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CC BY-NC-ND 4.0 · Asian J Neurosurg 2020; 15(03): 777-780
DOI: 10.4103/ajns.AJNS_370_19
Case Report

Artery of percheron and endoscopic endonasal surgery: Case report and review of the literature

Marta Pereira
Department of Neurosurgery, Sant Pau Hospital, Barcelona
,
Fernando Hernández
Department of Neurosurgery, Sant Pau Hospital, Barcelona
,
Carlos Cortés
Department of Neurosurgery, Sant Pau Hospital, Barcelona
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Artery of Percheron (AOP) is a rare anatomical variant in which a single perforating artery arising from the P1 segment of the posterior cerebral artery supplies paramedian thalami and rostral midbrain. The occlusion of AOP produces bilateral thalamic ischemia and may be a rare complication in relation to an extended endoscopic endonasal approach. We report the case of a patient who developed AOP damage during endoscopic endonasal surgery (EES); to our knowledge, this complication has been previously reported only in one case, in relation to a second surgery. We also review the anatomical variants in thalamic vascularization and the factors that may be involved in this complication. A 52-year-old female underwent an extended endoscopic endonasal approach with intraoperative neurophysiological monitoring. In the postoperative period, she presented with a decreased level of consciousness and bilateral mydriasis. Magnetic resonance imaging showed rostral midbrain and paramedian thalami ischemia congruent with AOP infarction. AOP infarction may be associated with extended EES when treating lesions with retrosellar extension. Every effort should be made to preserve the small perforating arteries. Intraoperative neurophysiological monitoring of the motor and sensory pathways may not detect damage to the AOP.

Key-words:

Artery of Percheron - endoscopic approach - pituitary - skull base - thalamic infarct

Financial support and sponsorship

Nil.




Publication History

Received: 23 December 2019

Accepted: 25 February 2020

Article published online:
16 August 2022

© 2020. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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