The field of cerebral revascularization is currently experiencing a major renaissance. We feel the time is appropriate for a textbook dedicated to exploring this subject in great detail, including its historical roots, anatomophysiological underpinnings, current microsurgical and endovascular techniques, and future possibilities.
Since the early days of Professor Yaşargil's pioneering work in the late 1960s, extracranial-to-intracranial (EC-IC) bypass techniques have continued to evolve. Today, they encompass several variations developed to address different pathologies, including cerebral ischemia, Moyamoya disease, skull base tumors, and complex aneurysms. The latter, complex/giant cerebral aneurysms, are the main pathology for which these techniques are utilized at this point. The indications for EC-IC bypass for large-vessel intracranial or extracranial occlusive disease remains unclear. We await the publication of the Carotid Occlusion Surgery Study subgroup analysis, as well as the Japanese EC-IC trial, to shed light on the possible surgical indications for ischemic disease.
In this monograph, evolving techniques in EC-IC bypass surgery are described. The image-guided STA-MCA bypass through a burr hole is elucidated. We also introduce our initial experience with a minimally invasive high-flow bypass technique using the internal maxillary artery that avoids a long cervical incision while providing a short interposition high-flow graft. The technique of excimer laser-assisted nonocclusive anastomosis (ELANA), as developed by Professor Tulleken, is delineated. Evolving endovascular techniques including the use of stents for giant aneurysms as well as reopening of an occluded internal carotid artery are described.
The contributors to this monograph represent some of the key pioneers in cerebrovascular surgery over the past three decades. Their contributions and the composite of their experience within this text allows for a unique understanding of cerebrovascular hemodynamics, natural history of giant aneurysms, evolving microsurgical and endovascular techniques, and a decision-making process for the management of these pathologies. The future of cerebral revascularization will undoubtedly rest on the evolving techniques and technologies of both the microsurgical and the endovascular arenas.
Key Features
- Sharpen your skills in Extracranial-to-Intracranial (EC-IC) Bypass Surgery with help from the first and only text entirely dedicated to this quickly evolving procedure.
- Get exclusive, first-hand expert knowledge from a an internationally renowned team of editors and contributors, all leaders in cerebrovascular care.
- See key EC-IC bypass procedures performed in detailed, step-by-step instructional video clips.
Website Features
- Consult the book from any computer at home, in your office, or at any practice location.
- Instantly locate the answers to your clinical questions via a simple search query.
- Quickly find out more about any bibliographical citation by linking to its MEDLINE abstract.
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- Videos: Access videos that demonstrate signs of common diseases and disorders as well as a variety of procedures.
Contents
I - CEREBRAL HEMODYNAMICS AND CEREBROVASCULAR IMAGING
- Chapter 1 - Autoregulation and Hemodynamics in Human Cerebrovascular Disease
- Chapter 2 - Using Cerebral Vaso-Reactivity in the Selection of Candidates for EC-IC Bypass Surgery
- Chapter 3 - PET Measurements of OEF for Cerebral Revascularization
- Chapter 4 - Assessment of Cerebrovascular Reactivity Using Emerging MR Technologies
- Chapter 5 - Decision Making in Cerebral Revascularization Surgery Using Intraoperative CBF Measurements
- Chapter 6 - New Days for Old Ways in Treating Giant Aneurysms—From Hunterian Ligation to Hunterian Closure?
II - EC-IC BYPASS SURGICAL TECHNIQUES
- Chapter 7 - Surgical Anatomy of EC-IC Bypass Procedures
- Chapter 8 - STA-MCA Microanastomosis: Surgical Technique
- Chapter 9 - OA-PICA Bypass
- Chapter 10 - The State of the Art in Cerebrovascular Bypasses: Side-to-Side in situ PICA-PICA Bypass
- Chapter 11 - Radial Artery Harvest for Cerebral Revascularization: Technical Pearls
- Chapter 12 - Saphenous Vein Grafts for High-Flow Cerebral Revascularization
- Chapter 13 - IC-IC Bypasses for Complex Brain Aneurysms
- Chapter 14 - EC-IC Bypass Using ELANA Technique
- Chapter 15 - Minimally Invasive EC-IC Bypass Procedures and Introduction of the IMA-MCA Bypass Procedure
III - CEREBRAL ISCHEMIA
- Chapter 16 - EC-IC Bypass Evidence
- Chapter 17 - EC-IC Bypass for Posterior Circulation Ischemia
- Chapter 18 - Cerebral Revascularization for Moyamoya Disease
- Chapter 19 - Carotid Endarterectomy
- Chapter 20 - Endovascular Therapies for Cerebral Revascularization
- Chapter 21 - Exploring New Frontiers: Endovascular Treatment of the Occluded ICA
IV - GIANT CEREBRAL ANEURYSMS
- Chapter 22 - Natural History of Giant Intracranial Aneurysms
- Chapter 23 - EC-IC Bypass for Giant ICA Aneurysms
- Chapter 24 - Cerebral Bypass in the Treatment of ACA Aneurysms
- Chapter 25 - Bypass Surgery for Complex MCA Aneurysms
- Chapter 26 - Bypass Surgery for Complex Basilar Trunk Aneurysms
- Chapter 27 - Surgical Revascularization of the Posterior Circulation
- Chapter 28 - EC-IC and IC-IC Bypass for Giant Aneurysms Using the ELANA Technique
- Chapter 29 - Endovascular Techniques for Giant Intracranial Aneurysms
- Chapter 30 - Fusiform Intracranial Aneurysms: Management Strategies
V - SKULL BASE TUMORS
- Chapter 31 - Decision-Making Strategies for EC-IC Bypass in the Treatment of Skull Base Tumors
- Chapter 32 - Intracranial Venous Revascularization
Book Review
"Definite or general rules to guide our evaluation process and point with certainty to correct indications for a particular treatment currently elude us, despite the availability of stable Xenon/CO2, MRI, SPECT, and PET.
In 1966, microvascular surgery on brain arteries of dogs proved to be a breakthrough, confirming the capability to perform reconstructive microneurovascular surgery and other procedures on patients. The EC-IC bypass is an excellent surgical option, but only for those select cases with occlusive brain artery diseases, having verified there are insufficient collaterals. Reconstructive microvascular surgery certainly contributed positively to the treatment of intracranial saccular and fusiform aneurysms, AVMs,[129,][131–141] cavernomas, and extrinsic and intrinsic tumors.[18] In the treatment of large, giant, and fusiform aneurysms[90,][142,][143]; AVMs; cavernous fistulas[43]; vasospasm[42]; invasive neck and skull base tumors; tumors invading and encasing brain arteries, veins,[23,][144–151] and venous sinuses[17,][38,][92,136,][142,][145–152]; and reconstructive microvascular surgery such as the in situ repair, intracranial bypass, or extracranial bypass (which are already effectively practiced) will be used on a broader scale in the future.
Basic sciences, scientific technology, and the medical and surgical industry undoubtedly provide sophisticated equipment and materials to promote neurosurgical treatments. I am more than satisfied and encouraged to learn of these advances described in the publications of the young colleagues included in this monograph. The coming generations of neurosurgeons will be well equipped to cope with the variations in hemodynamics in the field of neuroscience.
Intense laboratory exercise and practice will stimulate the creation of fresh avenues into research and clinical treatments, and will guide young generations of colleagues toward innovative and effective concepts in vascular neurosurgery."
-- M. Gazi Yaşargil, M.D.
Product Details
- Hardcover: 424 pages
- Publisher: Saunders; Har/Psc edition (2011)
- Language: English
- ISBN-10: 1437717853
- ISBN-13: 978-1437717853
- Product Dimensions: 11.1 x 8.8 x 0.9 inches
List Price: $274.00