Preface to the Series
Preface
Acknowledgments
Contents
Contributors
Part I: Cerebral Aneurysms: Workup and Treatment of Cerebral Aneurysms
Chapter 1: Cerebral Aneurysms: Formation, Growth, and Rupture
1 Introduction
2 Pathophysiology
2.1 Aneurysm Formation: Inflammation
2.2 Aneurysm Formation: Hemodynamics
2.3 Aneurysm Formation: Genetics
2.4 Aneurysm Formation: Risk Factors
3 Clinical Presentations
3.1 Clinical Signs and Symptoms of Unruptured Cerebral Aneurysms
3.2 Radiographic Presentation; Aneurysm Size and Location
3.3 Radiographic Presentation: Aneurysm Geometry
3.4 Aneurysm Growth: Risk Factors
3.5 Aneurysm Rupture: Risk Factors
3.6 Risk Stratification of Aneurysm Growth and Rupture
4 Cerebral Aneurysm Screening
5 Management
5.1 Conservative Management
5.2 Treatment Recommendations
References
Chapter 2: Current Imaging Techniques of Aneurysms
1 Introduction
2 CT Angiography
3 MR Angiography
4 Advanced and Emerging Noninvasive Imaging Techniques
5 The Role of Noninvasive Imaging in Clinical Management
5.1 Incidental Aneurysms
5.2 High-Risk Screening
5.3 Management of Asymptomatic, Unruptured Aneurysms
5.4 Diagnostic Workup of Headache or Neurological Symptoms
5.5 Diagnosis and Management of Ruptured Aneurysms
5.6 Surveillance of Treated Aneurysms
6 Conclusion
References
Chapter 3: Surgical Management of Intracranial Aneurysms: General Principles
1 Introduction
2 Pathophysiology and Clinical Presentation
3 Management Strategies
3.1 Preoperative Consideration
3.1.1 Imaging
3.1.2 Anesthesia
3.2 Intraoperative Consideration
3.2.1 Temporary and Permanent Clips
3.2.2 Intraoperative Imaging
Intraoperative Doppler Ultrasound
Indocyanine Green (ICG) Video Angiography
Intraoperative DSA
3.3 Management: General Treatment Approach of Intracranial Aneurysms
3.4 Management; Surgical Approaches
3.4.1 Pterional
3.4.2 Orbitozygomatic
3.4.3 Other Surgical Approaches
4 Conclusion
References
Chapter 4: Surgical Management of Intracranial Aneurysms: Technique and Pitfalls
1 Introduction
2 Pathophysiology and Clinical Presentation: Relevant Anatomy
2.1 PCOM Segment ICA Aneurysms
2.2 Middle Cerebral Artery (MCA) Bifurcation Aneurysms
2.3 Anterior Communicating Artery (ACOM) Aneurysms
2.4 Basilar Apex Aneurysms
2.5 Posterior Inferior Cerebellar Artery (PICA) Aneurysms
3 Management Strategies; Surgical Steps
3.1 PCOM Segment ICA Aneurysms (Fig. 5)
3.2 Middle Cerebral Artery (MCA) Bifurcation Aneurysms
3.3 Anterior Communicating Artery (ACOM) Aneurysms
3.4 Basilar Apex Aneurysms
3.5 Posterior Inferior Cerebellar Artery (PICA) Aneurysms
4 Conclusion
References
Chapter 5: Endosaccular Approaches to Intracranial Aneurysms
1 Introduction
2 Pathophysiology and Clinical Manifestations
2.1 Types of Aneurysms
2.2 Special Types of Aneurysms
3 Management Strategies
3.1 Primary Coil Embolization
3.2 Double Catheter Technique
3.3 Balloon-Assisted Coiling
3.4 Stent-Assisted Coiling
3.4.1 Simple Stent-Assisted Coiling
3.4.2 Stent-Jail Technique
3.4.3 Stent-Jack Technique
3.4.4 Y-Stenting Technique
3.4.5 Other SAC Techniques
3.5 Simple Stenting for Intracranial Dissecting Aneurysms
3.6 Salvation Techniques
3.7 Intrasaccular Flow Disruptions
3.8 Liquid Embolic Material
4 Conclusion
References
Chapter 6: Endoluminal Approaches to Intracranial Aneurysms
1 Introduction
2 Pathophysiology
3 Management Strategies
3.1 Preprocedure Preparation
3.2 Procedure Steps
3.3 Managing Periprocedure Adverse Technical Events
3.4 Managing Periprocedure Thromboembolic and Ischemic Complications
3.5 Managing Periprocedure Vascular Injury
3.6 Postprocedure Management: Antiplatelet Therapy
3.7 Postprocedure Management: Follow-Up Imaging and Delayed Complications
References
Part II: Cerebral Aneurysms: Critical Care of Aneurysmal Subarachnoid Hemorrhage
Chapter 7: Neurocritical Care Management of Aneurysmal Subarachnoid Hemorrhage, Early Brain Injury, and Cerebral Vasospasm
1 Introduction - Subarachnoid Hemorrhage
2 Epidemiology and Etiology
3 Pathophysiology
4 Grading of SAH for Management and Prognosis (Tables 1, 2, and 3)
5 Clinical Features and Diagnosis
5.1 Diagnosis
6 Management: Pre-securing of Aneurysm
6.1 Stabilization: Airway Protection and Hemodynamics
6.1.1 Blood Pressure Control
6.1.2 Antifibrinolytic Agents
6.1.3 Seizure Prophylaxis
6.1.4 Hydrocephalus
6.1.5 Intracranial Hypertension
Summary of Pre-aneurysmal Securing Phase
7 Management: Aneurysm Treatment
7.1 Coiling Versus Clipping
Summary Based on AHA Guidelines for Treatment of Ruptured Aneurysm
8 Management Post-aneurysm Repair
8.1 Intracranial Hypertension
8.2 Pain Management
8.3 Cerebral Vasospasm and Delayed Cerebral Ischemia (DCI)
8.3.1 Screening for Vasospasm
8.3.2 Nimodipine and Cerebral Vasospasm
8.3.3 How Do We Induce Hemodynamic Augmentation?
Limitations of Hemodynamic Augmentation
9 Endovascular Treatment for Cerebral Vasospasm
Summary of Recommendations: Post-aneurysmal Securing
10 Management of Medical Complications
10.1 Cardiac Complications
10.2 Pulmonary Complications
10.3 Anemia and Transfusion
10.4 Hypothalamic Dysfunction
11 Fever Control
11.1 Hyperglycemia
11.2 Hyponatremia and Hypernatremia
11.3 Deep Venous Thromboprophylaxis
12 Hospital Characteristics and Systems of Care
12.1 Ongoing Recovery, Functional, Behavioral, and Cognitive Outcome
12.2 Planning for Transition of Care to Rehabilitation or Long-Term Care Facilities
Appendix: Subarachnoid Hemorrhage Steps in Management (Adapted from Handbook of Neurological Therapy)
References
Chapter 8: Multimodality Monitoring of Aneurysmal Subarachnoid Hemorrhage
1 Introduction
2 Pathophysiology and Clinical Presentation
3 Presentation and Pathophysiology of Delayed Cerebral Ischemia
4 Management Strategies of Multimodality Monitoring in Delayed Cerebral Ischemia
4.1 Intracranial Pressure and Cerebral Perfusion Pressure
4.2 Brain Tissue Oxygenation
4.3 Cerebral Metabolism
4.4 Cerebral Blood Flow
4.5 Electroencephalography
5 Multimodality Monitoring Strategies
6 Conclusion
References
Part III: Cerebral Aneurysms: Special Considerations
Chapter 9: Intracranial Blister Aneurysms
1 Introduction
2 Pathophysiology
3 Clinical Presentations and Diagnostic Evaluation
4 Management
4.1 Surgical Strategies
4.2 Endovascular Strategies
4.3 Surgery Versus Endovascular Approach to Blister Aneurysms
4.3.1 Suggested Management Approach to Blister Aneurysms
5 Conclusion
References
Chapter 10: Giant Intracranial Aneurysms
1 Introduction
2 Pathophysiology
3 Clinical Presentations and Diagnostic Evaluation
4 Management
4.1 Surgical Strategies
4.2 Endovascular Strategies
4.3 Surgery Versus Endovascular Approach to GIAs
4.3.1 Suggested Management Approach to GIAs
5 Conclusion
References
Chapter 11: Atypical Aneurysms: Mycotic Aneurysms, Dissecting Aneurysms, and Pseudoaneurysms
1 Mycotic Aneurysms
1.1 Introduction
1.2 Pathophysiology and Clinical Presentation
1.3 Management Strategies
1.3.1 Diagnostic Approach
Imaging
Radiographic Features
ICMAs
Berry Aneurysms
1.3.2 Treatment Approach
2 Dissecting Aneurysms
2.1 Introduction
2.2 Pathophysiology and Clinical Presentation
2.3 Management Strategies
2.3.1 Diagnostic Approach
Imaging
2.3.2 Treatment Approach
3 Pseudoaneurysms
3.1 Introduction
3.2 Pathophysiology and Clinical Presentation
3.3 Management Strategies
3.3.1 Diagnostic Approach
Imaging
3.3.2 Treatment Approach
3.4 Conclusion
References
Part IV: Non-aneurysmal Cerebrovascular Malformations
Chapter 12: Brain Arteriovenous Malformations: Surgical, Endovascular, and Radiosurgical Techniques
1 Introduction
2 Pathophysiology and Clinical Presentation
3 Management Strategies
3.1 Diagnostic Approach
3.2 Management Strategies: Treatment Approach
3.2.1 Embolization
Pre-Embolization Considerations
Anesthesia Considerations (All AVMs)
Special Monitoring Considerations
Field of View Considerations
Pre-Surgical Embolization Procedure
Preparation
Procedure
Onyx
Key Onyx Principles
n-BCA Glue
Key N-BCA Principles
3.2.2 Surgical Technique
Preparation
Procedure
Postoperative Care and Complications
3.2.3 Stereotactic Radiosurgery
Dose Considerations
Target Delineation
Complication Management
Response Assessment
4 Conclusion
References
Chapter 13: Managing Complex Dural Arteriovenous Fistulas: Integrating Endovascular and Surgical Approaches
1 Introduction
2 Pathophysiology and Clinical Presentation
2.1 Pathophysiology
2.2 Clinical Presentations
3 Management Strategies
3.1 Diagnostic Approach
3.2 Treatment Approach
4 Conclusion
References
Chapter 14: Carotid Cavernous Fistulas
1 Introduction
2 Pathophysiology and Clinical Presentation
2.1 Pathophysiology
2.2 Clinical Presentation
2.2.1 Direct Fistula
2.2.2 Indirect Fistula
3 Management Strategies: Diagnostic Approach
3.1 Diagnostic Approach
4 Management Strategies: Treatment Approach
4.1 Conservative Management
4.2 Surgical Management
4.3 Radiosurgical Management
4.4 Endovascular Management
4.4.1 Endovascular Treatment: Direct CCFs
4.4.2 Endovascular Treatment: Indirect CCFs
5 Conclusion
References
Part V: Cerebrovascular Stroke
Chapter 15: Thrombotic Strokes
1 Introduction
2 Large Artery Extracranial Atherosclerotic Disease of the Neck
2.1 Introduction
2.2 Pathophysiology and Clinical Presentation
2.3 Management Strategies
2.3.1 Diagnostic Approach
2.3.2 Treatment Approach
3 Dissection of the Extracranial Arteries of the Neck
3.1 Introduction
3.2 Pathophysiology and Clinical Presentation
3.3 Management Strategies
3.3.1 Diagnostic Approach
3.3.2 Treatment Approach and Outcomes
4 Small Vessel Disease
4.1 Introduction
4.2 Pathophysiology and Clinical Presentation
4.3 Management Strategies
4.3.1 Diagnostic Approach
4.3.2 Treatment Approach and Outcomes
References
Chapter 16: Intracranial Atherosclerotic Diseases (ICAD)
1 Introduction
2 Epidemiology and Pattern of Disease
3 Pathophysiology and Clinical Presentation
4 Diagnostic Considerations
5 Management Strategies
6 Treatment Approach
7 Conclusion
References
Chapter 17: Embolic Ischemic Stroke
1 Introduction
2 Pathophysiology and Clinical Presentation
2.1 Management: Diagnostic Approach
2.1.1 TOAST
2.1.2 Imaging
2.1.3 Diagnostic Clues for Cardioembolism
2.1.4 Diagnosing Atrial Fibrillation
2.1.5 Diagnosing Endocarditis
2.1.6 Diagnosing Atrial Septal Abnormalities
2.1.7 Diagnosing Atrial Septal Aneurysm
2.1.8 Diagnosing Aortic Atheroma
2.2 Management: Treatment Approach
2.2.1 Atrial Fibrillation
2.2.2 Congestive Heart Failure
2.2.3 Atrial Septal Abnormalities
2.2.4 Aortic Atheroma
2.2.5 Aortic Dissection
2.2.6 Mechanical Circulatory Support Devices
References
Chapter 18: Cryptogenic Stroke and Stroke of ``Unknown Causeยดยด
1 Introduction
2 Patent Foramen Ovale
2.1 Pathophysiology
2.2 Management
2.2.1 Diagnostic Approach
2.2.2 Treatment Approach (Fig. 2)
2.2.3 Prognosis of stroke in the setting of PFO
3 Hypercoagulable States: Coagulopathies in Ischemic Stroke
3.1 Pathophysiology and Clinical Presentation
3.1.1 Homocysteinemia
3.1.2 Protein C and S
3.1.3 Factor V Mutations
3.1.4 Factor II Mutations
3.2 Diagnosis of Thrombophilias
4 Malignancy and Stroke
4.1 Pathophysiology and Clinical Presentation
4.2 Management
4.2.1 Diagnostic Approach
4.2.2 Treatment Approach
4.2.3 Treatment of Acute Stroke
5 Fibromuscular Dysplasia
5.1 Pathophysiology and Clinical Presentation
5.2 Management
5.2.1 Diagnostic Approach
5.2.2 Treatment Approach
6 Cervical Carotid Artery Dissection
6.1 Pathophysiology and Clinical Presentation
6.2 Management
6.2.1 Diagnostic Approach
6.2.2 Treatment Approach
7 Reversible Cerebral Vasoconstriction Syndrome
7.1 Pathophysiology and Clinical Presentation
7.2 Management
7.2.1 Diagnostic Approach
7.2.2 Management: Treatment Approach
7.3 Severe RCVS
8 Sickle Cell Disease
8.1 Pathophysiology and Clinical Presentation
8.1.1 Silent Cerebral Infarcts (SCIs)
8.1.2 Ischemic Stroke
8.1.3 Hemorrhagic Stroke
8.2 Management
8.2.1 Diagnostic Approach
8.2.2 Management: Treatment Approach
Stroke Prevention
Treatment of Acute Stroke in SCD
9 CADASIL
9.1 Pathophysiology and Clinical Presentation
9.2 Management
9.2.1 Diagnostic Approach
9.2.2 Treatment Approach
9.2.3 CADASIL and Stroke
10 CARASIL
10.1 Pathophysiology and Clinical Presentation
10.2 Management
10.2.1 Diagnostic Approach
10.2.2 Management: Treatment Approach
11 Fabryยดs Disease
11.1 Pathophysiology and Clinical Presentation
11.2 Management
11.2.1 Diagnostic Approach
11.2.2 Treatment Approach
11.2.3 Fabryยดs Disease and Stroke
References
Chapter 19: Endovascular Techniques for Emergent Large Vessel Occlusion
1 Introduction
2 Pathophysiology and Clinical Presentation
2.1 Pathophysiology
2.2 Clinical Presentation
3 Management Strategies
3.1 Diagnostic Approach
3.1.1 Time from Symptom Onset
3.1.2 Imaging
3.1.3 Location of ELVO
3.1.4 Stroke Severity
3.1.5 Age and Baseline Level of Functioning
3.2 Treatment Approach
3.2.1 Aspiration Techniques
3.2.2 Stent Retriever Techniques
3.2.3 Combination Techniques
4 Conclusion
References
Chapter 20: Spontaneous Intracerebral Hemorrhage
1 Introduction
2 Pathophysiology and Clinical Presentation
3 Management Strategies
3.1 Diagnostic Approach
3.2 Treatment Approach
3.2.1 Reversal of Coagulopathy and use of Hemostatic Agents
3.2.2 Surgical Hematoma Evacuation
3.2.3 Management of Complications
4 Outcome
5 Conclusion
References
Chapter 21: Central Nervous System Vasculitis: Primary Angiitis of the Central Nervous System
Abbreviations
1 Introduction
2 Pathophysiology and Clinical Presentation
3 Diagnostic Approach
3.1 Differential Diagnosis
3.2 Management Strategies
3.2.1 Diagnostic Approach
3.2.2 Lumbar Puncture and Laboratory Analysis
3.2.3 Imaging
3.2.4 Brain Biopsy
3.2.5 Histopathology
4 Treatment Approach and Outcomes
5 Conclusions
References
Chapter 22: Cerebral Venous Thrombosis
1 Introduction
2 Pathophysiology
2.1 Etiology
2.2 Anatomy: Location
2.3 Risk Factors
2.3.1 Transient Risk Factors
2.3.2 Permanent Risk Factors
3 Clinical Presentation
4 Management: Diagnostic Approach
4.1 Noninvasive Imaging
4.2 Invasive Imaging
4.3 Laboratory Testing
5 Management: Treatment Approach
5.1 Acute Phase
5.1.1 Treatment of Thrombosis (Fig. 3)
5.1.2 Complications
5.2 Chronic Phase
5.2.1 Oral Anticoagulation
6 Prognosis
7 Conclusion
References
Correction to: Cerebrovascular Disorders
Index