A rare case of guidewire migration to central nervous system. A surgical case report

Guidewire localization in breast conserving procedures is commonly performed. Although it is a relatively safe procedure, there are atypical complications that may occur. Here, we highlight a rare case of guidewire migration, affecting both the brain and spine.

This is the case of a 59-year-old female who underwent guidewire localization for a non-palpable breast mass nine (9) months prior to presentation to the neurosurgery outpatient clinic. At the time of the breast conserving procedure, the initial guidewire inserted could not be located, and a second one was placed. She presented with a one-month history of progressively worsening quadriparesis and headaches. Investigative imaging demonstrated the presence of a guidewire running along the cervical spinal canal and terminating in the left cerebellar hemisphere. She was monitored closely, with varied surgical interventions being considered. Auspiciously, she demonstrated resolution of her symptoms during this time and has remained clinically stable.

Guidewire localization is generally described as a simple, low-risk procedure. However, the associated impact of cases of migration to distal sites may be detrimental, affecting patient outcomes. There are critical steps that must be taken to avoid mishaps.

This is an extremely rare case of guidewire migration involving the central nervous system. It is essential that when guidewires are not located following insertion, further investigations are carried out to ensure that it is no longer in situ. This will avoid delayed presentations, with considerable associated morbidity and mortality.