Introduction to Vascular Neurosurgery

Description

This book aims to cover the majority of neurovascular diseases and management. The first section reviews neurovascular anatomy, the basics of angiography, and the basics of craniotomies for neurovascular diseases. Next, an entire section is devoted to intracranial aneurysms, covering the natural history, subarachnoid hemorrhage, endovascular management, microsurgical management, and vasospasm. Following this, a number of chapters are devoted to stroke including natural history, mechanical thrombectomy, intracranial stenosis, Moyamoya disease, bypass surgery, vertebrobasilar insufficiency, intracerebral hemorrhage, sinus thrombosis, and the surgical and endovascular management of extracranial carotid disease. Next, the text covers vascular malformations including arteriovenous malformation, arteriovenous fistulas, carotid cavernous fistulas, vein of Galen malformations, spinal malformations, and cavernous malformations. Finally, the book discusses a few miscellaneous topics including more recent advances in neurovascular care such as venous sinus stenting for idiopathic intracranial hypertension and middle meningeal artery embolization for subdural hematoma.  Written by experts in the field, Introduction to Vascular Neurosurgery provides a comprehensive summary of neurovascular disease and management. The book can be used as a daily reference and serves as a trusted resource for medical students, residents, fellows, and young attendings. Preface Contents Contributors Part I: Basics of Vascular Anatomy and Neurosurgical Treatment Chapter 1: Vascular Anatomy of the Brain Introduction Internal Carotid Artery C1, Cervical C2, Petrous C3, Lacerum C4, Cavernous C5, Clinoidal C6, Ophthalmic C7, Communicating Intracranial Branches of ICA Ophthalmic Artery Superior Hypophyseal Artery Anterior Choroidal Artery Anterior Cerebral Artery A1, Pre-communicating Anterior Communicating Artery A2, Post-communicating A3, Precallosal Pericallosal Artery Middle Cerebral Artery M1, Horizontal M2, Insular M3, Opercular M4, Cortical Branches Anterior Branches Intermediate Branches Posterior Branches Medial Temporal Artery Posterior Cerebral Artery P1, Pre-communicating P2, Ambient Perforating Arteries Cortical P3, Quadrigeminal P4, Calcarine Posterior Communicating Artery Basilar Artery Labyrinthine Arteries Cerebellar Arteries Posterior Inferior Cerebellar Artery Anterior Inferior Cerebellar Artery Superior Cerebellar Artery Remnants of the Embryonic Arterial System Venous System Superficial Veins Dural Venous Sinuses Superior Sagittal Sinus (SSS) Inferior Sagittal Sinus Straight Sinus Transverse Sinus Sigmoid Sinus Occipital Sinus Cavernous Sinus Superior Petrosal Sinus Inferior Petrosal Sinus Basilar Venous Plexus Deep Veins Internal Cerebral Veins Basal Vein Great Cerebral Vein of Galen Middle Meningeal Veins Conclusion References Chapter 2: Vascular Anatomy of the Neck/Spine Introduction Aortic Arch Aortic Arch Variants Carotid and Jugular Vasculature Common Carotid Artery Internal Carotid Artery External Carotid Artery Superior Thyroid Artery Lingual Artery Ascending Pharyngeal Artery (APA) Facial Artery (FA) Occipital Artery (OA) Posterior Auricular Artery (PAA) Superficial Temporal Artery (STA) Internal Maxillary Artery (IMax) Jugular Veins Internal Jugular Vein Anterior Condylar Vein Facial Vein Lingual Vein Pharyngeal Vein External Jugular Vein Scalp Veins External Carotid-Internal Carotid Artery Collaterals Vertebral Vasculature Vertebral Artery Variants Vertebral Veins Spinal Vascular Anatomy Spinal Arteries Spinal Veins Conclusion References Chapter 3: Basics of Angiography Indications Pre-procedure Evaluation Consent Access Femoral Radial Catheter Selection Catheters for Radial Access Aortic Arch Navigation and Initial Vessel Selection Roadmapping Double Flushing and Image Acquisition Hemostasis and Closure Devices Complications and Their Management Neurologic Complications Access Site Complications Conclusion References Chapter 4: Basics of Craniotomy General Principles Approaches for Anterior Circulation Aneurysms (e.g., AComA, PComA, MCA, ICA, Paraophthalmic, and Distal ACA) Pterional Craniotomy (Frontotemporal Sphenoidal) Patient Positioning Skin Incision, Temporal Muscle, and Scalp Handling Bone Flap, Dural Opening, and Pterional Closure Supraorbital Craniotomy Patient Positioning Skin Incision, Temporal Muscle, and Scalp Handling Bone Flap, Dural Opening, and Closure Lateral Supraorbital Craniotomy Positioning Skin Incision, Temporal Muscle, and Scalp Handling Frontotemporal Orbitozygomatic Craniotomy Skin, Fascial Flap, and Temporal Muscle Dissection Bone Flap and Modifications, Dural Opening, and Pterional Closure Approaches for Posterior Circulation Aneurysms (e.g., Used for Basilar Artery Bifurcation, Trunk and Branches, Vertebrobasilar Junction, Vertebral Artery, PICA, AICA, SCA, and Distal PCA) Subtemporal Preparation and Positioning Incision, Dissection, and Craniotomy Far Lateral Suboccipital Preparation and Positioning Incision, Dissection, and Craniotomy Extended Far Lateral Suboccipital Approach Transcondylar Extension Supracondylar Extension (Transtubercular) Midline Suboccipital Approach Retrosigmoid Other Approaches References Part II: Aneurysms Chapter 5: Presentation and Natural History Background Presentation Screening and Incidental Headache Mass Effect Thromboembolic Events Rupture Natural History Risks of Aneurysm Formation Risks of Aneurysm Progression Risks of Aneurysm Rupture Conclusion References Chapter 6: Subarachnoid Hemorrhage Management and External Ventricular Drain Placement Introduction Epidemiology and Risk Factors Clinical Presentation Imaging and Diagnosis Computed Tomography Lumbar Puncture Magnetic Resonance Imaging Noninvasive Vascular Imaging Angiography Grading Pathophysiology of Early Brain Injury Initial Management Airway Blood Pressure Management Intracranial Hypertension Intraparenchymal or Intraventricular Hemorrhage ICP Management Acute Hydrocephalus Seizure Management Volume Status Laboratory Studies Acute Cardiac Complications Acute Pulmonary Complications Sedation and Pain Management Rebleeding External Ventricular Drain Indications Preparation Technique EVD Management EVD Wean Protocol Complications Treatment Preparation Conclusion References Chapter 7: Endovascular Aneurysm Treatment Coiling Balloon-Remodeling Technique Comaneci Temporary Aneurysm Embolization Assist Device Stent-Assisted Coiling Flow Diversion Intrasaccular Devices Conclusion References Chapter 8: Microsurgical Aneurysm Treatment Introduction History of Surgical Management of Aneurysms Neuro-Imaging Evaluation Indications for Aneurysm Surgery in the Endovascular Era Pediatric Patients Multiple Aneurysms Very Small Aneurysms Endovascular Treatment Failures Contraindications to Dual Antiplatelet Therapies and Noncompliant Patients Associated Intracerebral Hemorrhage Large Aneurysms with Mass Effect Wide-Necked Aneurysms Complex Configuration Thrombotic Aneurysms Fusiform or Dolichoectatic Aneurysms Infectious Aneurysms Pseudoaneurysms Basic Principles of Surgery Anesthetic Considerations Positioning and Craniotomy Microsurgical Technique Conclusion References Chapter 9: Cerebral Vasospasm Background Discovery Angiographic Appearance and Predictors of Vasospasm After SAH Other Imaging Modalities for Detecting Vasospasm Epidemiology Pathophysiology Blood Extravasation and Local Increases in Subarachnoid Space Pressure RBC Clearance, Hemoglobin, and Its Vasoactive Degradation Products Other Peripheral Blood Cellular Players and Their Inflammatory Processes Remodeling of the Arterial Wall Other Contributing Processes That Can Have an Interplay with Vasospasm Management Diagnosis Triple H Systemic Prophylactic Therapies Rescue Interventions Outlook References Part III: Stroke Chapter 10: Acute Ischemic Stroke Presentation, Natural History, and Treatment Background Clinical Presentation Middle Cerebral Artery (MCA) Anterior Cerebral Artery (ACA) Posterior Cerebral Artery (PCA) Vertebrobasilar Stroke Syndrome Lacunar Infarcts Natural History Advanced Neuroimaging Intravenous Thrombolytics Large Vessel Occlusion Triage Future Considerations Conclusion References Chapter 11: Endovascular Management of Stroke Philosophy of Mechanical Thrombectomy Endovascular Treatment: Initial Negative Trials Endovascular Treatment: Positive Trials Extending the Time Window for Thrombectomy Techniques of Mechanical Thrombectomy (Fig. 11.1) Stent Retriever Technique Brief Technical Steps Direct Aspiration First Pass Technique (Adapt) (Case 1) Brief Technical Steps (Case 1) Solumbra (Case 2) Difficult and Challenging Situations Large Vessel Occlusions with Carotid Artery Occlusion (Tandem Lesions) Posterior Circulation Occlusion (Case 3) Distal Occlusions References Chapter 12: Surgical Management of Extracranial Carotid Disease Introduction Indications Imaging and Diagnosis Pre-Operative Medical Management Surgical Considerations Operative Anatomy Surgical Procedure Postoperative Care Complications and Management Conclusion References Chapter 13: Endovascular Management of Extracranial Carotid Disease Introduction Epidemiology Pathophysiology Clinical Presentation Endovascular Interventions for Carotid Stenosis Patient Selection Clinical Trials Anatomic Considerations in Patient Selection Technical Considerations Percutaneous Vascular Access Embolic Protection Devices Distal Filters Flow Arrest Carotid Stents Angioplasty Periprocedural Management Complications Evaluation for Recurrence and Subsequent Management Transcarotid Artery Revascularization (TCAR) Patient Selection Technical Considerations Procedural Steps TCAR Trials Conclusions References Chapter 14: Intracranial Atherosclerotic Disease Introduction Epidemiology and Risk Factors Mechanism of Stroke Imaging and Differential Diagnosis Treatment Medical Management Antiplatelet Therapy Versus Anticoagulation Risk Factor Modification Surgery Direct Bypass Indirect Bypass Endovascular Therapy Stenting Submaximal Angioplasty Future Directive Conclusion References Chapter 15: Moyamoya Disease Introduction Epidemiology Pathogenesis Pathology Genetics Pathophysiology Endothelial Progenitor Cells Endothelial Cells Smooth Muscle Cells Cytokines Environmental Factors Moyamoya Diagnosis Computed Tomography (CT) Computed Tomographic Angiography (CTA) Digital Subtraction Angiography (DSA) Magnetic Resonance Imaging (MRI) Magnetic Resonance Angiography (MRA) Moyamoya Syndrome Clinical Presentation Natural History Adult Disease Pediatric Disease Unilateral Disease Staging Computed Tomography Perfusion and Magnetic Resonance Imaging Perfusion Xenon Computed Tomography Positron Emission Tomography Single-Photon Emission Computed Tomography Blood Oxygen Level–Dependent (BOLD) Magnetic Resonance Imaging Medical Treatment Surgical Treatment Direct Revascularization STA-to-MCA Anastomosis Technique Indirect Revascularization Encephaloduroarteriosynangiosis (EDAS) Encephalomyosynangiosis (EMS) Encephaloduroarteriomyosynangiosis (EDAMS) Omental Transplantation Multiple Burr Holes Outcomes Following Revascularization Perioperative Care Endovascular Therapy Conclusion References Chapter 16: Posterior Circulation Stroke and Vertebrobasilar Insufficiency Introduction Anatomical Variants of the Posterior Circulation Disease Mechanisms of Posterior Circulation Stroke Vertebrobasilar Insufficiency Hemorrhagic Posterior Circulation Stroke Different Locations of Posterior Circulation Stroke Clinical Presentation Imaging Modalities Management of Posterior Circulation Stroke Intraarterial Thrombolysis Intravenous Fibrinolysis Mechanical Thrombectomy Conclusion References Chapter 17: Intracerebral Hemorrhage Introduction Pathophysiology Initial Evaluation BP and ICP Management Anticoagulation and Antiplatelet Reversal Imaging Considerations Discussing Prognosis A Brief History of Surgery for ICH Indications for Decompression Indications for Minimally Invasive Evacuation Stereotactic Thrombolysis with Catheter Drainage Craniopuncture Endoscopic Evacuation Endoscope-Assisted Evacuation Surgiscopic Evacuation Endoport-Mediated Evacuation Surgical Considerations with Case Example Conclusion References Chapter 18: Sinus Thrombosis Background Epidemiology Risk Factors Prognostic Factors Presentation Diagnosis Management of CVT Associated Complications Seizures Hydrocephalus and Intracranial Hypertension Development of Dural Arteriovenous Fistulas Treatment Choice of Anticoagulant Endovascular Management Catheter-Directed Thrombolysis Direct Aspiration Thrombectomy Stent Retrieval Thrombectomy Balloon Thrombectomy Balloon Venoplasty and Stenting Surgical Management Open Surgical Venous Sinus Thrombectomy Decompressive Craniectomy Conclusion References Part IV: Vascular Malformations Chapter 19: Arteriovenous Malformations: Presentation and Natural History Introduction Epidemiology Presentation Risk Factors for Hemorrhage Prior Hemorrhage Demographics Angioarchitecture Associated Aneurysms Risk Factors for Seizure Summary References Chapter 20: Arteriovenous Malformations: Treatment and Management Introduction Grading Tools and Prognostication Conservative Management: ARUBA Trial Treatment Strategies Endovascular Approaches Preoperative Embolization Pre- and Post-radiosurgery Embolization Standalone Therapy Risks and Complications of Embolization Microsurgical Treatment Principles of AVM Microsurgery Surgery Post-embolization or Radiosurgery Acute Ruptured Emergency Surgical Outcomes Radiosurgical Treatment Radiosurgery Outcomes Risks of Radiosurgery Conclusions References Chapter 21: Dural Arteriovenous Fistulas Introduction Dural Arteriovenous Fistulae (dAVFs) Description Pathophysiology Clinical Presentation Classification of Dural Arteriovenous Fistulae Borden Classification Scheme Cognard Classification Scheme Treatment Conclusion References Chapter 22: Carotid Cavernous Fistulas And Vein of Galen Malformations Introduction Carotid-Cavernous Fistulae Classification Epidemiology and Etiology Clinical Considerations Management Conservative, Noninvasive Management Endovascular Treatment Alternative Access Methods Radiosurgery Case Examples Indirect CCF Direct CCF Vein of Galen Malformations Epidemiology Formation Classification Clinical Features Treatment Case Presentation References Chapter 23: Spinal Vascular Malformations Introduction Epidemiology Normal Spinal Vascular Anatomy Classification Schemes Arteriovenous Lesions Dural Arteriovenous Fistulae Clinical Features Imaging Features Treatment Strategies Arteriovenous Malformations Clinical Features Imaging Features Treatment Strategies Pial Arteriovenous Fistulae Clinical Features Imaging Features Treatment Strategies Cavernous Malformations Clinical Features Imaging Features Treatment Strategies Spinal Aneurysms Conclusion References Chapter 24: Cerebral Cavernous Malformations Introduction Histopathology Epidemiology Pathogenesis of Sporadic and Familial CCMs Sporadic CCMs Familial CCMs Clinical Presentation Supratentorial/Hemispheric CCMs Brainstem CCMs Spinal Cord CCMs Imaging Findings Differential Diagnosis Natural History of CCMs: Risk of New and Recurrent Symptomatic Hemorrhage Events Clinical Management and Treatment Considerations Potential Role for Stereotactic Radiosurgery CCMs and Pregnancy References Part V: Miscellaneous Conditions and Endovascular Procedures Chapter 25: Venous Sinus Stenting for Idiopathic Intracranial Hypertension What Is Idiopathic Intracranial Hypertension? Symptoms/Diagnosis Nomenclature Pathogenesis Treatments What Is Venous Sinus Stenosis? Venous Sinus Stenting in IIH Patient Selection Evidence for Venous Sinus Stenting Transtenotic Gradient ICP Symptoms Visual Outcomes Adverse Events Procedural Considerations Antiplatelet Agents Intravascular Ultrasound Future Directions Stent Improvement Randomized Controlled Trials References Chapter 26: Middle Meningeal Embolization for Subdural Hematoma Background Presentation Middle Meningeal Artery Embolization Anatomy Procedure Risks, Complications, and Contraindications Future Directions References Chapter 27: Embolization of Head, Neck, and Spinal Tumors Introduction Pathophysiology Principles of Cerebral Angiography for Head, Neck, and Spine Tumors Embolization Techniques Typical Setup for Head and Neck Tumor Embolization Typical Setup for Direct/Percutaneous Tumor Embolization Typical Setup for Spinal Tumor Embolization Commonly Treated Tumors Meningioma Hemangiopericytoma Hemangioblastoma Glomus tumors (Paragangliomas) Juvenile Nasopharyngeal Angiofibroma Embolization of Spinal Tumors Intra-arterial Chemotherapy for Head and Neck Tumors Intra-arterial Chemotherapy for Intracranial Neoplasm Complications Perioperative Timing Conclusion References Chapter 28: Balloon Test Occlusion, Wada Test and Inferior Petrosal Sinus Sampling Balloon Test Occlusion Introduction Technique Modifications of the Balloon Test Occlusion Stump Pressure Measurements Hypotensive Challenge Transcranial Doppler Venous Phase Delay Cerebral Perfusion Assessment Neurophysiologic Monitoring Complications Wada Test Introduction Technique Current Role in Epilepsy Presurgical Evaluation Alternative Agents Complications Inferior Petrosal Sinus Sampling Introduction Technique Interpretation Complications Conclusion References Index