We analyzed patients who developed cerebral infarction along the distribution of the perforating artery after aneurysm surgery in order to learn how to avoid such complications in the future.
Neck clipping of a cerebral aneurysm was performed on 825 patients consecutively. Cerebral infarction along the distribution of the perforating artery was evaluated by a postoperative CT scan. We investigated the incidence of cerebral infarction, its causes, clinical symptoms and prognoses.
Postoperative CT scans demonstrated low-density areas in 35 patients (4.2%). We determined that the responsible arteries were the anterior choroidal artery (9 cases), posterior thalamoperforating artery (3 cases), lenticulostriate artery (7 cases), anterior thalamoperforating artery (7 cases) and recurrent artery of Heubner (9 cases).
The causes were attributed to occlusion due to neck clipping (48.6%), ischemia due to intraoperative temporary occlusion of the parent artery (20.0%), ischemia due to retraction of the perforating artery (17.1%) and direct injury (14.3%). Neurological deterioration appeared in 23 patients (2.8%) and remained in 13 (1.6%).
Cerebral infarction along the distribution of the anterior choroidal artery or the posterior thalamoperforating artery usually caused severe neurological deficit, resulting in a poor outcome. On the other hand, those of the lenticulostriate artery, anterior thalamoperforating artery or recurrent artery of Heubner did not have a serious effect on outcome.
Cerebral infarction along the distribution of the perforating artery was caused by neck clipping as well as temporary occlusion of the parent artery and retraction or injury of the perforating artery. To improve surgical results, it is particularly important to preserve the anterior choroidal artery and posterior thalamoperforating artery.
