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Personal Experiences
in Aneurysm Surgery

Oscar Sugar, MD, PhD
Oscar Sugar, MD, PhD
Professor Emeritus of Neurological Surgery
University of Illinois, Chicago
AANS Member Since 1952

Under the influence of Professor Percival Bailey, the resident staff at the University of Illinois Research and Educational Hospitals in Chicago in the 1940s was induced to take up the then newly developing procedure of angiography of the vessels to and in the brain. Eventual facility with percutaneous carotid angiography led to accidental vertebral angiography, followed by percutaneous deliberate vertebral angiography as developed by the residents, among whom were Drs. Holden, Chester Powell, and myself. Retrograde brachial vertebral angiography followed. By these procedures, a large number of intracranial vascular and neoplastic lesions were discovered, our first one was a large pericallosal aneurysm operated on in 1946 by Dr. Milton Tinsley with me assisting. Ocular loupes were used for magnification. The lesion was not visualized in the postoperative angiogram which I carried out. After becoming a junior staff member of the staff under Dr. Eric Oldberg, I carried out angiograms and was permitted to operate on intracranial aneurysms when they did not appear to be suitable for complete or graded gradual ligation of the common and internal carotid arteries in the neck. When the usual silver clips proved to be too small, the V Mueller Instrument Company made larger clips, applicator, etc. for me, and they were used along with ligation of the aneurysmal neck when necessary. I was happy to introduce to our hospital the spring clips popularized first by Dr. Mayfield in Cincinnati.

Wrapping the aneurysms with cotton or muslin was tried but did not prove to be a certain means of assuring control of the abnormality. Thanks to visitors from Japan, including a resident in training who later brought back a "plastic glue", we were able to use EDHplastic (Biobond) and tried other coverings such as those introduced by Dr. B. Selverstone on an experimental basis. None of these materials was approved by the Food and Drug Administration, and we stopped using them even on an experimental basis after laboratory tests indicated their drawbacks, such as necrosis which occurred on spread of the liquid to the nearby cortex, and erosion of the media of the vessels.

Some of the direct approaches to arteriovenous malformations were introduced during these formative years, including preliminary embolization, as well as alternation of operating team members during prolonged extirpations of widespread malformations, with increasing use of operative microsurgery.

My own participation in aneurysmal surgery declined after I had more administrative duties as Head of Neurosurgery at the University of Illinois (Chicago), but I continue to marvel at the ability of our radiologic associates to put small catheters in cerebral vessels via the femoral arteries and inject embolizing materials, etc.

An abstract of the oral history of Dr. Sugar is available.

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