classified into type I: aneurysm really arises from perforating artery, type II: saccular aneurysm involves perforating arteries arising from its neck (IIa) or dome (IIb), and type III: fusiform aneurysm involves perforating artery. Stent protection technology of PPT was applied in type I and III aneurysms, and coil-basket protection technology in type II aneurysms. An immediate outcome of aneurysmal obliteration after treatment was evaluated (satisfactory obliteration: the saccular aneurysm body is densely embolized (I), leaving a gap in the neck (IIa) or dome (IIb) where the perforating artery arising; fusiform aneurysm is repaired and has a smooth inner wall), and successful perforating artery preservation was defined as keeping the good antegrade flow of those perforators on postoperative angiography. The periprocedural complication was closely monitored, and clinical and angiographic follow-ups were performed. Results Six consecutive piANs (2 ruptured and 4 unruptured; 1 type I, 2 type IIa, 2 type IIb, and 1 type III) in 6 patients (aged from 43 to 66 years; 3 males) underwent endovascular therapy between November 2017 and July 2019. The immediate angiography after treatment showed 6 aneurysms obtained satisfactory obliteration, and all of their perforating arteries were successfully preserved. During clinical follow-up of 13–50 months, no ischemic or hemorrhagic event of the brain occurred in the 6 patients, but has one who developed ischemic event in the territory of involving perforators 4 h after operation and completely resolved within 24 h. Follow-up angiography at 3 to 10M showed patency of the parent artery and perforating arteries of treated aneurysms, with no aneurysmal recurrence. Conclusions Our perforator preservation technologies on the basis of the new neuro-interventional classification seem feasible, safe, and effective in protecting involved perforators while occluding aneurysm.

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Pure Motor Stroke Secondary to Cerebral Infarction of Recurrent Artery of Heubner after Mild Head Trauma: A Case Report

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2016.013 ◽

2016 ◽

Vol 4 (1) ◽

pp. 139-141

Author(s):

Ali Yilmaz ◽

Zahir Kizilay ◽

Ayca Ozkul ◽

Bayram Çirak

Keyword(s):

Ischemic Stroke ◽

Head Trauma ◽

Distal Part ◽

Brain Mri ◽

Artery Occlusion ◽

Acute Ischemia ◽

Post Traumatic ◽

The Brain ◽

Perforating Arteries ◽

Pure Motor

BACKGROUND: The recurrent Heubner's artery is the distal part of the medial striate artery. Occlusion of the recurrent artery of Heubner, classically contralateral hemiparesis with fasciobrachiocrural predominance, is attributed to the occlusion of the recurrent artery of Heubner and is widely known as a stroke syndrome in adults. However, isolated occlusion of the deep perforating arteries following mild head trauma also occurs extremely rarely in childhood.CASE REPORT: Here we report the case of an 11-year-old boy with pure motor stroke. The brain MRI showed an acute ischemia in the recurrent artery of Heubner supply area following mild head trauma. His fasciobrachial hemiparesis and dysarthria were thought to be secondary to the stretching of deep perforating arteries leading to occlusion of the recurrent artery of Heubner.CONCLUSION: Post-traumatic pure motor ischemic stroke can be secondary to stretching of the deep perforating arteries especially in childhood.

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

Neurologia medico-chirurgica ◽

10.2176/nmc.51.72 ◽

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

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Unilateral Tuberothalamic Artery Ischemia Caused by Pituitary Apoplexy

Journal of Neurological Surgery Part A Central European Neurosurgery ◽

10.1055/s-0038-1656514 ◽

2018 ◽

Vol 79 (06) ◽

pp. 550-554

Author(s):

Christoph Bettag ◽

Christoph Strasilla ◽

Andreas Steinbrecher ◽

Rüdiger Gerlach

Keyword(s):

Cerebral Ischemia ◽

Tumor Volume ◽

Pituitary Apoplexy ◽

Focal Cerebral Ischemia ◽

Internal Capsule ◽

Sudden Increase ◽

Pituitary Insufficiency ◽

Cranial Nerve Palsies ◽

Major Vessel ◽

Perforating Arteries

Background and Importance Pituitary apoplexy (PA) occasionally occurs in patients with pituitary adenoma and may cause severe functional deficits. Headache, pituitary insufficiency, visual impairment, and cranial nerve palsies are the most frequent symptoms in patients with PA. Secondary cerebral ischemia develops in only a limited number of PA patients. Two pathogenic mechanisms were previously proposed. One states that ischemia may be due to major vessel encasement or to vessel compression, as a result of extended tumor growth. The second states that cerebral vasospasm following PA may cause ischemia. We present another mechanism. After PA, a sudden increase in suprasellar tumor volume can lead to compression of perforating arteries causing hypoperfusion and subsequent focal ischemia of the thalamus, basal ganglia, and internal capsule. Clinical Presentation We present the case of a 75-year-old woman who, after having PA, developed cerebral ischemia in the territory of the left anterior thalamus and internal capsule that is primarily supplied by the tuberothalamic artery. Computed tomography and magnetic resonance imaging are used to describe how mechanical compression of the tuberothalamic artery caused this rare phenomenon. The recent literature, vascular anatomy, and pathophysiologic aspects of PA are discussed. Conclusion PA can lead to compression of perforating arteries, for example, the tuberothalamic artery supplying the thalamus or lenticulostriate region, and thus cause hypoperfusion and subsequent focal cerebral ischemia. This may occur when perforating cerebral arteries are affected and compressed by the sudden increase in tumor volume due to hemorrhage or tumor swelling.

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Clipping of Basilar Perforator Pure Arterial Malformation Aneurysm: 2-Dimensional Operative Video

Operative Neurosurgery ◽

10.1093/ons/opy382 ◽

2018 ◽

Vol 17 (2) ◽

pp. E67-E67 ◽

Cited By ~ 1

Author(s):

Stephan A Munich ◽

Marie Christine Brunet ◽

Robert M Starke ◽

Jacques J Morcos

Keyword(s):

Arteriovenous Malformations ◽

Correct Identification ◽

Microsurgical Clipping ◽

Intracranial Lesions ◽

History Of ◽

Offending Artery ◽

Arterial Malformation ◽

Rare Instance ◽

Perforating Arteries

Abstract Pure arterial malformations are rarely-encountered intracranial lesions, often mistaken for arteriovenous malformations. A minority of these lesions may harbor associated aneurysms. In a recent series of 12 patients with pure arterial malformations, 3 patients had associated aneurysms.1 As the authors describe, the presentation and natural history of pure arterial malformations generally are considered benign. In over 85% of cases reported in the literature, they are discovered incidentally and in cases with documented follow-up the angio-architecture tends to remain stable.1 However, here we present the case of an aneurysm associated with a pure arterial malformation managed with microsurgical clipping. The patient presented to us with the development of hemorrhage within and/or around the lesion and the development of a partial CN III palsy. Using a cranio-orbital approach, we successfully performed clipping of the offending vessel in the region of the basilar apex. Critical to the successful treatment of this lesion were: the correct identification of the offending vessel, recognition of the presence of perforating arteries, and clipping of the offending artery distal to the origin of the perforating arteries. This case represents a rare instance of a symptomatic pure arterial malformation with associated aneurysm. Verbal consent was provided by the patient for reproduction and publication of her case.

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Safe Stereotactic Biopsy for Basal Ganglia Lesions: Avoiding Injury to the Basal Perforating Arteries

Stereotactic and Functional Neurosurgery ◽

10.1159/000492057 ◽

2018 ◽

Vol 96 (4) ◽

pp. 244-248 ◽

Cited By ~ 2

Author(s):

Sumito Sato ◽

Mitsuru Dan ◽

Hirofumi Hata ◽

Kazuhiro Miyasaka ◽

Mitsuto Hanihara ◽

...

Keyword(s):

Basal Ganglia ◽

Stereotactic Biopsy ◽

Perforating Arteries

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Higher Pulsatility in Cerebral Perforating Arteries in Patients With Small Vessel Disease Related Stroke, a 7T MRI Study

Stroke ◽

10.1161/strokeaha.118.022516 ◽

2019 ◽

Vol 50 (1) ◽

pp. 62-68 ◽

Cited By ~ 15

Author(s):

Lennart J. Geurts ◽

Jaco J.M. Zwanenburg ◽

Catharina J.M. Klijn ◽

Peter R. Luijten ◽

Geert Jan Biessels

Keyword(s):

Small Vessel Disease ◽

Small Vessel ◽

Vessel Disease ◽

Mri Study ◽

Perforating Arteries

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Trigeminal Neuralgia Associated with a Primitive Trigeminal Artery Variant: Case Report

Neurosurgery ◽

10.1093/neurosurgery/52.5.1217 ◽

2003 ◽

Vol 52 (5) ◽

pp. 1217-1220

Author(s):

Yoji Tamura ◽

Hiroshi Shimano ◽

Toshihiko Kuroiwa ◽

Yoshihito Miki

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Trigeminal Neuralgia ◽

Internal Carotid ◽

Left Internal Carotid Artery ◽

Decompression Surgery ◽

Trigeminal Artery ◽

Cerebellar Artery ◽

Primitive Trigeminal Artery ◽

Perforating Arteries

Abstract OBJECTIVE AND IMPORTANCE A variant type of the primitive trigeminal artery (PTA) is a rare anomalous vessel that originates from the internal carotid artery and directly supplies the territory of the anteroinferior cerebellar artery and/or the superior cerebellar artery. We report a case of trigeminal neuralgia associated with this PTA variant, and we discuss the characteristics of this vessel. CLINICAL PRESENTATION A 51-year-old woman presented with a 10-year history of left paroxysmal facial pain. Magnetic resonance angiography and cerebral angiography demonstrated that an aberrant vessel originating from the left internal carotid artery directly supplied the cerebellum, without a basilar artery anastomosis. INTERVENTION Surgical exploration was performed via a left retrosigmoid approach. A loop of the aberrant vessel, which entered the posterior fossa through the isolated dural foramen, was compressing the trigeminal nerve. This aberrant vessel was displaced medially from the nerve with a prosthesis, with care to avoid kinking and avulsion of the perforating arteries. The patient's neuralgia resolved postoperatively. CONCLUSION Although the PTA variant is frequently associated with intracranial aneurysms, it is extremely rare for the variant to lead to trigeminal neuralgia. During microvascular decompression surgery, surgeons should be careful to prevent injury of the perforating arteries arising from the PTA variant.

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