Neurovascular Surgical Techniques Pascal M Jabbour
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1Neurovascular Surgical Techniques2
3Neurovascular Surgical Techniques
Editor Pascal M Jabbour MD Assistant Professor Department of Neurological Surgery Division of Neurovascular Surgery and Endovascular Neurosurgery Thomas Jefferson University Hospital Philadelphia, Pennsylvania, USA Foreword Issam Awad
4
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Neurovascular Surgical Techniques
First Edition: 2013
9789350900888
Printed at
5
In Memory of
Claire and Elie Chaanine my grandparents, they raised me to be the person I am.
They were the most loving parents I could ever have and I miss them so much.
 
To my wife and kids Maria, James and Jeffrey
Your support was crucial for this project to see the light.
 
To my mentor Issam Awad, it is because of you that I was able to
accomplish my dream of becoming a neurosurgeon.
 
To Robert Rosenwasser, you taught me everything
I know in Vascular Neurosurgery.
 
To my residents and fellows,
I learned so much from each one of you.
 
Finally to all my patients and their families, your courage in
fighting the disease is incredible, you are my inspiration…
 6
7Contributors 11Foreword
For the majority of the first century of neurosurgeons, vascular techniques remained tedious and challenging, testing the skill, courage and creativity of the founding fathers of our field. For several decades, after Harvey Cushing's manifesto on “The Special Field of Neurological Surgery” (Bulletin of the Johns Hopkins Hospital 16: 77-87, 1905), vascular interventions represented a minority of neurosurgeons’ practices, including masters, such as Cushing himself, Dandy, Olivecrona, Penfield, and later Yasargil, Malis and others. Neurovascular interventions by these early masters were remarkable and notable for their feasibility and technical mastery, but not particularly for their relative volume vis-á-vis nonvascular cases. Only in the late decades of the 20th century did a few master surgeons evolve into primary neurovascular surgeons, including Drake and Sundt. Unique techniques and microinstruments to handle cerebral blood vessels safely, and safe and reliable imaging by angiography, and later cross-sectional vascular imaging, all facilitated this trend. By the early 1980s, subspecialty training in neurovascular surgery developed, and schools of neurovascular surgery subspecialization emerged under Spetzler, Heros, Samson, Mullan, Ojemann, Ausman, Hopkins, Tew and several others. Sections and programs in neurovascular surgery became pillars of leading academic medical centers, led by trainees of these early masters, including Barrow, Martin, Batjer, Ogilvy, Charbel, Morcos, Lawton and many others (including the undersigned). By the dawn of the 21st century, endovascular techniques permeated neurovascular decision-making and discourse, and a number of new schools emerged, training neurosurgeons in endovascular approaches. Dualism and multidisciplinary integration of open microsurgical and neuroendovascular strategies and techniques have become a new and necessary component of mature neurovascular programs, and ultimately the training of future neurosurgeons. Early luminaries of our field, including Mullan and Drake, and later Hopkins and Rosenwasser, had foreseen and helped shape this trend.
One major school of neurovascular innovation and a philosophical birthplace of the dual training and practice of endovascular and open surgical techniques at the highest levels is the Jefferson School, led by Robert Rosenwasser and a phenomenal team of his colleagues. Their volume and experience have earned a leading status in the field. A particularly thoughtful and skilled rising star from this school, Pascal M Jabbour has undertaken an admirable task of assembling a compendium of current neurovascular techniques. His own career and experience are shaped by the maturation of these techniques, so his perspective is relevant, fresh and pragmatic. Unlike many previous technical publications in the field, this new book includes a practical assessment of endovascular as well as open surgical concepts and tools, aimed at the various pathologies. The 25 chapters are written by a virtual who's who of the field. Young innovators as well as veterans present a million teaching pearls on strategy, decision-making, technical decisions and execution.
Rhoton's Anatomical Canon is complemented in the early chapters by treatises on the venous circulation, and on the instruments and tools of the microvascular and endovascular armamentaria, and novel vascular imaging. Aneurysms, vascular malformations and occlusive disease are then considered sequentially, with a seamless balance of endovascular and open surgical considerations. Acute stroke, neurovascular trauma and spinal vascular malformations are then considered. Advocacy for one technical approach, so prevalent in most past publications, is replaced by a fresh multidisciplinary “problem-solving” approach, with a candid presentation of the advantages and limitations of different techniques. Final chapters venture into future trends, special microsurgical pearls unique to cavernous malformation surgery, and the use of quantified hemodynamics in neurovascular management.
This book neither aims toward nor is distracted by magisterial reviews of the biology, mechanisms of disease, natural history or outcome. It focuses like a scalpel (or catheter tip!) at the technical possibilities and their execution. It is amazing in how it weaves technical strategy and execution, which so influence clinical decision-making in neurovascular disease. It reflects a new way of thinking about neurovascular surgery technique, seamlessly crossing and integrating the endovascular and microsurgical realms. This book will enhance the knowledge base and wisdom of neurosurgeons at all levels of training, subspecialization and experience. There is something in those rich and friendly pages for everyone. Herein lies the genius of this monograph.
Issam Awad MD, MSc, FACS, FAHA, MA(Hon)
Professor of Surgery (Neurosurgery)
Neurology and Cancer Center
Director of Neurovascular Surgery
University of Chicago Medicine and Biological Sciences
Chicago, Illinois, USA12
13Preface
Neurovascular Surgical Techniques is the first book of its kind dealing with both open and endovascular techniques to treat neurovascular diseases. Each chapter has two parts; one detailing the open surgical techniques and the other detailing the endovascular techniques.
All the chapters are very well written by leaders in the field coming from different backgrounds in neurosurgery, neurology and interventional neuroradiology.
The chapters are rich with colored images and artist renderings making the concept of each chapter and the ideas behind it very clear and easy to follow.
The book covers a broad spectrum of neurovascular diseases from basic vascular anatomy, to the most complex diseases and the most up-to-date and innovative treatment modalities.
The authors have been encouraged to use their individual styles in writing and presentation avoiding monotony in exposition. Advances in the neurovascular world are happening at such a rapid pace that makes it difficult to capture them in a textbook, but we made every effort to bring to the readers the most up-to-date and sometimes controversial issues.
The book targets a wide readership, including general neurosurgeons, neurologists, radiologists, vascular neurosurgeons, interventional neuroradiologists, neurointensivists, stroke neurologists, residents, fellows, nurses and nurse practitioners.
I wish to acknowledge all the authors for their diligence and effort in bringing the material to the readership.
Hopefully our readership will find this book timely and informative, and it will undoubtedly be the mainstay of references for some time to come.
Pascal M Jabbour14
15Acknowledgments
The author would like to acknowledge Mrs Kelly McGuinness Pomarico for her contribution and hardwork, without her the book would not have seen the light.
Also, Mrs Chetna Malhotra Vohra (Senior Manager – Business Development), Ms Payal Bharti and all the team of Jaypee Brothers Medical Publishers (P) Ltd. New Delhi, India for all their hardwork, it was a long journey, thank you for making this happen.