Aneurysm Surgery:Past, Present and Future

Mario Zuccarello, M.D.University of Cincinnati,

Dept of NeurosurgeryMayfield Clinic

John Hunter(1728-1793)

HUNTERIAN LIGATION

Hunterian Ligation

461 patients with ICA ligation Mortality rate 20.7% Stroke rate 30%

Sahs, Perret, &Locksley, 1969

Egas Moniz(1874-1955)

1ST CEREBRAL ANGIOGRAPHY IN 1927

Harvey Cushing(1869-1939)

SILVER CLIP

Walter Dandy(1886-1946)

1ST CLIP ON ICA ANEURYSM

History of Aneurysm Clips

Aneurysm Surgery: Past

Dandy “ clipping of aneurysms is hopeless”

As late as the 1960s mean mortality 28.7%

Merritt in 1963 advised surgery only for aneurysms with large associated hematomas

Mayfield Connection

The problem “How to clip a large basilar

bifurcation aneurysm with a fragile neck and an adherent P1 segment” . . . Drake

“We need a different clip”

Mayfield Connection

1969 development of the fenestrated clip

The Cincinnati Post, March 28, 1970

Del Maestro, J Neurosurg 92, 2000

Proc Neurol Surg 9, 1978

Youmans 2, 1973

M. Gazi Yasargil(1925- )

OPERATING MICROSCOPE

MODERN CLIPS

Modern Clips