Background:
Neurovascular compression is an extremely rare etiology of isolated abducens nerve palsy. We describe a successfully treated case of isolated abducens nerve palsy due to sandwich-type compression by the vertebral artery (VA) and anterior inferior cerebellar artery (AICA).
Case Description:
A 30-year-old man presented with a 6-month history of horizontal diplopia without other symptoms. Magnetic resonance imaging (MRI) demonstrated pinching of the left abducens nerve between the elongated left VA and left AICA. MRI showed no abnormal findings in the brainstem, cavernous sinus, or orbit. Surgery was performed using a standard lateral suboccipital approach. The abducens nerve was found to be severely compressed from both sides by the VA and AICA, with marked indentation. First, the VA was transposed and fixed to the dura mater of the petrous bone using a Teflon sling with the dripping of fibrin glue. Next, because of limited mobilization due to penetration of the AICA into the nerve, the AICA transfixing the nerve was attached to the pons with Teflon felt and fibrin glue to move the AICA away from the main trunk of the abducens nerve. The abducens nerve palsy gradually improved and eventually resolved by 4 months after the operation.
Conclusion:
When an elongated vertebrobasilar artery is identified as the offending vessel on high-resolution MRI, microvascular decompression can be carefully considered as a treatment option for patients with isolated abducens nerve palsy.
Rapid advances in emergent mechanical thrombectomy have resulted in a higher occurrence of arterial perforations during neurointerventions. Here, we report a case of internal carotid artery (ICA) perforation during mechanical thrombectomy in a 78-year-old man with a left middle cerebral artery occlusion. The ICA was perforated by a microcatheter during thrombectomy, forming a direct carotid-cavernous fistula. A two-stage drainer occlusion was conducted because of cortical venous reflex aggravation and ocular symptoms. Here, we report the perforation details and treatment, adding to evidence that ICA perforation with the microcatheter body is a concern during mechanical thrombectomy.
Background:
Carotid endarterectomy (CEA) has been the standard preventive procedure for cerebral infarction due to cervical internal carotid artery stenosis, and internal shunt insertion during CEA is widely accepted. However, troubleshooting knowledge is essential because potentially life-threatening complications can occur. Herein, we report a case of cervical internal carotid artery injury caused by the insertion of a shunt device during CEA.
Case Description:
A 78-year-old man with a history of hypertension, diabetes, and hyperuricemia developed temporary left hemiplegia. A former physician had diagnosed the patient with a transient cerebral ischemic attack. The patient’s medical history was significant for the right internal carotid artery stenosis, which was severe due to a vulnerable plaque. We performed CEA to remove the plaque; however, there was active bleeding in the distal carotid artery of the cervical region after we removed the shunt tube. Hemostasis was achieved through compression using a cotton piece. Intraoperative digital subtraction angiography (DSA) revealed severe stenosis at the internal carotid artery distal to the injury site due to hematoma compression. The patient underwent urgent carotid artery stenting and had two carotid artery stents superimposed on the injury site. On DSA, extravascular pooling of contrast media decreased on postoperative day (POD) 1 and then disappeared on POD 14. The patient was discharged home without sequela on POD 21.
Conclusion:
In the case of cervical internal carotid artery injury during CEA, hemostasis can be achieved by superimposing a carotid artery stent on the injury site, which is considered an acceptable troubleshooting technique.
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