Surgical treatment of foreign body embolus in the Middle cerebral artery secondary to neck injury

• Published in: British journal of neurosurgery Vol. 34; no. 5; pp. 512 - 517
• Main Authors: Wang, Hui, Ning, Xin-Jie, Chen, Chuan, Lin, Cong, Liang, Jia-Ji, Li, Yu-Zhang
• Format: Journal Article
• Language: English
• Published: England Taylor & Francis 01.10.2020; Taylor & Francis Ltd
• Subjects: Adult; Arteriotomy; Cerebral Angiography; Embolism; Foreign bodies; Foreign Bodies - complications; Foreign Bodies - diagnostic imaging; Foreign Bodies - surgery; Foreign body; Granulation tissue; Humans; Intracranial arteries; Male; Middle Cerebral Artery; Neck Injuries; Neurosurgical Procedures; Sutures; Veins & arteries; Granulation tissue; Arteriotomy; Foreign body; Intracranial arteries; Middle cerebral artery
• ISSN: 0268-8697; 1360-046X
• DOI: 10.1080/02688697.2018.1556781

Background: We report a case of a foreign body embolus to the middle cerebral artery and reviewed similar cases previously reported. Methods: A 30-year-old man was seen 72 days after a penetrating neck injury with a 1-month history of numbness in the left limb and impairment of the fine movement in the left hand. Radiological examination revealed a foreign body in the M2 portion of the right middle cerebral artery (MCA). The patient received arteriotomy and in situ suturing. Results: During the operation, we found a metallic foreign body at the bifurcation of the M2 upper trunk of the right MCA, narrowed distal blood vessels and thinned vessel walls. The foreign body was surrounded by granulation tissue. Both foreign body and granulation tissue were removed slowly followed by in situ suturing. Indocyanine green angiography confirmed arterial patency. Three days after the surgery, the patient developed numbness and weakness in the left arm, with a muscle strength of grade 4. Computed tomography showed partial infarction in the right temporal lobe. Then, antispasmodic drugs were used. Muscle strength recovered by 14 days after the operation. Conclusions: In the subacute stage, surgery can be conducted to remove intra-arterial foreign bodies along with their surrounding granulation tissue if computed tomography perfusion suggests a decreased blood flow reserve capacity.