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. 2022 Feb 7;3(6):CASE21612.
doi: 10.3171/CASE21612. Print 2022 Feb 7.

Percheron-like artery infarction after transsphenoidal surgery: illustrative case

Lennart W Sannwald  1 , Andrea von Helden  2 , Hans-Joachim Wagner  3 , Dag Moskopp  1 , Mats L Moskopp  1   4
Affiliations

Percheron-like artery infarction after transsphenoidal surgery: illustrative case

Lennart W Sannwald et al. J Neurosurg Case Lessons. .

Abstract

Background: The transsphenoidal approach to the skull base has enjoyed increasing popularity for surgery of the sellar region avoiding brain retraction and causing few severe complications. While vitally important vessels in this region show a high degree of variability, some anatomical variants might be involved in characteristic complications.

Observations: We present the case of a 40-year-old female patient with acromegaly due to a pituitary adenoma that was transsphenoidally operated. Postoperatively, the patient presented with bilateral unresponsive mydriasis, loss of consciousness and tetraparesis. An MRI showed well-circumscribed bilateral paramedian thalamic infarctions which indicated a rare Percheron-like artery. At 2-year follow-up examination the patient was dramatically improved but with a profound impact on her ability to interact with the world.

Lessons: The basilar artery or perforators might be injured during dissection of suprasellar lesions. This vascular territory is essential to interaction of the brain with the outside world. We conclude that we will approach future suprasellar adenomas strictly intracapsularly.

Keywords: Percheron; bithalamic infarctions; pituitary surgery; transsphenoidal surgery.

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Conflict of interest statement

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

Figures

FIG. 1.
FIG. 1.
Initial T1-weighted contrast-enhanced cMRI of pituitary lesion. Please note the proximity between adenoma and vessels as highlighted by arrows.
FIG. 2.
FIG. 2.
Representative slices of cMRI 12 hours after operation. Please note signs of bilateral thalamic infarctions (A, FLAIR; B, ADC; C, DWI). Mesencephalic infarction not shown.
FIG. 3.
FIG. 3.
Representative slice of T1-weighted cMRI 2 years after operation.
See this image and copyright information in PMC

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