Morris, P. Practical Neuroangiography. Third Ed. Wolters Kluwer | Lippincott Williams & Wilkins; 2013; 528 pgs.; $239.00.
While acknowledging that most of the important aspects of becoming a neurointerventionalist (manual skills and decision-making ability) come with experience, this book aims to give first-year neurointerventional fellows basic background knowledge essential to understanding all aspects of neurointerventional procedures. As the author, Dr. Morris, says in his preface, the information contained in this book is what he wished had been available at the start of his own fellowship. He is right. This book is a tour de force—a comprehensive, well written, and well-illustrated book that would be a great asset for any beginning fellow.
The book is divided into three sections. First is “Techniques and Safety.” During this section of the book, due diligence is given to many essential but often overlooked details in performing cerebral angiograms. This section really puts the “practical” in Practical Neuroangiography. Tips are given, such as throwing away lidocaine from the tray as soon as the local anesthetic has been given because the “unwritten annals of neuroangioagraphy are replete with unreported incidents where syringes of clear fluid on the table have been used as contrast only to discover that the remaining 7ml of lidocaine that should have been used in the groin are now circulating in the patient’s brain, announced by the abrupt onset of status epilepticus.” Numerous drawings and associated detailed and understandable texts are given, explaining even the most basic aspects of procedures, such as cutaneous anesthesia, obtaining arterial access, and storing a wire in a water bowl. Additionally, the finer points of wire and catheter manipulation and handling are discussed. As an illustration of how comprehensive this book is, a whole chapter in this section is devoted to radiation safety, discussing physics/dosimetry, historical examples of radiation exposure effects, and practical tips to decrease radiation exposure during procedures.
The second section is “Anatomy.” Numerous cartoon drawings, DSAs, and cross sectional images are provided to illustrate both normal anatomy as well as common and uncommon variants. Because facility with anatomy is a prerequisite to becoming a competent neurointerventionalist, this section is quite detailed. The author illustrates the importance of anatomy through many clinical examples. In one account, he gives an example of a case performed at an outside hospital, of a patient who presented with moderate epistaxis controlled with conservative measures but was nonetheless taken for particle embolization of the internal maxillary artery. However, because of the ophthalmic artery arising from the middle meningeal artery, ECA embolization led to immediate monocular blindness.
The final section is titled “Vascular Diseases: Diagnosis and Treatment” and divided into the following chapters: “Intracranial Aneurysm: Diagnosis and Treatment,” “Vascular Malformations of the Brain,” “Cranial Dural Vascular Malformations,” “Vascular Malformations of the Spine,” “Pediatric Ischemic Stroke and Arteriopathy,” “Carotid Cavernous Fistulas,” “Nonaneurysmal Perimesencephalic Subarachnoid Hemorrhage,” “ENT Bleeding and Tumor Embolization,” “Reversible Cerebral Vasoconstriction Syndrome,” “Vasculiditis Involving the Central Nervous System,” “Dural Sinus Occlusive Disease,” “Cerebral Vasospasm,” “Angioplasty and Stenting of Atherosclerotic Disease,” “Endovascular Treatment of Ischemic Stroke and Vein of Galen Malformations.” Up-to-date techniques, current treatment options, and references are given in each chapter. While most images are, as expected, DSAs, a healthy amount of cross-sectional imaging and even patient photographs are provided. The images are well labeled and the legends informative.
The book is replete with quirky anecdotes and quips that illustrate important points and help to keep the reader engaged. For example, in the chapter “Safety and Complications,” Dr. Morris tells a story of a woman who mistakenly took all 30 Plavix tablets in one day instead of one per day. This important fact was missed by the fellow, who had double-checked that she had started her Plavix but was in too much of a rush to really get into the details of how she had taken the Plavix. Depending on reader preference, this style can be a little cumbersome. Instead of saying, “stick to a known routine during procedures,” the author illustrates this point by saying, “We only have two CDs in our music system. One of these is “The Greatest Hits of Marty Robbins” and we never play the other.”
Overall, this book is well researched, beautifully illustrated, and uniquely written. It is a must-read for all neurointerventional fellows. It would also make a good addition to the libraries of diagnostic neuroradiologists (fellows and practicing physicians alike) who have an interest in gaining a greater understanding and appreciation of what their interventional colleagues do.
