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Endovascular Management of an Embedded Intracranial Knife

Published online by Cambridge University Press:  02 December 2014

T E Darsaut ,
R A Ashforth ,
M M Chow  and
J M Findlay
T E Darsaut
Affiliation:
Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
R A Ashforth
Affiliation:
Division of Neurosurgery, Department of Radiology, University of Alberta, Edmonton, Alberta, Canada
M M Chow
Affiliation:
Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
J M Findlay
Affiliation:
Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
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Abstract

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Background:

Endovascular therapy (ET) is infrequently used in the setting of acute penetrating intracranial trauma.

Methods:

We report a case where ET was used immediately prior to and following removal of an embedded intracranial knife, which was found to be disrupting the anterior cerebral artery.

Results:

The proximal vessel was coiled and angiographically occluded and then the knife was removed with the microcatheter in place. Immediate angiography allowed us to see and quickly treat the contrast extravasation with further coiling. Despite full medical management, the patient died of elevated intracranial pressure.

Conclusion:

In this severely injured patient, endovascular therapy represented the most suitable means to attempt safe removal of the knife.

Résumé:

RÉSUMÉ: <span class='italic'> <span class='bold'>Contexte</span></span>:

En phase aiguë, on a souvent recours au traitement endovasculaire (TE) dans les traumatismes crâniens pénétrants.

<span class='italic'> <span class='bold'>Méthodes</span></span>:

Nous présentons un cas chez qui le TE a été utilisé immédiatement avant et après l’ablation d’un couteau intracrânien qui entravait l’artère cérébrale antérieure.

<span class='italic'> <span class='bold'>Résultats</span></span>:

On a placé des spirales pour occlure le vaisseau proximal au point de vue angiographique et le couteau a été retiré tout en gardant le microcathéter en place. L’angiographie faite surle- champ nous a permis de visualiser une extravasation de l’agent de contraste et de compléter le traitement par la mise en place de spirales. Le patient est décédé d’hypertension intracrânienne malgré un traitement médical intensif.

<span class='italic'> <span class='bold'>Conclusion</span></span>:

Le traitement endovasculaire était la meilleure option pour tenter de retirer le couteau tout en minimisant les risques chez ce blessé grave.

Type
Original Articles
Information
Canadian Journal of Neurological Sciences , Volume 34 , Issue 4 , November 2007 , pp. 460 - 463
Copyright
Copyright © The Canadian Journal of Neurological 2007

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