1. Aneurysm Surgery: Past, Present and Future Mario Zuccarello, M.D. University of Cincinnati, Dept of Neurosurgery Mayfield Clinic

2. John Hunter (1728-1793) HUNTERIAN LIGATION

3. Hunterian Ligation  461 patients with ICA ligation  Mortality rate 20.7%  Stroke rate 30% Sahs, Perret, &Locksley, 1969

4. Egas Moniz (1874-1955) 1 ST CEREBRAL ANGIOGRAPHY IN 1927

5. Harvey Cushing (1869-1939) SILVER CLIP

6. Walter Dandy (1886-1946) 1 ST CLIP ON ICA ANEURYSM

7. History of Aneurysm Clips

8. Aneurysm Surgery: Past  Dandy “ clipping of aneurysms is hopeless”  As late as the 1960s mean mortality 28.7%  Merritt in 1963 advised surgery only for aneurysms with large associated hematomas

9. Mayfield Connection  The problem “How to clip a large basilar bifurcation aneurysm with a fragile neck and an adherent P1 segment”... Drake “We need a different clip”

10. Mayfield Connection  1969 development of the fenestrated clip The Cincinnati Post, March 28, 1970

11. Del Maestro, J Neurosurg 92, 2000

12. Proc Neurol Surg 9, 1978 Youmans 2, 1973

13. M. Gazi Yasargil (1925- ) OPERATING MICROSCOPE MODERN CLIPS

14. Modern Clips