Cyanoacrylates, a group of rapidly polymerizing adhesives, have found widespread uses in oral and general surgery as well as surgical subspecialties, for example as hemostatic and anastomotic agents. They have been utilized most recently as materials for embolotherapy of complex cerebral and extra-cerebral vascular anomalies. The histopathology that results from their deposition in human tissues is thus an important consideration, and the subject of this review. Particular attention is given to the fate of cyanoacrylates in cerebral lesions after iatrogenic embolization procedures. The apparent toxicity of these plastics on blood vessel walls is discussed in relation to experimental observations. It is imperative that clinicians who use this group of substances evaluate their potential functions in the light of the pathologic findings.
SUMMARY A series of 9 patients have experienced hemisphere and retinal ischemia at an interval after occlusion of appropriate internal carotid arteries. All had radiological evidence of a persisting proximal stump to the occluded artery and, in most, pathological evidence of thrombotic material attached to atheromatous lesions within the stump. Thromboembolism from the stump via the anastomotic supply through ipsilateral common and external carotid arteries is thought to be responsible for the ischemic events to the brain or retina despite absence of flow through the internal carotid artery. Seven of the 9 were treated by surgical excision or obliteration of the stump and, when indicated, common and external carotid endarterectomy. Turbulence in the stump contributed to progressive atherosclerotic changes and probably aggravated thrombogenesis in this location with subsequent embolization into the anastomotic arteries.THE RELATIONSHIP between recurrent cerebral or retinal ischemic events and stenotic and ulcerative atheromatous lesions of the carotid artery is widely accepted. A statement has been made frequently that ischemic events could be expected to cease once a stenosed artery becomes occluded. 16Recent publications 7 ' 8 have drawn attention to ischemic events within the territory of an occluded artery. The majority of these later recurrent events appear to be of embolic origin related to stenotic and ulcerative lesions in the collateral circulation, particularly in the common and external carotid arteries. Continuing study of this type of case has drawn the authors' attention to the occurrence, in some of them, of lesions within the stump of the internal carotid artery which have been shown by angiography and pathological examination of surgical specimens to be capable of causing or contributing to the post-occlusion thromboembolic attacks. Patients and MethodsThis report is based on a prospective study of 9 patients presenting with retinal or cerebral ischemic event(s), all with evidence of occlusion of the internal carotid artery in the neck, and all with radiological evidence of a non-obliterated proximal remnant (a "stump") of the internal carotid artery. The clinical features have been analyzed and the radiological evidence assessed to determine if it is a reasonable assumption that the symptoms and signs could have been related to thromboembolism from the region of the stump. The availability of anastomotic channels to carry the emboli to the target organs of brain and eye was studied. In 7 of the 9 cases, pathological material was available, subsequent to surgery, and this was correlated with the radiological and clinical findings. The
Sixteen of 35 patients (46%) 21 years old or less who underwent surgical resection of a longstanding epileptic focus harbored tumors. The median duration of the seizure disorder prior to operation was 6.0 years for patients with and 7.6 years for those without tumor. Among the 35 patients, tumor was more common when intelligence and results of neurological examination were each normal, a plausible cause for uncontrolled seizures was lacking, and persistent focal delta activity occurred in a majority of electroencephalograms (EEGs). The type of seizures and the distribution of EEG spikes failed to distinguish patients with tumor from those without. Multifocal EEG spikes appeared in a majority of each group.
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