[The clinical application of intracranial artery canulation technique (author's transl)]

The introduction of the microscope into the neurosurgical operating theater brought the significant change on its operative results. However, even by means of the meticulous microsurgical techniques, certain intracranial lesion like deep-seated AVM cannot yet be successfully treated. Instead of the extravascular approach, intravascular treatment of these lesions has been evolved and become the great aid for the therapeutic purpose. In 1974 Serbinenko published his excellent work about his detachable balloon catheter technique. He succeeded in treating the intracranial lesions by the intravascular approach with the more exact manner than before. The balloon could make it possible to guide the small catheter into the distal branch of intracranial arteries. And also the balloon was detached and use as embolus. Until now, various balloon catheters become clinically available. Among them the catheter which Kerber devised is made of soft silicone and equipped with microballoon at the distal end. Although the balloon itself cannot be detached, it has a small hole at its top and can deliver the fluid through this opening (calibrated leak). The method for this catheter usage is as follows. Using Seldinger technique, the non-tapered thin wall catheter has to be placed on the proximal side of the attempted artery as the introducing catheter. Through it, balloon catheter is cannulated coaxically and navigated more distally with the inflation or deflation of the balloon. Clinical application of this catheter include the superselective angiography, drug infusion and selective embolization. For the embolization, fluid embolus must be chosen. At this time cyanoacrylate, a potent tissue adhesive, is used as the embolus and injected with the mixture of Pantopaque and tantalum powder. Two cases of deep seated cerebral AVM were treated by selective embolization. AVM was completely occluded in one case, in the other case the embolization was interrupted because of worsening of neurologic defecits. In conclusion, the calibrated leak balloon catheter (Kerber) has wide range of clinically applicable potential and will become the great aid for the intravascular treatment.