Download Cerebral Aneurysms: Advances in Diagnosis and Therapy by F. John Gillingham (auth.), Professor Dr. Dr. h.c. Hans PDF

By F. John Gillingham (auth.), Professor Dr. Dr. h.c. Hans Werner Pia, Dr. Charles Langmaid, Dr. Jan Zierski (eds.)

Microsurgery has led to very important alterations and growth within the therapy of cere­ bral aneurysms in recent times. purely 12 years in the past McKissock, probably the most skilled surgeons within the therapy of aneurysms pompared the result of operative and nonoperative therapy. He discovered that mortality and morbidity of cerebral aneurysms used to be no longer considerably plagued by even if the sufferers were operated upon or no longer. This view is held by way of many neursurgeons, and was once proven through result of the Co-operative examine in 1969. within the overview on remedy of aneurysms in growth in Neurological surgical procedure in 1969, ideas comparable to encasement with plastic compounds, piloinjection, stereotactic copper or electrical thrombosis and metal thrombosis and profound hypothermia in anaesthesia have been indexed. usually, those innovations now appear to be of little greater than historic curiosity. growth in contemporary yeats has been so huge, immense that one might achieve the influence that the most difficulties within the therapy of aneurysms were solved and that there are not any extra to be surmounted. this is often harmful and complacent considering, equivalent to Lord Moynihan indulged in through the thirties. hence we concept that the time had come to gather a bunch of specialists who may speak about a number 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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A. a. 10 + 30 I. I - + '* + + 35 Fig. 5. A ruptured aneurysm of anterior communicating artery, 6 2-year-old ~emale (case 29). Size 15 mm in diameter. Group B case without rerupture. ' the new protective layer extends from the original aneurysmal wall. Elastica Masson stam x 3. A aneurysm; NW new wall; truptured point ture. We investigated the histological findings of unruptured and ruptured aneurysms with stress on the clinical history. g. congenital, acquisition and combination theories have been debated.

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. 5). The degenerative processes seemed not to differ from those generally seen in atheromatosis of the basal vessels of the brain. Only remnants of the internal elastic lamina and smooth-muscle cells were found.

A. a. a. + 12 38 M ea I. a. b r. a. a. - - - Case Age Sex AN. Site of AN. Surgery No. No. 13 44 M eb I. a. c I. a. + 14 50 F ea I. a. eb I. a. r. a. a. eb I. a. &C r. a. 16 61 F ea I. a. a. &c r. a. 17 58 F ea r. a. a. 18 40 F & r. a. a. a. 21 47 M & I. a. a. a. 24 51 F & I. a. a. a. 27 40 M & I. a. a. a. 30 40 F & I. a. 31 77 F & r. a. a. 33 37 F & a. a. a. : middle cerebral artery e. a. : left r. a. : anterior cerebral artery Ruptured Aneurysms The size of the aneurysms was also measured. According to their case histories, the ruptured cases were classified into two groups: group A, cases that were fatal within 3 weeks after the initial haemorrhage; group B, cases that survived longer than 3 weeks after the initial haemorrhage.

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