Artery of Percheron Stroke following Endoscopic Pituitary Surgery

Background: The artery of Percheron (AoP) is a rare single thalamo-perforating branch of posterior cerebral artery (PCA) that provides bilateral blood supply to paramedian thalami and rostral midbrain. The occlusion rate of AoP is less than 0.6% and it usually occurs due to embolism or atherothrombosis and only two cases reporting this complication after transsphenoidal endoscopic endonasal approach (EEA) have been described in literature.

Porpoise: We report the case of a young female patient who underwent transsphenoidal EEA for the resection of a sellar lesion and developed bilateral thalamic ischemia due to AoP occlusion. The postoperative management provided a good recovery of the symptoms.

Methods: A 31-year-old woman was admitted to our department with a hemorrhagic sellar lesion. The patient underwent transsphenoidal endoscopic endonasal surgery for the resection of the sellar lesion. The procedure was held without complications. At the end of the surgery, the patient was unresponsive. She had no motor deficits and showed localizing response to pain with a GCS of 8. Anisocoria with left mydriasis was evident. Subsequent radiological pattern was consistent with acute ischemia due to AoP occlusion.

Results: Postoperative course was made in intensive care unit (ICU). The patient was discharged 5 weeks after surgery without consciousness alteration or sensory-motor deficits and with persistent left oculomotor nerve palsy with ptosis and mild mydriasis. The 6-month follow-up with RMI showed stability of radiological findings without any residual pituitary lesion

Conclusions: Ischemic complications following EEA are not frequent. Among these, bilateral thalamic infarct due to the occlusion of AoP is extremely rare, but it comes with typical radiological findings and clinical presentation. The presence of the AoP is very difficult to detect in the preoperative investigation. Anyway, if AoP stroke is suspected after EEA, early postoperative brain MRI is crucial for proper diagnosis and treatment.

Publikationsverlauf

Artikel online veröffentlicht:
05. Februar 2024