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The small neck of the aneurysm afforded an easy surgical attack. An
ordinary flat silver clip was placed over the sac and tightly
compressed obliterated it completely. The clip was flush with the
wall of the carotid artery. The sac, lateral to the silver clip,
was then picked up with the forceps and thrombosed by the
electocautery. Walter Dandy reporting his successful operation of a
posterior communicating aneurysm on March 23, 1937. Walter Dandy's
patient left the hospital in good health 2 weeks later, and from
his report one may gain the impression that the operation was an
easy task. Despite continuous developments during the following
decades, it was not until the introduction of the operating
microscope and microsurgical techniques that surgical treatment was
generally accepted. During the microsurgical era surgical results
have continued to improve due to diagnostical, neuroanaesthesi
ological, and microsurgical refinements, and improved
neurointensive care. Endovascular obliteration has become an
important treatment alternative but this has not been included in
this particular volume. The purpose of the present supplement of
the ACTA NEUROCHIRURGICA is to review some of the elements in the
neurosurgical management of patients with aneurysmal subarachnoid
haemorrhage that are important for a successful outcome. Professor
Helge Nornes has been a major force in the development of new
techniques and research strategies in this area for a number of
years and has recently retired from the National Hospital in Oslo."
The small neck of the aneurysm afforded an easy surgical attack. An
ordinary flat silver clip was placed over the sac and tightly
compressed obliterated it completely. The clip was flush with the
wall of the carotid artery. The sac, lateral to the silver clip,
was then picked up with the forceps and thrombosed by the
electocautery. Walter Dandy reporting his successful operation of a
posterior communicating aneurysm on March 23, 1937. Walter Dandy's
patient left the hospital in good health 2 weeks later, and from
his report one may gain the impression that the operation was an
easy task. Despite continuous developments during the following
decades, it was not until the introduction of the operating
microscope and microsurgical techniques that surgical treatment was
generally accepted. During the microsurgical era surgical results
have continued to improve due to diagnostical, neuroanaesthesi
ological, and microsurgical refinements, and improved
neurointensive care. Endovascular obliteration has become an
important treatment alternative but this has not been included in
this particular volume. The purpose of the present supplement of
the ACTA NEUROCHIRURGICA is to review some of the elements in the
neurosurgical management of patients with aneurysmal subarachnoid
haemorrhage that are important for a successful outcome. Professor
Helge Nornes has been a major force in the development of new
techniques and research strategies in this area for a number of
years and has recently retired from the National Hospital in Oslo."
Every few years a dissertation comes to the area of clinical
application of medical technology which carries us forward as on a
magic carpet into new regions of understanding and patient care.
This book is such a magic carpet. It brings together, in a clear
and incisive fashion, important hemodynamic principles with a
simple noninvasive method of application to a part of the cerebral
vasculature which has been relatively inaccessible. To the lucky
and perceptive person who reads this book, a feeling of excitement
and hope for progress is engendered. The diligent application of
the potentials of transcranial Doppler ultrasound brings new power
to our efforts in understanding the cerebral circulation and the
causes, treatment and prevention of cerebrovascular disorders.
Merrill P. Spencer, M. D. Director Institute of Applied Physiology
and Medicine Seattle, Wash. , July 1986 Acknowledgements I am
greatly indebted to Prof. He1ge Nornes, Oslo, who introduced me to
the fascinating study of cerebral hemodynamics in the early 1970's
and since then continually encouraged my interest in this field. It
was through his pioneering work on the cerebral circulation-using
peroperative electromagnetic flowmetry and Doppler techniques-that
the basis was laid for the noninvasive trans cranial approach to
the circle of Willis described in this book. I also gratefully
acknowledge the stimulating case discussions with Prof. Peter
Huber, Berne, at the very early introduction of trans cranial
Doppler, the inspiring exchange of ideas with Dr. Merrill P.
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