Clinical Neuroscience

First experiences with MR-compatible implants in the management of Aneurysmal subarachnoid haemorrhage

DÓCZI Tamás1, KÖVÉR Ferenc2, HORVÁTH Zoltán1, MÉSZÁROS István1, VADON Gábor2

NOVEMBER 20, 1996

Clinical Neuroscience - 1996;49(11-12)

Aneurysm clips made of titanium alloy were considered to be useful for clinical application due to the expected reduction in artifact formation on postoperative CT and MR. First, the behaviour of the new titanium clip (Aesculap) was investigated in phantom experiments in CT and MR scanners. After the in vitro tests had proved the applicability of the new implants, a series of operations was performed employing the new clip in 21 patients and the traditional phynox clip in 17 patients. All patients with a titanium implant had postoperative 11, T2 and proton-weighted MR scans. In 12 cases pre- and postoperative; in 9 cases only postoperative MR angiographies were carried out. In 4 patients both control MR- and catheter angiographies were performed. Clinical results as analysed at least 6 months following the operation were not different from those of 1992 and 1993 of the same team and were comparable to recently published data in the literature. The study has shown that ability to effectively diagnose clip-adjacent brain structures can be improved considerably by employing clips of titanium alloys. Concerning the value of postoperative MR angiography either with or without contrast material to control the effectiveness of aneurysm occlusion, the following conclusion was drawn: while the postoperative potency of the parent artery was clearly visualized in every case, it was impossible to define whether occlusion of the aneurysm had been complete.


  1. Department of Neurosurgery, University Medical School, Pécs
  2. Diagnostic Center of Pécs, Hungary



Further articles in this publication

Clinical Neuroscience

[Repeated stroke, psychotic episode - primary antiphospholipid syndrome?]


[The antiphospholipid syndrome described some 10 years ago is characterized by a predisposition to arterial and venous thrombosis and the presence of antiphospholipid antibodies. It is often associated with systemic lupus erythematosus, but its primary forms are also well known. Its clinical features are well known in neurology as well as in psychiatry. In this paper we present a case report with therapeutic implications. We discuss the importance of reccurent stroke at a young age in association with the possibility of a rare manifestation of antiphospholipid syndrome: organic brain disease, appearing in the form of schizoaffective psychopathological symptoms.]

Clinical Neuroscience

[Cluster headache and its treatment]


[Cluster headache, one of the most painful conditions known, is encountered infrequently in clinical practice. It is characterized by recurrent, unilateral attacks of severe intensity, brief duration and often accompanied by signs and symptoms of autonomic dysfunction. The actual cause of the pain has not been fully elucidated, but most authors believe that the pain arises as a result of a local vasodilatation with a release of certain neuropeptides to the perivascular tissues, resulting in sterile neurogenic inflammation and oedema. Aetiology is absolutely unknown. Treatment can be given as prophylaxis and/or as a symptomatic acute therapy for individual attacks. In the prophylaxis of episodic cluster headache ergotamine, calciumentry blockers, serotonin inhibitors and steroids are used. In chronic cluster headache lithium is the drug of choice, but verapamil may also be tried. Acute therapy has included ergotamine, oxygen inhalation and sumatriptan. Rarely, surgical intervention may be considered.]

Clinical Neuroscience

[Experiences with sumatriptan in the treatment of Cluster headache]


[Subcutaneously administered sumatriptan 6 mg is rapid, effective and well-tolerated for the acute treatment of cluster headache. Efficacy is maintained in long-term use. The authors report the results of the 5HT1 receptor agonist sumatriptan autoinjector in the treatment of 350 attacks in 20 cluster patients. After 20 minutes post injection the complete dissolution of headache was reported in 95% of the attacks. Slight and transient side-effects were experienced therefore non of the patients were discouraged from using the autoinjector device again. It is essential in the improvement of the quality of life of patients suffering from cluster headache.]

Clinical Neuroscience

[Quantitative monitoring of EEG variability following subarachnoid hemorrhage]


[Cerebral vasospasm causing focal ischemia is a frequent complication following subarachnoid hemorrhage. Monitoring of EEG may help to reveal hemispheric dysfunction in the postoperative period. Continuous monitoring of EEG was performed on 8 bipolar channel in 30 patients with subarachnoid hemorrhage during the first two weeks after aneurysm rupture. Computerized trend analysis of 8–16 hours long periods was made. Variability of relative alpha power was evaluated visually on a 4 grade scale and it was also measured quantitatively. EEG data were compared with daily transcranial Doppler values and clinical state. Symptomatic vasospasm was detected in 16 patients while other neurological complications developed in a further 4 cases during monitoring. Significant decrease of variability was observed in all of them. This change developed 1-2 days before other signs of vasospasm in 10 patients. The onset of variability decrease was unilateral in 4 cases. No remarkable decrease of variability was found in patients without neurological complication. Our data confirm that EEG monitoring is a useful tool for sensitively detecting deterioration of brain function. Relative alpha variability is an indicative EEG parameter that can signify hemispheric dysfunction caused by ischemia in an early subclinical stage, when still no Doppler signs of vasospasm or deterioration of clinical symptoms occur.]

Clinical Neuroscience

[Intravenous perfusion anaesthesia in neurosurgey part two]


[A retrospective analysis of 1300 neurosurgical perfusion narcoses performed by means of intravenously administered propofol-fentanyl-vecuron proved the advantage of this technique over traditional procedures. It decreased the recovery time, the incidence of postoperative nausea and vomiting, and muscle fibrillation. Propofol did not elevate either raised or normal intracranial pressures. Moreover, a trend reduction of raised ICP was observed. The incidence of cardiovascular complications was also reduced. Patients, especially the elderly, had a quick, subjectively well-tolerated induction of sleep and recovery. Comparison of parameters of propofol general anaesthesia with those of "combined balanced narcosis" and "perfusion ataranalgesia” statistically proved the significantly advantage of this new method. The conclusion has been drawn that propofol was a most appropriate drug for neurosurgical anaesthesia. ]

All articles in the issue

Related contents

Clinical Neuroscience

Chronic cerebrospinal venous insufficiency - disease or misdiagnosis?

PÁNCZÉL Gyula, SZIKORA István, BERENTEI Zsolt, GUBUCZ István, MAROSFŐI Miklós, KOVÁCS Krisztina, RÓZSA Anikó, RÓZSA Csilla

Background and purpose - Former studies reported internal jugular vein stenosis in patients with multiple sclerosis. We aimed to evaluate if these venous stenoses were real and cerebral venous outflow of patients with multiple sclerosis differed from that of normal controls. Methods - 20 controls were prospectively investigated by angiography and duplex ultrasound. Seven patients with multiple sclerosis underwent angiography in other centers; we reviewed these registrations and performed venous ultrasound examinations. Results - Angiography displayed >50% stenosis of internal jugular vein in 19 controls (69±17% on the right and 73±13% on the left side) and <50% stenosis in 1 control (43.5% and 44.6%). All 7 patients had at least one-sided stenosis. The mean degree of stenosis was 63±16% on the right and 67±13% on the left side. There was no significant difference in the degree of stenosis between patients and controls. However, these “stenoses” disappeared if the contrast agent was injected at a catheter position below the orifice of the subclavian vein during venography. The venous flow volume was also similar between groups: 479.7±214.1 and 509.8±212.0 ml/min (right and left side) in the patients and 461.3±224.3 and 513.6±352.2 ml/min in the control group; p=0.85 and 0.98 (right and left). Color and power duplex imaging also revealed normal blood flow of the internal jugular vein in all patients and controls. Conclusion - The cerebral venous status of patients with multiple sclerosis and controls were similar. The angiographic “stenoses” were virtual, caused by the contrast dilution effect of the non-contrast blood stream of the subclavian vein.

Clinical Neuroscience

[Simultaneous occurrence of cavernous angioma and developental venous anomaly]

KUNCZ Ádám, VÖRÖS Erika, BODOSI Mihály

[The significance of the simultaneous occurrence of cavernous angioma and developmental venous anomaly, the diagnostic possibilities and the surgical treatment are discussed based upon three cases. Angiography and magnetic resonance imaging together are necessary to get an accurate diagnosis. According to the literature and to the fact that it is the cavernous angioma that mainly causes the symptoms, the cavernosus angioma should be resected, while the developmental venous anomaly should be spared.]

Lege Artis Medicinae

[The role of MRI in the diagnosis of tumours]


[Imaging is important in the evaluation of tumour detection, staging to determine the response to therapy, to follow the patient to find an early recurrent tumour. The ability to assess cancer spread has been revolutionized by advances of digital imaging modalities, such as digital ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI). MRI is the method of choice for detecting and evaluating brain, spine, head and neck and musculoskeletal tumours, but it is complementary in the investigation of the thorax. US and CT remains the primary test for imaging the abdomen, while MRI plays a subsidiary role as a problem solving technique. In the evaluation of focal liver disease numerous prior reports have documented a superior performance of MRI compared to CT and US in the detection of primary and metastatic liver tumours. MRI is gaining more and more importance in imaging of the pelvis. Breast MRI is increasingly used as an adjunct to conventional imaging modalities. Several recent developments in MRI have altered the role of this imaging, and it is often the preferred choice among diagnostic tools for the detection and characterization of tumour cases.]

Clinical Neuroscience

[Post-traumatic ischemic stroke in childhood]


[A report is given about two children with post-traumatic ischemic stroke. In the first case a blunt head injury, in the second case a minor cervical trauma caused the ischemic cerebrovascular episodes. The diagnosis was made after repeated CT scans by the help by sonography. The possible traumatic origin of acute hemiparesis due to ischemic stroke in children is emphasized. ]

Clinical Neuroscience



[Introduction - Viscoelastic parameters of circumferential and meridional strips of ruptured and silent aneurysms were investigated (considered clinical and histological data either) in order to advance the prediction of risk of aneurysm rupture. Method - In our clinical practice, aneurysms managed by microsurgery aneurysm clipping were removed. Meridional and circumferential strips were cut. Strips were investigated by an uniaxial biomechanical instrument: distending force was recorded as the length of the strips was increased in steps. Normal stress-relaxation patterns were detected. The shape of strain curves well overlapped with the Standard Linear Solid Model curve, as had been expected. The viscosity, serial and parallel elastic moduli of the model were then computed. Results - Linear correlation was demonstrated amongst peek distending force detected and aneurysm strip thickness. Steric inhomogenity was detected at the meridional and circumferential strips. Strain-stress behaviour of ruptured and silent aneurysm specimen showed significant difference. Values of strips originated from patients suffered from hypertension as well as strips originated from aneurysms had been histologically found inflamed were higher. Discussion - Results of these observations are going to be used to set three dimensional computer model in cooperation with IT team of Budapest University of Technology and Economics to advance rupture risk prediction.]