Abstract
Removal of blood clot in the cistern is an important procedure in the operation for acute stage of ruptured cerebral aneurysm. Possible technical complications which may occur by this procedure were described. There were hemorrhagic infarction in the frontal lobe in relation to cutting of the veins traversing the Sylvian fissure and small infarction in the basal ganglia due to mechanical injury of the perforating arteries arising from the circle of Willis.
The hemorrhagic infarction tended to occur when the traversing veins were composed only with several of small tributaries of vein and eventually were cut during opening of the Sylvian fissure. Another risk was a damage of the large vein draining from the medial frontal region and traversing the proximal part of the fissure.
Damages of the perforating arteries may occur when the hard clots at the base was forcefully tried to be removed. It was also possible that a drainage catheter inserted in the prepontine cistern through the space behind the carotid artery may occlude the perforators. Cases of small infarction on postoperative CT were presented.
