Spetzler RF, Yashar M, Kalani S, Nakaji P, eds. Neurovascular Surgery. 2nd ed. Thieme; 2015; 1280 pp; 1904 ill; $399.99
The second edition of Neurovascular Surgery has just been published, and it represents the magnus opus in this field of neurosurgery. Nearly 100 chapters consolidate the current concepts, anatomic details, and advances in techniques in this evolving discipline. Edited by Drs. Spetzler, Yashar, Kalani, and Nakaji, over 200 authors have contributed to this 1280-page book.
Every sector of neurovascular surgery is covered in this exhaustive book. For the interventional neuroradiologist the book is an absolute “must have” and for those in diagnostic neuroradiology there should be access to this book, either through a colleague or via a departmental library. No one (at least no one I know of) will read this tome cover to cover; however, it will be a reference text for all types of subtypes of vascular lesions. The multiple artists’ renditions are outstanding, whether showing the typical pathology or demonstrating various surgical approaches. In general, the images (MRs, CTs, DSAs) are of high quality, although in some areas, such as the introductory chapter on cerebral AVMs, the imaging is outdated. However, this is more than compensated for by the better image quality in subsequent and preceding chapters.
There are 10 sections, each with multiple chapters. The sections are: Development, Anatomy and Physiology of the CNS; Evaluation and Treatment Considerations; Ischemic Stroke and Vascular Insufficiency; Cerebral and Spinal Cavernomas; Cerebral and Spinal Aneurysms; Cerebral and Spinal AVMS and AVFs; Disorders of Ephaptic Transmission; Vascular Considerations in the Management of Tumors; Surgical Approaches; and Cerebral Revascularization. (Parenthetically, “ephaptic” is not a term often used by neuroradiologists, but it refers to neural electrical impulses transmitted from a nerve fiber without mediation by a neurotransmitter.)
Clearly, the entire book applies to those dedicated to endovascular treatment, but there is also much of this book that pertains directly, and importantly, to diagnostic neuroradiology. In particular, the main anatomic displays of the ICA and VAs and the spinal vascular anatomy are important chapters. Certain chapters and concepts such as those on the pathophysiology of cerebral ischemia, diagnosis of brain infarction, endovascular treatment of carotid and vertebrobasilar insufficiency, and endovascular treatment of acute ischemic stroke, while constantly being re-evaluated, are valuable because they put under one roof the current state of the art (at least at the time when the chapters were written). Chapters on how and when to treat cavernous malformations of the spine and brain contain excellent images and extensive descriptions of the pathology and approaches to these frequently occult lesions.
Most interventionalists (and diagnostic neuroradiologists, for that matter) will find chapters on endovascular vs. surgical treatment of aneurysms, arteriovenous malformations, and arteriovenous fistulas of most interest. Here one can follow nearly step-by-step the way these are approached and the rationale behind each. Many issues a diagnostic radiologist faces and may have limited understanding of include stent-assisted coil occlusion, flow diversion, balloon remodeling, and coil occlusion. Those are well described and illustrated. One also gains an appreciation by drawings and actual patient imaging of what is involved in different types of intracranial aneurysm treatments. Intraoperative pictures give extra meaning to the surgical chapters. It is far easier for a radiologist to see what is going on through many brilliant drawings and photographs than by visiting the OR and trying to look through an operating microscope to see, for example, how branches emanating adjacent to or from aneurysms are handled. Staging of AVMs and dealing with giant lesions, both surgically and through endovascular means, are concepts that are important when interpreting studies.
Video content, accessed through a code that comes with each purchase, allows one to view 50 procedures. This is a nice supplement to this classic text. Some are of proper length and well explained by the accompanying narrative, such as the video on endovascular carotid stenting, or on a large MCA surgical clipping, but some are too short, such as the video on endovascular therapy of a large frontal AVM. In general, these video clips are of tremendous value, because in our professional lives we have virtually no opportunity or time to view these procedures in-person.
This classic text is highly recommended to all sections of neuroradiology and in particular to those training or actively involved in neurointerventions.
