Surgery Of Vertebrobasilar Aneurysms

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.

A simplified guide on the basics of aneurysm surgery from leading vascular surgeons Intracranial Aneurysm Surgery: Basic Principles and Techniques is a highly approachable and user-friendly manual that takes a step-by-step approach to explaining the techniques of aneurysm surgery. Its straightforward format makes it appealing to all levels, from trainees to seasoned practitioners by putting basic information at the reader's fingertips. Special Features: Offers readers a concise, easy-to-follow guide to aneurysm surgery, so neurosurgeons can quickly find the information they need Provides an opportunity for readers to learn the surgical techniques used by senior vascular neurosurgeons with stellar reputations in both open and endovascular treatment of aneurysms Uses an engaging and conversational writing style to make complex concepts easy to understand Introduces the authors' key guiding principles, including their philosophy of the operating room and skill progression, that are especially useful for trainees Includes beautiful original illustrations that elucidate aneurysm surgery techniques Mastering the approaches presented in Intracranial Aneurysm Surgery: Basic Principles and Techniques will not only help young surgeons learn their craft from highly respected specialists, but will also expand their technical abilities and understanding of the breadth of neurosurgical aneurysm pathology.

This is the first comprehensive book about surgery on and around the vertebral artery all along its cervical and intracranial course. This vessel has been considered for long as out of surgical reach leaving many different pathologies not or incompletely treated. The surgical exposure and control of the vertebral artery not only permit to treat lesions of the vertebral artery wall or developed in contact to it but also to improve the access to the intervertebral foramen (tumors, osteophytes), to the anterior aspect of the spinal cord (tumors, spondylotic spurs), to the foramen magnum and to the jugular foramen. This book written by leading experts includes all aspects of vertebral artery surgery from anatomy to imaging, surgical techniques and pathologies; it is illustrated by many figures especially operative views and schematic drawings so that the beginner as well as the experienced surgeon find useful information. One of the editors of this book (B. GEORGE) was recently awarded the Olivecrona award for his work on the surgery of the vertebral artery.

Our common interest in surgery of the vertebral artery was born in 1976, when as residents in the same hospital, we attended an attempt by two senior surgeons to treat an aneurysm of the vertebral artery at the C 3 level. Long discussions had preceded this unsuccessful trial, to decide if surgery was indicated and to choose the surgical route. Finally a direct lateral approach was performed, but access was difficult and correct treatment was impossible, resulting in only partial reduction of the aneurysmal pouch. Following this experience, we decided to seek a regular and well defined approach for exposition of the vertebral artery. Review of the literature indicated some surgical attempts, but the descriptions did not give the impression of safety and reproducibility. No landmark on the described surgical route appeared sufficiently reliable. Henry's anatomical work (1917) gave the only accurate description on vertebral artery anatomy, and it became the basis for our work. When the same patient was referred again one year later, after a new stroke in the vertebro-basilar system, we had behind us repetitive experience on cadavers of an original approach to the distal vertebral artery.

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.

The art of aneurysm microsurgery in a beautifully illustrated, step-by-step volume Finalist in 2012 IBPA Benjamin Franklin Awards Seven Aneurysms: Tenets and Techniques for Clipping combines the instructive nature of a textbook with the visual aspects of an atlas to guide readers through the surgical principles, approaches, and techniques they need to dissect and clip cerebral aneurysms. Comprised of three concise sections, the book distills the distinguished author's vast experience into a series of easily accessible tutorials presented through clear, systematic descriptions and stunning, full-color illustrations. The first section explains the critical concepts and basic tenets of aneurysm microsurgery followed by a section on the various craniotomies and exposures necessary for successful clipping. The final section covers microsurgical anatomy, dissection strategies, and clipping techniques for each of the seven most common aneurysm types that are the focus of this book. Features: Strategies for handling the seven aneurysms most often seen by neurosurgeons: PCoA, MCA, ACoA, OphA, PcaA, basilar bifurcation, and PICA 383 full-color surgical photographs demonstrate operative techniques; 77 high-quality drawings display anatomy and spatial relationships Succinct text facilitates quick reading and easy reference Clipping remains an essential treatment method for the most frequently encountered aneurysms. This must-have guide will enable neurosurgery residents, fellows, or practicing neurosurgeons to handle the majority of the aneurysms they will encounter with confidence and poise.

In July 2004 specialists in neurosurgery, neuroradiology, neurology and neurointensive care discussed recent trends at the 2nd Swiss Japanese Joint Conference on Cerebral Stroke Surgery, held in Zurich, Switzerland. New concepts were worked out during the conference and are published in this volume. The book starts with the topic intracranial aneurysms, discussing microsurgical and endovascular treatment modalities, as well as new surgical approaches. Further chapters deal with the management of unruptured aneurysms and with subarachnoid hemorrhage. Practical guidelines for vasospasm treatment are given. Together with contributions about arteriovenous malformations and fistulas, cerebral revascularization techniques and surgery related to the intracranial venous system a comprehensive overview about stroke surgery is given with an interdisciplinary approach. The book will be of interest for all specialists involved in therapy of cerebrovascular disease.

A visually-rich and portable atlas of intracranial aneurysm surgery Video Atlas of Intracranial Aneurysm Surgery is a content-rich reference that focuses on how to safely perform the full spectrum of surgical procedures for intracranial aneurysms. The work provides guidance on avoiding complications as well as anticipating and managing problems that may arise during surgery. Concise, high-quality videos are carefully woven throughout the atlas text, bringing to life the tips and techniques described in the book. This atlas is informed with the experience of Dr. Nussbaum, a seasoned neurosurgeon at The National Brain Aneurysm Center who has performed over 2,000 aneurysm surgeries. Key Features: Two DVDs containing 57 author-narrated operative videos that demonstrate the exposure, dissection, and clipping of a wide variety of intracranial aneurysms Beautiful detailed illustrations, intraoperative photos, and images guide the reader through the procedures Tables containing pearls, pitfalls, and complications specifically related to surgical exposure of aneurysms in every standard location provide a quick review of key information for each aneurysm site Video Atlas of Intracranial Aneurysm Surgery brings the spectrum of microsurgical procedures for intracranial aneurysms to residents, fellows, and younger neurosurgeons in an increasingly endovascular-focused field.

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 book will discuss and cover standard treatments and advances in some of the most controversial topics in cerebrovascular surgery traversing the whole arena, including open and interventional surgeries. They will be discussed with case scenarios, bail out strategies and complication handling, followed by advances in the subject. Some of the best academic cereberovascular physician will author these chapters with their vast experience. The book will be of particular benefit to neurosurgeons, neurologists, and radiologists. It will be particularly targeting residents, young and experienced faculty in the subject, and will provide first hand up to the mark information and experiences in cerebrovascular surgery.