Treatment of aneurysms with wires and electricity. A historical overview

History of Neurointervention

In this review article, we aim to provide a summary of the discoveries and developments that were instrumental in the evolution of the Neurointerventional field. We begin with developments in the advent of Diagnostic Cerebral Angiography and progress to cerebral aneurysm treatment, embolization in AVMs and ischemic stroke treatment. In the process we discuss many persons who were key in the development and maturation of the field. A pivotal aspect to rapid growth in the field has been the multidisciplinary involvement of the different neuroscience specialties and therefore we close out our discussion with excitement about ongoing and future developments in the field with a focus on treatments in the non-cerebrovascular disease realm.

Charles Hewitt Moore, FRCS (1821-1870): Medical innovator

Charles Hewitt Moore, a Fellow of the Royal Society of Medicine, practiced at Middlesex and St. Luke's Hospitals and was administratively active in The Medical and Chirurgical Society. From 1851 to 1868, he demonstrated expertise in general surgery and the lymphatic system; on pelvic deformity and disease; on the vascular system and aneurisms; on the etiology of cancer; and on the neurophysiology of sleep. He subscribed to two principles of medical investigation: anomalies can reveal new information; and the propagation of untested theory inhibited medical learning and practice. Translator of the German edition of Rokitansky's Handbook (vol. 3, 1851), Moore wrote twelve papers, three chapters for Holmes' System of Surgery (1860-1862), and two treatises. Renowned in vascular and cancer surgery, he combined ablation with ZnCl₂ against cutaneous and breast cancer. Theorizing that ganglionic nerve tissue was involved in the sleep cycle, he anticipated modern investigations into the sleep-related activity of basal ganglia, the only nerve tissue of that kind in the brain.

Endovascular aneurysm repair: a perioperative perspective

Endovascular aneurysm repair (EVAR), has surpassed open repair as the technique of choice in many centres in response to several large studies which showed significantly improved 30-day mortality. While several multicentre EVAR trials looked at surgical outcomes, very few have specifically investigated the effect of anaesthetic techniques or perioperative care of these patients. The purpose of this review to is to present some of the current evidence for the different aspects of perioperative management of patients undergoing EVAR. This includes surgical considerations, pre-operative assessment, and choice of anaesthetic technique as well as pharmacological protective strategies.

Aortic surgery: a historical perspective

Aortic aneurysms have been recognized since at least the 2nd century. However, little progress in their treatment was made until the early 1800s, when surgical ligation of these lesions sometimes proved successful. Until the mid 20th century, the most widespread approach was indirect treatment to provide palliation and prevent rupture. Such treatment involved introducing foreign materials into the aneurysm to promote blood coagulation or wrapping the aneurysm with plastic film to stimulate periarterial fibrosis. In 1888, Rudolph Matas introduced endoaneurysmorrhaphy, in which the diseased portion of the aorta was removed and a tunnel was constructed through the remaining healthy portion. This approach was widely used until the 1950s, when the advent of synthetic grafts allowed modern, direct repair. Emphasis began to be placed on excising aortic aneurysms and restoring pulsatile distal flow. In the 1980s, however, most surgeons reverted to the endoaneurysmorrhaphy technique-this time relining rather than removing the diseased portion of the aorta-thus bringing the history of aortic aneurysm surgery full circle. Today, an increasing number of aortic repairs are being achieved with endovascular methods, which offer new hope to patients at high risk for traditional aortic surgery.