Neurosurgery
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Case Reports
Foreign body embolization of the middle cerebral artery: review of the literature and guidelines for management.
Two cases of traumatic middle cerebral artery occlusion secondary to migratory intravascular metallic pellets are presented. Surgical removal of the occlusive pellet was achieved in one patient, and vessel patency was restored. ⋯ Factors such as the availability of a microvascular surgeon, the status of the neurological deficit resulting from the embolus, the time interval from injury to the proposed operation, and the extent of ancillary injuries sustained concurrently all bear weight on the decision to explore surgically or treat by medical measures. We believe that in cases of trauma an attempt to remove intravascular emboli is warranted to prevent migration of the embolus and distal propagation of thrombus, to avoid chronic sepsis, to prevent arterial erosion, and to restore the integrity of the vascular tree.
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A hypothesis of the pathophysiology of midcervical quadriplegia after posterior fossa operation with the patient in the sitting position under general anesthesia is presented. Observations and experimental evidence are presented to support the theory that stretch of the cervical spinal cord associated with neck flexion may be sufficient to impair the autoregulation of spinal cord blood flow enough so that the reduced, but otherwise acceptable, hemodynamic parameters associated with general anesthesia in the sitting position contribute to the risk of spinal cord infarction.