Dissection of perforating artery
needs delicate surgical skill that can be achieved after a relatively long learning curve.
The proximal perforating artery
(thick arrow) of the posterior tibial artery penetrates the septum to supply fibularis brevis muscle (PB).
Arrow indicates the main trunk of the perforating artery
proximally and distally.
A Progreat microcatheter was then introduced in a coaxial fashion into the first perforating artery
. Repeat angiography identified extravasation arising from a left distal profunda branch artery.
The preoperative angiogram showed the aneurysm neck that was incorporated into the origin of the perforating artery. For proximal LSA aneurysm, the optimal treatment remains controversial.[sup] Both surgical and endovascular treatment have been described primarily through case reports and small case series representing the experience of individual interventional neurosurgeons or neuroradiologists.
Endovascular treatment for cerebral perforating artery aneurysms.
Any fascial strands that may compress the perforating artery
or vein (once twisted) should be meticulously divided (Fig.
Type D: It is formed by superior deep palmar branch of the ulnar artery which anastomoses with an enlarged superior perforating artery of the 2nd interspace.
Type A: The inferior deep branch of ulnar artery anastomoses with the perforating artery of the 2nd interspace.
The distal ends of the thoracodorsal vessels, close to the origin of the muscle, are ligated and dissected toward the axilla, being careful not to damage the delicate venae comitantes that accompany the perforating artery
. Once the perforator is released, retractors are placed on the proximal latissimus dorsi muscle.
In our cases, it was highly likely that many of the brainstem perforators incorporated into the aneurysm sac were occluded by thrombus at the time of diagnosis and that the perforating artery
territories involved were already supplied by collateral circulation.
The nutrient artery of the femur in general proceeds of the second perforating artery
and when two nutrient arteries exist, they tend to detach from the first and third perforating arteries (Goss, 1976).