Cerebrovascular Surgery: Controversies, Standards and Advances

Foreword
Preface
Acknowledgements
Series Preface
Contents
Chapter 1: Tailored Skull Base Approach to Management of Intracranial Aneurysms
1.1 Introduction
1.2 Anterolateral Skull Base Approaches
1.2.1 Pterional Approach
1.2.1.1 Intervention
1.2.2 Fronto-Orbito-Zygomatic Approach and Variant (FOZ)
1.2.2.1 Intervention
1.2.3 Dolenc Approach and Kawase Approach
1.2.3.1 Intervention
1.3 Posterolateral Skull Base Approaches
1.3.1 Retrosigmoid Approach
1.3.1.1 Intervention
1.3.2 Combined Presigmoid Retrolabyrinthine Petrosal Approach
1.3.2.1 Intervention
1.3.3 Far-Lateral Approach and Extreme Lateral Inferior Trans-Condylar Approach (Elite)
1.3.3.1 Intervention
1.4 Recommended NS-Strategies for Management of Intracranial Aneurysms
1.5 Conclusion
References
Chapter 2: Microsurgical Treatment of Deep and Eloquent AVMs
2.1 Introduction
2.2 Standards
2.2.1 Description
2.2.2 Decision to Treat
2.2.3 Microneurosurgical Technique
2.3 Advances
2.4 Controversies
2.5 Illustrative Cases
2.5.1 Case 1
2.5.2 Case 2
2.5.3 Case 3
2.5.4 Case 4
2.5.5 Case 5
2.5.6 Case 6
2.5.7 Case 7
2.6 Conclusion
References
Chapter 3: Posterior Circulation Aneurysms
3.1 Introduction
3.2 Basilar Tip Aneurysms
3.2.1 Preoperative Considerations
3.2.2 Surgical Approaches: Anterolateral
3.2.3 Surgical Approaches: Lateral
3.2.4 Case Example
3.2.4.1 Case 1
3.3 Posterior Inferior Cerebellar Artery (PICA) Aneurysms
3.3.1 Preoperative Considerations
3.3.2 Surgical Approaches
3.3.3 Case Examples
3.3.3.1 Case 2
3.3.3.2 Case 3
3.3.3.3 Case 4
3.4 Vertebrobasilar Junction Aneurysms
3.4.1 Preoperative Considerations
3.4.2 Surgical Approaches
3.4.3 Case Example
3.4.3.1 Case 5
3.5 Aneurysms of the Basilar Trunk
3.6 Non-saccular Aneurysms of the Posterior Circulation
3.7 Endovascular Therapy for Posterior Circulation Aneurysms
References
Chapter 4: Ischemic Stroke Revascularization
4.1 Standard Surgical Strategies and Techniques
4.1.1 Indications
4.1.2 Surgical Strategies
4.2 Advanced Surgical Strategies and Techniques
4.2.1 Occipital Artery (OA)-Posterior Inferior Cerebellar Artery (PICA), STA-Superior Cerebellar Artery (SCA), STA-Posterior Cerebral Artery (PCA) Bypass for Posterior Circulation Ischemia
4.2.2 Bonnet Bypass for Unilateral Common Carotid Artery (CCA) Occlusion
4.2.3 Reverse Bypass Using a Naturally Formed “Bonnet” STA for Symptomatic CCA Occlusion
4.2.4 Absence of Donor Artery Such as the STA
4.2.5 Multiple Stenotic Lesions
4.3 Controversies
4.3.1 Surgical Indications
4.3.2 Acute Phase (Emergency) Bypass
References
Chapter 5: Hemorrhagic Stroke: Endoscopic Aspiration
5.1 Introduction
5.2 Intracerebral Hemorrhage
5.2.1 Standards
5.2.1.1 Case Illustration 1
5.2.2 Advances
5.2.2.1 Case Illustration 2
5.3 Intraventricular Hemorrhage
5.3.1 Standards
5.3.1.1 Case Illustration 3
5.3.1.2 Case Illustration 4
5.3.2 Advances
5.3.2.1 Case Illustration 5
5.3.3 Controversies Discussion
5.3.3.1 ICH
5.3.3.2 IVH
References
Chapter 6: Functional Outcomes of Microsurgical Resection for Cavernous Malformations of the Brainstem
6.1 Introduction
6.2 Surgical Indication, Approach, and Resection
6.3 Judgment of Complete Resection
6.4 Our Experience
6.5 Results of 33 Operations
6.6 Recurrent Hemorrhage During Follow-up
6.7 Recovery of Neurological Symptoms
6.8 Representative Cases
6.8.1 Case 1
6.8.2 Case 2
6.9 Discussion
6.10 Conclusions
References
Chapter 7: Giant Aneurysm Management
7.1 Introduction
7.2 Standards of Treatments
7.2.1 The Classification of Bypass Techniques
7.2.2 The Common Hemodynamic Assessment Technique
7.2.3 Bypass Strategy for GIAs Located at Different Locations
7.3 Case Illustration
7.4 Advances
7.4.1 Noninvasive Optimal Vessel Analysis (NOVA)
7.4.2 High-Resolution Vessel Wall MRI (HR-VW MRI)
7.4.3 The Hybrid Operating Room
7.5 Case Illustration
7.6 Controversies
7.7 Case Illustration
References
Chapter 8: Contralateral Clipping of Multiple Intracranial Aneurysms
8.1 Introduction
8.2 Selection Criteria for Contralateral Clipping of Aneurysm
8.2.1 Selection Criteria for Contralateral Ophthalmic Segment ICA Aneurysm Clipping
8.2.2 Selection Criteria for Contralateral Communicating Segment ICA Aneurysm Clipping
8.2.3 Selection Criteria for Contralateral ICA Bifurcation Aneurysm Clipping
8.2.4 Selection Criteria for Contralateral MCA Bifurcation Aneurysm Clipping
8.3 Surgical Nuances While Clipping of Multiple Intracranial Aneurysm Including Contralateral ICA and MCA Bifurcation Aneurysm
8.3.1 Proximal ICA Control
8.3.2 Placement of Proximal ICA Balloon by Angiographic Guidance
8.3.3 MCA Bifurcation Aneurysm Clipping
8.4 Outcome and Failure to Clip Contralateral Aneurysm in MIA
8.5 Advantages of Single Stage Clipping of Bilateral MIA
8.6 Disadvantages
8.7 Authors Experience and Case Example of Clipping of Multiple Bilateral Intracranial Aneurysms
8.8 Conclusion
References
Chapter 9: Moyamoya Disease-Standards and Advances in Revascularization Procedure and Peri-operative Management
9.1 Introduction
9.2 Surgical Indication of STA-MCA Bypass for MMD
9.2.1 Concept of Surgical Revascularization for MMD
9.2.2 Best Surgical Indication of STA-MCA Bypass for MMD
9.2.3 Controversy Issues of the Surgical Indication for MMD
9.3 Surgical Procedure of STA-MCA Bypass for Adult MMD
9.3.1 Standard Procedure of Direct/Indirect Combined Revascularization
9.4 Intrinsic Peri-Operative Hemodynamics and Optimal Peri-Operative Management
9.4.1 Ischemic Complication of Combined Revascularization Procedure for MMD
9.4.2 Significance of Transient Local Cerebral Hyperperfusion (CHP) in Adult MMD Patients
9.4.3 Limitation of the Current Peri-Operative Management Strategy
9.5 Conclusion
References
Chapter 10: Carotid Endarterectomy
10.1 Introduction
10.2 Evidence of CEA
10.2.1 CEA for Symptomatic Carotid Stenosis
10.2.2 CEA for Asymptomatic Carotid Stenosis
10.2.3 CEA vs. CAS
10.3 Theoretical Background of CEA
10.4 Timing of Surgery
10.5 Imaging
10.5.1 Carotid Ultrasonography (CUS)
10.5.2 Magnetic Resonance Imaging (MRI) and Angiography (MRA) (Fig. 10.1)
10.5.3 Computed Tomography Angiography (CTA) (Fig. 10.2)
10.5.4 Other Imaging Modalities
10.6 Anatomy of CEA (Fig. 10.3)
10.7 Preoperative Management
10.7.1 Risk Management of General Anesthesia
10.7.2 Antiplatelet Therapy
10.8 Neurophysiological Monitoring and Shunt Usage
10.9 Standard Surgical Procedure (Figs. 10.4–10.7)
10.10 Controversial Issue
10.10.1 Eversion or Standard CEA?
10.10.2 Primary Closure or Patch Angioplasty?
10.10.3 Restenosis After CEA
10.11 Postoperative Management
10.12 Complication and its Management
10.12.1 Myocardial Infarction
10.12.2 Nerve Palsies
10.12.3 Cerebral Hyperperfusion Syndrome (CHS)
10.13 CEA for High Risk Patients (Advanced)
10.14 Summary
References
Chapter 11: Carotid Angioplasty and Stenting for Occlusive Diseases
11.1 Introduction
11.2 Medical Treatments
11.3 Indication of CAS
11.4 Preoperative Evaluation
11.5 Treatment Method and Maneuver
11.6 The Importance of Tailored CAS
References
Chapter 12: Complex Intracranial Aneurysms
12.1 Introduction
12.2 Standards
12.2.1 Giant/Large Middle Cerebral Artery Bifurcation Aneurysms
12.2.2 Unruptured Symptomatic Intracavernous Giant/Large Internal Carotid Artery Aneurysms
12.2.3 Ruptured Intradural Vertebral Artery Dissecting Aneurysms
12.3 Advances
12.3.1 Recurrent Intradural ICA Aneurysms Following Previous Coil Embolization
12.3.2 Giant/Large Distal ACA Aneurysms
12.3.3 Unruptured Symptomatic Giant/Large Basilar Trunk Saccular Aneurysms
12.4 Controversies
12.4.1 Bypass Selection upon Therapeutic ICA Occlusion
12.4.2 PAO Strategy: Coiling or Clipping?
12.4.2.1 Intracavernous Giant/Large ICA Aneurysms
12.4.2.2 Paraclinoid Giant/Large ICA Aneurysms
12.4.2.3 Intradural VA Dissecting Aneurysms
12.4.3 Surgical Strategy for Fusiform Giant Partially Thrombosed Basilar Trunk Aneurysms
12.5 Conclusion
References
Chapter 13: Endovascular Treatment for Anterior Communicating Artery Aneurysms
13.1 Characteristics of the Anterior Communicating Artery Aneurysm
13.2 Treatment Strategy for Anterior Communicating Artery Aneurysm
13.3 Indications for Treatment of Anterior Communicating Artery Aneurysm
13.3.1 Case 1 Simple Technique
13.3.2 Double Catheter Technique
13.3.3 Balloon Assist Technique
13.3.4 Stent Assist Technique
13.3.5 Postoperative Care
13.4 Characteristics of Anterior Communicating Artery Distal Aneurysms
13.4.1 Treatment Strategy for ACA Distal An
13.4.2 Treatment Indications for ACA Distal An
13.4.3 Case 1
13.5 The Future of ACA Distal An
References
Chapter 14: Management of Dural Arteriovenous Fistulas
14.1 Standard Management
14.1.1 Treatment Strategy
14.1.2 Transvenous Embolization (TVE)
14.1.3 Transarterial Embolization (TAE)
14.1.4 Complications of Treatment
14.1.4.1 Complications of TAE
Migration of the Embolic Materials via the Arterial Anastomosis
Migration of the Embolic Materials to the Venous Side
Ischemia of the Vasa Nervorum
14.1.4.2 Complications of TVE
Mass Effect to the Cranial Nerves
Venous Infarction and Bleeding
14.2 Advances
14.2.1 Selective TVE
14.2.2 Onyx Embolization
14.2.3 Spinal Dural and Epidural AV Shunts
14.3 Controversies
14.3.1 Timing of Treatment
14.3.2 Shunt Location and Treatment Modality
14.3.3 Surgical Treatment
References
Chapter 15: Keyhole Approach in Cerebral Aneurysm Surgeries
15.1 Introduction
15.2 Pros and Cons of Keyhole Clipping Compared with Standard Craniotomy
15.3 Surgical Indications of Clipping via the Supraorbital Keyhole Approach
15.4 Preoperative Imaging and Surgical Simulation
15.5 Keyhole or Standard Craniotomy?
15.5.1 ICA Aneurysm
15.5.2 Internal Carotid-Paraclinoid Aneurysm
15.5.3 AcomA Aneurysm
15.6 Surgical Technique of Supraorbital Keyhole Clipping
15.7 Representative Cases
15.8 Future Prospects
15.9 Reminds
References
Chapter 16: Repeated Aneurysm Intervention
16.1 Introduction
16.2 Occlusion Rate After Surgical and Endovascular Treatment
16.3 AN Regrowth
16.4 Rebleeding
16.5 Retreatment: Indications and Risks
16.6 Follow-up Controls
16.7 Future Directions
16.8 Conclusion
16.9 Our Experience
References
Chapter 17: Management of Wide-Necked Basilar tip Aneurysms
17.1 Introduction
17.2 Selection of Surgical Approach
17.3 Treatment Strategy Using Hybrid Surgery
17.4 Case Presentation
17.5 Conclusion
References
Author Index
Subject Index