NeuroEndovascular Challenges

Book Series: Frontiers in Neurosurgery

Volume 1

by

Simone Peschillo

DOI: 10.2174/97816810800551150101
eISBN: 978-1-68108-005-5, 2015
ISBN: 978-1-68108-006-2
ISSN: 2405-7401 (Print)
ISSN: 2405-741X (Online)



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Remarkable advances have been made in embolization of cerebral aneurysms, arteriovenous malformations and stroke treatment during the past dec...[view complete introduction]

Table of Contents

Foreword

- Pp. i-ii (2)

Guido Guglielmi

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Preface

- Pp. iii-iv (2)

Simone Peschillo

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List of Contributors

- Pp. v-vi (2)

Simone Peschillo

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Introduction: The New Era of Endovascular Treatment

- Pp. 3-32 (30)

A. Caporlingua, C. Colonnese and S. Peschillo

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Challenging Cranial Arteriovenous Fistulas

- Pp. 33-66 (34)

Guglielmo Pero

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Arteriovenous Malformations

- Pp. 67-93 (27)

Marco Cenzato and Alberto Debernardi

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Complex Aneurysms From Endovascular and Surgical Points of View

- Pp. 94-120 (27)

D. Cannizzaro, R. Delfini, A. Caporlingua and A. Santoro

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Spinal Vascular Pathology

- Pp. 121-138 (18)

E. Orrù, G. Guarnieri, J. Gabrieli, M. Muto and F. Causin

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Endovascular Reperfusion Management for Acute Ischemic Stroke

- Pp. 139-153 (15)

Paolo Machi, Kiriakos Lobotesis and Alain Bonafé

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State-of-the-Art and Future Perspective of Devices for Neuroendovascular Treatment

- Pp. 154-178 (25)

Arani Bose, John Lockhart, Dave Barry and Sophia S. Kuo

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Endovascular Management of Brain Tumors: What’s in the Future?

- Pp. 179-210 (32)

A. Caporlingua, F. Caporlingua and S. Peschillo

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Dual Antiplatelet Therapy in Neuroendovascular Procedures

- Pp. 211-231 (21)

Flavia Temperilli, Giorgio Re and Fabio M. Pulcinelli

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Anesthesia Options for Endovascular Neurosurgery

- Pp. 232-252 (21)

Italia La Rosa, Filippo Pecorari and Giovanni Rosa

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Appendix

- Pp. 253-258 (6)

Simone Peschillo, Antonio Santodirocco and Alessandro Caporlingua

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Subject Index

- Pp. 259-267 (9)

Simone Peschillo

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Foreword

This well written book shows the fascinating evolution and rapid growth of the discipline of endovascular neurosurgery from the early pioneering days until today. In a Pindaric flight, it comes to my mind that the early pioneering days of endovascular therapy resemble the work carried out in a garage by Wozniak and Jobs at the beginning of the Apple era, as the worked to create a revolutionary computer. In our discipline I was part, together with a few fellow enthusiasts, of the "garage work" of our discipline and, although now retired, I cannot resist in keeping myself au courant on the progeniture that came from that early work. I am happy that the young generation of interventionalists, leveraging from the work of pioneers, is so active and inclined to improvement. This book clearly depicts how our discipline inexorably evolved step by step to form a marvellous, revolutionary, and exciting era. The vast majority of aneurysms, for example, are nowadays treated by the endovascular approach, worldwide. Cooperation between physicians and industry is a key factor leading to advancement. Enthusiasm and academic work also play a pivotal role.

This book is enlightening in that it spans from the history (outstandingly presented by the Editor) to the most recent technical advancements (superbly portrayed by the authors of chapter VII). Given the fast pace and creativity of the young generation of physicians and engineers, one may rightly think that the best is still to come! In my days I used to say: "largo ai giovani!" (give way to the young people!).

This book teaches and confirms that, differently from the past, the current evaluation of novel techniques and devices (and the consequent clinical impact) is no longer based on personal, often irrational, opinions or, worse, "gut feelings". On the contrary, nowadays multicenter studies and clinical trials allow for a more rational, scientifically sound, empirically accurate and fact-based way of evaluation, influencing the decision making process in a positive and logical manner.

Undeniably, treatment of brain arteriovenous malformations constitutes, by tradition, a setback in our discipline, that often, but not always, leads to dissatisfaction and to the impossibility to cure, even with the more recent embolic agents. It is my opinion that in any kind of neuroendovascular disease, the use of liquid agents (namely glue) implies a significant degree of uncontrollability, and carries a not negligeable risk of incurring in "problems". This is not a good thing.

On a similar topic, this book provides in the appendix, with good reason, an always welcomed description of the "dangerous anastomosis", tacitly reiterating the importance of not injecting glue in particular areas of the vascular tree.

This book offers a well documented, extensive, and up to date panorama of the revascularization techniques utilized in acute ischemic insults. This is a field in continuous evolution that already allows tremendous results in brain salvaging endeavors.

The in depth, analytic, and accurate description of the complex issue of double antiplatetet therapy in neuroendovascular procedures provides highly valuable information and practical guidelines.

On a personal note, I would like to reiterate that our procedures should not be called "minimally invasive", specially when interacting with patients and their families. It may give a false sense of an innocuous, easy procedure. Instead, our procedures, although less invasive than surgery, are indeed invasive: in fact the reality is that they may become very complex, treacherous, and potentially lifethreatening.

I would like to congratulate the Editor, Simone Peschillo, M.D., Ph.D, and all the other authors for giving our community a precious instrument of knowledge.

Guido Guglielmi
Department of Interventional Neuroradiology
University of California at Los Angeles
Los Angeles, California
Department of Neurology and Psychiatry, “Sapienza”
University of Rome, Rome, Italy


Preface

An appreciation of the history of vascular and endovascular neurosurgery requires a journey that starts far from the modern age, in the ancient past. Undeniable traces can be uncovered more than 2700 years before Christ, when the first description of an arterial aneurysm was made. From that moment on, neurosurgery matured through the millennia toward a discipline which, during the last century, has seen tremendous advancements.

This particular history is scattered with both anecdotal and fascinating events, which led the first neurosurgeons to develop increasingly complex techniques, and also to take risks and, not uncommonly, to make hazardous choices. Passing through the era of pure extravascular extracranial approaches, vascular neurosurgery evolved toward ever less invasive procedures making its way through the intracranial and finally into the endovascular space.

We symbolically fixed the year in which modern endovascular neurosurgery was born as 1927: this was the year in which a Portuguese professor of neurology, Egas Moniz, performed the first cerebral angiography marking the beginning of the endovascular era.

As the product of different disciplines, endovascular neurosurgery matured thanks to the efforts of pioneers from different domains in medical sciences. Initially, endovascular intracranial navigation was exclusively guided by blood flow; subsequently, magnetically guided devices, among others, made their appearance and were followed by the modern micro-catheters equipped with guide-wires which finally allowed arterial bifurcations to be negotiated. An undeniable contribution was provided by Serbinenko, the father of the detachable balloon embolization technique. Nevertheless, when an Italian neurosurgeon, Guido Guglielmi, presented his endovascular detachable coil embolization system in 1991, everything changed and endovascular neurosurgery was endowed with new perspectives.

None of this would have been possible without those ground-breakers whose effort, dedication and passion made massive contributions to vascular and endovascular neurosurgery as we know it. During the past 10 years, the most remarkable advances have been made in embolization of cerebral aneurysms, arteriovenous malformations and stroke treatment.

Endovascular techniques are less invasive than other forms of neurosurgery; however, endovascular neurosurgery is becoming more complicated as the technology is becoming more sophisticated. In the early stage, a single microcatheter was required to deliver a coil into an aneurysm. Nowadays, the artery is usually congested with multiple catheters, balloons or stents for the treatment of challenging aneurysms.

The current situation presents the neurosurgical community with the dualism of “open surgery versus endovascular treatment” for the management of intracranial cerebrovascular disease. Endovascular neurosurgery is, however, rapidly delineating an exclusive domain in neurosurgery and most contemporary authors already no longer consider the dualism in terms of opposition but rather in terms of synergy.

The history of endovascular neurosurgery has gifted the authors of this book, and we hope the readers too, with the inspiration required for the pro-active creation of a better future. This very particular history encourages us to pursue innovation regardless of currently shared convictions and dogmas. It teaches us that scientists must broaden their horizons, crossing the boundaries existing between different disciplines, seeking innovation by treading as yet unbeaten paths. Modern medical science is moving toward an increasingly hyper-specialized universe, in which the galaxies cross each other very rarely. And yet, an intersection between the galaxies is essential for further development. For the very same reason, young neurosurgeons should make efforts to broaden their range of feasible therapeutic options grasping, for instance, both the art of the catheter as well as the art of the knife.

The target audience of this e-book includes endovascular neurosurgeons, vascular neurosurgeons, neuroradiologists and neurologists. The detailed and comprehensive nature of the book makes it most suitable for practicing endovascular and vascular neurosurgeons who have a solid knowledge of neuroangiography. This is not an introductory level text on the neurosciences: the Editor’s and authors' intent is to share information they feel is useful for the performance of endovascular neurosurgery. The rapid growth in the number of those performing endovascular neurosurgery is evidence of the need for such a book.

The main idea of this work is to trigger discussion on the principal issues that are still debated in this field, and not to reiterate the same topics that are easily found in other texts.

Simone Peschillo

List of Contributors

Editor(s):
Simone Peschillo
Department of Neurology and Psychiatry
Endovascular Neurosurgery/Interventional Neuroradiology “Sapienza” University of Rome
Rome
Italy




Contributor(s):
Alain Bonafé
Centre Hospitalier Universitaire Gui de Chauliac
Montpellier
France


Alberto Debernardi
Department of Neurorsurgery
Niguarda Ca' Granda Hospital
Milan
Italy


Alessandro Caporlingua
Department of Neurology and Psychiatry, Neurosurgery, "Sapienza"
University of Rome
Rome
Italy


Antonio Santodirocco
Department of Neurology and Psychiatry, Interventional Neuroradiology, "Sapienza"
University of Rome
Rome
Italy


Antonio Santoro
Department of Neurology and Psychiatry, Neurosurgery, "Sapienza"
University of Rome
Rome
Italy


Arani Bose
Interventional Neuroradiologist
New York
USA


Claudio Colonnese
Department of Neurology and Psychiatry Neuroradiology, "Sapienza"
University of Rome
Rome
Italy


Dave Barry
Department of Neurology and Psychiatry Neuroradiology, "Sapienza"
University of Rome
Rome
Italy


Emanuele Orrù
Neuroradiology Service, Department of Radiology
University of Padova
Italy


Fabio M. Pulcinelli
Department of Experimental Medicine, "Sapienza"
University of Rome
Rome
Italy


Federico Caporlingua
Department of Neurology and Psychiatry, Neurosurgery, "Sapienza"
University of Rome
Rome
Italy


Filippo Pecorari
Department of Anesthesia and Intensive Care, Policlinico Umberto 1
"Sapienza" University of Rome
Rome
Italy


Flavia Temperilli
Department of Experimental Medicine
"Sapienza" University of Rome
Rome
Italy


Francesco Causin
Chief of Neuroradiology Service, Department of Radiology
University of Padova
Italy


Gianluigi Guarnieri
Neuroradiology Service
Cardarelli Hospital
Naples
Italy


Giorgio Re
Department of Anesthesia and Intensive Care, Policlinico Umberto 1
"Sapienza" University of Rome
Rome
Italy


Giovanni Rosa
Department of Anesthesia and Intensive Care, Policlinico Umberto 1
“Sapienza” University of Rome
Rpme
Italy


Guglielmo Pero
Department of Neuroradiology
Niguarda Ca' Granda Hospital
Milan
Italy


Italia La Rosa
Department of Anesthesia and Intensive Care, Policlinico Umberto 1
“Sapienza” University of Rome
Rome
Italy


John Lockhart
Interventional Neuroradiologist
New York
USA


Joseph Gabrieli
Neuroradiology Service, Department of Radiology
University of Padova
Italy


Kiriakos Lobotesis
Imperial College Healthcare NHS, London
United Kingdom


Marco Cenzato
Department of Neurorsurgery
Niguarda Ca' Granda Hospital
Milan,
Italy


Mario Muto
Neuroradiology Service
Cardarelli Hospital
Naples
Italy


Paolo Machì
Centre Hospitalier Universitaire Gui de Chauliac
Montpellier
France


Roberto Delfini
Department of Neurology and Psychiatry, Neurosurgery
"Sapienza" University of Rome
Rome
Italy


Simone Peschillo
Department of Neurology and Psychiatry, Endovascular Neurosurgery/Interventional Neuroradiology
"Sapienza" University of Rome
Rome
Italy


Sophia S. Kuo
Interventional Neuroradiologist
New York
USA




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