title: [Responding to Arterial Perforation during Endovascular Neurosurgery].
abstract: During endovascular neurosurgery, various devices, such as catheters, are passed through the intracranial arteries to access target vessels; the arteries can thereby be perforated. Even though such incidents are serious and should be dealt with appropriately, few case reports or standard procedures have been published. Herein, we report two cases of arterial perforation that occurred recently in our hospital. In the first case, the patient had been treated preoperatively using feeder occlusion of an arteriovenous malformation; the microcatheter perforated the feeder, which branched from the middle cerebral artery. The feeder and perforation site were occluded by injection of n-butyl 2-cyanoacrylate (NBCA) through the same microcatheter, and complete hemostasis was thereby achieved. The second case occurred during an embolization of the middle meningeal artery (MMA) to treat a refractory chronic subdural hematoma;the microcatheter perforated a branch of the MMA. Both the perforation and the artery were embolized using platinum coils and by injecting NBCA, and hemostasis was achieved. Considering the anatomical and pathological properties of the injured vessels, favorable results were achieved with appropriate intervention.
authors.affiliation: Department of Neurosurgery, Hiroshima City Hiroshima Citizens Hospital.
authors.forename: Kenichiro
authors.initials: K
authors.lastname: Muraoka
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Tomita
authors.forename: Ken
authors.initials: K
authors.lastname: Kuwahara
authors.forename: Yu
authors.initials: Y
authors.lastname: Takahashi
authors.forename: Yu
authors.initials: Y
authors.lastname: Okuma
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Tanabe
authors.forename: Toshinari
authors.initials: T
authors.lastname: Meguro
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Hirotsune
authors.forename: Shigeki
authors.initials: S
authors.lastname: Nishino
mesh_terms: D000369:Aged, 80 and over; D002533:Cerebral Angiography; D002543:Cerebral Hemorrhage / Q000209:etiology / Q000601:surgery*; D004621:Embolization, Therapeutic; D004659:Enbucrilate / Q000627:therapeutic use; D057510:Endovascular Procedures; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000150:complications*; D008297:Male; D008576:Meningeal Arteries / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D019635:Neurosurgical Procedures; D014656:Vascular Surgical Procedures
chemical_list: D004659:Enbucrilate