Lawton MT. Seven Bypasses: Tenets and Techniques for Revascularization. Thieme; 2018; 698 pp; 1,519 ill; $279.99.
It was a real pleasure reviewing Seven Bypasses: Tenets and Techniques for Revascularization by Michael T. Lawton, MD. This is the third installation in Dr. Lawton’s trilogy of cerebrovascular surgery textbooks, the other two being Seven Aneurysms and Seven AVMs. Continuing a tradition of excellence, this work is another masterpiece. Although this book is highly technical and primarily geared towards neurosurgeons, this treasure of knowledge will occupy a special place in the library of every practitioner dealing with cerebrovascular disease.
Neuroradiologists, in particular, are called upon to evaluate and “unravel” complex post-operative images, which often involve bypasses. In these complex scans, whether it is angiograms, CTs, MRIs, etc., normal anatomy and imaging findings are distorted on multiple levels by the original pathology, the surgical procedure, and the potential surgical complications. This layered complexity may challenge even neuroradiologists who are used to these cases, let alone practitioners who are called to evaluate such patients infrequently. Dr. Lawton’s textbook covers everything that a neuroradiologist may need to intelligently interpret nearly every case.
True master surgeons are often very busy clinically, resulting in little or no time for writing a textbook themselves. As such, in today’s time, most textbooks have become a collage of different authors, each one with varying degrees of experience, knowledge, and commitment. Frankly, most chapters are written by residents and fellows with little or no experience, and who, in the end, receive little (if any) supervision by the experts. One of the unique aspects of this textbook is that it is written from cover to cover by Dr. Lawton himself. Dr. Lawton is not only one of the most well regarded cerebrovascular neurosurgeons of this era, but is also a notorious teacher and educator. As such, this textbook’s structure and content are reflective of his vast experience, his talent, and his love for teaching. Even though, the title is “Seven Bypasses,” in line with the other textbook of the series, the actual content is pretty much “all inclusive” in terms of the current options for cerebral revascularization.
The first section analyzes the three main types of anastomosis – end-to-side, side-to- side, and end-to-end, while the second section is dedicated to many of the technical aspects of performing a bypass, such as ways to improve dexterity, harvesting the grafts, suturing and tissue handling, as well as ways to trouble shoot the anastomosis.
The third section analyzes, in detail, the 7 conceptual bypasses:
1) The extra-cranial intra-cranial bypass
2) The extra-cranial intra-cranial bypass with interposition graft
3) Re-implantation bypass
4) In-situ bypass
5) Re-anastomosis
6) Intracranial bypasses with interposition graft
7) Combination bypasses
A tremendous number of real cases from Dr. Lawton’s extensive experience are presented within each subsection, covering in a near exhaustive fashion almost all the clinical scenarios someone could encounter. Even though no case in medicine is exactly the same, it is most likely that the problem at hand will have many similarities to one of the examples presented.
Finally, the fourth section provides a different perspective, analyzing a variety of bypass options based on four anatomical locations:
1) MCA
2) ACA
3) Basilar artery
4) PICA
Perhaps, the strongest point of this textbook is how magnificently it is illustrated. Every concept discussed is visually depicted, not only with one, but multiple illustrations to ensure that the reader really understands what the author is trying to say. In contrast to many other surgical textbooks in which intra-operative images resemble abstract art with a red hue. Each and every one of the images shown here are crisp, beautifully annotated, and highly educational. Each case presented is accompanied by a tiny “big picture” schematic to clarify the complex anatomy. Of particular interest to neuroradiologists is that there are hundreds of angiograms, MRIs/MRAs and CTAs to illustrate how each of the examples appears on imaging.
The book is not intended to be a review on the current evidence for bypass surgery and therefore references and guidance for further reading are scant. Instead, this is meant to be a vehicle into a master bypass surgeon’s mind, heart, and soul – while elegantly giving access to the breadth of their experience. I really believe that this book is like no other, and should be regarded as a work of art. It is one of the classics!
