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Thoralf M. Sundt Jr. and George Kees Jr.

worsening the neurological deficit. It is often necessary to occlude a small perforating vessel in a limited space with a small aneurysm clip. The length of the smallest aneurysm clip currently available approximates 9 mm. This is far too large a clip to place in the depth of the wound as it obscures other bleeding points and interferes with the remaining portion of the procedure. To solve this problem, we have designed a miniclip and a microclip for use in these situations. Design and Use of Clips The miniclip is approximately 3 mm in length and is constructed of

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Brian T. Andrews, Arthur Lutz, Joshua B. Bederson and Lawrence H. Pitts

A number of microvascular clips for both temporary 1, 2 and permanent 3 occlusion of blood vessels have been described, but none appears to be appropriate for blood vessels smaller than 800 µ in diameter. We recently developed an easily constructed cross-lock microvascular clip that provides reliable, reversible occlusion of blood vessels 300 µ to 1 mm in diameter. Description of Clip The microclip is made of Type 302 stainless steel spring wire 0.28 mm (0.011 in.) in diameter. The clip is approximately 6.0 mm (0.240 in.) long and 2.5 mm (0

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Ralph G. Dacey Jr., Gregory J. Zipfel, William W. Ashley, Michael R. Chicoine and Michael Reinert

nearly simultaneously making an arteriotomy and inserting 13 microclips circumferentially into the graft and recipient vessel. The device creates a compliant (nonrunning suture) anastomosis and provides a systems-based approach to the problem of technically inconsistent anastomoses. We report here the first description of the use of this device for creation of a high-flow EC–IC arterial bypass in a patient with a traumatic pseudoaneurysm of the proximal intracranial ICA. Illustrative Case History and Examination This 43-year-old righthanded man was

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Neurosurgical Forum: Letters to the editor To The Editor Milton D. Heifetz , M.D. Beverly Hills, California 844 845 The excellent article by Dr. Dujovny and colleagues was well thought out, comparing the endothelial damage associated with the use of different microclips. Unfortunately, the Heifetz clip that was used in this study was not the Heifetz microclip, but was a small aneurysm clip which should not be used as a microclip. This has been confirmed by telephone conversation with Dr. Dujovny. The

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Neurosurgical Forum: Letters to the editor To The Editor Raymond J. Powers Edward Weck & Company Inc. Research Triangle Park, North Carolina 844 845 We read with great interest the study by Dr. Dujovny and colleagues (Dujovny M, Osgood CP, Barrionuevo PJ, et al: SEM evaluation of endothelial damage following temporary middle cerebral artery occlusion in dogs. J Neurosurg 48: 42–47, January, 1978) on endothelial damage as the result of application of microclips. This sort of detailed and painstaking study can

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Ryszard Mrówka and Andrzej Frydrych

T he success of microvascular anastomosis depends on perfect hemostasis and stabilization of the vessels to be joined. Hemostasis is achieved by different types of temporary microclips, such as the Yaşargil, Stevenson, and Acland microclips. 5 Stabilization, however, is technically more difficult to obtain, and this problem has not yet been solved completely. It can be achieved to a certain degree by the use of an internal splint, in the form of a Silastic tube inserted into the lumen of the vessels being joined. 2, 4, 5 Special-purpose clamps are also in

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Manuel Dujovny, Carroll P. Osgood, Pedro J. Barrionuevo, Alfred Perlin and Nir Kossovsky

T he commercially available microclips currently used for temporary occlusion of small arteries are simply miniature versions of cerebral aneurysm clips. They were originally designed for permanent placement, and inflict considerable endothelial damage when applied temporarily to small arteries. Materials and Methods This study included 150 mongrel dogs weighing between 15 and 25 kg, divided into acute and chronic groups. The acute animals were divided into six subgroups of 20 each, while the chronic animals were divided into six subgroups of five each

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malformation containing NBCA can easily be transected using standard microsurgical techniques, frequently reducing the need for microclips during AVM resection. The NBCA-Pantopaque mixture is easily compressible and does not impede excision or increase the amount of parenchymal retraction. On the other hand, it is our opinion that microcoils may contribute to difficulties in clip application and transection. The potential for mutagenesis and toxicity following embolization remains an unanswered question. However, cyanoacrylates have been used in medical practice for up to

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Toshiki Yoshimine and Takehiko Yanagihara

revealed a vein on the surface of the cerebral peduncle posteriorly, the ICA inferiorly, and the PCoA at the center ( Fig. 3 left ). In many animals, the anterior choroidal artery originated from the ICA at a location distal to the origin of the PCoA; however, it sometimes originated from the ICA together with the PCoA, or branched directly from the PCoA. After the proximal part of the PCoA was freed from surrounding arachnoid membranes, the PCoA was electrocoagulated and divided. (Instead of electrocoagulation, a micro-clip can be applied for investigation of the post

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Argon laser-induced arterial photothrombosis

Characterization and possible application to therapy of arteriovenous malformations

Brant D. Watson, W. Dalton Dietrich, Ricardo Prado and Myron D. Ginsberg

O cclusion of vessels supplying an arteriovenous malformation (AVM), 16 especially the small, delicate high-flow feeder vessels on the under-surface of the nidus, 25 remains challenging. Permanent mechanical occlusion of these thin-walled vessels by recently developed microclips 2, 22 has been proposed as an alternative to bipolar coagulation under water, but their utilization nonetheless requires considerable skill and experience in order to avoid the induction of hemorrhage and damage to adjacent tissue. More commonly, transvascular embolization 11 is