Neuropathological changes related to the transorbital application of ethyl 2-cyanoacrylate adhesive to the basal cerebral arteries of cats

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✓ The long-term toxic effects of ethyl 2-cyanoacrylate adhesive were evaluated histologically in 25 cats. Fresh medical- or commercial-grade adhesive was introduced transorbitally into the subarachnoid space in the vicinity of the right middle cerebral artery. Three sham-operated animals served as controls. The animals were sacrificed at intervals ranging from 2 days to 6 months. For both medical- and commercial-grade adhesive, neuropathological examination disclosed acute and chronic granulomatous inflammation of the meninges and evidence of severe vascular damage, including vessel wall necrosis, inflammation, thrombosis, and occasionally hemorrhage. Most animals showed cerebral infarcts of variable size in the territories of distribution of the basal arteries which were in contact with adhesive. The results of this study show that ethyl 2-cyanoacrylate is capable of producing severe arterial and parenchymal damage. The risk of its deleterious effects should be weighed against its potential benefits. Clinical experience would suggest that ethyl 2-cyanoacrylate can be used in difficult situations as long as care is taken to protect the brain and local blood vessels.

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Address reprint requests to: Thomas W. Smith, M.D., Department of Pathology (Neuropathology), University of Massachusetts Medical Center, 55 Lake Avenue North, Worcester, Massachusetts 01605.

© AANS, except where prohibited by US copyright law.

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    Photomicrographs showing leptomeningeal and arterial changes in animals sacrificed at different times after application of adhesive. Upper Left: Section from a cat with 6 months survival. There is marked leptomeningeal fibrosis and chronic inflammation. Refractile adhesive can be seen in the subarachnoid space. Note the foreign-body giant cells surrounding the adhesive. H & E, × 66. Upper Right: Section from a cat with 2 weeks survival. The wall of an artery in contact with adhesive shows transmural necrosis and infiltration by acute inflammatory cells. The lumen is occluded by a recent thrombus. H & E, × 160. Lower Left: Section from a cat 6 weeks after application. The lumen of the middle cerebral artery is completely occluded by an organizing thrombus. The internal elastic lamina is intact, but there is fibrosis of the media and adventitia. Adhesive can be seen in the subarachnoid space surrounding the vessel. Verhoeff-van Gieson, × 66. Lower Right: Another specimen at 6 weeks showing two arteries surrounded by adhesive in the subarachnoid space. The vessel on the left contains an organized recanalized thrombus. The vessel on the right shows marked intimal proliferation. Verhoeff-van Gieson, × 66.

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    Coronal section from an animal sacrificed at 6 weeks showing a large organizing infarct in the right cerebral hemisphere in the territory of the middle cerebral artery. The Verhoeff-van Gieson stain for elastic tissue was used.

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