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

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.

Computed tomography of cerebral infarction along the distribution of the basal perforating arteries. Part II: Thalamic arterial group.

Radiology ◽  
1985 ◽  
Vol 155 (1) ◽  
pp. 119-130 ◽  
Author(s):  
S Takahashi ◽  
K Goto ◽  
H Fukasawa ◽  
Y Kawata ◽  
K Uemura ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Cerebral Infarction ◽  
Perforating Arteries

Anterior Communicating Artery Aneurysms

Neurosurgery ◽  
2002 ◽  
Vol 51 (4) ◽  
pp. 993-996 ◽  
Author(s):  
Howard A. Riina ◽  
G. Michael Lemole ◽  
Robert F. Spetzler
Keyword(s):  
Anterior Communicating Artery ◽  
Aneurysm Surgery ◽  
Vascular Control ◽  
Surgical Success ◽  
Anterior Communicating Artery Aneurysms ◽  
Intraoperative Planning ◽  
Complex Lesions ◽  
Perforating Arteries

Abstract ANTERIOR COMMUNICATING ARTERY aneurysms are complex lesions for which surgical success requires extensive preoperative and intraoperative planning. Adherence to the tenets of aneurysm surgery, including vascular control and preservation of perforating arteries, is essential for their exclusion from the circulation.

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.

scholarly journals Endoscope- versus microscope-integrated near-infrared indocyanine green videoangiography in aneurysm surgery

2019 ◽  
Vol 131 (5) ◽  
pp. 1413-1422 ◽  
Author(s):  
Gerrit Fischer ◽  
Jana Rediker ◽  
Joachim Oertel
Keyword(s):  
Blood Flow ◽  
Indocyanine Green ◽  
Digital Subtraction Angiography ◽  
Digital Subtraction ◽  
Aneurysm Surgery ◽  
Indocyanine Green Videoangiography ◽  
Aneurysm Neck ◽  
Aneurysm Occlusion ◽  
Perforating Arteries

OBJECTIVEThe quality of surgical treatment of intracranial aneurysms is determined by complete aneurysm occlusion while preserving blood flow in the parent, branching, and perforating arteries. For a few years, there has been a nearly noninvasive and cost-effective technique for intraoperative flow evaluation: microscope-integrated indocyanine green videoangiography (mICG-VA). This method allows for real-time information about blood flow in the aneurysm and the involved vessels, but its limitations are seen in the evaluation of structures located in the depth of the surgical field, especially through small craniotomies. To compensate for these drawbacks, an endoscope-integrated ICG-VA (eICG-VA) was developed. The objective of the present study was to assess the use of eICG-VA in comparison with mICG-VA for intraoperative blood flow evaluation.METHODSIn the period between January 2011 and January 2015, 216 patients with a total of 248 intracranial saccular aneurysms were surgically treated in the Department of Neurosurgery of Saarland University Medical Center in Homburg/Saar, Germany. During 95 surgeries in 88 patients with a total of 108 aneurysms, intraoperative evaluation was performed with both eICG-VA and mICG-VA. After clipping, evaluation of complete aneurysm occlusion and flow in the parent, branching, and perforating arteries was performed using both methods. Intraoperative applicability of each technique was compared with the other and with postoperative digital subtraction angiography as a standard evaluation technique.RESULTSEvaluation of completeness of aneurysm occlusion and of flow in the parent, branching, and perforating arteries was more successful with eICG-VA than with mICG-VA, especially for aneurysm neck assessment (88.9% vs 69.4%). For 63.9% of the aneurysms (n = 69), both methods were equivalent, but in 30.6% of the cases (n = 33), the eICG-VA provided better results for evaluating the post-clipping situation. In 4.6% of these aneurysms (n = 5), the information given by the additional endoscope considerably changed the surgical procedure. Thus, one residual aneurysm (0.9%), two neck remnants (1.9%), and two branch occlusions (1.9%) could be prevented. Nevertheless, two incomplete aneurysm occlusions (1.9%) and six neck remnants (5.6%) were revealed by postoperative digital subtraction angiography.CONCLUSIONSEndoscope-integrated ICG-VA seems to be an improvement that might increase the quality of aneurysm surgery by providing additional information. It offers higher illumination, magnification, and an extended viewing angle. Its main advantage is its ability to assess deep-seated aneurysms, especially through small craniotomies, but further studies are required.

scholarly journals Preservation of Perforating Arteries in Cerebral Aneurysm Surgery: Clinical Usage of Polyglactin Mesh

2016 ◽  
Vol 44 (2) ◽  
pp. 81-87
Author(s):  
Hidetoshi MURATA ◽  
Shinichiro YOSHIKAWA ◽  
Tetsuhiro HIGASHIDA ◽  
Takahiro TANAKA ◽  
Shun YOSHIDA ◽  
...  
Keyword(s):  
Cerebral Aneurysm ◽  
Aneurysm Surgery ◽  
Perforating Arteries
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