Full Description
Microsurgery has brought about important changes and progress in the treatment of cere bral aneurysms in recent years. Only 12 years ago McKissock, one of the most experienced surgeons in the treatment of aneurysms pompared the results of operative and nonoperative treatment. He found that mortality and morbidity of cerebral aneurysms was not significantly affected by whether the patients have been operated upon or not. This view is held by many neursurgeons, and was confirmed by results of the Co-operative Study in 1969. In the review on treatment of aneurysms in Progress in Neurological Surgery in 1969, techniques such as encasement with plastic compounds, piloinjection, stereotactic copper or electric thrombosis and metallic thrombosis and profound hypothermia in anaesthesia were listed. In general, these techniques now seem to be of little more than historical interest. Progress in recent yeats has been so enormous that one may perhaps gain the impreSSion that the main problems in the treatment of aneurysms have been solved and that there are no more to be surmounted. This is dangerous and complacent thinking, such as Lord Moynihan indulged in during the thirties. For this reason we thought that the time had come to assemble a group of experts who could discuss the various unsolved and contro versial problems of aneurysm surgery in the friendly and relaxed atmosphere of a "work shop".
Contents
1 History of Aneurysm Surgery.- 2 Morphology and Aetiology.- 2.1 Pathology and Aetiology of Intracranial Aneurysms.- 2.2 Factors Related to Growth, Rupture and Spontaneous Healing of Cerebral Aneurysms.- 2.3 Origin, Rupture and Growth of Cerebral Aneurysms: a Clinicopathological Study.- 2.4 Discussion.- 3 Classification.- 3.1 Introduction.- 3.2 Extracranial Internal Carotid Aneurysms.- 3.3 Intracranial Internal Carotid Artery Aneurysms.- 3.4 Aneurysms of the Anterior Cerebral Artery.- 3.5 Aneurysms of the Middle Cerebral Artery.- 3.6 Aneurysms of the Vertebral Artery.- 3.7 Aneurysms of the Basilar Artery.- 3.8 Aneurysms of the Posterior Cerebral Artery.- 4 Distribution of Cerebral Aneurysms.- 5 Clinical Pathology and Pathophysiology.- 5.1 Noninvasive Regional Cerebral Blood Flow Measurement in Subarachnoid Haemorrhage.- 5.2 Cerebral Blood Flow in Subarachnoid Haemorrhage.- 5.3 Subarachnoid Haemorrhage and Cerebral Vasospasm.- 5.4 Cerebral Vasospasm: Prediction, Prevention and Protection.- 5.5 Hydrocephalus Following Subarachnoid Haemorrhage.- 5.6 Discussion.- 6 Neuroradiological Diagnosis.- 6.1 Cerebral Angiography.- 6.2 Computer Tomography.- 7 Conservative Treatment.- 7.1 Preoperative Treatment of Intracranial Aneurysms.- 7.2 Preoperative Management of Ruptured Intracranial Aneurysms with Antifibrinolytic Treatment.- 7.3 Discussion.- 8 Operative Treatment.- 8.1 General Therapeutic Problems.- 8.2 Special Therapeutic Problems.- 8.3 Giant Cerebral Aneurysms.- 8.4 Multiple Aneurysms.- 8.5 Traumatic Aneurysms.- 8.6 Aneurysms of Childhood.- 8.7 Special Technical Problems.- 8.8 Operative Treatment of Complications.- 9 Prognosis of Operative Treatment.- 9.1 A 25 Year Study.- 9.2 Summary.- 9.3 Discussion.- 10 Final Comments.- 11 References.- 12 Subject Index.
