By Eric Nussbaum, J Mocco
In Cerebral Revascularization: Microsurgical and Endovascular Techniques, popular surgical specialists mix their services to supply the most up-tp-date and finished assurance of open mind skip and endovascular techniques presently available.
A specific advent familiarizes readers with a number of the symptoms for those technically not easy tactics. Concise chapters then offer thorough assurance of surgical concepts, issues, and results utilizing case examples from the authors' personal collections to aid organize readers for surgical procedure. bettering the textual content all through, operative images and angiographic photographs basically reveal the pre-, peri-, and postoperative administration of ischemic stroke, large aneurysms, and the spectrum of complicated cerebrovascular diseases.
- Extensive assurance of extracranial-intracranial
pass and the newest in endovascular treatment
- 369 fine quality operative pictures and
endovascular photographs illustrate key innovations
- A particular emphasis at the important function perioperative care performs in optimizing sufferer outcomes
Neurosurgeons, citizens, and fellows will usually check with this definitive advisor in either the working room and the catheterization lab. it's also an crucial source for interventional radiologists, neurologists, vascular neurosurgeons, or for somebody who must examine extra approximately those state-of-the-art cerebral revascularization techniques.
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Additional resources for Cerebral revascularization: microsurgical and endovascular techniques
A vascular loop can be placed around the ECA and brought downward toward the chest helping pull the bifurcation caudal. For a carotid endarterectomy, it is best not to dissect underneath the carotid bifurcation for two reasons. First, this puts the superior laryngeal nerve at risk, which can lead to swallowing diﬃculties, and second, dissecting under the bifurcation can lead to an increased risk of embolic complications from dislodgment of plaque. Accordingly, during a high dissection, the distal ICA is dissected free and then if necessary, as a last step the underside of the bifurcation is mobilized.
Particularly during the postdilation portion of the procedure, patients may be prone to transient bradycardia and hypotension. 2 mg Robinul (Pfizer Pharmaceuticals, New York, NY) and keep atropine available. Roughly 20% of our patients have demonstrated limited but persistent hypotension, which may require pharmacologic treatment and may last for 1 to 3 days in some cases. Following the procedure, all patients are maintained on antiplatelet therapy, generally a combination of aspirin and Plavix (Bristol-Myers Squibb, New York, NY) for at least 3 months.
The important point here is that the surgeon should have a reliable technique for monitoring collateral blood flow during carotid surgery. A second principle for cervical carotid artery surgery is exposure (Fig. 1). There are times when it proves necessary to be able to expose the distal carotid artery well up to the skull base. For example, a high carotid bifurcation, a high plaque extending up the distal ICA, a preoperative prediction based on an isolated circulation that a shunt will be necessary, a carotid body tumor and/or cervical carotid artery aneurysm will require consideration and planning for a high neck dissection.