Krings T, Geibprasert S, ter Brugge KG.  Case-Based Interventional Neuroradiology. Thieme 2011, 446 pages, $99.95.

This is a very useful, well-organized, well-illustrated, and comprehensive collection of cases covering the gamut of interventional neuroradiology.  The case-based organization works very well for readers, such as myself, with a short attention span.  Like many others, I learn best when my reading is directed, based on a real patient or problem that I have encountered, rather than chapters in a textbook.   The three authors are all affiliated with the very productive and well-respected Diagnostic and Interventional Neuroradiology program at Toronto Western Hospital and the University of Toronto.

There are 72 cases.  Each case begins with a clinical presentation and some diagnostic imaging.  Subsequent imaging or intervention is then described.  The section under “Treatment” includes a list of the devices and drugs used in the treatment of a lesion.  Alternative treatment options are discussed.   There is a narrative description of the procedure itself with images as needed.  Finally, and constituting most of the report, is a discussion of the disease and the work-up, including both clinical imaging and treatment options.  A final section of “Pearls and Pitfalls” is listed, followed by relevant literature.  Each case description is approximately 5-6 pages long.  There are 10 sections.  The first and longest is for aneurysms and subarachnoid hemorrhage.  This is followed by brain arteriovenous malformations (AVMs) and cranial dural arteriovenous fistulas (DAVFs).  It should be noted that the Toronto group has particular expertise in this area.  The remaining sections encompass head and neck vascular lesions, tumors, trauma, stroke, pediatric vascular interventions, spine vascular interventions, and, finally, spine percutaneous interventions.  The cases presented represent straightforward standard cases one is likely to encounter in practice.  There are no cases that I would consider to be exceptional or rare.  Many of the cases focus on common complications that occur and provide very useful instruction in how to recognize, avoid, and manage these situations.   The index is also useful as a cross-reference to look up particular diseases or devices.

There are rapid iterative changes in interventional devices.   While the diseases and natural history for these lesions are relatively constant, the devices used for their treatment are anything but static.  The devices and techniques in this book are generally up to date.  For example, one of the aneurysms was treated with a Pipeline device.  There is a notable omission of ethyl-vinyl alcohol (EVAL) as a liquid embolic agent.   All the AVMs and dural AVFs included in this collection were treated with n-butyl cyanoacrylate (nBCA).   This clearly reflects the practice of these extremely experienced and capable operators.  For many interventionalists, including this reviewer, EVAL has largely replaced nBCA owing to the former agent’s ease of use and superior penetrating quality.   These two agents are not interchangeable and have different advantages and disadvantages.   This aspect of the book is unbalanced and a slight limitation.  This is a minor point, however.

Purchase of the book allows one-year access to the online RadCases database maintained by the publisher Thieme.  The cases presented in the book are not available in this online format.  In fact, it does not appear that there are any cerebrovascular cases available yet.  Online access to this book would be very useful, given its case-based format.

In summary, this is a very good resource that I would recommend to all interventional neuroradiology fellows to read in its entirety.  It is comprehensive and covers the field extremely well.  There is great discussion of the existing literature, the technical details, and the possible complications that occur from these procedures.  Neuroradiology fellows and radiology residents should be encouraged to use this as a resource as they encounter relevant cases.  This book will also have great value for neurosurgery and neurology trainees, as well as stroke fellows involved in the care of patients with cerebrovascular disease.  Again, I find its case-based approach to be very compelling.