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Anesth Analg 2006;102:896-899
© 2006 International Anesthesia Research Society
doi: 10.1213/01.ane.0000195580.31382.38

NEUROSURGICAL ANESTHESIA

Cerebral Ischemia as an Apparent Complication of Anterior Cervical Discectomy in a Patient with an Incomplete Circle of Willis

John C. Drummond, MD, Raymond N. Englander, MD, and Catherine J. Gallo, MD

Department of Anesthesiology, The University of California, San Diego; VA Medical Center, San Diego; Department of Neurology, Department of Neurosurgery, Sacred Heart Medical Center, Eugene, Oregon

Address correspondence and reprint requests to John C. Drummond, MD, VA Medical Center, Anesthesia Service-125, 3350 La Jolla Village Drive, San Diego CA 92161. Address e-mail to jdrummond{at}ucsd.edu.

A 58-yr-old patient sustained a cerebral ischemic injury in the distribution of the carotid artery ipsilateral to retraction during an anterior cervical discectomy. Relative hypotension was permitted during the anesthetic. Angiography revealed an anatomic variant of the circle of Willis that resulted in minimal collateralizaton of the left internal carotid artery territory. The combination of that vascular variant with relative hypotension and some degree of carotid compression appears to have resulted in clinically significant cerebral ischemia.






Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 2006 by the International Anesthesia Research Society.