Pereira MR, Hernandez FM and Cortes CA
Introduction: Artery of Percheron (AOP) is a rare anatomical variant in which a single perforating artery arising from P1 segment of the posterior cerebral artery supplies paramedian thalami and rostral midbrain. Occlusion of AOP produces bilateral thalamic ischaemia 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; 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. Case report: A 52-year-old female underwent an extended endoscopic endonasal approach with intraoperative neurophysiological monitoring. In the postoperative period she presented with decreased level of consciousness and bilateral mydriasis. MRI showed rostral midbrain and paramedian thalami ischaemia congruent with AOP infarction. Conclusion: Artery of Percheron infarction may be associated with extended endoscopic endonasal surgery when treating lesions with retrosellar extension. Every effort should be made to preserve the small perforating arteries. Intraoperative neurophysiological monitoring of motor and sensory pathways may not detect damage to the artery of Percheron.
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