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