A simple bracing technique to correct kinking of arterial branches to avoid ischemic sequelae during neurovascular surgery

Kinked Perforator Due to Clipping of Parent Vessel Aneurysm: Technical Note and Lessons Learned

BACKGROUND

Adverse outcomes after aneurysm clipping can be potentially reversible, when managed appropriately.

METHODS

This is a case report describing kinking of a perforator due to clipping of parent vessel aneurysm.

RESULTS

Complete recovery of a high-grade motor deficit was achieved after instant reintervention with application of smaller clips in combination with gelfoam soaked in papaverine.

CONCLUSION

Use of evoked potentials and intraoperative digital subtraction angiography are recommended and may help in preclinical diagnosis. Knowledge of delayed perforator kinking as a complication may lead to a more rapid diagnosis and management.

Intracranial stenting after tumor exeresis complicated by delayed kinking of the middle cerebral artery

During intracranial tumor resection, the delayed kinking of a major encased vessel has never been described in literature. We present a case which required urgent endovascular treatment performed through a stent positioning. A patient was hospitalized with symptomatic sphenoid meningioma in the left middle cranial fossa. Twelve days after surgery, right-sided hemiplegia and aphasia occurred. Digital subtraction arteriography revealed a kinking of the M1 segment of the left middle cerebral artery and diffuse vasospasm. At first, intra-arterial nimodipine has been administered, obtaining the remission of the vasospasm. Secondly, a stent was positioned to treat the kinking, achieving a complete flow restoration.