Microsurgery as an aid to middle cerebral artery endarterectomy.

1. Instrumentation and technique for microsurgical reconstruction of small arteries are described. 2. Two cases are reported in each of which an obstruction was removed from the middle cerebral artery for early hemiplegia. 3. The work presented is of a preliminary nature. No conclusions can be drawn as to ultimate value. Further clinical trial seems justified.

Microvascular patch technique with and without Silastic T-tube bypass.

Poor patency results in the surgery of small vessels operated on between 1959 to 1964 was demonstrated to be in part due to the long period of occlusion of the operated vessel during surgery and the presence of a foreign body (suture) in the lumen of the vessel postoperatively. New suture techniques and T-tube bypass were introduced at that time. New experimental data have not been extensively sought since that time. To provide further current data regarding the above observations, 110 arterial vessels (60 carotid arteries 1.1 to 1.3 mm in outside diameter (OD) and 50 femoral arteries 0.6 to 0.7 mm OD) were operated on in rats to compare the bypass versus non-bypass and vein patch closure techniques. In 1-mm vessels, patency rates 1 month after surgery were 100% regardless of the use of bypass or type of closure. Improved visualization, better suture material, and improved surgical skill were probably chiefly responsible for this success. The success rate was not as encouraging, however, in vessels of 0.6 mm OD. The following points are brought out: 1) The presence of the bypass causes damage to the intima in 0.6 mm OD vessels and should not be used. Smaller bypasses do not conduct blood well. 2) Bypass is not required in 1-mm vessels as the patency rate is satisfactory and not altered by its use. 3) The major indication for T-tube bypass is in vessels of 1 mm OD and larger, that nourish tissue which would be damaged by vascular occlusion for 20 to 40 minutes. 4) Foreign body (suture) in the lumen is poorly tolerated in 0.6 mm vessels, but can be tolerated more easily in larger vessels. 5) Techniques that limit the amount of suture material in the lumen are indicated in 0.6-mm vessels. 6) After 1 month, suture material has an epithelial covering and if patency has been maintained for that period of time it is likely to remain.

[A method for the continuos recording of intracraneal pressure]. / Metodo para registro continuo da pressão intracraniana

91 patients with acute head injuries, hydrocephalus, cerebral infarction, subarachnoid hemorrhage, encephalitis, intracerebral hemorrhage, or carbon monoxide intoxication have been so monitored by using the Numoto pressure switch by a method herein described. The main advantage has been the knowledge of the level of intracranial pressure at any given time and the early detection of a rising pressure when this phenomenon occurred. There were no complications except for 3 cases of infection. Two of these cases were minor purulent collections only at the site of exit of the tube in the scalp. One patient with a compound wound, cerebral laceration, and intracerebral hematoma developed a wound infection and brain abscess which required drainage.