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Vein graft replacement of the middle cerebral artery after unsuccessful embolectomy: case report
L N Sekhar1, Y Iwai, D C Wright
1Department of Neurosurgery, University of Pittsburgh School of Medicine, Pennsylvania.
Insights
A patient with a cavernous sinus hemangioma experienced middle cerebral artery (MCA) occlusion during surgery. Vein graft replacement successfully restored blood flow, preventing major neurological deficits.
Area of Science:
- Neurosurgery
- Vascular Neurology
- Cerebrovascular Surgery
Background:
- Cavernous sinus hemangiomas present unique surgical challenges.
- Cerebral angiography and balloon occlusion tests are crucial for preoperative planning.
- Intraoperative complications like arterial occlusion require prompt management.
Observation:
- A patient undergoing cavernous sinus hemangioma resection developed intraoperative embolic occlusion of the middle cerebral artery (MCA).
- Initial embolectomy was unsuccessful in restoring sustained blood flow.
- Recanalization of the MCA was achieved using a saphenous vein graft.
Findings:
- Successful removal of the cavernous sinus lesion was performed.
- Middle cerebral artery (MCA) occlusion occurred intraoperatively, necessitating intervention.
- Vein graft replacement of the MCA M2 segment restored patency and prevented permanent neurological damage.
Implications:
- Saphenous vein grafting is a viable option for managing intraoperative MCA occlusion when embolectomy fails.
- Prompt revascularization is critical to avoid significant neurological deficits after cerebrovascular events.
- This case highlights the importance of preparedness for unexpected intraoperative vascular complications in complex neurosurgical procedures.
Abstract:
A forty-one-year-old man with a cavernous hemangioma of the right cavernous sinus underwent a preoperative cerebral angiogram and a balloon occlusion test of the internal carotid artery. During the operation to remove the cavernous sinus lesion, the ipsilateral electroencephalogram was found to be abnormal. An embolic occlusion of the M2 and M3 segments of the middle cerebral artery (MCA) was discovered. A platelet and thromboembolus was removed via multiple incisions, and flow was restored. The cavernous sinus lesion was removed uneventfully. At the end of the operation, the MCA was found to be reclotted. Flow was eventually restored by replacing the M2 segment of the MCA with a 2-cm saphenous vein graft. The patient recovered without any deficits of brain function and with transient deficits of Cranial Nerves III and VI. Computed tomography revealed infarcts in the temporal and parietal areas. When MCA embolectomy is unsuccessful, vein graft replacement should be considered to restore flow and to avoid major neurological deficits.