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.

Professor Fox has undertaken the monumental In his Preface, Dr. Fox has quoted Cannon task of compiling the available data on intracra and Rosenblueth in questioning where to stop nial arterial aneurysms. The magnitude and ex the record. One can only document progress tent of the undertaking attest to the tremen to date-and certainly the advances in this field dous amount of information which has are noteworthy-and then make some cau accumulated in the past few decades and to tious predictions for the future. They have cor the accelerated pace at which the field has ex rectly made note that the overall morbidity panded, particularly since the end of World and mortality of these aneurysm patients re War II. mains unacceptably high, largely as a result of Our heritage can be traced to many sources, the secondary complications of the subarach among whom should be mentioned such nota noid hemorrhage itself. More attention should bles as Willis, Quincke, Blackall, Moniz, Dott, be directed in the future to the recognition of Dandy, Hounsfield, and others. The modern era those patients with unruptured aneurysms and includes a number of investigators and clini those with minimal bleeds. Hopefully infor cians, some of whom have contributed to this mation will be forthcoming as to which indi magnificent tome. The bibliography of over viduals are at risk because of some unusual con 4000 references represents the increasing in genital, metabolic, or acquired defect.

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.

Cerebral Revascularization: Techniques in Extracranial-to-Intracranial Bypass Surgery, by Saleem I. Abdulrauf, MD, FACS, offers unmatched expert guidance. Through a series of dynamic, step-by-step instructional videos of the most common and uncommon procedures, you will deepen your understanding of these techniques and be able to confidently perform them. Edited and written by international leaders in neurosurgery, this definitive reference - with a foreword written by M. Gazi Yasargil, MD creator of the procedure – is the first and only text entirely dedicated to this surgery and provides you with exclusive, authoritative information. Access the full text, video library, and reference links to PubMed at www.expertconsult.com. Sharpen your skills in Extracranial-to-Intracranial (EC-IC) Bypass Surgery with help from the first and only text entirely dedicated to this quickly evolving procedure. Get exclusive, first-hand expert knowledge from a an internationally renowned team of editors and contributors, all leaders in cerebrovascular care. See key EC-IC bypass procedures performed in detailed, step-by-step instructional video clips. Access the full text online including the complete video library, reference lists, and additional online-only information at www.expertconsult.com.

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.

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."

Every so often a gathering of minds and experience occurs that results in an all encompassing overview in depth of such a vast subject as Cerebro-Vascular Malformations, as occurred in Verona in June 1992 and which warrants publication. Professors Da Pian and Pasqualin deserve high compliment and it is a measure of the respect in which they are held that virtually all those most knowledgeable around the world attended, presented their work and thoughts and contributed to intense discussion. Ljunggren's opening historical survey set the stage and must be the most comprehensive yet published. Subarachnoid hemorrhage from aneurysm rupture still constitutes, I dare say, the most difficult problem for neurosurgeons, in relief of the brain injury and arterial reaction and the technical perfection of aneurysm obliteration, even for small, as well as large and giant sacs. Very large high flow A VMs can be as demanding too. The bulk of the conference was devoted to subarachnoid hemorrhage, aneurysms and A VMs which were discussed under about 14 headings each. But vein of Galen malformations, dural A VMs, cavernous angiomas and venous angiomas (renamed developmental venous anomalies) came under scrutiny, not always with consensus. Trends are perceptible such as fibrinolysis of subarachnoid clot, non surgery for Galenic and dural malforma tions, the benignity of venous angioma, but there is still much variation in approach, pharmacologically, technically and with such as the evolving endovascular and radiosurgical stories, used alone or in conjunction.