Injuries to perforating arteries are one of the most frequent complications during aneurysmal surgery. Extreme care should be taken to avoid them. Out of 366 cases that underwent radical surgery for cerebral aneurysms, 33 were reviewed that had circulatory impairment of perforating artery (confirmed by CT scan). Of the 33 cases, 18 were internal carotid artery (the incidence was 14.2%), 2 middle cerebral artery (1.3%), 2 horizontal portion of anterior cerebral artery (40%), 6 anterior communicating artery (5.3%), and 5 basilar artery aneurysms (9.3%).
The causes of injury to perforating artery were as follows: insufficient identification of the perforator (9 cases), improper retraction of the brain or vessels (9 cases), temporary occlusion (5 cases), kinking or stenosis due to the clip (5 cases), premature rupture (2 cases), and others (3 cases). A neurological deficit remained in 39.3% of the cases; a particularly high incidence was noted in anterior thalamoperforating artery injuries, anterior choroidal artery injuries, and recurrent artery of Heubner injuries.
In order to reduce perforator injuries, we must manipulate carefully, approach by the minimal brain retraction method, avoid using temporary clipping, and identify perforating artery sufficiently (e. g. using endoscope).