Recent Progress in the Management of Cerebrovascular Diseases : Treatment Strategies, Techniques and Complication Avoidance

This book has included 19 recent topics about the treatment of cerebrovascular diseases from basics to surgical (include microneurosurgical, endovascular, endoscopic and Stereotactic radiosurgical techniques) aspects in the management of cerebrovascular diseases. With illustrative cases, the treatment strategies, techniques and complication avoidance have been covered extensively in the chapters to guide the readers on when and what to expect the worst in surgeries. The neurosurgical aspect in the present scenario of COVID is also included. This book will assist the junior neurosurgeons and junior neurological physicians in endeavoring to learn the core concepts and common problems of cerebrovascular surgery. This is a worthwhile addition in this ever growing field of cerebrovascular surgery. Preface Contents Contributors 1: Aneurysm Wall Property 1.1 Introduction 1.2 Understanding the Cerebral Aneurysms 1.3 Radiological Advancement and Clinical Correlation 1.4 Future of Aneurysm Management 1.5 Conclusion References 2: Pathogenesis of Thrombosed Giant Aneurysm 2.1 Introduction 2.2 Illustrative Case 1 2.3 Illustrative Case 2 2.4 Discussion 2.5 Conclusion References 3: Cerebral Vasospasm and Subarachnoid Hemorrhage 3.1 Introduction 3.2 Case Report 3.3 Discussion 3.3.1 Surgical Technique/Management 3.3.2 Outcome 3.3.3 Advantages and Limitations 3.3.4 Complication Avoidance 3.4 Conclusion References 4: White Fibers of the Brain: A Novel Classification 4.1 Introduction 4.2 Specimen Preparation and Steps of Dissection 4.3 Novel Classification of the Brain White Fiber System 4.4 The First Layer/Superficial Group 4.4.1 Short Association or U Fibers 4.5 The Second Layer/the Middle Group 4.5.1 Superior Longitudinal Fasciculus (SLF) 4.5.1.1 Course and Connections 4.5.1.2 Function 4.5.2 Arcuate Fasciculus (AF) 4.5.2.1 Course and Connections 4.5.2.2 Function 4.5.3 Ventral Occipital Fasciculus 4.5.3.1 Course and Connections 4.5.3.2 Function 4.5.4 Middle Longitudinal Fasciculus 4.5.4.1 Course and Connections 4.5.4.2 Function 4.5.5 Inferior Longitudinal Fasciculus (ILF) 4.5.5.1 Course and Connections 4.5.5.2 Function 4.5.6 Inferior Fronto-Occipital Fasciculus (IFOF) 4.5.6.1 Course and Connections 4.5.6.2 Function 4.5.7 Uncinate Fasciculus (UF) 4.5.7.1 Course and Connections 4.5.7.2 Function 4.5.8 Sagittal Stratum and the Optic Radiations 4.5.8.1 Course and Connections 4.5.8.2 Function 4.5.9 Cingulum 4.5.9.1 Course and Connections 4.5.9.2 Function 4.5.10 Medial and Lateral Olfactory Striae 4.5.10.1 Course and Connections 4.5.10.2 Function 4.6 The Central Group 4.6.1 Corpus Callosum 4.6.1.1 Course and Connections 4.6.1.2 Function 4.6.2 Anterior Commissure 4.6.2.1 Course and Connections 4.6.2.2 Function 4.6.3 Hippocampal Commissure/Psalterium 4.6.3.1 Course and Connections 4.6.3.2 Function 4.7 The Vertical Group 4.7.1 Internal Capsule 4.7.1.1 Course and Connections 4.7.1.2 Function 4.7.2 External Capsule 4.7.2.1 Course and Connections 4.7.2.2 Function 4.7.3 Corona Radiata 4.7.3.1 Course and Connections 4.7.3.2 Function 4.8 The Third Layer/Deep Group 4.8.1 Fornix 4.8.1.1 Course and Connections 4.8.1.2 Function 4.8.2 Mammillothalamic and Mammillotegmental Tracts 4.8.3 Stria Terminalis 4.8.4 Stria Medullaris Thalami 4.9 Surgical Implications of the Classification 4.9.1 Classification of Gliomas Based on Anatomical Understanding 4.9.2 Surgical Strategy 4.10 Conclusions References 5: Computational Fluid Dynamics in Cerebral Aneurysms 5.1 Introduction 5.2 CFD Methodology 5.3 Illustrative Cases 5.4 Results and Discussion 5.4.1 Blood Flow Modelling with Theoretical Physics 5.4.2 Aneurysmal Neck as the Deciding Factor 5.4.3 Pattern in Ruptured Aneurysms 5.4.4 Wall Shear Stress as Deciding Factor 5.5 Limitations of CFD Studies References 6: Carotid Endarterectomy: Surgical Nuances 6.1 Introduction 6.2 History 6.3 Preoperative Evaluation 6.4 Indications for Carotid Endarterectomy (CEA) 6.5 Technique 6.6 Exposure for a High Bifurcation or Plaque 6.7 Arteriotomy and Endarterectomy 6.8 Closure 6.9 Comparison of Conventional and Eversion Carotid Endarterectomy 6.10 Complications of CEA 6.11 Management of Complications 6.12 Conclusion References 7: Blister Aneurysm of Middle Cerebral Artery Bifurcation (Case Report and Review) 7.1 Introduction 7.2 Illustrative Case 7.3 Discussion 7.4 Advantage and Limitation 7.5 Complication Avoidance 7.6 Conclusion References 8: Flexible Endoscopic Aspiration of Intraventricular Hemorrhage 8.1 Introduction 8.2 Case Report 8.3 Discussion 8.3.1 Surgical Technique 8.3.2 Outcome 8.3.3 Advantages and Limitations 8.3.4 Complications Avoidance 8.4 Conclusion References 9: Endoscopic Evacuation of Cerebral Haematoma 9.1 A. Small Putaminal Haemorrhage 9.1.1 Introduction 9.1.2 Pre-Procedure Preparations 9.1.3 Trephination and Puncture 9.1.4 Evacuation of Haematoma 9.1.5 Haemostasis 9.1.6 Irrigation of Haematoma Cavity 9.2 B. Large Putaminal Haemorrhage 9.2.1 Conclusion 9.3 Subcortical (Lobar) Haemorrhage 9.3.1 Introduction 9.3.2 Before the Procedure 9.3.3 Evacuation of the Haematoma 9.3.4 Haemostasis 9.3.5 Conclusion 9.4 Cerebellar Haemorrhage 9.4.1 Before the Procedure 9.4.1.1 Timing of the Operation 9.4.1.2 Anaesthesia, Position, and Burr Hole 9.4.2 Trephination and Puncture 9.4.3 Evacuation of Haematoma 9.4.4 Haemostasis 9.4.5 Closure of Craniotomy 9.5 Conclusion References 10: Management (Surgical and Endovascular) of Acute Ischemic Stroke 10.1 Introduction 10.2 Case Report 10.2.1 Case 1 10.2.2 Case 2 10.3 Discussion 10.4 Surgical Technique/Management 10.4.1 Mechanical Thrombectomy with Stent Retrievers 10.4.2 Decompressive Craniectomy 10.5 Outcome 10.6 Advantages and Limitations 10.7 Complication Avoidance 10.8 Conclusion References 11: Contralateral Aneurysm Clipping 11.1 Introduction 11.2 Indications and Criteria 11.3 How to Plan and Proceed! (Figs 11.1, 11.2, 11.3, 11.4, 11.5, 11.6, and 11.7) 11.4 Conclusion References 12: Multimodality Management of Brain AVMs 12.1 Introduction 12.2 Issues in Surgery for AVMs 12.3 Indications for Surgery 12.4 Surgical Planning 12.5 Type of AVM Nidus 12.6 Case Illustration 12.6.1 Motor Strip AVM 12.6.1.1 Case Description 12.6.1.2 Indication for Surgery 12.6.1.3 Imaging 12.6.2 Surgical Planning 12.6.2.1 Goel’s Classification of AVMs 12.6.2.2 Spetzler-Martin Grading of Arteriovenous Malformation 12.7 Preoperative Embolization 12.8 Assessment of a Case for Surgery 12.9 Issues in Planning of Surgery 12.10 Indicators of High-Flow AVM 12.11 Surgical Technique 12.12 Postoperative Care and Outcome 12.13 Complication Avoidance 12.13.1 Control of Bleeding During Surgery 12.13.2 Postoperative Bleeding 12.14 Role of Awake Craniotomy and Brain Mapping 12.15 Preoperative Embolization 12.16 Stereotactic Radiosurgery 12.17 Conclusions References 13: Superficial Temporal Artery-Middle Cerebral Artery Bypass Combined with Encephalo-Duro-Myo-Synangiosis in Treating Moyamoya Disease 13.1 Skin Incision 13.2 Temporal Muscle and Bone Flap 13.3 Dura 13.4 Skin Artery Dissection 13.5 Selection of the Cortical Arteries for Anastomosis 13.6 Artery Anastomosis 13.7 Temporal Muscle Processing and Bone Fixation 13.8 Postoperative Management and Follow-Up 14: Stereotactic Radiosurgery for Brain AVM 14.1 Introduction 14.2 AVM Management 14.3 AVM Radiosurgery Techniques 14.4 Indications for the Use of SRS in AVMs 14.5 Grading Systems of Brain AVM 14.6 Outcomes of SRS for AVMs 14.7 CyberKnife Radiosurgery for Brain AVM in Huashan Hospital 14.8 Cyberknife Radiosurgery Planning 14.9 Volume-Staged and Dose-Staged SRS 14.10 Radiosurgery for Unruptured AVMs 14.11 Adverse Radiation Effects References 15: Endovascular Recanalization for Chronic Occlusion of Carotid Artery 15.1 Introduction 15.2 Case Presentation 15.3 Discussion 15.3.1 Surgical Technique/Management 15.3.2 Outcome 15.4 Advantages and Limitations 15.5 Complication Avoidance 15.6 Conclusion References 16: Multimodality Technique of Microvascular Decompression Syndrome 16.1 Introduction 16.2 Simple MVD References 17: Posterior Circulation Aneurysms Management 17.1 Introduction 17.2 Case Report (Figs. 17.1, 17.2, 17.3) 17.2.1 Case 1 Surgical Clipping of Basilar Artery Apex Aneurysms 17.2.2 Case 2 Stent-Assisted Coiling of VA Aneurysm 17.2.3 Case 3 Flow Diversion for the Treatment of vertebral artery dissecting aneurysm 17.3 Discussion 17.3.1 Surgical Technique 17.3.1.1 Endovascular Intervention 17.3.2 Surgical Treatment 17.4 Complications 17.5 Outcome and Follow-Up 17.6 Conclusion References 18: Onyx Embolization of Intracranial Dural Arteriovenous Fistula (Trans-Arterial Approach, Transvenous Approach, and Combined Approach) 18.1 Illustrative Case 1 18.2 Illustrative Case 2 19: Experience in Neurosurgery During the Prevalence of COVID-19 19.1 Introduction 19.2 Case Report 19.3 Management 19.4 Outcome 19.5 Discussion 19.6 For patients with spontaneous intracerebral hemorrhage, CTA examination is more frequently used to exclude aneurysms, and time-consuming and laborious DSA and MR examinations are less frequently used to reduce exposure. When the amount of hemato 19.7 For patients suspected of COVID-19 in general wards, Wang Xuan et al. of Wuhan Union Hospital introduced a procedural treatment, specifically: 19.8 Main existing deficiencies, problems and consideration about the next step 19.9 Conclusion