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Paul Weiss

without risk of rupture of the link, is a major factor in the success of the ensuing regeneration process. A gap of several millimeters between the nerve ends has been found quite acceptable. The maximum tolerable length compatible with good regeneration remains to be determined. Where force becomes necessary to bring the nerve ends within range, it should not be applied at the ends or within the sleeve, but at more remote levels; for instance, by a sling stitch of tantalum wire looped through both stumps well above and below the sleeve region. This loop should take

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P. E. Wiklund

, with checks of the blood values, electrocardiograms, urine tests, etc. INDICATIONS From the present series one may distinguish three main indications for controlled hypotension at intracranial operations. (1) Arterial aneurysms In such cases the blood pressure is not reduced until the surgeon approaches the aneurysm, and at its exposure and ligation. With a fall in blood pressure the tension in the aneurysmal sac decreases and the risk of rupture is substantially lessened. Exposure can be done more readily, and if the aneurysm should rupture, the

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Gösta Norlén and Alec S. Barnum

a thread 30 ( Fig. 6 ) is the procedure of choice, although naturally with an aneurysm firmly bound by adhesions this is more hazardous than packing about the sac with muscle and/or gelfoam, and the latter procedure may be the more prudent in some cases. The objection has been raised that dissection of the neck of the aneurysm carries a great risk of rupture during the procedure. This occurred in 2 of our 22 cases of intracranial operation and both patients survived. We have found the use of controlled hypotension by hexamethonium compounds of extreme value in

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Kenneth G. Jamieson

of spontaneous subarachnoid haemorrhage has largely been settled. The great importance of the information so to be gained, without which surgical treatment cannot be planned, considerably outweighs the risk of rupture of an aneurysm by the injections. Indeed, this risk has seemed rather remote. In the present instance there is a clear demonstration of such an occurrence. In Fig. 1 the aneurysm is intact and in Fig. 2 it has ruptured, while the onset of headache was during the last injection. The fountain of dye seen spurting from the aneurysm well illustrates

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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

it has been thought necessary to take the thread behind the carotid artery twice in order to catch the aneurysmal stalk in the loop. With this technique even aneurysms scarcely visible behind the carotid artery can be ligated. If the stalk lies fairly close to the carotid bifurcation the thread sometimes has to be conveyed first behind the carotid artery and then, on its way back, behind the anterior and middle cerebral arteries before the stalk can be caught. In order to reduce the risk of rupture attempts have been made not to mobilize the aneurysmal sac itself

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Albert W. Cook, Donald M. Dooley and E. Jefferson Browder

anticipated or prevented in the future. The procedure itself can be carried out rather simply. Hypothermia is not required. Amputation of part of the frontal lobe is not necessary if hyperventilation anesthetic technique and/or spinal fluid drainage is employed. The aneurysmal sac itself should not be dissected. At times it may seem as if a neck of the aneurysmal sac could easily be isolated but this must not be done. It is during dissection of the sac that the risk of rupture, with potential increase in mortality and morbidity, is greatest. Moreover, a frequent finding

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J. R. Youmans, G. W. Kindt and O. C. Mitchell

thrombosis or cerebral infraction, the raising of the blood pressure to force more blood through the intracranial and extracranial collateral circulation may be considered. 5, 9 Of course, the risk of rupture of the aneurysm would have to be balanced against the risk of thrombosis or infarction if an inadequate cerebral blood flow persists. The findings of this study suggest that the quite labile cerebral blood flow pattern exists only for the first 48 to 72 hours following common carotid ligation. If an adequate cerebral blood flow can be maintained during this period

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Charles G. Drake

into the interpeduncular cistern above and behind the dorsum sellae. We have found that two surgical adjuncts, magnification of vision and profound hypotension under normothermia, are important for safe exposure and occlusion of any aneurysms. These surgical aids seem even more indispensable for basilar aneurysms since the confining nature of the exposure makes it imperative that the investments and connections of the aneurysm be seen clearly and the clip or ligature applied accurately with minimal risk of rupture. Rupture of a basilar aneurysm before completion of

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J. Bonnal and A. Stevenaert

aneurysm under tension. While the carotid artery was occluded for 4 min 30 sec with a Mayfield clip, the neck was ligated without risk of rupture. Fig. 2. Case 2. Left angiography before operation ( top left and right ), 10 days after operation ( bottom left ), and 3 months after operation ( bottom right ). Transient postoperative hemiplegia and aphasia disappeared a few days later except for very slight right hemiparesis. Ten days after the operation, angiography showed the persistence of the aneurysm with a narrowed neck, angiospasm of the carotid artery

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Influencing Mortality in Intracranial Aneurysm Surgery: Analysis of 186 Consecutive Cases Ronald L. Paul James G. Arnold Jr. March 1970 32 3 289 294 10.3171/jns.1970.32.3.0289 Risk of Rupture of a Second Aneurysm in Patients With Multiple Aneurysms Olli Heiskanen Irja Marttila March 1970 32 3 295 299 10.3171/jns.1970.32.3.0295 Classification of Anterior Communicating Aneurysms as a Basis for Surgical Approach Gary D. Vanderark Ludwig C. Kempe March 1970 32 3 300 303 10.3171/jns.1970.32.3.0300 Cerebral Hemodynamics and Metabolism Following Experimental