J. Therapy of Intracranial Aneurysm

Ryuichi TSUGANE, Kenichiro SUGITA, Naomi MUTSUGA, Akinari DOI
1971 Neurologia medico-chirurgica  
Artificial embolization has been applied in the management of large and inoperable intracranial arteriovenous malformations by several investigators. The accurate placement of the emboli still remains the problem. In the usual embolizing method, embolus which was introduced into the carotid artery flows into the middle cerebral artery and the malformations located mainly in the anterior cerebral artery territory have not been embolized. In an attempt to embolize the malformation in the anterior
more » ... cerebral artery area, a huge electric magnet for ophthalmology was applied for pulling in the embolus into the anterior cerebral artery. The model experiments were performed on "Y" and "T" shaped glass tube under the various flow rates of water. The steel balls of I to 3 mm in diameter could be safely pulled into sideways at 900 Gauss or more. The maximum capacity of the magnent (100V-30 Amp) was 1500 Gauss at the distance of 5 cm from the head of the magnent and 600 Gauss at 10 cm. The animal experiments were performed on dogs embolizing the renal artery under the control of the magnet. The results were satisfactory. Clinical experiences are consisted of four arteriovenous malformations fed from both the anterior and middle cerebral arteries and one malformation located in basal ganglia fed from the dilated lenticulosteriate arteries. In the anterior and middle cerebral artery group, the magnet was placed at the fronto-temporal area, not to exceed 8 cm from the bifurcation of the internal carotid artery. In a case of the basal ganglia, the magnet was placed at the vertex directing to the base of the skull. The size of the steel ball was decided according to the diameter of feeding artery. In the first three cases, non-coated steel balls were used. In latter cases, silicon coated steel balls were used to avoid inadequate vascular responses to the emboli. 84 to 95% of the steel balls embolized the aimed arteries and the other 16 to 5% flew into the feeding arteries from the middle cerebral artery. In each cases one to three balls embolized the arteries to the normal brain. No case showed the permanent sign due to the mislocation of the emboli. We have no experience of a case in which the emboli passed the malformation and flew into the venous circulation. In two cases the diminishment of the malformation on serial angiogram was almost complete and in the other three cases it was moderately accomplished. But the follow-up angiography revealed newly formed collateral circulation and visualization of the -317-
doi:10.2176/nmc.11.317 fatcat:rm3quw6varb3taep2oqa7nwi3i