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Aneurysms of the Middle Cerebral Artery

Report of Seven Operative Cases; Review of Literature; Evaluation of Surgical Therapy

Daniel Petit-Dutaillis and Hal W. Pittman

the parent artery because it immediately disappeared after a higher placement of the clip on an arteriosclerotic aneurysm. Case 1 . (Aneurysm clipped; well 8 years later.) H.C., 21-year-old female, was admitted to the Hôpital de la Pitié May 28, 1946 with severe generalized headache for 1 month, and diplopia and ptosis of the right eyelid for 3 weeks. Examination revealed only a complete right oculomotor nerve paralysis. Spinal fluid was yellow. Arteriogram revealed a small aneurysm near the bifurcation of the right internal carotid artery. At craniotomy (Dr

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Carl J. Graf

, intracranial internal carotid artery clipping was made. Extracranial internal carotid artery ligation was done in the sixth. In 3 of the cases of anterior communicating aneurysm clips were applied to both anterior cerebral arteries and the aneurysm was removed in 1. One of these patients recovered but was severely deteriorated and has remained so. In 1 patient the neck of the aneurysm was clipped and reinforcement with muscle was accomplished. This patient recovered. In this group of anterior communicating aneurysms 8 (80 per cent) of the patients died. Vertebral

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E. H. Botterell, W. M. Lougheed, J. W. Scott and S. L. Vandewater

. At the same time, ventricular fibrillation in this case must be attributed to the use of hypothermia. An excellent result, finally. Case 5 . Rupture of aneurysm of right middle cerebral artery. Neck of aneurysm clipped after 22 days: hypothermia and bilateral common carotid and vertebral occlusion 2 minutes. Re-exploration and resection of oedematous frontal lobe. Recovery with motor and sensory deficit left arm. Aug. 3, 1954 . L.S., D.64417, a woman 30 years of age, was admitted to the Toronto General Hospital. She had suffered a subarachnoid haemorrhage on

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Arterial Aneurysms of the Internal Carotid Artery and its Bifurcation

An Analysis of 69 Aneurysms Treated Mainly by Direct Surgical Attack

G. af Björkesten

wrapped with hammered muscle, Gelfoam, etc. In 44 patients 46 aneurysms were attacked intracranially. The methods of treatment are shown in Table 4 . TABLE 4 Aneurysms attacked intracranially Location Method of Treatment Total Thread Silver Clip Thread and Clip Wrapping Infraclinoid — — — 1 1 Supraclinoid 12 19 * 4 3 38 Carotid bifurcation 3 1 — 3 7  Total 15 20 4 7 46 * 3 aneurysms clipped in 1 patient. TIMING OF OPERATION

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Aneurysms of the Pericallosal Artery

A Study of 14 Cases Verified Angiographically and Treated Mainly by Direct Surgical Attack

Lauri Laitinen and Aarno Snellman

 Total 320 100% TABLE 2 Summary of 14 cases of pericallosal aneurysm Case Sex Age No. of Hemorrhages Interval Between Bleeding(s) and Admission Verified Hemorrhage Neurological Signs Site of Aneurysm(s) Treatment Operative Complications Control Angiography Follow-Up Time, and Late Results 1 L.V. F 51 2 3 mos. 1 mo. +  — Lt. peric. Aneurysm clipped Transient rt. hemiparesis Aneurysm not filling 22 mos. Well. Died from recurrent subarach. hem. 2 T.R. F 21

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Paul Karlsberg and John E. Adams

death could be attributed to factors other than isolation and occlusion of the vessels of the neck. Autopsies of 2 of the remaining 3 patients disclosed the following: 1) an internal carotid-posterior communicating aneurysm clipped across its base with ipsilateral infarction of the middle cerebral artery; no arterial thrombosis or intracerebral hematoma; 2) infarction in the territory of the parent vessel of the aneurysm (anterior cerebral), but also thrombosis of the ipsilateral internal carotid artery intracranially with infarction of the area supplied by this

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nurse. The attached receptacle (a measuring cup will do) is used to receive discarded pledgets, thus avoiding their loss and facilitating the postoperative count. Miniature Torsion Bar Spring Aneurysm Clip William B. Scoville , M.D. Department of Neurosurgery, Hartford Hospital, Hartford, Connecticut Clipping still constitutes the treatment of choice in the majority of brain aneurysm operations. Spring clips are replacing malleable clips, but those presently in use have over-large loops or handles. In an effort to do away with this bulk, Lewis Bros. of

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J. Lawrence Pool and Robert P. Colton

therefore apply an aneurysm clip more accurately and with less chance of traumatizing or compromising the lumen of the parent vessel ( Fig. 3 ). The microscope has proved especially useful for aneurysms of the anterior communicating and middle cerebral artery. 2. The small but vital perforating vessels that arise from major arteries of the circle of Willis can be clearly identified with the aid of the microscope. Injury to these vessels can therefore be avoided during dissection or during the application of temporary clips. For example, branches from the proximal or

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F. Miles Skultety and Hiro Nishioka

subarachnoid hemorrhage. The neck of the aneurysm was clipped. She did fairly well for five days, at which time she had a convulsive seizure and became progressively less responsive. She died 11 days postoperatively. Case #229 A 42-year-old female, was operated upon and the neck of the aneurysm clipped. It is not known how many days had elapsed from the subarachnoid hemorrhage to the operation. She died in the immediate postoperative period, but it is not known how long she survived after operation. Case #5483 A 59-year-old male, presented with symptoms of a

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Harvey W. Buchsbaum and Robert P. Colton

was done. A coronal incision was made across the anterior fontanel immediately anterior to the coronal suture. A 4×4 cm free flap of bone was removed from the right frontal region. A right midfrontal cortical incision was made and the ventricle entered. Cortical collapse was prevented during surgery by gently packing the frontal horn of the right lateral ventricle with cotton balls soaked in warm Ringer's solution. A Mayfield aneurysm clip was placed across the cephalic end of the Pudenz shunt within the lumen of the lateral ventricle to prevent air embolization