PubMed · 1567008
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S Fraser. 1992. A problem with a multilumen catheter.. https://doi.org/10.1111/j.1365-2044.1992.tb02146.x
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Because of ongoing controversy, the issue of vascular repair or ligation for patients with cerebrovascular injuries and preoperative central neurologic deficits is frequently debated. A total of 133 patients with penetrating cerebrovascular injuries were analyzed. The frequency of preoperative neurologic deficit was 20% (27 patients). The common carotid and internal carotid arteries were the most frequently injured structures, with a 29% and 15% incidence of preoperative neurologic deficits, respectively. The results of carotid repair in all patients whose preoperative deficit was limited to weakness or paralysis were favorable (seven patients normal or improved, two patients unchanged). The results of repair in patients whose preoperative deficit was characterized by obtundation were variable (four patients improved, four patients worsened or died). The results of carotid ligation were also variable (one improved, one unchanged, three worsened or died). Limited numbers of patients with preoperative neurologic deficits and the retrospective nature of this review prohibit definite conclusions. Therefore a multicenter, prospective, randomized trial of ligation or vascular repair for comatose patients with cerebrovascular injuries is proposed.
We examined the frequency and site of major complications after intranasal micro-endoscopic ethmoidectomy. Injury of the orbital periostium was significantly more frequent on the right than on the left side, but there was no side predominance for damage to the dura mater. Surgery on the lamina papyracea and the lateral wall of the sphenoid sinus is more dangerous on the side on which the surgeon stands during the operation. The use of the microscope, the endoscope and preoperative CT scan of the paranasal sinuses helps to avoid major complications.