Introduction to Vascular Neurosurgery

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