Vascular neurosurgery

see Open vascular neurosurgery.

see Vascular neurosurgeon.

The first Gamma Knife in the US in 1987

Guglielmi detachable coils in 1991

The International Subarachnoid Aneurysm Trial (ISAT) in 1999

The International Study of Unruptured Intracranial Aneurysms (ISUIA) in 2003

Onyx liquid embolic material in 2005

Pipeline endovascular device in 2011

Carotid Occlusion Surgery Study (COSS) in 2011

Randomized Trial of Unruptured Brain Arteriovenous Malformations (ARUBA) in 2014

Multiple clinical trials validating the efficacy of mechanical thrombectomy for acute ischemic stroke caused by large vessel occlusion in 2015.

Over the last few decades, cerebrovascular surgery has gravitated towards a minimally invasive philosophy without compromising the foundational principles of patient safety and surgical efficacy. Enhanced radiosurveillance modalities and increased average life expectancy have resulted in an increased reported incidence of intracranial aneurysms. Although endovascular therapies have gained popularity in the recent years, microsurgical clipping continues to be of value in the management of these aneurysms owing to its superior occlusion rates, applicability to complex aneurysms and reduced retreatment rates. The concept of keyhole transcranial procedures has advanced the field significantly leading to decreased post-operative neurological morbidity and quicker recovery. The main keyhole neurosurgical approaches include the supraorbital craniotomy (SOC), lateral supraorbital craniotomy (LSOC), minipterional craniotomy (MPTC), mini-orbitozygomatic craniotomy and the mini anterior interhemispheric approach (MAIA). As these minimally invasive approaches can have an inherent limitation of a narrow viewing angle and low regional illumination, the use of endoscopic assistance in such procedures is being popularized. Neuroendoscopy can aid in the visualization of hidden neurovascular structures and inspection of the parent arterial segment without undue retraction of the lesion.

A review of Gandhi et al. from the Barrow Neurological Institute, Department of Neurological Surgery, Phoenix,focuses on the historical progression of intracranial aneurysm surgery, the technical details of various minimally invasive approaches, patient selection and clinical outcomes of the anterior circulation aneurysms and useful tenets to avoid complications during these procedures. Meticulous preoperative planning to understand the patient's vascular anatomy, the orientation and relationship of the aneurysm to adjacent structures, use of neuronavigation guidance and endoscopic assistance if needed can lead to an optimal surgical outcome while minimizing neurological morbidity and mortality 1).

Most neurovascular innovations have been introduced by using case series followed by a observational study. A better approach would be a pragmatic randomized trial. Two important aspects of trial design, patient selection and randomized allocation, remain poorly understood. We discuss the role trial methodology can play in the protection of patients being offered innovative treatments 2).

The complex, highly technological field of neurovascular surgery is quickly expanding, encompassing traditional surgical approaches, as well as Neuroendovascular treatment and neurointerventional techniques. The last decade has seen increased cross-specialty interest in utilizing minimally invasive techniques to help prevent and treat cerebrovascular disease. Concurrently, there has been important research analyzing the efficacy of surgical methods versus endovascular approaches and the clip versus coil discussion.

While vascular neurosurgery has undergone unprecedented advances during the past decade, enabling safer and easier access to previously untreatable pathology, this progress has been accompanied by confusion as to what constitutes best, or even acceptable, practice.

see Neurovascular center

see Arteriovenous malformation

see Cavernous malformation

see Intracranial Aneurysm

see Moyamoya disease

see Ischemic Stroke

see Carotid Artery Disease

Trends in Cerebrovascular Surgery (Acta Neurochirurgica Supplement)

This volume provides an overview of new concepts in neurovascular interventions based on clinical and scientific knowledge of cerebrovascular disorders. It especially focuses on subarachnoid hemorrhage and cerebrovascular malformations, e.g. aneurysms, arterio-venous malformations, and cavernomas. A separate part addresses cerebral revascularization for both complex aneurysms and ischemia.

All contributions were written by recognized experts and cover original papers presented at the 7th European Japanese Stroke Surgery Conference, held in Verona, Italy in June 2014. The authors present new trends and strategies for managing emerging problems, as well as in-depth discussions on controversial issues in the field.

Tetsuya Tsukahara National Hospital Organization, Kyoto Medical Center, Mukaihata-cho 1, 612-8555 Fukakusa, Fushimi-ku, Kyoto, Japan

Alberto Pasqualin Verona City Hospital, Institute of Neurosurgery, Piazzale Stefani 1, 37100 Verona, Italy

Giuseppe Esposito, MD, PhD Consultant Neurosurgeon, Department of Neurosurgery, University Hospital Zurich, Frauenklinikstrasse 10, 8091 Zurich, Switzerland

Luca Regli University Hospital Zurich, Department of Neurosurgery, Frauenklinikstrasse 10, 8091 Zurich, Switzerland

Giampietro Pinna Verona City Hospital, Institute of Neurosurgery, Piazzale Stefani 1, 37100 Verona, Italy


Controversies in Vascular Neurosurgery

This concise, easy-to-use book offers expert insights into current controversies in vascular neurosurgery with a view to providing the practitioner with authoritative practical guidance that will assist in the management of difficult disease entities.

Here, experts in the field discuss the various tools available and explain how best to use them when confronted by different pathologies, drawing upon their personal experience. Each chapter focuses on a specific case that is discussed by two experienced surgeons; a third author then evaluates the case, highlighting the available evidence and pearls in the treatment of that particular disease. The authors have been carefully chosen to provide a truly balanced viewpoint on paradigms that they themselves use. They therefore have a sound understanding of the thought processes of surgeons when dealing with challenging diseases for which there may be no single correct path. Furthermore, they are well placed to identify not only appropriate uses of new treatment options and technologies but also circumstances in which their use is best avoided. The ultimate benefactor of this book will be the patient: our biases as physicians should never become a patient’s morbidity.

Gandhi S, Cavallo C, Zhao X, Belykh E, Lee M, Yoon S, Labib M, Meybodi AT, Moreira LB, Preul MC, Nakaji P. Minimally invasive approaches to aneurysms of the anterior circulation: selection criteria and clinical outcomes. J Neurosurg Sci. 2018 Sep 10. doi: 10.23736/S0390-5616.18.04562-9. [Epub ahead of print] PubMed PMID: 30207433.
Fahed R, Darsaut TE, Raymond J. The introduction of innovations in neurovascular care: Patient selection and randomized allocation. World Neurosurg. 2018 Jun 23. pii: S1878-8750(18)31343-3. doi: 10.1016/j.wneu.2018.06.127. [Epub ahead of print] PubMed PMID: 29945010.
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