Percheron-like artery infarction after transsphenoidal surgery: illustrative case

Area of Science:

• Neurosurgery
• Vascular Neurology

Background:

• Transsphenoidal surgery is increasingly popular for sellar region tumors.
• This approach avoids brain retraction and has low complication rates.
• However, anatomical variations in the sellar region can lead to characteristic complications.

Purpose of the Study:

• To report a rare case of thalamic infarction following transsphenoidal surgery for a pituitary adenoma.
• To highlight the potential risks associated with the transsphenoidal approach, particularly concerning vascular structures.

Main Methods:

• Case report of a 40-year-old female patient with acromegaly.
• Transsphenoidal surgery for a pituitary adenoma.
• Postoperative MRI to identify the cause of neurological deficits.

Main Results:

• The patient developed bilateral unresponsive mydriasis, loss of consciousness, and tetraparesis post-surgery.
• MRI revealed bilateral paramedian thalamic infarctions, suggestive of a Percheron artery territory infarction.
• At 2-year follow-up, the patient showed significant improvement but with lasting neurological deficits.

Conclusions:

• Injury to the basilar artery or its perforators, including the Percheron artery, can occur during suprasellar lesion dissection.
• This vascular territory is critical for cognitive and interactive functions.
• Future suprasellar adenoma surgeries will be approached strictly intracapsularly to minimize risk.