Principles and Ergonomics of Direct Aneurysm Surgery

  • Robert R. Smith
  • Yuri N. Zubkov
  • Yahgoub Tarassoli


With the operating microscope, in the 1960s came a powerful, unobstructed light source and magnified anatomy. Shortly following this development, delicate and fine dissectors, forceps and scissors became available. Aneurysm clips were gradually modified to accommodate and make best use of this new technology. Direct microsurgical clipping by craniotomy has become the most commonly applied procedure for managing an intracranial aneurysm and is currently available to virtually every aneurysm surgeon. Because of the many variations in aneurysm size, shape, and location, and peculiarities in anatomy of accompanying vessels, each operation must remain highly individualized. This chapter describes those procedures that must be used to achieve a successful outcome in a patient harboring an intracranial aneurysm and the auxiliary therapy required to accomplish this to its best advantage.


Intracranial Aneurysm Posterior Inferior Cerebellar Artery Parent Artery Bone Flap Sylvian Fissure 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Traeger SM, Hemning RJ, Dobkin W, Gianotta S, Weirl MH, Weiss M. Hemodynamic effects of pentobarbital therapy for intracranial hypertension. Crit Care Med. 1983;11:697–701.PubMedCrossRefGoogle Scholar
  2. 2.
    Cottrell JE, Robustelli A, Post K, Turndorf H. Furosemide and mannitol-induced changes in ICP and serum osmola-rity and electrolytes. Anesthesiology. 1977;47:28–30.PubMedCrossRefGoogle Scholar
  3. 3.
    Dandy WE. Intracranial Arterial Aneurysms. New York: Comstock; 1944, reprinted 1969.Google Scholar
  4. 4.
    Kaplan HA. Results of obliteration of specific cerebral veins and dural venous sinuses: animal and human studies. In: Kapp JP, ed. The Cerebral Venous System and its Disorders. Boca Raton, FL: Grune and Stratton Inc; 1984:275–282.Google Scholar
  5. 5.
    Dujovny M, Kossovsky N, Perlin A, Segal R, Diaz F, Ausman JI. Intracranial clips: an examination of the devices used for aneurysm surgery. Neurosurgery. 1984; 14: 257–267.PubMedCrossRefGoogle Scholar
  6. 6.
    Sugita K, Hirota T, Iguchi I, Mizutami T. Comparative study of the pressure of various aneurysm clips. J Neuro-surg. 1976;44:723–727.Google Scholar
  7. 7.
    Gertz SD, Renneis ML, Forbes MS, Kawamura J, Sunaga J, Nelson E. Endothelial cell damage by temporary arterial occlusion with surgical clips: study of the clip site by scanning and transmission electron microscopy. J Neuro-surg. 1976;45:514–519.Google Scholar
  8. 8.
    Symon L, Momma F, Murota T. Assessment of reversible cerebral ischemia in man: intraoperative monitoring of the somatosensory evoked response. Acta Neurochir (Wein). 1988;42:3–7.CrossRefGoogle Scholar
  9. 9.
    Batjer H, Samson DS. Management of intraoperative aneurysm rupture. Clin Neurosurg. 1990;36:275–288.PubMedGoogle Scholar
  10. 10.
    Batjer HH, Samson DS. Retrograde suction decompression of giant paraclinoidal aneurysms. Technical note. J Neurosurg. 1990;73:305–306.PubMedCrossRefGoogle Scholar
  11. 11.
    Pertuiset B. Intraoperative aneurysmal rupture and reduction by coagulation of the sac. In: Pia HW, Langmaid C, Zierski J, eds. Cerebral Aneurysms—Advances in Diagnosis and Therapy. Berlin: Springer-Verlag; 1979:398–401.Google Scholar
  12. 12.
    Karhunen PJ. Neurosurgical vascular complications associated with aneurysm clips evaluated by postmortem angiography. Forensic Sci Int. 1991;51:13–22.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag New York, Inc. 1994

Authors and Affiliations

  • Robert R. Smith
    • 1
    • 2
  • Yuri N. Zubkov
    • 3
  • Yahgoub Tarassoli
    • 4
  1. 1.Department of NeurosurgeryThe University of Mississippi Medical CenterJacksonUSA
  2. 2.Methodist Neurological InstituteJacksonUSA
  3. 3.Department of Cerebrovascular SurgeryA.L. Polenov Neurosurgical Research CenterSt. PetersburgRussia
  4. 4.Mehr HospitalTehranIran

Personalised recommendations