ABSTRACT
OBJECTIVE: To analyse the self-closing aneurysm clip historical evolution. MATERIALS AND METHODS: The authors reviewed the self-closing aneurysm clip's 50-year history. Major neurosurgical books, journals, testimonials, authors' personal experience, and scientific databases were analysed. RESULTS: Self-closing aneurysm clip malfunction was found to be related to different clip strengths (too strong or too weak) and clip's corrosion or fracture due to diverse stainless steel biocompatibility issues. It was found that 301, 401, 402, 58, and 17-7 PH alloys were not suitable for human implantation due to high risk of corrosion. In counterpart, 316MOSS, Elgiloy, Phynox, and titanium alloys were more biocompatible and less prone to corrosion. The last group showed no motion on the magnetic field. Titanium clip has shown to be artifact free on computerized tomography followed by high-grade cobalt-chromium clip all the other aneurysms clip present a significant artifact. The Federal Drugs and Administration/American Society of Testing and Materials (FDA/ASTM) was a major contributor on safety development of self-closing aneurysm clip. CONCLUSION: Our 36-year self-closing aneurysm clip experience is reported.
Subject(s)
Intracranial Aneurysm/history , Surgical Instruments/history , Vascular Surgical Procedures/history , History, 20th Century , History, 21st Century , Humans , Intracranial Aneurysm/surgery , Neurosurgical Procedures/history , Surgical Instruments/adverse effects , Surgical Instruments/standards , United States , United States Food and Drug Administration/history , Vascular Surgical Procedures/adverse effects , Vascular Surgical Procedures/instrumentationABSTRACT
OBJECTIVE: Reviews of the brain retractor evolution are described. Instrument characteristics as well as the physiopathological and histopathological damage of the brain are induced by brain retraction. MATERIALS AND METHODS: The literature related to the brain retractor was reviewed. Journals, books, personal testimony, government patents, and electronic media databases were analysed. RESULTS: The brain retractor started as a hand-held flat ribbon manufactured on copper and stainless steel. This shape evolved into a shovel. Several shapes acquired from the early period were from a tappered, spoon shape covered by silicone. The posterior evolution was the development of the articulate arm, fixed to the skull or to the self-retaining subcutaneous retractor, or attached to a frame or to a stereotactic instrument. The pressure monitor was the most important safety addition. CONCLUSION: In conclusion, a better monitor system needs to be developed to avoid brain injury.