Neurointerventional Management: Diagnosis and Treatment PDF

Preface

The second edition of Interventional Neuroradiology has been re-titled Neurointerventional Management. The new title highlights only one facet of the revolutionary changes, that of terminology, that characterize this rapidly advancing field. The book is intended to provide the clinical practitioner with background information and specific descriptions of the anatomy, techniques, disorders, procedures, and decisions most commonly encountered in neurointerventional management. Throughout the past decade, neuroendovascular techniques have revolutionized therapy of disorders of the head, neck, and central nervous system. These procedures have now become standard treatment for many of the most common neurovascular disorders and make possible treatment of many patients who only a short time ago would have had no reasonable therapeutic options.

With progress, however, comes the requirement for increased knowledge and technical skill in order to deliver these treatments safely and effectively. Areas of fundamental knowledge in neurointerventional management cross the boundaries of classically delineated medical and surgical specialties including neurosurgery, neuroradiology, and neurology. Required knowledge includes familiarity with neuroradiologic imaging of vascular disease, knowledge of vascular anatomy, and thorough understanding of cerebrovascular disorders and their endovascular treatments. Most importantly, skill in basic neurointerventional techniques must be coupled with good clinical judgment in patient management and decision-making.

Ongoing rapid advances in neuroimaging require neurointerventional practitioners to have excellent diagnostic skills with noninvasive neuroimaging modalities to identify the presence of cerebrovascular disease, evaluate its effects, identify potential candidates for neurointerventional procedures, and document the results of treatment. Separate chapters on CT, MR and ultrasonographic evaluation of cerebrovascular disease emphasize the current noninvasive evaluation of disorders of importance to neurointerventionalists. In addition, the authors have made every effort throughout the text to illustrate the integration of current neuroimaging into the performance and decision-making associated with interventional neuroradiologic procedures.

As in all radiologic or surgical based specialties, thorough understanding of pertinent anatomy is essential. For the neurointerventionalist, cerebrovascular anatomy is the workplace. Anatomic knowledge underlies the understanding of many, if not all, cerebrovascular disorders, provides routes of endovascular access, and defines the scope of treatment options. Chapters covering pertinent vascular anatomy of special importance to neurointerventional procedures have been included and updated from the previous edition. These chapters are directed at key anatomic concepts as well as specific anatomic features of the head, neck, brain, and spine vasculature.

It is through basic neurointerventional techniques that treatment is delivered to the individual patient. No amount of theoretical understanding can overcome poor technique in an environment as unforgiving as the cerebrovascular system. Discussion of basic techniques with appropriate illustrations should prove useful for those of all levels of experience from students entering the field to experienced practitioners who may benefit from review or additional technical options.

Coupled with anatomic and technical knowledge is the requirement for understanding the epidemiology, pathophysiology, and clinical features of the increasing numbers of cerebrovascular disorders that are now amenable to endovascular treatment. Clinically oriented discussions of the most common conditions of interest to neurointerventional practitioners have been authored by recognized experts in the field. Treatment discussions are illustrated with current images to emphasize pertinent technical and anatomic details. Extensive and current references are included to serve as a basis for further research.

Perhaps most essential to successful neurointerventional practice is the requirement for correlating the appropriate application of knowledge and technical skills to the care of patients. The clinical emphasis on topics throughout the book is designed to illustrate the importance of integrating clinical information, knowledge of disease processes, and technical skill through the use of good clinical judgment to formulate and perform effective neurointerventional procedures.