Neuroimaging Clinics of North America: Interventional Head and Neck Imaging. Suresh K. Mukherji (consulting editor) and Dheeraj Gandhi (guest editor). Volume 19, Number 2, May 2009, theclinics.com 2009, 240 pages, $99.00.
Regardless of whether one performs head and neck interventions, the May issue of the Neuroimaging Clinics of North America should be of interest to all neuroradiologists. This book is guest edited by Dr. Dheeraj Gandhi and has contributions from 24 authors. Ten chapters cover the major diseases and conditions with which an interventionalist may have to deal including biopsies/aspirations of mass lesions, thermal ablations, treatment of vascular tumors.
The book begins appropriately with an overview of the various techniques available for imaging head and neck lesions — examples are shown/described of CT fluoroscopy, CT Angiography, MR, DSA, PET-CT. Of greater interest particularly for those who are becoming involved with intervention is the chapter on approaches for percutaneous needle placement. Even if for those not actively involved in these procedures, there is value in understanding how various lesions can and should be approached. After a brief summary of the spaces of the neck, CT images guidance, the most commonly used image guidance method for non palpable lesions, is illustrated and described, specifically the sub zygomatic, retromandibular, paramaxillry, submastoid, retromastoid, transoral, posterior neck and infrahyoid approaches (anterior lateral, posterolateral, posterior). The potential complications and means to avoid them are well described. The one item missing (and this is a minor complaint) is the lack of diagnoses in the legends for each of the demonstrated approaches. While this is clearly a chapter on technique, the reader will be asking him/herself — what was that lesion they biopsied?
Applications of relatively new techniques, primarily radiofrequency ablation and cyroablation, have found their way into treatment strategies in head and neck tumors, especially in the post operative patient, where repeat surgery is problematic. This chapter even looks ahead to other potential ablation techniques such as microwave, MR guided US and laser ablation, also of which could be used in the future.
Most of this book (112 out of 148 pages) is devoted to head and neck vascular lesions or vascular problems and therefore will be of interest to the more traditional interventionalist/neurointerventionist. These chapters deal for example with direct percutaneous embolization of vascular tumors such as JNAs and indirect transarterial therapy. Excellent examples of various tumors both pre and post treatment are shown. Staging of tumors by imaging and what this staging could imply for interventions is included. Vascular malformations and their treatment of the head and neck are discussed in two chapters (one on low flow, the other on high flow). The former deals with venous malformations/capillary-lymphatic-venous malformations and image guided therapeutic approaches to these complex multi-compartmentalized lesions. The latter deals with treatment of high flow vascular malformations which are predominately anteriovenous malformations. Site specific strategies along with syndromic and non-syndromic conditions are briefly mentioned.
The images, are of good quality and are nicely supplemented by patient photographs in a number of instances — these reinforce how disfiguring many of the lesions are.
The last 3 chapters deal with the imaging and treatment more dramatic vascular clinical conditions of the skull base and neck — carotid cavernous fistulas (direct/indirect), cervical carotid dissections, and the carotid blowout syndrome as a complication of surgery and for radiation of head and neck tumors.
This is another fine addition to the Neuroimaging Clinics of North America. Even for those who do not subscribe to the series, this single book purchase allows an appreciation of the intervention options and difficulties encountered in the treatment of certain head and neck lesions.
