✓ A new technique for percutaneous imaging of a one-piece lumboperitoneal shunt is described. Patency of the shunt can be assessed by the intraperitoneal spread of contrast medium which is injected intrathecally via the lumbar route. No special equipment or instrumentation is required other than a typical lumbar puncture tray and a general examination tilt table for fluoroscopy.
Yusuke Ishiwata, Toshinori Yamashita, Kaoru Ide, Gakuji Gondo, Nobumasa Kuwana and Takeo Kuwabara
Kazuhiko Fujitsu, Yuusuke Ishiwata, Gakuji Gondo, Satoshi Fujii and Deng Dong Feng
✓ A technique combining wrapping and clipping using a Silastic sheet coated with Dacron mesh is described for treatment of fusiform or broad-based cerebral aneurysms. This sheet is easily tailored to wrapping the aneurysm base while avoiding involvement of the cranial nerves or branching vessels. The sheet is semitransparent so that the caliber of the newly constructed parent artery is easily adjusted during wrap-clipping. After the aneurysm and the parent artery have been circumferentially wrapped with the sheet, aneurysm clips are applied on the sheet so that the base of the aneurysm is clipped between the two leaves of the sheet. This wrap-clipping technique avoids the risks involved in extracting the aneurysm from the parent artery. The Dacron mesh coating the outer surface and sufficient clip closing pressure are both helpful in preventing the clip blades from sliding. Similar previously reported techniques are reviewed and discussed in detail.
Yusuke Ishiwata, Yasuhiro Chiba, Toshinori Yamashita, Gakuji Gondo, Kaoru Ide and Takeo Kuwabara
✓ Surface cooling and thermistor recording over shunt tubing was used in 23 studies of cerebrospinal fluid shunt patency in 19 patients with lumboperitoneal shunts and normal-pressure hydrocephalus. Shunt patency was shown by downward reflection of the recording trace similar to that obtained for ventriculoperitoneal shunts. Obstruction was demonstrated by a flat-line recording or an upward deflection.
Yusuke Ishiwata, Shigeo Inomori, Kazuhiko Fujitsu, Satoshi Nishimura, Kazuhiro Hirata, Gakuji Gondo, Toshinori Yamashita, Hideyo Fujino and Takeo Kuwabara
✓ A new encircling clip made of a silicone tube has been designed for treating accidentally injured cerebral vessels. No special holders are necessary. This clip can be tailored depending on the shape of the injured vessel. The clip is a simple and effective tool for achieving complete hemostasis.