Description
Springer Surgery of Vertebrobasilar Aneurysms London Ontario Experience on 1767 Patients by Charles G. Drake, Sydney J. Peerless, Juha A. Hernesniemi, Preface by M.G. Yasargil
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._x000D_ Table of contents : - _x000D_
1. Historical Notes.- 2. Clinical Material.- 3. Small Aneurysms at the Bifurcation of the Basilar Artery: 493 Patients.- Clinical Features.- Early Surgical Experience.- Anatomical Features.- The Subtemporal Approach.- Induced Intraoperative Hypotension.- The Transsylvian (Pterional) Approach.- Other Approaches.- Upward Projecting Basilar Bifurcation Aneurysms.- High Basilar Bifurcation.- Low Basilar Bifurcations.- Forward Projecting Aneurysms.- Backward Projecting Aneurysms.- Results.- 4. Large (or Bulbous) Basilar Bifurcation Aneurysms (12.5-25 mm): 265 Patients.- Clinical Features.- Results.- 5. Analysis of Operative Morbidity in Basilar Bifurcation Aneurysms: Small and Large (Non-Giant): 758 Patients.- Perforator Injury or Occlusion.- Final Comments on Non-Giant Basilar Bifurcation Aneurysms.- 6. Giant Basilar Artery Bifurcation Aneurysms: 137 Cases.- Anatomical Features of Giant Basilar Bifurcation Aneurysms.- Clinical Features.- Treatment.- Explored Only.- Intra-Aneurysmal Occlusion.- Neck Clipping.- Vertebral Artery Occlusion.- Basilar Artery Occlusion.- 7. Non-Giant (Small and Large) Basilar Superior Cerebellar Artery Aneurysms: 210 Patients.- Anatomical Features.- Clinical Features.- Treatment.- 8. Giant Basilar-Superior Cerebellar Artery Aneurysms: 56 Patients.- Anatomical Features.- Clinical Features.- Explored Only.- Neck Clipping.- Basilar Artery Occlusion.- 9. Midbasilar Trunk Aneurysms: 44 Patients.- Anatomical Features.- Clinical Features.- Approach.- Results.- 10. Basilar-Anterior Inferior Cerebellar Artery Aneurysms: 41 Patients.- Anatomical Features.- Clinical Features.- Approaches.- Results.- 11. Giant Basilar Trunk Aneurysms: 59 Patients.- Anatomical Features.- Clinical Features.- Treatment.- Neck Clipping.- Parent Artery Occlusion.- Trapping.- 12. Vertebral-Basilar Junction Aneurysms: 77 Patients.- Anatomical Features.- Clinical Features.- Approach.- Results.- 13. Giant Vertebrobasilar Junction Aneurysms: 39 Patients.- Treatment.- Vertebral Artery Occlusion.- Unilateral Vertebral Occlusion.- Bilateral Vertebral Occlusion.- Trapping and Evacuation.- 14. Non-Giant Aneurysms of the Vertebral Artery: 181 Patients.- Anatomical Features.- Classification.- Clinical Features.- Approaches.- Results.- 15. Giant Vertebral Aneurysms: 40 Patients.- Anatomical Features.- Clinical Features.- Treatment.- 16. Non-Giant Aneurysms of the Posterior Cerebral Artery: 59 Patients.- Anatomical Features.- Clinical Features.- Subtemporal Approach.- Results.- 17. Giant Posterior Cerebral Aneurysms: 66 Patients.- Anatomical Features.- P1 Aneurysms.- P1-P2 Junction Aneurysms.- P2 and P3-P4 Aneurysms.- Clinical Features.- P1 and P1-P2 Junction Aneurysms.- P2-P4 Aneurysms.- Treatment.- P1 Aneurysms.- P1 /P2 Posterior Communicating Aneurysms.- P2-P4 Aneurysms.- 18. Multiple Aneurysms: 462 Patients.- Treatment.- 19. Vertebrobasilar Aneurysms and Associated AVMs: 54 Patients.- General Principles of Treatment.- Patients.- Treatment.- Summary of Poor Results.- 20. Solitary Incidental Vertebrobasilar Aneurysms: 70 Patients.- 21. Vertebrobasilar Artery Aneurysms in Children: 49 Patients.- Clinical Features.- Treatment.- 22. Timing of Surgery.- Rebleeding: Transfer of Patients.- Early versus Late Surgery.- Final Comments on Timing of Surgery.- 23. The Anesthetic Management of Patients During Posterior Fossa Aneurysm Surgery.- Preoperative Preparation.- Premedication.- Anesthesia Management.- Monitoring.- Induction.- Maintenance.- Fluid Administration.- Induced Hypotension, Temporary Arterial Occlusion, and Cerebral Protection.- Emergence and Recovery.- Positioning.- Monitoring of Brain Stem Function.- Complications.- Conclusion.- 24. Endovascular Saccular Treatment of Posterior Circulation Aneurysms.- Detachable Balloons.- Thrombosis with Coiled Wires.- Experience at the University of Western Ontario, 1971 to 1994.- Conclusions.- 25. Complications of Surgery for Vertebrobasilar Artery Aneurysms and Final Comments.- Factors Increasing Complication Rates.- Influence of Surgical Timing.- Complications During Anesthesia.- Problems in Exposure.- Intraoperative Aneurysm Rupture.- Perforator Injury.- Inadvertent Major Vessel Occlusion.- Postoperative Deterioration of Neurological State.- Memory Deficits.- Postoperative Hematoma.- Incomplete Occlusion and Re-Operation (Failed Aneurysm Surgery).- Vasospasm.- Rebleeding.- Postoperative Infection.- Medical Complications.- Hydrocephalus.- Statistical Analysis for Predictors of Poor Outcome.- Discussion.- Final Comments.- References._x000D_