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A new clip applier

Technical note

Joseph T. McFadden

T he ideal applier should be a one-handed instrument that, among its other attributes: 1) reliably holds the clip until deliberately released; 2) allows clip rotation in any plane to the most advantageous angle; 3) opens the clip to maximum aperture without damage to the spring; 4) releases instantaneously without drag; 5) easily regrasps the placed clip for removal or readjustment; and 6) never obstructs visibility in the field. In continued pursuit of these goals, we have produced a new clip applier ( Fig. 1 ) with global approximating surfaces contoured

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Fenestrated clips for internal carotid artery aneurysms

Technical note

Shigekiyo Fujita

A large majority of internal carotid artery (ICA) aneurysms grow toward the posterior or posterolateral aspect of the parent artery. 1 The fenestrated clips that are currently available are hard to apply except when the aneurysm protrudes toward the posteromedial aspect of the ICA. In addition, when an ICA aneurysm becomes larger, the diameter of the neck enlarges in the direction of the major axis of the parent artery. To clip the aneurysm safely, the ICA should be inserted into the window of a fenestrated clip with blades bent almost at a right angle so

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A brief history of the development of the Mayfield clip

Technical note

Frank H. Mayfield and George Kees Jr.

H istorical description of the origin and use of the surgical instrument known as the “Mayfield clip” seems appropriate. Prior to 1952, during operations on saccular aneurysms it was usually possible to control the situation with tissue forceps. Sometimes, however, disaster occurred due either to massive hemorrhage or to occlusion of the parent vessel when an attempt was made to embrace the aneurysm with permanent ligatures or malleable metal clips. The Schwartz cross-legged clip, introduced during this period, was not intended for permanent placement and

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A new intracranial Silastic encircling clip for hemostasis

Technical note

Yusuke Ishiwata, Shigeo Inomori, Kazuhiko Fujitsu, Satoshi Nishimura, Kazuhiro Hirata, Gakuji Gondo, Toshinori Yamashita, Hideyo Fujino, and Takeo Kuwabara

A variety of hemostatic procedures have been described in the field of neurosurgery. 1–4 We have designed a new hemostatic clip made of silicone to obtain rapid and complete hemostasis. The merits and characteristics of this Silastic encircling clip are discussed. Description and Use of Instrument The Silastic encircling clip * is made of silicone and has two components: a cylindrical part with a longitudinal slit and two wings ( Fig. 1 ). The clips are available in five sizes, with a luminal diameter of 1.5, 2.0, 2.5, 3.0, or 3.5 mm. Special clip

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Movement of hemostatic clips from the ventricles through the aqueduct to the lumbar spinal canal

Case report

Niels Sörensen and Jürgen Krauss

F oreign bodies have been reported to migrate within the brain and within the ventricle system as well as from a cranial location to the spinal canal. 1, 7–9, 11, 12, 19, 20 The earliest report by Vilvandré and Morgan 19 was published in 1916. Iatrogenic implantation of foreign bodies bears some risk of dislocation. Microsurgical treatment of intracranial aneurysms by clip application has been complicated by clip failure; 3, 4, 6, 10, 14, 17 in 1986, Oyesiku and Jones 13 reported the migration of an infratentorially applied Heifetz aneurysm clip to the

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Direct repair of a blisterlike aneurysm on the internal carotid artery with vascular closure staple clips

Technical note

Toshiharu Yanagisawa, Kazuo Mizoi, Taku Sugawara, Akira Suzuki, Tohru Ohta, Naoki Higashiyama, Masataka Takahashi, Toshio Sasajima, and Hiroyuki Kinouchi

B listerlike aneurysms of the ICA are a special type of lesion, with an extremely thin-walled appearance including the neck of the aneurysm. 1, 4–7 These lesions are easy to rupture intraoperatively, resulting in the formation of a large defect on the ICA. In such a situation, it is very difficult to reconstruct the ICA while preserving patency of the parent artery. We report a new technique in which vascular closure staple clips are used for direct repair of the tear on a blisterlike aneurysm. Case Report History and Examination This 65-year

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Treatment of fusiform intracranial aneurysms by circumferential wrapping with clip reinforcement

Technical note

Joshua B. Bederson, Joseph M. Zabramski, and Robert F. Spetzler

prevent ischemic deficits. 27 Reinforcement typically does not eliminate the aneurysm and is therefore associated with a high incidence of rebleeding or postoperative progression of symptoms. 8, 23 We report a modification of the traditional wrapping technique, which includes a clip-reinforced cotton sling to reduce the diameter of fusiform and atherosclerotic aneurysms while sparing important perforators. Operative Technique A schematic view of an aneurysm typically treated by this technique is depicted in Fig. 1 left . To treat such aneurysms, we use a

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Clip Slippage

Neurosurgical Forum: Letters to the Editor To The Editor C. N. Pidgeon , M.SC., F.R.C.S.I. Beaumont Hospital Dublin, Ireland 725 725 Abstract Slippage of an aneurysm clip as a result of insufficient clip-closing force cannot be predicted, even when using force-testing devices. Descriptions of intraoperative clip slippages are rarely found in the literature. The authors summarize four unusual cases in which titanium aneurysm clips slipped by a scissorslike mechanism during surgery. They analyze the possible

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Aneurysm clips

Deon F. Louw, Taro Kaibara, and Garnette R. Sutherland

. Pioneering Era The modern goal of intracranial aneurysm surgery is to isolate the thin-walled sac from the arterial flow while maintaining the normal patency of the parent artery and adjacent branches. On March 23, 1937, Walter Dandy 4 was the first person to accomplish this by applying a V-shaped, malleable silver clip to the neck of an internal carotid artery aneurysm. Dandy's paper is a fascinating account of his treatment of a 43-year-old alcoholic man who had a painful right third nerve palsy. A diagnosis of “aneurysm along the circle of Willis” was contemplated

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Aneurysm Clips

Neurosurgical Forum: Letters to the Editor To The Editor Joseph T. McFadden , M.D. Vail, Colorado 1114 1116 Abstract This communication outlines the development of aneurysm clips, from those originally used by Walter Dandy to those in use today. The history is rich, with many contributions from neurosurgical pioneers and innovators. As a result, the modern neurosurgeon has a wide selection of biocompatible aneurysm clips from which to choose, clips that have known closing pressures and various sizes and shapes