Eight Aneurysms

This book introduces the basic tenets and technique skills for endovascular embolization and provides the most up-to-date technical advancements, treatment strategy evolution, and literature review related to the endovascular treatment of brain aneurysms. The most special feature of this book is how the content is organized. The morphology, instead of the location, dictates the treatment strategy applied and procedure skills required for the endovascular treatment of brain aneurysms. Hence, the book is structured with a new conceptual way of classifying aneurysms into eight different types based on the morphological characteristics of brain aneurysms. The specific technical skills and treatment strategies for these different aneurysm categories are described separately in their own chapters. Another important feature of the book is the combination of detailed technical descriptions of the skills, strategies, and advancement in the field accompanied with case presentations. The large and comprehensive collection of the case presentations further enhances the points in the text. This book can be used as a handbook on endovascular treatment of brain aneurysms. It can also help physicians in the early careers of these subspecialties for their daily practice and board preparation. The text will provide the most up-to-date knowledge for more experienced endovascular neurosurgeons and interventionalists on the topics of new techniques and endovascular products. Additionally, it can also serve as a practice guidance resource for nurse practitioners and physician assistants of the above subspecialties.

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.

The small neck of the aneurysm afforded an easy surgical attack. An ordinary flat silver clip was placed over the sac and tightly compressed obliterated it completely. The clip was flush with the wall of the carotid artery. The sac, lateral to the silver clip, was then picked up with the forceps and thrombosed by the electocautery. Walter Dandy reporting his successful operation of a posterior communicating aneurysm on March 23, 1937. Walter Dandy's patient left the hospital in good health 2 weeks later, and from his report one may gain the impression that the operation was an easy task. Despite continuous developments during the following decades, it was not until the introduction of the operating microscope and microsurgical techniques that surgical treatment was generally accepted. During the microsurgical era surgical results have continued to improve due to diagnostical, neuroanaesthesi ological, and microsurgical refinements, and improved neurointensive care. Endovascular obliteration has become an important treatment alternative but this has not been included in this particular volume. The purpose of the present supplement of the ACTA NEUROCHIRURGICA is to review some of the elements in the neurosurgical management of patients with aneurysmal subarachnoid haemorrhage that are important for a successful outcome. Professor Helge Nornes has been a major force in the development of new techniques and research strategies in this area for a number of years and has recently retired from the National Hospital in Oslo.

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.

Cardiovascular Pathology, Fourth Edition, provides users with a comprehensive overview that encompasses its examination, cardiac structure, both normal and physiologically altered, and a multitude of abnormalities. This updated edition offers current views on interventions, both medical and surgical, and the pathology related to them. Congenital heart disease and its pathobiology are covered in some depth, as are vasculitis and neoplasias. Each section has been revised to reflect new discoveries in clinical and molecular pathology, with new chapters updated and written with a practical approach, especially with regards to the discussion of pathophysiology. New chapters reflect recent technological advances with cardiac devices, transplants, genetics, and immunology. Each chapter is highly illustrated and covers contemporary aspects of the disease processes, including a section on the role of molecular diagnostics and cytogenetics as specifically related to cardiovascular pathology. Customers buy the Print + Electronic product together! Serves as a contemporary, all-inclusive guide to cardiovascular pathology for clinicians and researchers, as well as clinical residents and fellows of pathology, cardiology, cardiac surgery, and internal medicine Offers new organization of each chapter to enable uniformity for learning and reference: Definition, Epidemiology, Clinical Presentation, Pathogenesis/Genetics, Light and Electron Microscopy/Immunohistochemistry, Differential Diagnosis, Treatment and Potential Complications Features six new chapters and expanded coverage of the normal heart and blood vessels, cardiovascular devices, congenital heart disease, tropical and infectious cardiac disease, and forensic pathology of the cardiovascular system Contains 400+ full color illustrations and an online image collection facilitate research, study, and lecture slide creation

At the 8th European Congress of Neurosurgery, which took place in Barcelona, September 6-11, 1987, a great number of papers from all fields of neurosurgery were presented, reflecting the major advances that have been achieved in recent years. The Programme Committee of the European Association of Neurosurgical Societies has selected the highlights of the congress for publication. These contributions were carefully edited and compiled in two supplement volumes of "Acta Neurochirurgica."