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Lee PH, Hsu HJ, Tien CH, Huang CC, Huang CY, Chen HF, Yeh ML, Lee JS. Characterizing the Impact of Compression Duration and Deformation-Related Loss of Closure Force on Clip-Induced Spinal Cord Injury in Rats. Neurol Int 2023; 15:1383-1392. [PMID: 37987461 PMCID: PMC10661265 DOI: 10.3390/neurolint15040088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 11/05/2023] [Accepted: 11/08/2023] [Indexed: 11/22/2023] Open
Abstract
The clip-induced spinal cord injury (SCI) rat model is pivotal in preclinical SCI research. However, the literature exhibits variability in compression duration and limited attention to clip deformation-related loss of closure force. We aimed to investigate the impact of compression duration on SCI severity and the influence of clip deformation on closure force. Rats received T10-level clip-induced SCI with durations of 1, 5, 10, 20, and 30 s, and a separate group underwent T10 transection. Outcomes included functional, histological, electrophysiological assessments, and inflammatory cytokine analysis. A tactile pressure mapping system quantified clip closure force after open-close cycles. Our results showed a positive correlation between compression duration and the severity of functional, histological, and electrophysiological deficits. Remarkably, even a brief 1-s compression caused significant deficits comparable to moderate-to-severe SCI. SSEP waveforms were abolished with durations over 20 s. Decreased clip closure force appeared after five open-close cycles. This study offers critical insights into regulating SCI severity in rat models, aiding researchers. Understanding compression duration and clip fatigue is essential for experiment design and interpretation using the clip-induced SCI model.
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Affiliation(s)
- Po-Hsuan Lee
- Division of Neurosurgery, Department of Surgery, National Cheng Kung University Hospital, Tainan 701, Taiwan; (P.-H.L.); (C.-H.T.); (C.-C.H.); (C.-Y.H.)
| | - Heng-Juei Hsu
- Department of Neurosurgery, Tainan Municipal Hospital, Tainan 701, Taiwan;
| | - Chih-Hao Tien
- Division of Neurosurgery, Department of Surgery, National Cheng Kung University Hospital, Tainan 701, Taiwan; (P.-H.L.); (C.-H.T.); (C.-C.H.); (C.-Y.H.)
| | - Chi-Chen Huang
- Division of Neurosurgery, Department of Surgery, National Cheng Kung University Hospital, Tainan 701, Taiwan; (P.-H.L.); (C.-H.T.); (C.-C.H.); (C.-Y.H.)
| | - Chih-Yuan Huang
- Division of Neurosurgery, Department of Surgery, National Cheng Kung University Hospital, Tainan 701, Taiwan; (P.-H.L.); (C.-H.T.); (C.-C.H.); (C.-Y.H.)
| | - Hui-Fang Chen
- Department of Cell Biology and Anatomy, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan;
| | - Ming-Long Yeh
- Department of Biomedical Engineering, National Cheng Kung University, Tainan 701, Taiwan;
- Medical Device Innovation Center, National Cheng Kung University, Tainan 701, Taiwan
| | - Jung-Shun Lee
- Division of Neurosurgery, Department of Surgery, National Cheng Kung University Hospital, Tainan 701, Taiwan; (P.-H.L.); (C.-H.T.); (C.-C.H.); (C.-Y.H.)
- Department of Cell Biology and Anatomy, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan;
- Institute of Basic Medical Sciences, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan
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Córdova JSZ, Demichelis ME, Valeria F, Garavaglia G, Chaddad F, Rangel CC, Ordóñez-Granja J, Campero A, Marín G, Baldoncini M. Histological changes of vascular clipping in Wistar rats. Surg Neurol Int 2022; 13:561. [PMID: 36600772 PMCID: PMC9805646 DOI: 10.25259/sni_1022_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 11/17/2022] [Indexed: 12/04/2022] Open
Abstract
Background During aneurysm microsurgery, the aneurysmal sac is excluded from circulation by placing one or more clips at the base of the aneurysm. In some cases of complex aneurysms or subarachnoid hemorrhage history, transient clipping before definitive clipping is necessary. The closing force of the transient clip is less than the permanent clip; however, it is sufficient to stop circulation to the aneurysmal sac. The aim of the following work is to analyze and describe histological changes caused by transient and permanent clipping of the abdominal aorta in Wistar-type rats, to study the correlation between the closing force of the clip and the time, it remains on the vascular tissue structures. Methods Six groups were formed, with 10 rats each, whereby temporary clipping of the abdominal aorta was performed with subsequent sampling of the site where the vascular clip was placed. The groups were: control and temporary clipping with: 2, 5, 10, and 15 and permanent clipping with 5 min. Results Resection samples of the 3 μm thick aorta were obtained through the routine histological technique and special histochemical techniques (Masson's Trichrome and orcein) from the six groups. Transmural changes were found from Group II-VI. Conclusion There is a vascular histological effect after both transient and permanent clipping. The sum of time and strength of the clip induce vascular changes visible at 5 min.
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Affiliation(s)
| | | | - Forlizzi Valeria
- Laboratory of Microsurgical Neuroanatomy, Second Chair of Gross Anatomy, School of Medicine, University of Buenos Aires, Buenos Aires
| | - Gustavo Garavaglia
- Department of Pathology of the Faculty of Medicine, Buenos Aires University, Buenos Aires, Argentina
| | - Feres Chaddad
- Department of Neurosurgery, Sao Paulo Federal University, Sao Paulo, Brazil
| | | | | | - Alvaro Campero
- Department of Neurosurgery, Hospital Padilla de Tucuman, San Miguel de Tucuman, Argentina
| | - Gerardo Marín
- Neural Dynamics and Modulation Lab, Cleveland Clinic, Ohio, United States,,Corresponding author: Gerardo Marín, Neural Dynamics and Modulation Lab, Cleveland Clinic, Ohio, United States.
| | - Matias Baldoncini
- Laboratory of Microsurgical Neuroanatomy, Second Chair of Gross Anatomy, University of Buenos Aires, Buenos Aires, Argentina
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Use of a microsurgical vascular clip system for temporary bilateral occlusion of the four main uterine vessels for laparoscopic enucleation of very large intramural uterine fibroids. Arch Gynecol Obstet 2022; 306:1597-1605. [PMID: 35882651 PMCID: PMC9519638 DOI: 10.1007/s00404-022-06675-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 06/14/2022] [Indexed: 11/18/2022]
Abstract
Objectives The goal of this study was to examine the safety, feasibility, and effectiveness of the use of a microsurgical temporary vascular clip system to facilitate the laparoscopic enucleation of very large intramural uterine fibroids. Methods In this retrospective study, the surgical outcomes of 26 patients who underwent laparoscopic myomectomy with temporary uterine vessel clipping for very large (the largest measured diameter ≥ 9 cm) symptomatic intramural uterine fibroids in two tertiary referral hospitals between September 2017 and March 2020 were examined. Titan-made vascular clips (YASARGIL® Aneurysm Clip System) were used to temporarily occlude the bilateral uterine arteries and utero-ovarian vessels. Main outcomes included operating time, blood loss, number of leiomyomas and weight, conversion rate, intra- and postoperative complication rates, and length of hospital stay. Results Twenty six patients were included. Dominant intramural uterine fibroid diameters were 9–22 cm. The general characteristics of the patients were similar. The mean surgery duration and intraoperative blood loss were 175.3 ± 32.7 (range 120–250) min and 241.1 ± 103 (range 100–450) ml, respectively. The median postoperative drop in hemoglobin was 0.89 ± 0.75 g/dL. No patient required blood transfusion. No procedure was converted to laparotomy. No major intra- or postoperative complication occurred. Conclusions Laparoscopic myomectomy for very large intramural uterine fibroids can be performed safely and effectively, with less intraoperative blood loss, using vascular clips for temporary clamping of the bilateral uterine vessels.
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Valoración de la lesión vascular tras la aplicación de métodos extraluminales de oclusión temporal. ANGIOLOGIA 2014. [DOI: 10.1016/j.angio.2014.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Abstract
This study was designed to evaluate microvascular clip potential for causing changes in vessel-wall tissue and the extent to which this potential is influenced by features of the clip. Light and scanning electron microscopy were used to examine vessel-wall changes after temporary clip occlusion. Vessel patency is shown to be influenced by anastomosis and clip site, changes in occlusion force due to material fatigue are described, and novel clip features to reduce vessel trauma are proposed. Evaluation of mechanical clip properties showed that material fatigue does not lead to relevant loss of precision in alpha-type clips. While the modified clip designed to reduce trauma cannot abolish trauma altogether, it significantly reduces the associated changes and hence the risk of thrombosis. Arteries were more sensitive than veins to clip-induced trauma, with increased occlusion force producing more severe damage than increased clipping time. Maximal changes were seen in the tunica media. These results indicate the paramount importance of applying modest clip pressure commensurate with the requirements of microvascular Surgery.
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Affiliation(s)
- Thomas S Kühnel
- Department of Otorhinolaryngology, University of Regensburg, Regensburg, Germany.
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6
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Toyota BD, Ferguson GG. Basilar artery dissection: an early postoperative complication of aneurysm clipping. Case report. J Neurosurg 1994; 81:139-42. [PMID: 8207518 DOI: 10.3171/jns.1994.81.1.0139] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Recurrent subarachnoid hemorrhage (SAH) in the early period following successful clipping of a cerebral aneurysm is unusual. The authors report a unique case of distal basilar artery dissection and fatal SAH on the 6th day postoperatively. It is concluded that this complication was related to vascular trauma inflicted by repositioning the aneurysm clips during a seemingly uneventful procedure for a basilar artery tip aneurysm.
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Affiliation(s)
- B D Toyota
- Division of Neurosurgery, University Hospital, London, Ontario, Canada
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Charbel FT, Ausman JI, Diaz FG, Malik GM, Dujovny M, Sanders J. Temporary clipping in aneurysm surgery: technique and results. SURGICAL NEUROLOGY 1991; 36:83-90. [PMID: 1891760 DOI: 10.1016/0090-3019(91)90223-v] [Citation(s) in RCA: 71] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The use of temporary clipping has become an established tool in the armamentarium of the aneurysm surgeon. Our experience with 62 consecutive patients is presented, detailing operative protocols and results. Twenty-two had unruptured aneurysms (35%), 15 were grade I (24%), 16 grade II (25%), five grade III (8%), and four grade IV (7%). The aneurysms were mainly located in the middle cerebral artery (29 patients) and the anterior communicating artery (13 patients). Eleven of our 62 patients (17%) developed a new, persistent postoperative deficit. However, in only one case (2%) was temporary clipping felt to be implicated in the development of the deficit. In three other patients (5%), the effect of temporary clipping, although unlikely, could not be excluded. Overall, 92% of our patients with temporary clipping had good to excellent outcome, with 3% mortality and 5% morbidity. We believe that temporary clipping is a safe procedure that contributes significantly to a better outcome.
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Affiliation(s)
- F T Charbel
- Henry Ford Neurosurgical Institute, Detroit, Michigan 48202
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Pabst TS3rd, Flanigan DP, Buchbinder D. Reduced intimal injury to canine arteries with controlled application of vessel loops. J Surg Res 1989; 47:235-41. [PMID: 2770280 DOI: 10.1016/0022-4804(89)90113-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Arterial intimal damage caused by elastic vessel loops was quantitated to determine (1) if they produce intimal injury, (2) if the injury is proportional to the force applied, and (3) if the injury is less than that produced by vascular clamps. Vessel loops were wrapped around 30 canine artery segments (5 mm in diameter) and a gram scale was connected to each to measure the force applied. The minimal occlusive force (MOF) and 150, 200, and 250 g force were applied for 30 min. For comparison, a Fogarty vascular clamp was applied at MOF for 30 min. Arteries were then reperfused for 30 min. Half was immediately harvested (group I); the remaining half was harvested at 2 weeks (group II). Scanning electron micrographs were made of each artery's intimal surface and graded from 0 (no injury) to 5 (severe intimal fracture). Mean injury grades were calculated. The MOF for vessel loops was 99 g. In group I, arteries subjected to less than 200 g force had a mean injury grade of 1.0 +/- 0.4; while those exposed to 200-250 g force had an injury grade of 3.5 +/- 0.7. The severity of injury was linearly correlated with the force applied (r = 0.72, P less than 0.009). In group II, the injury grade of 0.4 +/- 0.5 in arteries at MOF was significantly less than the injury grade of 2.8 +/- 0.5 in those at 200-250 g force, (P less than 0.0005). Injury grades of 3.7 and 3 were seen in groups I and II, respectively, when Fogarty clamps were applied. We conclude that vessel loops applied at MOF produce minimal injury. At greater occlusive forces, the injury is proportional to the force applied approaching that of a Fogarty clamp. Intimal injuries may be minimized when vessel loops are applied at MOF.
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Affiliation(s)
- Pabst TS3rd
- Department of Surgery, University of Illinois, College of Medicine, Chicago 60064
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Ausman JI, Diaz FG, Malik GM, Fielding AS, Son CS. Current management of cerebral aneurysms: is it based on facts or myths? SURGICAL NEUROLOGY 1985; 24:625-35. [PMID: 4060041 DOI: 10.1016/0090-3019(85)90120-x] [Citation(s) in RCA: 64] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The overall morbidity and mortality from aneurysmal subarachnoid hemorrhage have not changed significantly over the past 30 years in spite of great progress in surgical technology and diagnostic capabilities. Most series report major morbidity and mortality figures of approximately 60%. The reason for the currently poor prognosis is due, in part, to the sometimes devastating effect of the initial hemorrhage over which we have no control. Another reason for our inability to improve these dismal statistics may be that the currently accepted treatment regimens have proven to be ineffective. Eighteen misconceptions or "myths" surrounding the treatment of aneurysmal subarachnoid hemorrhage have been identified as factors that have largely determined the currently accepted, ineffective treatment protocols, and these are discussed.
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Smahel J, Laszczower M. New disposable microvascular clamp. Microsurgery 1985; 6:129-31. [PMID: 4021787 DOI: 10.1002/micr.1920060215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
A new design for a plastic microvascular clamp is described. The clamp consists of two flat blades, with eyes permitting application and removal of the clamp with cross-forceps. Closure is effected by the elasticity of a rubber ring placed around the blades, obviating the need for an articular joint or a spring mechanism. The new design simplifies production of the clamp, which is intended to be disposable, i.e., for once-only use.
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Dujovny M, Kossovsky N, Kossowsky R, Perlin A, Fernandez Gatti E, Segal R, Diaz FG. Mechanical and metallurgical properties of vascular clips designed for temporary use. Microsurgery 1983; 4:124-33. [PMID: 6669006 DOI: 10.1002/micr.1920040211] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Six commonly used surgical clips (Kleinert-Kutz, Pivot, Vari-Angle, Yasargil, Biemer, and Acland) that have been designated by their manufacturer as being suitable for temporary occlusion were studied in terms of their mechanical and metallurgical properties. Opening and closing forces were determined for all of the clips. Significant variations in clip force with respect to blade gap were found in all of the pivot-type clips. Metallurgical testing showed that all six clips exhibited properties that contraindicate long-term implantation.
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