Deshaies EM, Eddleman CS, Boulos AS. Handbook of Neuroendovascular Surgery. Thieme 2011; 496 pages; 202 illustrations; $109.99.
The Oxford Concise English Dictionary defines a handbook as “a book giving information such as facts on a particular subject.” The authors of the Handbook of Neuroendovascular Surgery go to some lengths to make the point that this text is just that: a handbook, a quick reference guide, and intended for the labcoat pockets of the newly minted attending, fellow, or other practitioner. This is prudent, because it sets an appropriate level of expectation for the book’s content.
The book is edited by neurosurgeons, and the foreword by Dr. Robert Rosenwasser, the Chairman of Neurological Surgery at Jefferson Medical Center, is unabashedly directed at a neurosurgical audience. However, radiologists and neurologists practicing neurological intervention should not be discouraged from reading further, as the viewpoints espoused within the text are balanced ones. A total of 28 contributors (from various training backgrounds) are credited for their work in over 21 chapters and 2 appendices. Appendix A is a summary of the tables contained in other portions of the book, with vascular anatomy plates and the National Institutes of Health Stroke Scale, while Appendix B contains high quality illustrations. In the style of other recent publications from the Thieme stable, additional online content is available at www.mediacenter.thieme.com through use of an access code provided under a scratch panel on the book’s first page. The online content consists of electronic versions of Appendix B in the book, with stated application for patient education and Powerpoint presentations. The contribution of this section to the education of the average reader is small, and should not influence purchase of the text.
The book is organized logically into three sections, progressing from basic concepts through advanced techniques. The first section, “Introduction,” focuses on fundamentals of cranial and spinal vascular anatomy, coagulation, and anesthesia for endovascular cases. The information presented is concise and accessible, supplemented by useful tables such as size classification of the neurovasculature, events in the timeline of arterial development, and anomalies of the Circle of Willis. Not every image provided is as useful, however, because of the small size of the images and required resolution. The authors apportion a significant section to spinal vasculature, which is excellent focus, as this represents information that traditionally has not been readily accessible in other formats, and certainly not at the bedside. The very brief section on anticoagulant, thrombolytic, and antiplatelet agents is circumscribed in value, but expanded in the Appendix section A4 at the end of the book. A thoughtful section on endovascular anesthesia and medications provides a rapid reference for commonly encountered drugs, with a variety of tables to summarize and rapidly reference the information. For example, a table on medications for cerebral vasospasm is included in this section and includes dosage per vessel—valuable information for the practicing clinician. However, this useful table is not cross-referenced in the section on aneurysm treatment and cerebral vasospasm, or the index, and hence may escape the notice of a reader referring to the book at the bedside to answer that specific question.
The next section, titled “Equipment and Techniques,” focuses on radiation physics, access and closure devices, endovascular equipment and techniques, complications, pre- and intraoperative monitoring, and diagnostic venous procedures. This is the book’s strongest section. Radiation Physics provides enough information without excessive technicality, including dose thresholds for adverse effects. The chapter on vascular access is exceptionally well written and comprehensive, addressing such niches as pediatric and superior ophthalmic vein access. Of similar high caliber is the review of endovascular equipment, which is well organized, enhanced by multiple tables that enumerate equipment and sizes, and is even inclusive of equipment unavailable in the United States market (the latter being both a nod to the US audience and a recognition that this text is a Neurointerventional resource on continents other than North America). Readers will find a profusion of tips in the section on technique, with concepts both refined (choosing a microcatheter tip shape to provide adequate back-up force during aneurysm coiling) and simple (having a patient turn his head to change the angle of the carotid while trying to retrieve a filter device after carotid stenting). While much of this second section of the book is more useful for trainees, these technical tips will contain food for thought for operators at all levels of experience, reflecting the current literature, and the authors’ experience and preferences. An entire section is dedicated to a discussion of endovascular complications, arranged in temporal sequence from groin access to post-procedural complications, with suggested corrective approaches (for example, securing a stretched coil with stent placement). The point that anticipation of complications is key to minimizing adverse outcomes is reinforced throughout the text. This section is a quick reference, but complications are addressed elsewhere in the text, and readers should refer to the individual sections for the full benefit of the book’s guidance. Interestingly, a sizable chapter is dedicated to intraoperative neurophysiological monitoring, reflective perhaps of the Neurosurgical backgrounds of the authors. While this may be of restricted application to many interventionalists, the chapter makes for interesting reading and is well explained. Finally, the endovenous procedures addressed are inferior petrosal sinus sampling and transvenous manometry. The section adheres to technical details and wisely skirts controversies, with enough detail provided to make an operator comfortable preparing for and performing such an intervention.
The third and final section of the book is titled “Treatment of Specific Disease Entities.” This deals with the scope of endovascular interventions. Again, the neurosurgical heritage of the handbook is visible in the discussion and accompanying illustrations of open surgical procedures, but for non-neurosurgeons these present an interesting (albeit narrow) glimpse into the world of open vascular neurosurgery. Succinct information is tabulated or diagrammed (for instance, fibromuscular dysplasia subtypes are summarized in a single diagram, immediately visually accessible, condensed into type I, II and III, presumably referring to medial, intimal, and advential changes). The chapter regarding dural arteriovenous fistulae is surprisingly short given the range of pathologies encompassed by the title. Carotico-cavernous and other dural fistulae are intermingled, but a more distinct separation of the two would likely have been a more effective means of presenting the information, given the differences in classification and therapeutic indications and approaches. An evidence-based medicine portion reviews studies reporting outcomes from treating and observing various dural shunt lesions, but more clearly classifying hemorrhage risk by Borden or Cognard class would have been a helpful addition. The ischemic stroke chapter ably reviews major trials and available data but suffers from a lack of practical details about the approach to the occlusive lesion itself, despite reviewing equipment choices. The excellent chapter concerning traumatic conditions the Neurointerventionalist will encounter is likely to be frequently referred to. Combining various forms of trauma into a single chapter is both organizationally valuable and easily accessible for rapid reader access (in the elevator on the way to the emergency department to review an urgent case, for example!). Similarly superb is the chapter on spinal vascular interventions, which is clear and readable, continuing the worthwhile attention paid to spinal vascular anatomy and pathology that is mentioned earlier in this review. Clinical pearls are to be found at the end of each chapter, in this section and the previous two. Pearls range from the practical (“Leaving the coil pusher at the tip of the microcatheter… after placement of the last coil can prevent the coil tail from catching in the microcatheter tip and pulling the coil into the parent artery”) to the sensible (“A pre-treatment functional MRI can be very helpful when determining the safety of each potential therapy”), to the philosophical (“Large artery ischemic stroke is a high morbidity and mortality disease- don’t expect miracles and don’t be easily discouraged”). Similarly, each chapter ends with recommended reading and a reference list, providing an expeditious resource for those with the opportunity to review information outside the confines of the text.
Expecting a published text to remain current is unreasonable in a field developing as rapidly as Neurointerventional care, but the text does a cogent job of covering newer technology, such as flow diverters and newer coil systems (for example, the Penumbra 400 coils). Other areas, such as spinal and pelvic augmentation, are entirely absent and represent deficiencies (possibly by design) in the scope of the text, which confines itself solely to vascular disease.
Not many books of similar intent exist in Neuroendovascular surgery, and in this regard the text fills a useful niche. The authors comment that “Each editor desperately searched for a handbook during fellowship training that would serve as a guide and quick reference book, but found none. Out of necessity came our concept of the Handbook of Neuroendovascular Surgery. The book will invariably be compared to the other prominent text in this role, Handbook of Cerebrovascular Disease and Neurointerventional Technique by Harrigan and Deveikis, (Humana Press, 1st edition, 2009). The latter is a more comprehensive text, superior in organization and scope, but sacrifices size and portability as a result. Readers of the Handbook of Neuroendovascular Surgery should look elsewhere for detailed descriptions or an in-depth exploration of the nuances of Neurointerventional care. They are not to be found here. However, the authors of the Handbook of Neuroendovascular Surgery set out to produce a conglomerate of rapid facts and technical and clinical pearls for operators preparing for cases, and in this they are eminently successful. The book is a valuable resource, and an excellent icebreaker for pocket handbooks for our field.
