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Subcallosal and Heubner artery infarcts following surgical repair of an anterior communicating artery aneurysm: a causal relationship with postoperative amnesia and long-term outcome

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Abstract

Since the 1950s, amnesia or memory impairment has been repeatedly reported in patients following surgical repair of anterior communicating artery (ACoA) aneurysms. Postoperative infarctions following surgical repair of ACoA aneurysms are classified as involvement of the subcallosal artery (the largest unpaired perforator of the ACoA), the recurrent artery of Heubner (RAH), or a combination of both. Postoperative amnesia can seriously affect the patient’s quality of life, thus prompting physicians to discuss the symptomatology of the three infarction patterns. We made the following speculations regarding the causal relationship between the infarction pattern and postoperative amnesia. First, postoperative amnesia is most likely caused by an infarction in the territory of the subcallosal artery, particularly in the column of the fornix, a constituent of the Papez neuronal circuit. Second, infarction in the RAH territory alone is unlikely to cause significant amnesia. Third, infarcted foci in the RAH territory, when associated with a subcallosal artery infarction, can cause considerable frontal dysfunction due to impaired frontostriatal circuits in patients with postoperative amnesia, with resultant worsening of the long-term outcome or quality of life.

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Acknowledgements

This work was supported by JSPS KAKENHI grant number JP15K10290.

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Authors and Affiliations

  1. Department of Diagnostic Radiology, Graduate School of Medicine, Tohoku University, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan

    Shunji Mugikura, Shoki Takahashi & Kei Takase

  2. Department of Behavioral Neurology and Cognitive Neuroscience, Graduate School of Medicine, Tohoku University, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan

    Hirokazu Kikuchi & Etsuro Mori

  3. Department of Neurosurgery, Graduate School of Medicine, Tohoku University, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan

    Miki Fujimura

Authors
  1. Shunji Mugikura
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  2. Hirokazu Kikuchi
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  3. Miki Fujimura
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  4. Etsuro Mori
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  5. Shoki Takahashi
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  6. Kei Takase
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Corresponding author

Correspondence to Shunji Mugikura.

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All study participants provided informed consent, and the study design was exempt from ethics review board approval.

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All authors declare that they have no competing interests.

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Mugikura, S., Kikuchi, H., Fujimura, M. et al. Subcallosal and Heubner artery infarcts following surgical repair of an anterior communicating artery aneurysm: a causal relationship with postoperative amnesia and long-term outcome. Jpn J Radiol 36, 81–89 (2018). https://doi.org/10.1007/s11604-017-0703-2

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  • DOI: https://doi.org/10.1007/s11604-017-0703-2

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