P revious reports have covered the initial development and clinical progress on the use of clip-grafts for the repair of carotid artery aneurysms and tears in major vessels. 7, 8 Clinical experience with clip-grafts in aneurysm surgery now justifies a final report, particularly detailing the application of these clips to selected anterior communicating artery aneurysms using a newly developed right-angle clip applier. To consider the relative applicability of this clip for aneurysms in general, the author's experience with 75 aneurysms in various locations is
Part 4: Relative application to various aneurysms and repair of anterior communicationg aneurysms using right-angle clip holder.
Thoralf M. Sundt Jr.
Thoralf M. Sundt Jr.
the drugs, 6, 7 the levels of critical cerebral blood flow, 8 and the ischemic tolerance of neural tissue 8 have been considered previously. Material and Methods Selection of Patients This study includes 159 patients with an acute SAH or with a mass lesion effect from an aneurysm without recent SAH. They were all operated on by the author (148 cases) or by a chief resident with the author serving as first assistant (11 cases). The operating microscope was used in all cases. Patients were graded according to the classification of Botterell, et al. 1 In
Thomas J. Rosenbaum and Thoralf M. Sundt Jr.
N eurovascular microsurgery relies heavily upon the spring-action, straight-jawed aneurysm clip and over 25 designs are commercially available, 3 each with unique advantages and disadvantages. Intelligent application of aneurysm clips depends upon a knowledge of the physical and mechanical characteristics of the clip as it interacts with the tissue to which it is applied. Descriptive and mechanical information is available, 1, 3–14 but laboratory trials that take into consideration the role of the vessel have not been reported. Prompted by this lack of
Neurosurgical Forum: Letters to the editor Editorial Comment Thoralf M. Sundt , Jr. , M.D. , Editor, Journal of Neurosurgery Rochester, Minnesota 159 159 The importance of the use of precise terms is exemplified in several papers that have recently crossed the Editor's desk. The case in point relates to the use of the term “embolization” for the management of intracranial aneurysms with balloons and coils. We have systematically corrected every paper coming to us implying that coils or balloons were
Related and unrelated to grade of patient, type of aneurysm, and timing of surgery
Thoralf M. Sundt Jr., Shigeaki Kobayashi, Nicolee C. Fode, and Jack P. Whisnant
I t is the purpose of this report to correlate specific types of preoperative, operative, and postoperative complications of cerebral aneurysm surgery in one surgeon's experience with the timing of surgical intervention, the location and size of the aneurysm, the neurological grade of the patient, and the methods of treatment. We have included surgically treated aneurysms that were acting as mass lesions or were not associated with a recent hemorrhage (within 30 days); these cases are included so as to contrast complications that were purely surgical and
Thoralf M. Sundt Jr., Bruce W. Pearson, David G. Piepgras, O. Wayne Houser, and Bahram Mokri
A neurysms of the extracranial internal carotid artery (ICA) are uncommon lesions. Much of the relatively restricted literature on the subject has referred to single cases, 1, 8, 13, 16, 17, 19, 30, 31, 38, 39 dealt with aneurysms primarily involving the carotid bifurcation, 25 or discussed false aneurysms resulting from trauma 10 or a previous carotid endarterectomy. 11, 25 Only a few reports include aneurysms of the distal ICA. 5, 7, 14, 15, 25, 28, 37 The surgical approaches to false aneurysms 10, 11, 20 and aneurysms of the carotid bifurcation 23, 25
Operative experience with 80 cases
Thoralf M. Sundt Jr. and David G. Piepgras
A neurysms greater than 2.5 cm in diameter are, by convention, classified as giant aneurysms. The review of Morley and Barr 9 includes early major references, and the report by Sonntag, et al. , 16 summarizes more recent work. Drake 3 and Yaşargil and Smith 19 have reported their experience. These studies, and a number of other well documented case reports, 1, 4, 14, 15 illustrate the individual characteristics of giant aneurysms. It seemed appropriate to review the techniques, results, and complications of the surgical management of giant aneurysms in
S. V. Ramana Reddy and Thoralf M. Sundt Jr.
T he association of carotid-cavernous fistula with a concomitant false aneurysm of the intracranial internal carotid artery (ICA) is uncommon, and only a few cases have been reported in the literature. 1, 5, 6, 9, 11, 21, 22 In most of these cases, the abnormalities were secondary to head injuries, 1, 11, 22 although occasionally they resulted from trauma during transsphenoidal surgery. 9, 13 The few reported cases were successfully treated by a trapping procedure alone, 9 trapping combined with controlled muscle embolization, 1, 13, 22 or more recently
Benjamin R. Gelber and Thoralf M. Sundt Jr.
C arotid ligation has been a useful treatment for some aneurysms unsuitable for direct intracranial clipping. In the past it has been used with reasonable success to control aneurysms of the internal carotid artery (ICA) in the cavernous sinus and carotid-ophthalmic aneurysms. 6 It has also been tried for some anterior communicating artery aneurysms. 20 Currently, using the operating microscope, most anterior communicating artery aneurysms and carotid-ophthalmic aneurysms can be obliterated by direct intracranial approach. 26 However, carotid ligation
John L. D. Atkinson, Thoralf M. Sundt Jr., O. Wayne Houser, and Jack P. Whisnant
T he current controversy surrounding prophylactic surgery for incidental asymptomatic aneurysms makes it necessary to determine the incidence of these lesions in the general population. Available data on the incidence of aneurysms have been acquired to date from autopsy series, and these statistics are quite variable. Reasons for this variability include: inherent bias of any autopsy series along with reasons for the examination, population and demographic differences, methods of data accumulation, and the interest of the pathologist. The asymptomatic