Metallic fragment embolization to the cerebral circulation.
Metallic fragment embolization to the cerebral circulation.
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DOI：
10.1097/00005373-197303000-00013
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发表时间：
1973-03
期刊：
影响因子：
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通讯作者：
MAJOR JOHN P. Kapp;Ltc Isaac Gielchinsky;MAJOR RICHARD Jelsma
中科院分区：
文献类型：
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作者：
MAJOR JOHN P. Kapp;Ltc Isaac Gielchinsky;MAJOR RICHARD Jelsma
提交人的意见不一定反映陆军部门的意见。小腿切开。无入口伤，无脑膜或脑部疤痕。颈动脉显示正常，大脑中动脉未探及。手术后，患者的神经学变化不大。术后第6天行右颈动脉造影，显示金属碎片位于三叉处大脑中动脉内。只有一条大脑中动脉远端分支通畅。6天后，经上一次开颅手术显露大脑中动脉。三支主干中有两支为纤维索，第三支通畅，大脑中动脉壁未见增厚。在断裂处做了纵向动脉切开术。碎片非常附着在动脉壁上，很难从动脉壁上分离出来。动脉切开术以连续6-0Tevdek关闭。未使用抗凝剂。患者的病程并不复杂，术后神经学改变不大。术后动脉造影显示大脑中动脉在起始处形成血栓。病例2.这名19岁的美国士兵在入院前3天右颈因手榴弹爆炸而受伤。受伤后立即出现左臂和左腿无力。另一家医院行颈部探查，未发现血管损伤。患者报告在受伤后的最初3天，左侧无力有轻微的改善。检查显示病人神志清醒，精神状态良好。没有头部或面部的伤口。右侧胸锁乳突肌前缘有一个缝合的线形切口。气管切开插管已就位。面部中央偏左，虚弱。左臂极度偏瘫，只有肩部和肘部有粗大的运动。左腿有轻微的虚弱。左侧深肌腱反射减弱。感觉
The views of the authors do not necessarily reflect the opinions of the Department of the Army. niotomy. No entry wound and no meningeal or cerebral scars were found. The carotid artery ap-peared normal; the middle cerebral artery was not explored. Postoperatively, the patient was neurologically unchanged. A right carotid arteriogram performed on the sixth postoperative day showed that the metallic fragment was lodged within the middle cerebral artery at the trifurcation. Only one branch of the middle cerebral artery distal to the fragment was patent. Six days later the middle cerebral artery was ex-posed through the previous craniotomy. Two of the three main branches were fibrous cords, the third branch was patent, and the wall of the middle cerebral artery did not appear thickened. A longitudinal arteriotomy was made over the frag-ment. The fragment was quite adherent to the arterial wall, and was separated from the wall with some difficulty. The arteriotomy was closed with continuous 6-0 Tevdek. Anticoagulants were not used. The patient had an uncomplicated course, and was neurologically unchanged postoperatively. A postoperative arteriogram showed that the middle cerebral artery was now thrombosed at its origin.Case 2. This 19-year-old American soldier received a wound of the right neck from a grenade explosion 3 days prior to admission to the 24th Evacuation Hospital. There was immediate onset of weakness of the left arm and leg following the injury. Neck exploration was performed at an-other hospital, and no vascular injury was found. The patient reported slight improvement in the left-sided weakness during the initial 3 days fol-lowing injury. Examination revealed a conscious and oriented patient. There were no cranial or fa-cial wounds. There was a sutured linear incision along the anterior border of the right sternocleidomastoid muscle. A tracheostomy tube was in place. There was a left central facial weakness. The left arm was extremely paretic, with only gross move-ment at the shoulder and elbow. There was mod-erate weakness of the left leg. Deep tendon re-flexes were diminished on the left side. Sensation