Sutureless microvascular anastomosis using a neodymium-yag laser

A technique is described in which a Neodymium-YAG laser is used to anastomose arteries 0.8 to 1.0 mm in diameter. Heat generated by the laser causes fusion of the collagen of the media, making direct handling of the vessel wall unnecessary. Four variations of the technique were performed in 120 rat carotid arteries. Angiographic and scanning electron microscopic studies were carried out immediately after surgery and at intervals of 1 day to 6 months after anastomosis. Patency rates as high as 92.5% were recorded. The technique that produced the most secure anastomosis was considered to be one in which a vascular strut was used as an aid in apposition, followed by the application of a piece of vein wall to the anastomosis with tissue adhesive. The main advantages of the laser technique are speed and consistency. Complications such as disruption and aneurysm formation are considered to be rare.

Repair of small blood vessels with the neodymium-YAG laser: a preliminary report

A technique for repair of incisions in small blood vessels (diameter, 0.3 to 1.0 mm) in the rat is described using a Neodymium-YAG laser. It is possible to seal the incision without the use of sutures and to preserve the lumen of the vessel. The advantages of this technique over electrocoagulation and microsuture techniques are pointed out. Although the work is in preliminary stages, the technique is considered to be relatively safe, and the potential use of the application in human surgery is indicated. The possible complications of this technique are pointed out.

Asymmetry in the skull

Various linear and angular measurements were taken in 118 normal skulls of adult humans. The two halves of the skulls were found to be symmetrical. The phenomenon of asymmetry of various parts of the body, in relation to cerebral dominance and specific skills has been discussed in view of the findings of the study and in the light of the available literature.

Arteriovenous malformations of vein of Galen: microsurgical treatment

The surgical technic used at the neurosurgical clinic in Zürich in eradicating arteriovenous malformations of the vein of Galen is described. It is based on experience with nine cases. The surgical approach is made posteriorly. The right occipital lobe is retracted laterally from the falx cerebri. The multiple feeding vessels demonstrated in the angiogram are occluded; first, on the right side, then the left, and finally beneath the malformation. The draining vein of Galen is not occluded or removed. The use of the operating microscope is essential.

Microsurgical pterional approach to aneurysms of the basilar bifurcation

The authors describe a microsurgical frontolateral pterional approach to aneurysms of the basilar bifurcation. Results of surgery in 38 patients are presented.

Anatomical observations of the subarachnoid cisterns of the brain during surgery

Subarachnoid cisterns and their contents are described briefly in the light of observations made during microsurgical explorations. The concept of intracranial surgery in terms of moving from one cistern to another is presented here with particular emphasis on the cisterns in surgical approaches to intracranial vessels and nerves for the treatment of aneurysms, arteriovenous malformations, and for surgery of basal tumors.

Arteriovenous malformations of the anterior and the middle portions of the corpus callosum: microsurgical treatment

The arterio-venous malformations of the corpus callosum are distinct clinical and surgical entities. Review of literature reveals 45 documented cases of which 32 were treated surgically. The authors (M.G.Y.) had 18 such patients of which eight involved the anterior and the middle portions of the corpus callosum. (No. 8 involved the whole callosum). The patients were in the younger age group. Headache and stiffness of the neck were the common presenting features. Seizures were rare and there was a paucity of localizing neurological signs. These AVMs are supplied mainly by the pericallosal arteries and occasionally by branches of the posterior cerebral artery. The drainage is by septal veins, the inferior sagittal sinus and the superior sagittal sinus. Radical excision of these AVMs in the anterior and the middle portions of the corpus callosum was accomplished without operative mortality and with minimal morbidity. Radical removal of these anomalies with microsurgical techniques is the treatment of choice.

Anterior approach to the cervical spine

The anterior approach to surgical treatment of disorders of the cervical spine is described, and the technique and advantages are outlined. A series of 66 patients who underwent 75 procedures is reported. The follow-up period ranged from one to five years. Good to excellent results were obtained with 91% of the operations for disc disease, and good results in all cases of fracture-dislocation. Adequate relief of pain was obtained with anterolateral cordotomy in two patients with malignant disease. Only minor complications were encountered; these were easily corrected or cleared up spontaneously. This approach is recommended in preference to the posterior approach for disc disease and fracture-dislocations of the cervical spine.

Use of diazepam in carotid angiography

Diazepam (Valium) has been used in 100 patients as a sedative for cerebral angiography. No serious complications were encountered. The advantages of this drug as well as the precautions for its use are listed.

Surgery of intact intracranial aneurysms

✓ The author reports his experience with 15 cases involving intact intracranial aneurysms. The most common symptom was headache; less common symptoms were seizures and cranial nerve involvement. Twelve patients were treated surgically without any operative mortality or morbidity. Relief of headaches occurred in the eight patients in whom the aneurysm was clipped or the carotid artery was ligated in the neck. It is recommended that most intact intracranial aneurysms be treated surgically. Certain contraindications are discussed.

Diagnosis of extradural hematoma by brain scan

Brain scanning has made possible the recognition of an extradural hematoma resulting from head injury in three patients who had no lateralizing neurological signs. We recommend that, when time permits, scanning be considered as a preliminary step in diagnostic studies after head injury.

Comparison of oxygen saturation of blood in azygos vein and superior vena cava

Blood samples from the superior vena cava (SVC) are usually considered an acceptable representation of mixed systemic venous return in identifying and quantifying left-to-right atrial shunts. However, if during sampling from the SVC unrecognized entrance of the catheter into the azygos vein takes place, diagnostic errors may result. Blood samples from the azygos vein were collected from 60 children with congenital heart disease and the oxygen saturations ranged from 20% to 92%. These saturations were compared to those of samples taken from the superior vena cava above the entrance of the azygos vein. No substantial difference (saturation within ±4%) was found in 24 patients, while 28 patients had a significantly higher saturation in the azygos vein (from +5% to +21%) and eight patients had a lower saturation (from –5% to –16%). A significant left-to-right shunt may be overlooked or erroneously thought to be present when sampling of blood takes place unknowingly from the azygos vein. Examples are presented.

Approaching from the groin it was possible to catheterize the azygos vein in two thirds of the cases when a deliberate attempt was made to do so.