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Full Description
An incomparable collection of evidence-based cavernoma road trips through the cerebral terrain
Seven Cavernomas: Tenets and Techniques for Resection is the fourth volume in a remarkable series by internationally renowned neurosurgeon Michael T. Lawton. As with the three prior volumes, Dr. Lawton leverages his vast expertise as a leading cerebrovascular neurosurgeon, sharing insights and knowledge gained from operating on over 1,400 cavernomas. Seven Cavernomas integrates quintessential clinical, anatomical, and microsurgical concepts into a comprehensive heuristic to position neurosurgeons to achieve the best patient outcomes with cavernoma microsurgical resection.
Section 1 details the 10 cavernoma tenets, starting with a taxonomy for classification by location and surface representation. Subsequent chapters describe brainstem and cerebral anatomy as well as dissection techniques in detail, covering the triangle concept, arterial landmarks, hotspots of brain eloquence, recurrence, patient selection, and cartography. Section 2 examines the seven types of cavernous malformations, with insightful pearls on resection techniques. The closing chapter concludes with discussion of the future role neurosurgery will play in understanding how the brain gives us our consciousness, emotion, memory, and intelligence.
Key Highlights
Taxonomy of seven cavernoma types and 35 subtypes guides the neurosurgeon to choose the most optimal approaches, execute the operation skillfully, and maximize intraoperative performance
Brainstem cavernous malformation cartography maps out the special relationships between the craniotomy, subarachnoid approach, anatomical triangles, safe entry zones, and arteries as vascular waypoints
An impressive compendium of 65 surgical videos and eight animations captures the action, progression, movement, and technical nuances that sculpt the art of neurosurgery
A total of 500 exquisitely rendered illustrations and clinical images delineate anatomical components with stunning accuracy
This volume is an essential reference for every vascular neurosurgeon. The book demonstrates in meticulous detail how the art and science of map-making is a path to crystallizing the art and science of cavernoma resection. The taxonomy provides a consistent nomenclature for discussion while providing technical and navigational nuance, inspiring confidence, and empowering neurosurgeons to improve patient outcomes.
Contents
Section I The Tenets
1 Taxonomy
1.1 Classifying Surgical Pathology
1.2 Informing Surgical Strategy
1.3 Neuroanatomy
1.4 Neuroradiology
1.5 Neurology
1.6 Neurosurgery
1.7 Seven Cavernomas Framework
2 Subarachnoid Dissection
2.1 Seven Surgical Corridors
2.1.1 Cerebral Sulci
2.1.2 Sylvian Fissure
2.1.3 Interhemispheric Fissure
2.1.4 Ventricular System
2.1.5 Tentorial Fissure
2.1.6 Cerebellopontine Cistern
2.1.7 Cisterna Magna
2.2 Conclusion
3 Triangle Concept
3.1 The Triangle Concept
3.2 A System of Anatomical Triangles
3.3 Midbrain Triangles
3.3.1 Carotid-Oculomotor Triangle
3.3.2 Oculomotor-Tentorial Triangle
3.3.3 Supracerebellar-Supratrochlear and Supracerebellar-Infratrochlear Triangles
3.3.4 Infragalenic Triangle
3.4 Pontine Triangles
3.4.1 Posteromedial (Kawase) Triangle
3.4.2 Glossopharyngeal-Cochlear Triangle
3.4.3 Supra- and Infratrigeminal Triangles
3.4.4 Interlobular Triangle
3.5 Medullary Triangles
3.5.1 Vertebrobasilar Junctional Triangle
3.5.2 Subtonsillar Triangle
3.5.3 Vagoaccessory Triangle
3.5.4 Cerebellar Vallecular Triangle
3.6 Thalamic and Basal Ganglial Triangles
3.6.1 Supracarotid-Infrafrontal Triangle
3.6.2 Caudate-Thalamostriate Triangle
3.6.3 Septocaudate Triangle
3.6.4 Infragalenic Triangle
3.7 Cerebral and Cerebellar Triangles
3.7.1 Vallecular Triangle
3.7.2 Interlobular Triangle
3.8 Clinical Evidence
3.9 Conclusion
4 Arterial Landmarks
4.1 Rivers of the Brain
4.2 Middle Cerebral Arteries
4.3 Anterior Cerebral Arteries
4.4 Internal Carotid Artery
4.5 Posterior Cerebral Arteries
4.6 Superior Cerebellar Artery
4.7 Anterior Inferior Cerebellar Artery
4.8 Posterior Inferior Cerebellar Artery
4.9 Arterial Dissection Codes
5 Safe Entry Zones
5.1 From Inoperable to Operable
5.2 Clinical Evidence
5.3 The Safety of Safe Entry Zones
5.4 The 21 Brainstem Safe Entry Zones
5.5 Midbrain Safe Entry Zones
5.5.1 Interpeduncular Zone
5.5.2 Anterior Mesencephalic Zone
5.5.3 Lateral Mesencephalic Sulcus Zone
5.5.4 Intercollicular Zone
5.5.5 Supracollicular and Infracollicular Zones
5.6 Pontine Safe Entry Zones
5.6.1 Supratrigeminal and Infratrigeminal
5.6.2 Middle Cerebellar Peduncle or Lateral Pontine
5.6.3 Area Acustica
5.6.4 Median Sulcus (Pons)
5.6.5 Suprafacial Collicular
5.6.6 Superior Foveal
5.6.7 Pontomedullary Sulcus
5.7 Medullary Safe Entry Zones
5.7.1 Anterolateral Sulcus
5.7.2 Olive
5.7.3 Posterolateral Sulcus and Lateral Medullary
5.7.4 Median Sulcus (Medulla)
5.7.5 Infrafacial Collicular
5.7.6 Posterior Median Sulcus
5.7.7 Posterior Intermediate Sulcus
5.8 Accuracy of Preoperative MRI in Determining Surface Proximity
5.9 Neuronavigation, Hemosiderin Stain, and Neuromonitoring
5.10 Brainstem CM Taxonomy and Associated SEZs
6 Resection Technique
6.1 The Mulberry
6.2 Extracapsular Resection Technique
6.3 Intracapsular Resection Technique
6.4 Brain Transgression
6.5 Technical Overview of the Trans-MCP Approach
6.6 Superomedial Trajectory Beyond the SEZ: Superior Cerebellar Peduncle
6.7 Posteromedial Trajectory Beyond the SEZ: Pontine Tegmentum
6.8 Invisible Triangles
6.9 Orienteering Beyond
7 Eloquent Noneloquence
7.1 Ten Percent Myth
7.2 Eloquent Noneloquence
7.3 Clinical Evidence
7.4 Eloquent Cortex
7.5 Large-Scale Brain Networks
7.6 Seven Hotspots of Cerebral Eloquence
7.7 Expanding the Concept of Cerebral Eloquence
8 Residual and Recurrent Cavernous Malformations
8.1 Problem of Recurrence
8.2 Clinical Evidence
8.3 Detection
8.4 Surgical Blind Spots
8.5 Right-Angle Method
8.6 Fine Line
9 Patient Selection
9.1 Rationale for a Brainstem Cavernous Malformation Grading Scale
9.2 Lawton Brainstem CM Grading Scale
9.3 Elements of the Brainstem CM Grading System
9.3.1 Size
9.3.2 Crossing the Axial Midpoint
9.3.3 Developmental Venous Anomaly
9.3.4 Age
9.3.5 Hemorrhage
9.4 Validation of the Brainstem CM Grading System
9.5 Clinical Application
9.6 Giant Cavernomas
9.7 Hannegan's Sign
10 Neurosurgical Cartography
10.1 Jackson Hole
10.2 Cartography
10.3 Maps as Metaphors for the Seven Cavernomas
10.4 Seven Cavernomas Maps
10.5 Maps for Safe Passage
10.6 Maps for Education
10.7 Maps for Exploration
10.8 The Metaphor
Section II The Seven Cavernomas
11 Superficial Cerebral Cavernous Malformations
11.1 Introduction
11.2 Neuroanatomy of Superficial Cerebral Cavernous Malformation Subtypes
11.2.1 Convexity
11.2.2 Medial
11.2.3 Basal
11.2.4 Sylvian
11.3 Clinical Evidence
11.4 Resection Strategies for Superficial Cerebral Cavernous Malformations
11.4.1 Convexity Subtype
11.4.2 Medial Subtype
11.4.3 Basal Subtype
11.4.4 Sylvian Subtype
11.5 Superficial Cerebral Cavernous Malformations and Approach Selection
11.6 Approach Technique
11.7 Presenting Symptom
11.8 Clinical Syndromes
11.9 Conclusion
12 Basal Ganglia Cavernous Malformations
12.1 Introduction
12.2 Neuroanatomy of Three Basal Ganglia Cavernous Malformation Subtypes
12.2.1 Caudate
12.2.2 Putaminal
12.2.3 Pallidal
12.3 Clinical Evidence
12.4 Basal Ganglia Cavernous Malformation Subtypes
12.4.1 Caudate
12.4.2 Putaminal
12.4.3 Pallidal
12.5 Conclusion
13 Thalamic Cavernous Malformations
13.1 Introduction
13.2 Neuroanatomy of Thalamic Cavernous Malformation Subtypes
13.2.1 Anterior
13.2.2 Medial
13.2.3 Lateral
13.2.4 Choroidal
13.2.5 Pulvinar
13.2.6 Geniculate
13.3 Clinical Evidence
13.4 Resection Strategies for Thalamic Cavernous Malformation Subtypes
13.4.1 Anterior
13.4.2 Medial
13.4.3 Lateral
13.4.4 Choroidal
13.4.5 Pulvinar
13.4.6 Geniculate
13.5 Iterative Advances
13.6 Conclusion
14 Midbrain Cavernous Malformations
14.1 Introduction
14.2 Neuroanatomy of the Five Midbrain Cavernous Malformation Subtypes
14.2.1 Interpeduncular
14.2.2 Peduncular
14.2.3 Tegmental
14.2.4 Quadrigeminal
14.2.5 Periaqueductal
14.3 Clinical Evidence
14.4 Resection Strategies for Midbrain Cavernous Malformations
14.4.1 Interpeduncular
14.4.2 Peduncular
14.4.3 Tegmental
14.4.4 Quadrigeminal
14.4.5 Periaqueductal
14.5 Conclusion
15 Pontine Cavernous Malformations
15.1 Introduction
15.2 Neuroanatomy of the Six Pontine Cavernous Malformation Subtypes
15.2.1 Basilar
15.2.2 Peritrigeminal
15.2.3 Middle Peduncular
15.2.4 Inferior Peduncular
15.2.5 Rhomboid
15.2.6 Supraolivary
15.3 Clinical Evidence
15.4 Resection Strategies for Pontine Cavernous Malformations
15.4.1 Basilar Subtype
15.4.2 Peritrigeminal Subtype
15.4.3 Middle Peduncular Subtype
15.4.4 Inferior Peduncular Subtype
15.4.5 Rhomboid Subtype
15.4.6 Supraolivary Subtype
15.5 Signs and Syndromes
16 Medullary Cavernous Malformations
16.1 Introduction
16.2 Neuroanatomy of the Five Medullary Cavernous Malformation Subtypes
16.2.1 Pyramidal
16.2.2 Olivary
16.2.3 Cuneate
16.2.4 Gracile
16.2.5 Trigonal
16.3 Clinical Evidence
16.4 Resection Strategies for Medullary Cavernous Malformations
16.4.1 Pyramidal Subtype
16.4.2 Olivary Subtype
16.4.3 Cuneate Subtype
16.4.4 Gracile Subtype
16.4.5 Trigonal Subtype
16.5 Conclusion
17 Cerebellar Cavernous Malformations
17.1 Introduction
17.2 Neuroanatomy of the Six Cerebellar Cavernous Malformation Subtypes
17.2.1 Suboccipital
17.2.2 Tentorial
17.2.3 Petrosal
17.2.4 Vermian
17.2.5 Tonsillar
17.2.6 Deep Nuclear
17.3 Clinical Evidence
17.4 Resection Strategies for Cerebellar Cavernous Malformations
17.4.1 Suboccipital, Vermian, and Tonsillar
17.4.2 Tentorial
17.4.3 Petrosal
17.4.4 Deep Nuclear
17.5 Conclusion
18 Seven Cavernomas: Project Connectomunculus and the Mind
18.1 Seven Cavernomas Cartography
18.2 The Connectomunculus
18.3 The Mind
18.4 Gallery of Functional Networks
19 Suggested Readings
Contributors
Index
