By F. John Gillingham (auth.), Professor Dr. Dr. h.c. Hans Werner Pia, Dr. Charles Langmaid, Dr. Jan Zierski (eds.)
Microsurgery has caused very important adjustments and growth within the remedy of cere bral aneurysms in recent times. purely 12 years in the past McKissock, the most skilled surgeons within the therapy of aneurysms pompared the result of operative and nonoperative therapy. He came across that mortality and morbidity of cerebral aneurysms used to be no longer considerably laid low with even if the sufferers were operated upon or no longer. This view is held via many neursurgeons, and used to be proven by way of result of the Co-operative learn in 1969. within the evaluate on therapy of aneurysms in growth in Neurological surgical procedure in 1969, strategies equivalent to encasement with plastic compounds, piloinjection, stereotactic copper or electrical thrombosis and metal thrombosis and profound hypothermia in anaesthesia have been indexed. normally, those strategies now appear to be of little greater than old curiosity. growth in contemporary yeats has been so huge, immense that one may well achieve the impact that the most difficulties within the remedy of aneurysms were solved and that there are not any extra to be surmounted. this is often risky and complacent pondering, resembling Lord Moynihan indulged in in the course of the thirties. hence we proposal that the time had come to gather a bunch of specialists who may well talk about some of the unsolved and contro versial difficulties of aneurysm surgical procedure within the pleasant and cozy surroundings of a "work shop".
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Extra resources for Cerebral Aneurysms: Advances in Diagnosis and Therapy
Continuous ventricle drainage was performed to control intracranial pressure. Recurrent haemorrhage occurred four times during 15 days after the initial haemorrhage, and the patient died on the 17th day. Histologically, thrombus and a newly formed protective layer was identified at the rupture point. In this case, new haemorrhage was believed to have occurred through the protective layer. Indian ink perfusion examination revealed that the haemorrhage had occurred through the protective layer and bled outwardly (Fig.
At high magnification, the calcium had a coral-like structure (Fig. 4). On histologic analysis, fat-staining masses were situated deeply subintimally: they appeared as either round bodies or continuous masses between thin intimal and adventitial layers. The atheromatous masses generally bore a morphologic resemblance to the calcifications seen in microradiography. Aneurysmal rupture was present at sites near degenerative atheromatous or atherosclerotic changes. At the microscopic level lipid inftltration as well as calcium were found within the various layers of the aneurysmal walls (Fig.
A secondary evagination at that point may have been smoothed out and an atheromatous plaque, detached as a consequence of circulatory conditions. Seen through the surgical microscope, such a point generally is somewhat darker and bluish or reddish in colour. From the surgical point of view, in order to avoid preoperative rupture it always seems preferable to leave such a weak point untouched and to try to reach the neck directly with the clip, within freeing the aneurysm as a whole. If anatomical circumstances are such that a clip is to be placed over a part of the aneurysm where a secondary evagination is seen in the microscope, it is always safer to try to wrap that part (Fig.