Walter E. Dandy's contributions to vascular neurosurgery

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Although Walter E. Dandy (1886–1946) is appropriately credited with the first surgical clipping of an intracranial aneurysm in 1937—a procedure that established the modern field of vascular neurosurgery—his numerous other contributions to this specialty are not as well known. Dandy can be credited with the first detailed description of the vein of Galen malformation, the first description of x-ray visualization of an intracranial aneurysm, the first characterization of basilar artery dolichoectasia, and the publication of the first comprehensive operative case series of arteriovenous malformations, cavernous malformations, and developmental venous anomalies. In addition, Dandy performed the first surgical trapping of a cavernous internal carotid artery (ICA) aneurysm by clipping the supraclinoid ICA and ligating the cervical ICA, and he also executed the first intracranial surgical clipping of the ICA to treat a carotid-cavernous fistula. In this article the authors describe Dandy's contributions to the field of vascular neurosurgery.

Abbreviations used in this paper: AVF = arteriovenous fistula; AVM = arteriovenous malformation; BA = basilar artery; CA = carotid artery; CCF = carotid-cavernous fistula; CM = cavernous malformation; DVA = developmental venous anomaly; ICA = internal CA; PCoA = posterior communicating artery; SAH = subarachnoid hemorrhage; VA = vertebral artery.

Article Information

Address correspondence to: Rafael J. Tamargo, M.D., Department of Neurosurgery, Johns Hopkins Hospital, Meyer 8-181, 600 North Wolfe Street, Baltimore, Maryland 21287. email: rtamarg@jhmi.edu.

Please include this information when citing this paper: published online September 4, 2009; DOI: 10.3171/2009.7.JNS09737.

© AANS, except where prohibited by US copyright law.

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Figures

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    Photograph of Walter Dandy at age 31 years, taken during his time as a resident under William Halsted. From The Alan Mason Chesney Medical Archives of The Johns Hopkins Medical Institutions.

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    Lateral skull x-ray showing aneurysm wall calcification in bilateral ICA aneurysms. Reprinted from Dandy WE: Intracranial Arterial Aneurysms. Copyright 1944 by Comstock Publishing Co., Inc.; renewed 1972 by Mrs. Walter E. Dandy. Used by permission of the publisher, Cornell University Press.

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    Photographs of the first patient to undergo clipping of an intracranial aneurysm in 1937 by Dandy, showing preoperative right-sided ptosis and third nerve palsy (A). Photographs taken at 13 days (B) and 7 months (C) after surgery, showing excellent improvement in right third nerve function. Originally printed in Dandy WE: Intracranial aneurysm of the internal carotid artery: cured by operation. Ann Surg 107:654–659, 1938. Reprinted from Dandy WE: Intracranial Arterial Aneurysms. Copyright 1944 by Comstock Publishing Co., Inc.; renewed 1972 by Mrs. Walter E. Dandy. Used by permission of the publisher, Cornell University Press.

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    Lateral (upper) and skull base (lower) x-ray films showing the position of the silver clip (arrows) used by Dandy to occlude the first intracranial aneurysm in 1937. Originally printed in Dandy WE: Intracranial aneurysm of the internal carotid artery: cured by operation. Ann Surg 107:654–659, 1938. Reprinted from Dandy WE: Intracranial Arterial Aneurysms. Copyright 1944 by Comstock Publishing Co., Inc.; renewed 1972 by Mrs. Walter E. Dandy. Used by permission of the publisher, Cornell University Press.

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    Drawing of Dandy's first surgical clip occlusion of an intracranial aneurysm in 1937. Originally printed in Dandy WE: Intracranial aneurysm of the internal carotid artery: cured by operation. Ann Surg 107:654–659, 1938. Reprinted from Dandy WE: Intracranial Arterial Aneurysms. Copyright 1944 by Comstock Publishing Co., Inc.; renewed 1972 by Mrs. Walter E. Dandy. Used by permission of the publisher, Cornell University Press.

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    Drawing showing locations at which clips or bands may be placed to treat an ICA aneurysm. Aneur. = aneurysm; Int. carotid a. = ICA; Ophth. a. = ophthalmic artery. Reprinted from Dandy WE: Intracranial Arterial Aneurysms. Copyright 1944 by Comstock Publishing Co., Inc.; renewed 1972 by Mrs. Walter E. Dandy. Used by permission of the publisher, Cornell University Press.

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    Drawing of the resection of an intracranial AVM performed by Dandy in 1925. Originally printed in Dandy WE: Arteriovenous aneurysm of the brain. Arch Surg 17:190-243, 1928. Copyright 1928 by American Medical Association. All rights reserved.

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    Drawings showing Dandy's technique of trapping a cavernous ICA aneurysm between a ligature on the ICA in the neck and an intracranial clip. Com. = common; Ext. carotid a. = external CA; n. = nerve; v. = vein. Left: Originally published in Dandy WE: The treatment of internal carotid aneurysms within the cavernous sinus and the cranial chamber: report of three cases. Ann Surg 109:689–711, 1939. Right: Illustration reprinted from Dandy WE: Intracranial Arterial Aneurysms. Copyright 1944 by Comstock Publishing Co., Inc.; renewed 1972 by Mrs. Walter E. Dandy. Used by permission of the publisher, Cornell University Press.

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    Drawing of a craniotomy for resection of a CM performed by Dandy. Original illustration is in the Max Brödel Archives, Department of Art as Applied to Medicine, Johns Hopkins University, Baltimore, Maryland.

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