Yoshiki Ichinose

Remote-control vascular occluder: technical note.

We have designed a new remote-control vascular occluder for the temporary control of arterial blood flow. It is a modification of the biopsy forceps used in stereotactic surgery. The arm of the occluder is flexible and can be set so that it does not disturb the surgeons view. The occluder is positioned with the blades open on the vessel to be occluded. This device, which is held with a self-retaining retractor connected to the head frame, enables an immediate on-off remote control of arterial occlusion by closing and releasing the blades with a closing button and releasing lever, respectively. Partial closure of the blades is also feasible. The device can be set in a narrow operating field, when proximal control of a parent artery is necessary at its segment distant from the exposed operating field. It can be used in a variety of vascular cases, including giant aneurysms and large arteriovenous malformations.

Ventriculocisternal drainage via endoscopic third ventriculostomy after endovascular embolization for aneurysmal subarachnoid haemorrhage

Coil embolization is a favoured method of treating acutely ruptured aneurysms. However, subarachnoid clots cannot be removed with endovascular treatment, which is disadvantageous from the view point of preventing vasospasm. The authors report intrathecal fibrinolytic therapy via a ventricular drainage tube instituted after endoscopic third ventriculostomy for effective prevention of vasospasm after coil embolization. Two cases of poor grade aneurysmal subarachnoid haemorrhage were treated with interlocking detachable coils. Following the acute stage embolization, endoscopic third ventriculostomy was performed and a drainage tube was inserted into a lateral ventricle or basal cistern. Intrathecal fibrinolytic therapy with Urokinase was performed via the drain tube to a spinal drain. In both cases, the subarachnoid clot disappeared rapidly without any clinical signs of vasospasm. Copyright 1999 Harcourt Publishers Ltd.