Giant Intracranial Aneurysms

This atlas focuses on the imaging and treatment options available for giant intracranial aneurysms since 1990s in the beginning of the so-called modern endovascular era. During this period, there were significant advances made in the therapy of small intracranial aneurysms though the treatment of giant aneurysms continued to pose an insurmountable challenge. At the turn of this century, this grim scenario gradually improved with better understanding of the pathophysiology of giant intracranial aneurysms. This changed scenario in giant intracranial aneurysm therapy has been illustrated with the aid of informative clinical case studies. The clinical presentation of giant aneurysms in adults and children is described as are the merits of different imaging modalities explained and illustrated. Extensive consideration has been given to modern fusion imaging that has improved our insight into the nature of the disease. Endovascular treatment approaches (including illustrative open surgical approaches) and reconstructive and deconstructive strategies are fully documented, with careful attention given to factors that influence management strategies, treatment choice and complications.The atlas will be a valuable reference and practical aid for neuroradiologists, neurosurgeons, neurologists, fellowship trainees, postgraduate & graduate students.

The first aneurysms explored by such pioneers of neurosurgery as Cushing and Dandy were the giant intracranial aneurysms. These giant aneurysms present many therapeutic difficulties and, because of their unique anatomical features and size, may present in a multitude of ways. With the advent of specialized imaging techniques such as computed tomography (CT), mag netic resonance imaging (MRI) and selective angiography, preoperative diag nosis today is most often accomplished without difficulty. However, com pletely thrombosed giant aneurysms may mimic other lesions with mass effect (such as basilar meningiomas, chordomas or chondromas) and their true anatomical shapes and relations to other cranial structures can only be ascer tained by direct operative inspection. Due to their morphological features (thrombosed, nonthrombosed, par tially thrombosed, fusiform), anatomical variations and difficult locations, giant aneurysms present new challenges for the modern neurosurgeon. Al though microsurgical techniques have rendered direct surgical treatment of giant intracranial aneurysms safer, elimination of the aneurysm without dis turbing the hemodynamics continues to be problematic. Some of these lesions have relatively small necks and can therefore be clipped fairly easily. Others have large necks, are fusiform, or contain perforators; how best to treat these lesions is a question still unresolved by presentday neurosurgery.

Giant Intracranial Aneurysms discusses the numerous advances in the understanding of the pathophysiology, diagnosis, treatment and outcomes related to this serious and challenging problem. Written by acknowledged leaders in the field, Giant Intracranial Aneurysms is on its way to becoming the standard reference source on the subject for years to come. A sampling of the topics covered in Giant Intracranial Aneurysms include: Morphology and structural pathology Hemodynamics and pathophysiology of giant intracranial aneurysms Clinical manifestations Imaging and diagnostic evaluation Therapeutic strategies and treatment options Giant fusiform and serpentine aneurysms Endovascular treatment (Distributed by Thieme for the American Association of Neurological Surgeons)

This open access book presents the diagnosis, investigation and treatment of neurovascular diseases, and offers expert opinions and advice on avoiding complications in neurovascular surgery. It also covers complication management and post-operative follow-up care. The book is divided in to three parts; the first part discusses common approaches in neurovascular surgery, describing the steps, indications for and limitations of the approach, as well as the associated complications and how to avoid them. The second part addresses surgical treatment based on pathology, taking the different locations of lesions into consideration. The third part focuses on the technological developments that support neurovascular surgery, which may not be available everywhere, but have been included to help vascular surgeon understand the principles. This book is a guide for young neurosurgeons, neurosurgery residents and neurosurgery fellows, as well as for medical students and nurses who are interested in neurosurgery or are associated with this field in any way. It is also a useful teaching aid for senior neurosurgeons.

This volume provides an overview of new concepts in neurovascular interventions based on clinical and scientific knowledge of cerebrovascular disorders. It especially focuses on subarachnoid hemorrhage and cerebrovascular malformations, e.g. aneurysms, arterio-venous malformations, and cavernomas. A separate part addresses cerebral revascularization for both complex aneurysms and ischemia. All contributions were written by recognized experts and cover original papers presented at the 7th European Japanese Stroke Surgery Conference, held in Verona, Italy in June 2014. The authors present new trends and strategies for managing emerging problems, as well as in-depth discussions on controversial issues in the field.

It is a great privilege to write the foreword for this classical work of Professor Charles Drake. There is no doubt that intracranial aneurysms have existed since the beginning of time. This terrifying disease of the brain arteries, with its dramatic consequences for the patient, has surely been observed in all human collectives, although clear definition and description in the literature began only 300 years ago. During the last century, clinical signs and symptoms have been carefully observed and analyzed, and 100 years ago, the first attempts were made for surgical treatment, such as the ligature of external and internal carotid and vertebral arteries. With the introduction of angiography, an entirely new dimension of diagnosis and differential diagnosis of the vascular diseases of CNS, was accomplished. In the years between 1945 and 1970, the neurosurgeon was increasingly stimulated to directly eliminate intracranial aneurysms. The most respected and avoided location, the aneurysms at the bifurcation of the basilar artery, remained as a "dark corner. " Several pioneers of neurosurgery attempted to explore the interpeduncular fossa, but finally retreated. Not so Charles Drake. His vision must have been stronger than his anxiety, after experiences of initial fatalities, to persevere more decisively in this desperate fight instead of to yield. Such steadfastness requires enormous courage. But what distin guishes courage! Surgical courage is not just a fearless or unscrupulous action.

Two top neurosurgeons deliver complete, up-to-date guidance on the diagnosis and management of cerebrovascular aneurysms and malformations in this groundbreaking new resource. Stressing a multidisciplinary, team approach, this text presents a wealth of information on the treatment of aneurysms, the management of subarachnoid hemorrhage, techniques to occlude aneurysms*both surgical and endovascular*patient selection, and more.

This book's focus is on diagnosis and treatment of intracranial aneurysm, abdominal and thoracic aortic aneurysms. It addresses neurosurgical, vascular and cardiothoracic surgeons and interventional radiologists, but also anyone engaged in vascular medicine. It presents is an effort to collect an up-to-date account of existing knowledge, involving recent developments in this field. Various experts described details of established knowledge or newly recognized advances associated with diagnosis, treatment, perioperative management and mechanism. This is the first book that deals with the whole body aneurysm, such as cerebral aneurysm, abdominal aneurysm, and splenial aneurysm and to learn the latest developments in other fields is always useful. I hope this book will be used worldwide by vascular surgeons and interventionalists enhancing their knowledge and stimulating the advancement of this field.