The Clinical Relevance of the Thalamogeniculate Arteries in Endoscopic Endonasal Surgery for Giant Pituitary Adenomas in the Interpeduncular Fossa

Abstract

Bilateral thalamic stroke is usually due to compromised artery of Percheron, an anatomical variation of the vascular supply of the thalamus. The stroke in this area is very uncommon, and is mainly due to top of the basilar syndrome. Other causes are extremely rare. We describe the case of a patient with a pituitary adenoma who underwent surgery and later presented with a bilateral thalamic infarct, suggesting compromise of the artery of Percheron. This would be the third case published in the literature about this complication. We present a literature review about the vascular supply of the thalamus, the artery of Percheron, and its involvement in pituitary surgery.

Keywords

stroke - thalamus - thalamic supply - artery of percheron

Publication History

Received: 07 June 2021

Accepted: 07 March 2022

Article published online:
27 June 2022

• References

• 1 Rhoton Jr AL. The cerebrum. Anatomy. Neurosurgery 2007;61(1, Suppl):37–118, discussion 118–119
• 2 Matheus MG, Castillo M. Imaging of acute bilateral paramedian thalamic and mesencephalic infarcts. AJNR Am J Neuroradiol 2003; 24 (10) 2005-2008
• 3 Percheron G. The anatomy of the arterial supply of the human thalamus and its use for the interpretation of the thalamic vascular pathology. Z Neurol 1973; 205 (01) 1-13
• 4 Bogousslavsky J, Miklossy J, Deruaz JP, Regli F, Assal G. Unilateral left paramedian infarction of thalamus and midbrain: a clinico-pathological study. J Neurol Neurosurg Psychiatry 1986; 49 (06) 686-694
• 5 Schmahmann JD. Vascular syndromes of the thalamus. Stroke 2003; 34 (09) 2264-2278
• 6 Kocaeli H, Yilmazlar S, Kuytu T, Korfali E. The artery of Percheron revisited: a cadaveric anatomical study. Acta Neurochir (Wien) 2013; 155 (03) 533-539
• 7 Khanni JL, Casale JA, Koek AY, Espinosa Del Pozo PH, Espinosa PS. Artery of Percheron infarct: an acute diagnostic challenge with a spectrum of clinical presentations. Cureus 2018; 10 (09) e3276
• 8 Lazzaro NA, Wright B, Castillo M. et al. Artery of Percheron infarction: imaging patterns and clinical spectrum. AJNR Am J Neuroradiol 2010; 31 (07) 1283-1289
• 9 Uz A. Variations in the origin of the thalamoperforating arteries. J Clin Neurosci 2007; 14 (02) 134-137
• 10 Pedroza A, Dujovny M, Ausman JI. et al. Microvascular anatomy of the interpeduncular fossa. J Neurosurg 1986; 64 (03) 484-493
• 11 Lang J, Brunner FX. Uber die Rami centrales der Aa. cerebri anterior und media. Gegenbaurs Morphol Jahrb 1978; 124 (03) 364-374
• 12 Park SQ, Bae HG, Yoon SM, Shim JJ, Yun IG, Choi SK. Morphological characteristics of the thalamoperforating arteries. J Korean Neurosurg Soc 2010; a 47 (01) 36-41
• 13 Kaya AH, Dagcinar A, Ulu MO. et al. The perforating branches of the P1 segment of the posterior cerebral artery. J Clin Neurosci 2010; 17 (01) 80-84
• 14 Caruso P, Manganotti P, Moretti R. Complex neurological symptoms in bilateral thalamic stroke due to Percheron artery occlusion. Vasc Health Risk Manag 2016; b 13: 11-14
• 15 Motegi H, Terasaka S, Shiraishi H, Houkin K. Thalamic arteriovenous malformation fed by the artery of Percheron originating from the contralateral posterior cerebral artery in a child. Childs Nerv Syst 2014; 30 (07) 1313-1315
• 16 Lin PC, Lee CW, Liu HM, Xiao FR. Acute infarction in the artery of Percheron distribution during cerebral angiography: a case report and literature review. J Radiol Case Rep 2018; 12 (07) 1-9
• 17 Rangel-Castilla L, Gasco J, Thompson B, Salinas P. Bilateral paramedian thalamic and mesencephalic infarcts after basilar tip aneurysm coiling: role of the artery of Percheron. Neurocirugia (Astur) 2009; 20 (03) 288-293
• 18 Sudhakar N, Ray A, Vafidis JA. Complications after trans-sphenoidal surgery: our experience and a review of the literature. Br J Neurosurg 2004; 18 (05) 507-512
• 19 Reddy K, Fewer D, West M. Complications of the transsphenoidal approach to sellar lesions. Can J Neurol Sci 1991; 18 (04) 463-466
• 20 Kuroyanagi T, Kobayashi S, Takemae T, Kobayashi S. Subarachnoid hemorrhage, midbrain hemorrhage and thalamic infarction following transsphenoidal removal of a pituitary adenoma. A case report. Neurosurg Rev 1994; 17 (02) 161-165
• 21 Yano S, Hide T, Shinojima N. Efficacy and complications of endoscopic skull base surgery for giant pituitary adenomas. World Neurosurg 2017; 99: 533-542
• 22 Sankar T, Souster J, Steinke DE. Bilateral thalamic infarction following transsphenoidal surgery. Can J Neurol Sci 2008; 35 (04) 522-525
• 23 Aryan S, Thakar S, Hegde AS. Artery of Percheron infarction after endoscopic pituitary surgery. Acta Neurochir (Wien) 2016; 158 (10) 1973-1975
• 24 Mortini P, Barzaghi R, Losa M, Boari N, Giovanelli M. Surgical treatment of giant pituitary adenomas: strategies and results in a series of 95 consecutive patients. Neurosurgery 2007; 60 (06) 993-1002 , discussion 1003–1004
• 25 Elshazly K, Kshettry VR, Farrell CJ, Nyquist G, Rosen M, Evans JJ. Clinical outcomes after endoscopic endonasal resection of giant pituitary adenomas. World Neurosurg 2018; 114: e447-e456
• 26 Kuga D, Toda M, Ozawa H, Ogawa K, Yoshida K. Endoscopic endonasal approach combined with a simultaneous transcranial approach for giant pituitary tumors. World Neurosurg 2019; 121: 173-179
• 27 Fallah N, Taghvaei M, Sadaghiani S, Sadrhosseini SM, Esfahanian F, Zeinalizadeh M. Surgical outcome of endoscopic endonasal surgery of large and giant pituitary adenomas: an institutional experience from the Middle East. World Neurosurg 2019; 132: e802-e811
• 28 Gondim JA, Almeida JP, Albuquerque LA, Gomes EF, Schops M. Giant pituitary adenomas: surgical outcomes of 50 cases operated on by the endonasal endoscopic approach. World Neurosurg 2014; 82 (1–2): e281-e290
• 29 Billings M, Dahlin R, Zampella B, Sweiss R, Lawandy S, Miulli D. Conditions associated with giant pituitary tumors at the time of surgery effecting outcome morbidity and mortality. Surg Neurol Int 2019; 10: 92
• 30 Koutourousiou M, Gardner PA, Fernandez-Miranda JC, Paluzzi A, Wang EW, Snyderman CH. Endoscopic endonasal surgery for giant pituitary adenomas: advantages and limitations. J Neurosurg 2013; 118 (03) 621-631
• 31 Kuo CH, Yen YS, Wu JC. et al. Primary endoscopic transnasal transsphenoidal surgery for giant pituitary adenoma. World Neurosurg 2016; a 91: 121-128
• 32 Constantino ER, Leal R, Ferreira CC, Acioly MA, Landeiro JA. Surgical outcomes of the endoscopic endonasal transsphenoidal approach for large and giant pituitary adenomas: institutional experience with special attention to approach-related complications. Arq Neuropsiquiatr 2016; 74 (05) 388-395
• 33 Cusimano MD, Kan P, Nassiri F. et al. Outcomes of surgically treated giant pituitary tumours. Can J Neurol Sci 2012; a 39 (04) 446-457
• 34 Juraschka K, Khan OH, Godoy BL. et al. Endoscopic endonasal transsphenoidal approach to large and giant pituitary adenomas: institutional experience and predictors of extent of resection. J Neurosurg 2014; 121 (01) 75-83