Journal of Cerebrovascular and Endovascular Neurosurgery

Korean Society of Cerebravascular Surgeons (대한뇌혈관외과학회)
권호 표지
DOI QR코드

DOI QR Code

Bilateral Infarction of the Recurrent Arteries of Heubner Following Clipping of an Anterior Communicating Artery Aneurysm

  • Lee, Sang Hyub (Department of Neurosurgery, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine) ;
  • Lee, Chul Hee (Department of Neurosurgery, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine) ;
  • Park, In Sung (Department of Neurosurgery, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine) ;
  • Han, Jong Woo (Department of Neurosurgery, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine)
  • Received : 2018.01.17
  • Accepted : 2018.03.15
  • Published : 2018.03.31
⟨ Previous Next ⟩

Abstract

A 50-year-old woman reported to the emergency department with thunderclap headache and vomiting. Non-enhanced brain computed tomography (CT) showed a subarachnoid hemorrhage of Hunt-Hess Grade II and Fisher Grade III. Brain angiography CT and transfemoral cerebral angiography (TFCA) revealed an aneurysm of the anterior communicating artery. A direct neck clipping was performed using the pterional approach. The post-operation CT was uneventful. Six days postoperatively, the patient became lethargic. The mean velocity (cm/s) of the middle cerebral artery peaked at 173 cm/s on the right side and 167 cm/s on the left. A TFCA revealed decreased perfusion in both recurrent arteries of Heubner (RAH), but no occlusion in either. Intra-arterial nimodipine injection was administered. On the 7th postoperative day, CT demonstrated a newly developed low-density lesion in the RAH territory bilaterally. The cause of the infarction was attributed to decreased perfusion caused by cerebral vasospasm. The patient was discharged with no definite neurologic deficit except for mild cognitive disorder.

Keywords

References

  1. Berman SA, Hayman LA, Hinck VC. Correlation of CT cerebral vascular territories with function: I. Anterior cerebral artery. AJR Am J Roentgenol. 1980 Aug;135(2): 253-7. https://doi.org/10.2214/ajr.135.2.253
  2. Caplan LR, Schmahmann JD, Kase CS, Feldmann E, Baquis G, Greenberg JP, et al. Caudate infarcts. Arch Neurol. 1990 Feb;47(2):133-43. https://doi.org/10.1001/archneur.1990.00530020029011
  3. Critchley M. Syndromes of the anterior cerebral artery. Proc R Soc Med. 1930 Mar;23(5):630-2.
  4. El Falougy H, Selmeciova P, Kubikova E, Haviarova Z. The variable origin of the recurrent artery of Heubner: an anatomical and morphometric study. Biomed Res Int. 2013;2013:873434.
  5. Fisher CM, Kistler JP, Davis JM. Relation of cerebral vasospasm to subarachnoid hemorrhage visualized by computerized tomographic scanning. Neurosurgery. 1980 Jan;6(1):1-9. https://doi.org/10.1227/00006123-198001000-00001
  6. Friedman JA, Goerss SJ, Meyer FB, Piepgras DG, Pichelmann MA, McIver JI, et al. Volumetric quantification of Fisher Grade 3 aneurysmal subarachnoid hemorrhage: a novel method to predict symptomatic vasospasm on admission computerized tomography scans. J Neurosurg. 2002 Aug;97(2):401-7. https://doi.org/10.3171/jns.2002.97.2.0401
  7. Gomes F, Dujovny M, Umansky F, Ausman JI, Diaz FG, Ray WJ, et al. Microsurgical anatomy of the recurrent artery of Heubner. J Neurosurg. 1984 Jan;60(1):130-9. https://doi.org/10.3171/jns.1984.60.1.0130
  8. Kolias AG, Sen J, Belli A. Pathogenesis of cerebral vasospasm following aneurysmal subarachnoid hemorrhage: putative mechanisms and novel approaches. J Neurosci Res. 2009 Jan;87(1):1-11. https://doi.org/10.1002/jnr.21823
  9. Loukas M, Louis RG Jr, Childs RS. Anatomical examination of the recurrent artery of Heubner. Clin Anat. 2006 Jan;19(1):25-31. https://doi.org/10.1002/ca.20229
  10. Miller SP, O'Gorman AM, Shevell MI. Recurrent artery of Heubner infarction in infancy. Dev Med Child Neurol. 2000 May;42(5):344-6. https://doi.org/10.1017/S0012162200000608
  11. Mizuta H, Motomura N. Memory dysfunction in caudate infarction caused by Heubner's recurring artery occlusion. Brain Cogn. 2006 Jul;61(2):133-8. https://doi.org/10.1016/j.bandc.2005.11.002
  12. Sasaki T, Kodama N, Matsumoto M, Suzuki K, Konno Y, Sakuma J, et al. Blood flow disturbance in perforating arteries attributable to aneurysm surgery. J Neurosurg. 2007 Jul;107(1):60-7. https://doi.org/10.3171/JNS-07/07/006
  13. Schmidt JM, Wartenberg KE, Fernandez A, Claassen J, Rincon F, Ostapkovich ND, et al. Frequency and clinical impact of asymptomatic cerebral infarction due to vasospasm after subarachnoid hemorrhage. J Neurosurg. 2008 Dec;109(6):1052-9. https://doi.org/10.3171/JNS.2008.109.12.1052
  14. Vergouwen MD, Ilodigwe D, Macdonald RL. Cerebral infarction after subarachnoid hemorrhage contributes to poor outcome by vasospasm-dependent and -independent effects. Stroke. 2011 Apr;42(4):924-9. https://doi.org/10.1161/STROKEAHA.110.597914
  15. Weidauer S, Lanfermann H, Raabe A, Zanella F, Seifert V, Beck J. Impairment of cerebral perfusion and infarct patterns attributable to vasospasm after aneurysmal subarachnoid hemorrhage: a prospective MRI and DSA study. Stroke. 2007 Jun;38(6):1831-6. https://doi.org/10.1161/STROKEAHA.106.477976