Dumont AS, Lanzino G, Sheehan JP. Brain Arteriovenous Malformations and Arteriovenous Fistulas. Thieme; 2017; 296 pp; 152 ill; $169.99
In the world of cerebrovascular neurosurgery, few pathologies are as misunderstood as brain arteriovenous malformations (AVMs) and dural arteriovenous fistulae (dAVFs). Significantly more complex than ischemic stroke or brain aneurysms, these lesions are also decidedly less common. This combination of rarity and complexity leads to a widespread misunderstanding of these lesions even among so-called experts. Indeed, it is not uncommon to hear people at meetings commenting in ways that belie a fundamental misunderstanding of these lesions.
It is thus quite refreshing to have a dedicated text focused specifically on these challenging lesions, Brain Arteriovenous Malformations and Arteriovenous Fistulas by Dumont, Lanzino, and Sheehan.
This is a challenging task and one that on balance the editors do quite well. The major topics of importance are covered, including anatomy and physiology, treatment rationale, and the different treatment modalities. It is my opinion that the best papers and texts truly reflect the senior authors’ personal experience and expertise, rather than simply quote prior literature, which has less benefit. The chapters accomplish this with variable success, but most do an excellent job of achieving this goal. Unfortunately, some (for example the chapter on endovascular treatment of cerebellar AVMs), clearly suffer from a lack of attention from the senior author and are essentially 1-page review articles with little added benefit to readers.
In addition, given the complexity, the readership is highly benefited by diagrams and figures rather than intraoperative pictures and angiograms, which are difficult to interpret. In this modern era, the standard is professional-grade diagrams to adequately convey complex topics. Several chapters in this text accomplish this goal admirably, such as Lawton’s Chapter 1 and Cohen-Gadol’s Chapter 13. The senior authors clearly took care to offer their thoughts in the primary texts, which are supplemented with multiple professional-grade figures and diagrams. Others, such as Lanzino’s Chapter 16 on the surgical treatment of dAVFs, have simply text, which is a missed opportunity. This is a complex surgical topic to convey and text alone is simply inadequate. The sections on radiosurgery are well covered, as expected with Dr. Sheehan, a noted SRS expert.
While there are certainly several other texts on this topic, this updated version is welcome. In addition, it is nice to see a specific focus on dAVFs. These are often mentioned as a byproduct of a larger discussion on brain AVMs but are, in fact, distinct and very different lesions. The pathophysiology, treatment strategy, and morbidity are completely different from brain AVMs. Thus, a key benefit of this text is that it gives these challenging lesions their due representation. The chapter on endovascular treatment of dAVFs is sophisticated and helpful for the unfamiliar reader to comprehend.
I would recommend this book without reservation for anyone attempting to understand these complex lesions and certainly for anyone who manages patients with AVMs or dAVFs. Given the heavy reliance of cerebrovascular pathologies on catheter angiography, it will be challenging to understand many of the chapters without a basic understanding of angiographic anatomy, so the truly uninitiated will benefit from secondary resources as well.
