Endovascular Neurosurgery

Transcription

1 Endovascular Neurosurgery

2 Springer-Verlag London Ltd.

3 Paul Butler (Ed.) Endovascular Neurosurgery A Multidisciplinary Approach, Springer

4 Paul Butler, MRCP, FRCR Department of Neuroradiology, The Royal London Hospital, Whitechapel, London E1 El 1BB, UK ISBN ISBN (ebook) DOI / British Library Cataloguing in Publication Data Endovascular neurosurgery: : a multidisciplinary isciplinary approach 1. I. Nervous system - Surgery 2. Blood-vessels - Endoscopic surgery 1. Butler, Paul, '8 Library of Congress Cataloging-in-Publication Data Endovascular neurosurgery: : a multidisciplinaryapproach1paulapproach 1 Butler (ed.). p. cm. Includes bibliographical references and index. 1. I. Nervous system-surgery. 2. Blood-vessels-Endoscopic surgery. 3. Cerebrovascular disease-surgery. 1. Butler, Paul, 1952 June 4- [DNLM: 1. I. Cerebrovascular Disorders-surgery. 2. Neurosurgical Procedures. 3. Vascular Surgical Procedures. WL 355 E ] RD594.2.E '8-dc21 DNLMIDLC DNLM/DLC for Library of Congress Apart from any fair dealing for the purposes of research or private study, or criticism or review, as permitted under the Copyright, Designs and Patents Act 1988, this publication may only be reproduced, stored or transmitted,, in any form or by any means, with the prior permission in writing of the publishers, or in the case of reprographic reproduction in accordance with the terms of licences issued by the Copyright t Licensing Agency. Enquiries concerning reproduction outside those terms should be sent to the publishers. Springer-Verlag London 2000 Originally published by Springer-VerlagLondon Limited in Sof'tcover Softcover reprint of the hardcover 1st edition 2000 The use of registered names, trademarks, etc. in this publication does not imply, even in the absence of a specificstatement, statement, that such names are exempt from the relevant laws and regulations and therefore free for general use. Product liability: The publisher can give no guarantee for information about drug dosage and application thereof contained in this book. In every individual case the respective user must check its accuracy by consulting other pharmaceutical literature.. Typeset by EXPOHoldings, Malaysia 28/ Printed on acid-free paper SPIN

5 Preface With a few notable exceptions, neuroradiologists have taken the lead in developing the specialty of endovascular neurosurgery. As a result they had to play a prominent role in the overall care of the patient and the patient's family, reacquainting themselves with some of the principles of the medical management of neurosurgical patients, neurological intens ive care and neuroanaesthesia. Since neuroradiologists are not primarily clinicians, from the outset there has had to be a collaboration with clinical neuroscientists, radiation therapists and anaesthetists. In my own centre, and I am sure in most others, each patient is discussed by a number of relevant specialists at specially convened meetings and a treatment plan agreed, which is then put to the patient. The neuroradiologist must be closely involved in obtaining informed consent, seeing the patient on the ward and be available subsequently, if necessary, to explain adverse outcomes to the patients and their relatives. This is a little removed from the ways of diagnostic neuroradiology, which the vast majority of neuroradiologists in the United Kingdom still practise alongside their interventional work. Endovascular neurosurgery or interventional vascular neuroradiology is a rapidly evolving specialty and it seems that never a month passes without news of some technical innovation originating either from the manufacturing companies or from the inventive minds of neurointerventionists worldwide. This can sit a little uneasily with the current requirement for evidence-based medicine. Put simply, it is very likely, given the pace of change, that a carefully controlled study of one or other technical aspect of treatment may be overtaken by events and the information derived may thus be rendered obsolete. Additionally, many reports in the literature deal with small numbers of patients, are frequently anecdotal and may draw contradictory conclusions. Among the few large trials, the CAVATAS trial on carotid angioplasty coordinated by Atkinson Morley's and St George's Hospitals, London has proved extremely valuable. The results of the International Subarachnoid Haemorrhage Trial (ISAT) organised by the Oxford group are eagerly awaited. Because of a perceived imperative to treat, studies on the natural history of haemorrhagic cerebrovascular disease are few and were often written decades ago. The decision to treat a lesion expectantly may be a difficult one. This book emphasises the multidisciplinary nature of endovascular neurosurgery. The contributors have together analysed published data on the natural history of cerebral aneurysms, arteriovenous v

6 vi Preface malformations and cervical arterial degenerative disease and treatment outcomes. The methodology of endovascular treatment and patient monitoring are also described and this book represents what I believe to be a balanced account of the current practice and place of endo vascular neurosurgery in the United Kingdom. Paul Butler London 1999

7 Contents Natural History ofintracranial Aneurysms and Vascular Malformations: Indications for Combined Surgical! Endovascular Treatment John S. Norris and Peter]. Hamlyn. 2 Interventional Neuroradiology: Techniques in Embolisation of Cerebral Aneurysms and Arteriovenous Malformations Anil R. Gholkar and ]oti ]. Bhattacharya Endovascular Treatment ofintracranial Aneurysms: The Oxford Experience W.E.H. Lim andlames V. Byrne 39 4 Cavernous Sinus Lesions Robert ]. Sellar 57 5 Cerebral Arteriovenous Malformations Robert ]. Sellar 73 6 The Endovascular Treatment ofspinal Vascular Abnormalities Brian E. Kendall The Endovascular Treatment ofcarotid and Vertebral Artery Atherosclerotic Disease Andrew Clifton and Mart in M. Brown Neurological Monitoring During Endovascular Procedures Steven White and Richard Langfo rd Radiation Therapy and Vascular Malformations Piers N. Plowman Index vii

8 Contributors [oti J. Bhattacharya, MRCP, FRCR Institute of Neurological Sciences Southern General Hospital Glasgow GSI 4TF, UK Martin M. Brown, MAMD, FRCP Professor of Neurology Department of Clinical Neurology The Nat ional Hospital for Neurology and Neurosurgery Queen Square London WC1N 3BG, UK Iarnes V. Byrne, MD, FRCS, FRCR Department ofneuroradiology The Radcliffe Infirmary Woodstock Road Oxford OX2 6HE, UK Andrew Clifton, MA, MRCP, FRCR Atkinson Morley's Hospital Copse Hill, Wimbledon London SW20 ORE, UK Ani! R. Gholkar, FRCR Newcastle General Hospital Westgate Road Newcastle-upon-Tyne NE4 6BE, UK Peter J. Hamlyn, BSc, MD, FRCS, FISM Consultant Neurosurgeon The Royal Hospitals NHS Trust Whitechapel, London El lbb, UK Brian E. Kendall, FRCS, FRCP, FRCR The Royal Free Hospital Pond Street London NW3 2QG, UK ix

9 x Contributors Richard Langford, FRCA Senior Lecturer and Hon. Consultant Anaesthetist St Bartholornew's Hospital 38 Little Britain West Srnithfield London ECIA 7BE,UK W.E.H. Lirn, FRCR Consultant Radiologist Singapore General Hospital Outrarn Road Singapore 0316 John S. Norris, FRCS(SN) Consultant Neurosurgeon Hurstwood Park Neurological Centre The Princess Royal Hospital Haywards Heath West Sussex RH16 4EX, Uk Piers N. Plowman, MA, MD, FRCP, FRCR Consultant Radiotherapist St Bartholornew's Hospital 38 Little Britain West Srnithfield London ECIA 7BE, UK Robert J. Sellar, MRCP, FRCR Western General Hospital Crewe Road South Edinburgh EH4 2XU, UK Steven White, DPhil, MRCPsych Consultant Neurophysiologist St Bartholornew's Hospital 38 Little Britain West Srnithfield London ECIA 7BE, UK