title: Microsurgical glue embolectomy of the middle cerebral artery following embolization of a maxillofacial arteriovenous malformation.
abstract: With increasing application of endovascular therapies worldwide, the management of procedure-related complications has become increasingly important. Of particular interest is the surgical management of complications refractory to endovascular recanalization. Here, we present the unique surgical management of an inadvertent intracranial glue embolus following urgent glue embolization of a maxillofacial arteriovenous malformation. This is the first report to document management of this complication. An arteriotomy was performed and the glue, despite being adhered to the vessel intima, was retrieved in its entirety from the middle cerebral artery (MCA). Following the procedure, the patient developed a new thrombus at the previous glue site, likely related to endothelial injury. With post-operative heparin therapy, the patient recovered to baseline neurological state. This report demonstrates that microsurgical arteriotomy and glue embolectomy of the MCA is feasible, safe and may be useful in the management of complications of inadvertent intracranial glue embolization.
authors: Division of Neurosurgery and Interventional Neuroradiology, Toronto Western Hospital, 399 Bathurst Street, University of Toronto, Ontario, Canada. george.m.ibrahim@gmail.com
authors: George M
authors: GM
authors: Ibrahim
authors: Amal
authors: A
authors: Abou-Hamden
authors: Jai Jai Shiva
authors: JJ
authors: Shankar
authors: Aditya
authors: A
authors: Bharatha
authors: Karel
authors: K
authors: ter Brugge
authors: Michael
authors: M
authors: Tymianski
mesh_terms: D000328:Adult; D001165:Arteriovenous Malformations / Q000601:surgery*; D017128:Embolectomy / Q000379:methods*; D004621:Embolization, Therapeutic / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D008297:Male; D020768:Middle Cerebral Artery / Q000601:surgery*