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Kenichiro Sugita, Toshiyuki Hirota, and Ryuichi Tsugane

O ne of the hazards of intracranial aneurysm surgery is that structures behind the aneurysm cannot be easily observed; the aneurysm or the parent vessel is therefore occasionally retracted so forcibly that additional arterial spasm or premature rupture of the aneurysm may occur. In several cases of aneurysm with this potential operative problem we have used a nasopharyngeal mirror under an operative microscope to observe the structures behind the aneurysm or the parent vessel. Material and Operative Technique The smallest of the nasopharyngeal mirrors

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Takashi Handa, Yoshio Suzuki, Kiyoshi Saito, Kenichiro Sugita, and Sunil J. Patel

S pinal artery aneurysms are rare and are usually associated with arteriovenous malformations (AVM's). 2, 6, 12 Symptoms of subarachnoid hemorrhage (SAH) and/or spinal cord involvement guide the physician to the correct diagnosis, although this is often difficult. Isolated spinal artery aneurysms are infrequently reported, 3–5, 9–11, 13, 14, 17–19 and little is known about their clinicopathology. The unusual presentation of such a case prompted this contribution. Case Report This 3-year-old girl initially developed quadriparesis 8 months prior to

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Kenichiro Sugita, Shigeaki Kobayashi, Toshiki Takemae, Yuichiro Tanaka, Hiroshi Okudera, and Michihiko Ohsawa

A neurysms of the vertebral artery frequently have unusual shapes and characteristics and exhibit a fusiform, serpentine, dissecting, or giant appearance. 2–4, 6, 8, 11, 21 In the literature and in our experience, most small aneurysms of an unusual shape such as fusiform or dissecting aneurysms where neck clipping is not feasible have been treated with proximal ligation of the vertebral artery with minimum complications; this is because the contralateral vertebral artery and the posterior communicating artery compensate for the interrupted blood supply to the

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Yuichiro Tanaka, Hideaki Hara, Genki Momose, Shigeru Kobayashi, Shigeaki Kobayashi, and Kenichiro Sugita

T he trigeminal and proatlantal arteries supply the cranial and caudal portions of the brain stem, respectively, in the embryonic stage, where they play more important roles than the otic and hypoglossal arteries. These vascular channels usually regress by the time the embryo reaches a length of 14 mm. 10 We report an adult case with coexisting proatlantal intersegmental and trigeminal arteries; the latter is further associated with an aneurysm. The role of the proatlantal intersegmental artery in relation to the development of the occipital artery is

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Shigeaki Kobayashi, Kazuhiko Kyoshima, Hirohiko Gibo, Sathyaranjandas A. Hegde, Toshiki Takemae, and Kenichiro Sugita

C arotid-ophthalmic artery aneurysms are of considerable surgical interest. 1, 3, 7, 11 With the advent of microsurgical techniques their management has changed from conservative surgery to direct surgical clipping. Fox, 4 Nutik, 9 and Yaşargil, et al. , 11 have classified the aneurysms arising from the inferior wall of the internal carotid artery (ICA) separately and have called them “paraclinoid aneurysms” or “ventral carotid aneurysms.” Some of these were considered unclippable or were associated with disastrous surgical results. 9 There is a small

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Kenichiro Sugita, Shigeaki Kobayashi, Toshiki Inoue, and Toshiki Takemae

I mprovements in instrumentation can make previously difficult or impossible operations easy and successful. 1 The application of the standard and fenestrated aneurysm clips has been reported previously. 5–7 We have developed seven different kinds of aneurysm clip with ultra-long blades, and have used them effectively in 30 clinical cases over the past 5 years. We report some of these cases and describe the characteristics and application of these clips with ultra-long blades. Description of Ultra-Long Clips Besides the 55 varieties of Sugita clips of

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Kenichiro Sugita, Shigeaki Kobayashi, Kazuhiko Kyoshima, and Fukuo Nakagawa

S ome aneurysms with peculiar shapes or in unusual locations cannot be obliterated by ordinary clipping methods. For such difficult cases, several special methods have been devised, such as those involving copper wire insertion, stereotaxic thrombosis, detachable balloons, and remote tourniquets. 1, 2, 4, 8–10, 12 We believe that the improvement of the shape of aneurysm clips will enable successful clipping of most types of difficult aneurysms. We have previously described a clipping method for fusiform vertebral aneurysms using fenestrated clips. 15, 16 In

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Kenichiro Sugita, Shigeaki Kobayashi, Toshiki Inoue, and Tatsuo Banno

S urgery of vertebral artery aneurysms presents two difficult problems. The first is the narrow operative field surrounded by the medulla and lower cranial nerves, and the second is the high incidence of fusiform aneurysms. Wrapping a fusiform aneurysm in this location with muscle or muslin is difficult because of the limited surgical space and the many adjacent vital structures. In many cases, only partial coating of the aneurysm or proximal ligation of the vertebral artery is achieved. 1, 4 Our newly designed fenestrated clip with angled blades * makes it

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Kenichiro Sugita, Shigeaki Kobayashi, Akira Shintani, and Naomi Mutsuga

S urgical treatment of aneurysms of the basilar artery has been one of the most difficult procedures, even in the era of the operating microscope. 3, 16, 17 While many papers have reported on operative techniques and their results on aneurysms of the anterior portion of the circle of Willis, only a small number of papers have been published on aneurysms of the basilar artery. We are reporting on our surgical technique and operative results in 32 cases of basilar artery aneurysms performed under an operating microscope. Summary of Cases Clinical

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Kenichiro Sugita, Toshiyuki Hirota, Ikuzo Iguchi, and Tetsuro Mizutani

N umerous forms of aneurysm clips are available commercially, 1, 3, 5, 7, 9, 11, 18–20 but there has been no comparative study of these clips from a mechanical point of view. We have tested spring clips designed by Heifetz, 8 Scoville, 16 Kerr, 10 and Yasargil, 21 the classical silver clip, 6 Olivecrona clip, 12 and Weck's hemoclip, 14 and examined their effect on animal arteries after temporary clipping. A newly designed bayonet-shaped aneurysm clip is described and results of similar tests are also reported. Description of Sugita's Clip The