NEUROSURGERY— BOTTERELL and LOUGHEED 



365 



Fig. 2. — Dissection to expose carotid and vertebral arteries. 



both common carotid and vertebral arteries were occluded for 10 minutes to reduce 

 bleeding to a trickle. The neck of the aneurysm was clipped and this was reinforced 

 with muscle. 



Postoperatively the patient made an excellent recovery, and there was no neuro- 

 logical deficit. 



Certain arteriovenous malformations, either because of their situation or large 

 size, or both, have heretofore been impossible to remove. Reduction of blood flow 

 by means of bilateral cervical occlusion of carotid and vertebral arteries can make 

 possible successful surgical removal. 



Of the 40 cases, there have been 32 aneurysms of which 18 were operated upon 

 in the acute stage. There have been four deaths among the acute cases (due to 

 overwhelming brain damage), plus one death from ventricular fibrillation. Ventric- 

 ular fibrillation occurred in a second case, but cardiac resuscitation was success- 

 fully performed. 



During operation the aneurysm ruptured in 18 instances, and by means of carotid 

 or carotid and vertebral occlusion, a "dry" or "relatively dry" surgical field was 

 obtained, and a clip placed accurately on the neck of the aneurysm (fig. 5). The 



