Neurosurgical forum Letters
to t h e e d i t o r
Anearysm Clips
Treatment of Low Back Pain
To THE EDITOR: Dr. Sugita and colleagues (Sugita K, Hirota T, Iguchi I, et al.: Comparative study of the pressure of various aneurysm clips. J Neurosurg 44:723-727, June, 1976) published pictures of what is referred to as the Sugita clip and describe it as a "newly designed bayonet-shaped aneurysm clip . . . " The enclosed figure is a photograph of some of the models of a clip that has been manufactured to my design since 1970 by the Kees Surgical Specialty Company of Cincinnati, Ohio. Mr. George Kees has a patent on
To THE EDITOR: Doctors Seres and Newman describe good immediate salvage of chronic low back pain cases by a multidisciplinary approach (Seres JL, Newman RI: Results of treatment of chronic low-back pain at the Portland Pain Center. J Neurosurg 45:32-36, July, 1976). Most of their cases were the well known combination of intractable pain, significant psychiatric elements, and drug dependence. However, at a 3-month follow-up, renewed drug dependence had increased from 5% on discharge to 22%. Foltz and White, 4 Ballantine, et al.,' this writer and Lighthill, 8 and others have reported long-range results in this triage with stereotaxic limbic target surgery. Presumably it is a matter of degree and many milder cases will respond to this approach as reported without requiring surgery. At the Fourth International Congress of Psychiatric Surgery (Madrid, September 1975) I reported 43 limbic target patients followed for up to 20 years. 2 It would be helpful if Drs. Seres and Newman could supply long range outcome assessments 1 to 2 years after the multidisciplinary technique including data on medications and need for further medical care or hospitalization. M. HUNTERBROWN, M.D. Santa Monica, California
this clip (No. 3,827,438) issued on August 6, 1974. This clip has been on display at the Microsurgical Symposium sponsored in Cincinnati annually since 1971, and it was displayed at the World Congress of Neurosurgery in Tokyo, Japan, in October, 1973. It has been displayed at all major neurosurgical meetings in the United States since 1970. This attempt to correct the priority for this clip has no commercial motivation. The proceeds from these clips as well as proceeds from the modifications of the Mayfield clip have been handled according to the precedent set by Dr. Mayfield. All profits belong to the manufacturer, the Kees Surgical Specialty Company, to be used for further development of neurosurgical instrumentation. JOSEPH T. MCFADDEN,M.D.
Norfolk, Virginia
J. Neurosurg. / Volume 46 / January, 1977
References 1. Ballantine HT Jr, Cassidy WL, Flanagan NB, et ai: Stereotaxic anterior cingulotomy for neuropsychiatric illness and intractable pain. J Neorosnrg 26:488-495, 1967 2. Brown MH: Limbic target surgery in the treatment of intractable pain with drug addiction, in Proceedings IV International Congress of Psychiatric Surgeons. Baltimore: University Park Press, 1976 (in press) 129
to t h e e d i t o r
Anearysm Clips
Treatment of Low Back Pain
To THE EDITOR: Dr. Sugita and colleagues (Sugita K, Hirota T, Iguchi I, et al.: Comparative study of the pressure of various aneurysm clips. J Neurosurg 44:723-727, June, 1976) published pictures of what is referred to as the Sugita clip and describe it as a "newly designed bayonet-shaped aneurysm clip . . . " The enclosed figure is a photograph of some of the models of a clip that has been manufactured to my design since 1970 by the Kees Surgical Specialty Company of Cincinnati, Ohio. Mr. George Kees has a patent on
To THE EDITOR: Doctors Seres and Newman describe good immediate salvage of chronic low back pain cases by a multidisciplinary approach (Seres JL, Newman RI: Results of treatment of chronic low-back pain at the Portland Pain Center. J Neurosurg 45:32-36, July, 1976). Most of their cases were the well known combination of intractable pain, significant psychiatric elements, and drug dependence. However, at a 3-month follow-up, renewed drug dependence had increased from 5% on discharge to 22%. Foltz and White, 4 Ballantine, et al.,' this writer and Lighthill, 8 and others have reported long-range results in this triage with stereotaxic limbic target surgery. Presumably it is a matter of degree and many milder cases will respond to this approach as reported without requiring surgery. At the Fourth International Congress of Psychiatric Surgery (Madrid, September 1975) I reported 43 limbic target patients followed for up to 20 years. 2 It would be helpful if Drs. Seres and Newman could supply long range outcome assessments 1 to 2 years after the multidisciplinary technique including data on medications and need for further medical care or hospitalization. M. HUNTERBROWN, M.D. Santa Monica, California
this clip (No. 3,827,438) issued on August 6, 1974. This clip has been on display at the Microsurgical Symposium sponsored in Cincinnati annually since 1971, and it was displayed at the World Congress of Neurosurgery in Tokyo, Japan, in October, 1973. It has been displayed at all major neurosurgical meetings in the United States since 1970. This attempt to correct the priority for this clip has no commercial motivation. The proceeds from these clips as well as proceeds from the modifications of the Mayfield clip have been handled according to the precedent set by Dr. Mayfield. All profits belong to the manufacturer, the Kees Surgical Specialty Company, to be used for further development of neurosurgical instrumentation. JOSEPH T. MCFADDEN,M.D.
Norfolk, Virginia
J. Neurosurg. / Volume 46 / January, 1977
References 1. Ballantine HT Jr, Cassidy WL, Flanagan NB, et ai: Stereotaxic anterior cingulotomy for neuropsychiatric illness and intractable pain. J Neorosnrg 26:488-495, 1967 2. Brown MH: Limbic target surgery in the treatment of intractable pain with drug addiction, in Proceedings IV International Congress of Psychiatric Surgeons. Baltimore: University Park Press, 1976 (in press) 129
