Yasargil Microneurosurgery Study Guide

Yaşargil Microneurosurgery Study Guide is designed for effective learning and study of the neurosurgical principles contained in seminal microneurosurgery textbooks. From normal microsurgical anatomy to aneurysms, arteriovenous malformations, and CNS tumor microsurgery, this study guide provides a question-and-answer format to knowledge of the background, anatomy, and techniques of microneurosurgery. This work is a practical guide to the application of microneurosurgery to a variety of brain conditions, including intracranial aneurysms, extrinsic and intrinsic tumors, while providing guidance on instrumentation and equipment, neuroanesthesia, complications, and more. This practical book is ideal for neurosurgeons, neurologists, neuroanatomists, and other technical experts with a clinical interest in brain microsurgery.

Cover image
Title page
Table of Contents
Copyright
Dedication
Foreword
Preface
Section I. Microsurgical anatomy of the basal cisterns and vessels of the brain, diagnostic studies, general operative techniques, and pathological considerations of the intracranial aneurysms
Chapter 1. Operative Anatomy
Subarachnoid cisterns
Normal cisternal anatomy
Intracranial arteries
Perforating arteries to basal ganglia and brainstem
Cerebral veins
Chapter 2. Diagnostic studies for ruptured aneurysms
Lumbar puncture
Electroencephalogram
Radiological investigation
Cerebral angiography
Internal carotid aneurysms
Vertebrobasilar aneurysms
Diagnostic difficulties in cerebral angiography
Computerized tomography
Chapter 3. General operative techniques
Instruments
Operative approach
Aneurysm clipping
Alternative methods of aneurysm treatment
Special operative problems
Chapter 4. Anesthesia for microsurgical procedures in neurosurgery
Chapter 5. Pathological considerations
Classification
Distribution
Familial occurrence of cerebral aneurysms
Occurrence without hereditary syndrome
Associated vascular anomalies
Pathology of saccular aneurysm formation and rupture
Natural history of ruptured aneurysms
Cerebral ischemia and infarction
Vasospasm
Prolonged chronic spasm or narrowing of the arteries
Cerebral edema
Ventricular dilatation and communicating hydrocephalus
Unexplained SAH
Section II. Clinical considerations, surgery of the intracranial aneurysms, and results
Chapter 6. Clinical considerations
Clinical presentation
Special clinical presentations
Chapter 7. Internal carotid artery aneurysms
Infraclinoid ICA aneurysms
Carotid ophthalmic aneurysms
Distal medial wall aneurysm
Superior wall aneurysms
Inferior wall aneurysm of the ICA
Carotid-posterior communicating aneurysm
Anterior choroidal artery aneurysms
Internal carotid bifurcation aneurysms
Chapter 8. Middle cerebral artery aneurysms
Relationship to the subarachnoid cisterns
Relationship to MCA
Lateral wall of proximal MCA
Medial wall of proximal MCA
MCA bifurcation
Operative technique
Chapter 9. Anterior cerebral and anterior communicating artery aneurysms
Proximal ACA aneurysms I.E. from A1 (precommunicating segment)
Anterior communicating artery (AComA) aneurysms
Distal (pericallosal) anterior cerebral artery aneurysms
Chapter 10. Vertebrobasilar aneurysms
Background
Basilar artery bifurcation aneurysms
Upper basilar trunk aneurysms
Posterior cerebral artery aneurysms (P1)
Aneurysms at the P1–P2 junction
Aneurysms of the P2 segment
Aneurysms of the P3 segment
Aneurysms of the lower basilar artery
Fusiform aneurysms of the lower basilar artery
Distal superior cerebellar artery aneurysms
Saccular aneurysms of the vertebral artery
Fusiform aneurysms of the vertebral artery
Distal PICA aneurysms
Chapter 11. Giant intracranial aneurysms
Chapter 12. Multiple aneurysms
Chapter 13. Unoperated cases
Chapter 14. Complications of aneurysm surgery
CNS complications
General medical complications
Chapter 15. Addendum
New series of aneurysm patients 1979–83
Chapter 16. Final comments
Section III. Arteriovenous malformation of the brain, history, embryology, pathological considerations, hemodynamics, diagnostic studies, and microsurgical anatomy
Chapter 17. History of cerebral AVMs
Chapter 18. Embryology
Embryogenesis of the early vascularization of the CNS
Vascular malformations—embryology
Chapter 19. Pathological considerations
Pathogenesis
Locations of AVMs
The nidus
Sizes, shapes and elements of AVMs
Elements of an AVM
Enlargement, growth, and regrowth of AVMs
Growth
Spontaneous regression and thrombosis
Multiple AVMs
Association of persistent trigeminal artery and AVMs
Association of aneurysm and AVM
Intracranial AVM with stenosis and occlusion of major vessels
Chapter 20. Hemodynamics
Cerebral circulation
Effects of AVMs upon cerebral function
Operative considerations regarding hemodynamics
Chapter 21. Diagnosis and follow-up of patients with cerebral AVM using Doppler ultrasound
Chapter 22. Neuroradiological evaluation
Computed tomography
MRI
Cerebral angiography
Chapter 23. Microsurgical anatomy of the brain
Supratentorial sulci and fissures
Fissures
Vascular patterns
Infratentorial sulci and fissures
Organization of cerebral microcirculation
The venous system of the brain
The collateral circulation
Chapter 24. Cortical blood vessels of the human brain
Blood vessels of the cerebral cortex
Blood vessels of the cerebellar cortex
Chapter 25. Anatomy of the calcarine sulcus
Section IV. AVM of the brain, clinical considerations, general and special operative techniques, surgical results, nonoperated cases, cavernous and venous angiomas, and neuroanesthesia
Chapter 26. Anatomical location of AVMs from the surgical viewpoint
Chapter 27. Clinical considerations
Chapter 28. Surgical concerns
General operative concepts and techniques
Opening of fissures and sulci
Chapter 29. Special surgical considerations
Convexity (pallial) AVMs
Deep central AVMs
Conclusions concerning central AVMs
Chapter 30. Summary of operative results
Chapter 31. Children with AVMs
Chapter 32. Nonoperated patients with AVM
Chapter 33. Venous, cavernous, and occult angiomas
Neuroradiological considerations
Clinical features and surgical results
Chapter 34. Final comments on AVMs
Chapter 35. Anesthesia in the surgery of cerebrovascular malformations
Section V. CNS tumors: Surgical anatomy, neuropathology, neuroradiology, neurophysiology, clinical considerations, operability, and treatment options
Chapter 36. Anatomy
Embryology
Divisions of the brain
Cerebrum
Summary
Infratentorial anatomy
Vascular anatomy
Chapter 37. Neuropathology
Introduction
General considerations: categorization of CNS tumors
Specific considerations
Tumor infiltration
Peritumoral changes
Tumor demarcation
Brain tumor: adherence and adhesiveness
Tumor vascularization
The number and types of tumors
Conclusions
Chapter 38. Neuroradiology
Current neuroimaging with CT and MRI
The application of neuroimaging capabilities to CNS tumors
Postoperative changes
Difficulties and limitations of neuroimaging
Peritumoral changes
Cleavage
Summary
Chapter 39. Neurophysiology
Neural and glial parenchymal systems
Pathophysiology: cerebral edema
Cerebrospinal fluid system
Cerebrovascular system
Circumventricular organ system
Neuroendocrine system
Central nervous and immune systems
Chapter 40. Clinical considerations—operability
Section VI. Microsurgery of CNS tumors: Instrumentation and equipment, laboratory training, surgical approaches, strategies, tactics and techniques, surgery and results of extrinsic and intrinsic tumors, interventional neuroradiology, neuroanesthesia, and complications
Chapter 41. Instrumentation and equipment
Operating table systems
Surgical instrumentation
Chapter 42. Laboratory training
Chapter 43. Surgical approaches
The supine position
Lateral position
Semisitting position
Sitting position
Patient positioning and intracranial hemodynamics
Safety and comfort of the patient
Comfort of the surgeon
The incision
The size and site of the craniotomy
General craniotomy techniques
Craniotomies and individual approaches
Localization, targeting, and navigation of tumors
Chapter 44. Strategies, tactics, and techniques
Surgical strategy
Atraumatic brain retraction
Elimination of tumor vascularization and preservation of hemodynamics
Incision closure
Difficulties
Summary
Chapter 45. Acoustic neurinomas
Clinical presentation
Microsurgical technique
Outcome
Complications
Operative morbidity
Bilateral acoustic neurinoma
Natural history of acoustic neurinomas
Conclusions
Chapter 46. Other less common neurinomas: orbital, oculomotor, trigeminal, facial, glossopharyngeal, accessory, and hypoglossal
Trigeminal neurinomas
Glossopharyngeal neurinomas
Orbital and oculomotor neurinomas
Facial neurinomas
Hypoglossal neurinomas
Chapter 47. Glomus jugulare tumors
Surgical treatment and results
Chapter 48. Meningiomas
Localization and spread
Operative removal on specific intracranial locations
Surgical results
Tumor site and surgical outcome
Surgical outcome, postoperative course, and complications
Completeness of resection
Recurrence
Histologic considerations
Metabolic and other factors
Systemic effects
Endocrinologic factors
Genetic aspects
Neuroradiologic aspects
Conclusions
Chapter 49. Hemangiopericytoma
Chapter 50. Chondromas
Chapter 51. Chordomas
Chapter 52. Epidermoid and Dermoid tumors
Chapter 53. Intracranial lipoma
Chapter 54. Transcranial surgery for large pituitary adenomas
Localization
Clinical presentation
Surgical outcome
Chapter 55. Craniopharyngiomas
Surgical approaches
Surgical outcome
Complications and recurrence
Chapter 56. Optic gliomas
Chapter 57. Esthesioneuroblastoma (olfactory neuroblastoma)
Chapter 58. Arachnoid cysts
Chapter 59. Neocerebral and neocerebellar tumors
Neocerebral tumors
Neocerebellar tumors
Surgical approaches
Chapter 60. Limbic and paralimbic tumors
Surgical approaches
Surgical results
Chapter 61. Midline tumors (Corpus callosum, Septum pellucidum, Basal ganglia, Diencephalon and Brainstem)
Corpus callosum tumors
Basal ganglia tumors
Diencephalon tumors
Brainstem tumors
Surgical results
Chapter 62. Intraventricular tumors
Surgical approaches
Histopathology of intraventricular tumors
Surgical results in specific tumor groups
Conclusions
Chapter 63. Pineal tumors
Chapter 64. Patient population and outcomes of glioma groups
Summary (glial–neural tumors)
Chapter 65. Malignant transformation
Chapter 66. Embryonal CNS tumors
Medulloblastoma
Primitive neuroectodermal tumor PNET
Ependymoblastoma
Neuroblastoma
Chapter 67. CNS non-Hodgkin's lymphoma and primary intracranial sarcoma
Primary CNS non-Hodgkin's lymphoma
Primary intracranial sarcoma
Chapter 68. Germ cell tumors
Germinomas
Teratoma
Embryonal carcinoma
Chapter 69. Vascular tumors
Hemangioblastoma
Cavernomas
Chapter 70. Cerebral metastases
Chapter 71. Interventional neuroradiology in the management of CNS tumors
Indications of embolization
Principles of tumor embolization
Embolization of meningiomas
Tentorial and posterior fossa meningiomas
Postembolization control of meningiomas
Chapter 72. Neuroanesthesia for microsurgery of CNS tumors
Supine position
Sitting position
Chapter 73. Summary of outcomes: Whole series
Chapter 74. Summary: childhood tumors
Chapter 75. Intra and postoperative complications
Seizures
Hydrocephalus
Pineal–hypothalamic–pituitary axis dysfunction
Iatrogenic complications
Other complications
Neurointensive care
Chapter 76. Final remarks
Abbreviations

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Yasargil Microneurosurgery Study Guide

Books I, II, IIIA, IIIB, IVA, and IVB

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Leonard Kranzler

Aikaterini Panteli