Plastic in the Brain

Doctors dread an embolus (from the Greek for a stopper), whether it be a blood clot, a blob of fat, or a bubble of air. An embolus can travel through an artery until it is caught at a narrow point, then shut off circulation to the tissues beyond. But last week two Georgetown University neurosurgeons reported that they had gone to a lot of trouble to make ultramodern emboli in the form of plastic pellets, and had used them to correct a brain defect.

The patient was a woman of 47 who for 15 years had had episodes of numbness and weakness in her right arm and leg, and some speech difficulty. The trouble, Drs. Alfred J. Luessenhop and William T. Spence decided, was that part of the brain, with an abnormal connection between arteries and veins, was getting too much blood from an enlarged artery. So they wanted an embolus to serve as a stopper in this artery.

In fact, they used four emboli, the surgeons reported in the A.M.A. Journal: tiny spheres of plastic (methyl methacrylate), with metal fragments inside to show up on X rays, and ranging from 2.5 mm. to 4.2 mm. in diameter. They opened the left side of the anesthetized patient's neck to expose the main branching of the carotid artery, principal supplier of blood to the brain. At 15-minute intervals they inserted successively larger plastic emboli. All came to rest at the base of the malformation, reducing its blood supply. The last and biggest pellet lodged for a while in a wrong spot and threatened trouble, but eventually settled just where the doctors wanted it. Seven weeks after surgery, the patient could write legibly with her right hand, had no more speech difficulty.

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