Magnetic resonance imaging and aneurysm clips

A review

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The problem of implanted metals causing tissue damage by movement in patients exposed to MRI fields has produced a confusing welter of erroneous, pseudoscientific publications about magnetics, metals, medical equipment, and tissue compatibility. Quite simply, among the devices made for implantation, only those fabricated of stainless steel have the ferromagnetic properties capable of causing such accidents. The author, who introduced the basic design of the modern aneurysm clip in the late 1960s and then a cobalt nickel alloy as an improvement over steel, while chairing the neurosurgical committee assigned to the task of establishing neurosurgical standards at American Society for Testing and Materials, exposes this flawed information and offers clear guidelines for avoiding trouble.

Abbreviations used in this paper:AANS = American Association of Neurological Surgeons; ASTM = American Society of Testing and Materials; CNS = Congress of Neurological Surgeons; MIT = Massachusetts Institute of Technology.

Article Information

Address correspondence to: Joseph T. McFadden, M.D., 513 Mowbray Arch, Norfolk, Virginia 23507. email: tedmcfadden1@me.com.

Please include this information when citing this paper: published online April 13, 2012; DOI: 10.3171/2012.1.JNS111786.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Photograph of an inexpensive electrical test clip, which could be adapted to provide a small effective artery clamp. Adapted with permission from Black SPW, German WJ: A clamp for temporarily occluding small blood vessels. J Neurosurg 11:514–515, 1954.

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    Schwartz aneurysm clip. Photograph by Robert Ander (2011) from the author's collection.

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    Mayfield stainless-steel aneurysm clip. Photograph by Robert Ander (2011) from the author's collection.

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    McFadden-Mayfield aneurysm clip. From the author's collection.

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    Scoville miniature torsion-bar aneurysm clip. Photograph by Robert Ander (2011) from the author's collection.

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    McFadden aneurysm clip. Photograph from the author's collection.

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    Photographs of a McFadden Vari-Angle aneurysm clip showing the opening brake mechanism (short arrows in A), the anti-scissor guard (long arrow in B), and holes in the spring limbs (C); the short arrows in C indicate the brake. Photographs by Robert Ander (2011) from the author's collection.

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    Aneurysm clip recovered at autopsy. Reprinted with permission from Klucznik RP, Carrier DA, Pyka R, Haid RW: Placement of a ferromagnetic intracerebral aneurysm clip in a magnetic field with a fatal outcome. Radiology 187:855–856, 1993. Radiological Society of America.

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    An array of Mayfield and Schwartz clips on multiple aneurysms. Used with permission from Hamby WB: Multiple intracranial aneurysms: aspects of treatment. J Neurosurg 16:558–563, 1959.

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    Radiographs showing a variety of aneurysm clips: Schwartz clip (A), McFadden Vari-Angle clip (B), McFadden-Mayfield clip (C), and McFadden Vari-Angle clip (D).

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    Drawing of Charrière forceps. Reprinted from Møller-Christensen V: The History of Forceps: an Investigation on the Occurrence, Evolution and Use of the Forceps From Prehistoric Times to the Present Day. Copenhagen: Levin and Munksgaard, 1938.

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    Nunneley's device (left) and Taylor's forceps (right). Reprinted from Møller-Christensen V: The History of Forceps: an Investigation on the Occurrence, Evolution and Use of the Forceps From Prehistoric Times to the Present Day. Copenhagen: Levin and Munksgaard, 1938.

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    Rendering of a Thompson-Walker penile clamp developed in the 1920s. Courtesy of Speedway Surgical Co. (http://www.speedwaydelhi.com).

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    Helical coiled spring–powered cross-action clip. Reprinted from Møller-Christensen V: The History of Forceps: an Investigation on the Occurrence, Evolution and Use of the Forceps From Prehistoric Times to the Present Day. Copenhagen: Levin and Munksgaard, 1938.

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    Hair pin. Reproduced from US Patent no. 2,888,938, Hair Clip, Inventor Joseph L. St. Hilaire, June 2, 1959.

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    Modified No. 3 safety pins used as artery clamps. From Di-Palma JR: A simple artery clip. Science 92:44, 1940. Reprinted with permission from AAAS.

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