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For the first time in the history of medicine, advances in technology have outpaced our ability to apply them in the clinical setting. With the likelihood of rapid change in the healthcare arena, a more critical question emerges in the adoption of new technology, which is what should we be doing with it. The brain remains the last frontier in medicine where we still lack a full understanding of its function and vast neural network. This allows for a perfect union of technology and discovery to contribute to better outcomes and develop cures for disorders of the nervous system. The ability to access virtually every area of the brain via the cerebrovasculature has never been more important. This text presents new technological advances in a comprehensive and balanced way. As we have learned countless times in modern medicine, new is not always better and in fact may be deleterious. The ability to assess newer techniques in a way that is always in the patient's best interest is the ultimate goal. Leaders in the field of vascular neurosurgery discuss new technologies as well as their controversies, from neurointervention and embolic protection devices to robot-assisted endovascular intervention and precision surgery for aneurysms. The result is an unbiased and comprehensive picture of the latest innovations in cerebrovascular surgery and the manner in which they are applied in the clinical setting. Advanced Technologies in Vascular Neurosurgery focuses on new procedures and technology as opposed to the traditional and stale “clip vs. coil” discussions. It the first discussion of artificial intelligence and robotics in vascular neurosurgery in text.
Since the introduction of electrosurgery the techniques of surgery on the nervous system have passed through further improvements (bipolar coagulation, microscope), even if the procedure was not substantially modified. Today, laser represents a new "discipline", as it offers a new way of performing all basic maneuvers (dissection, demolition, hemostasis, vessel sutures). Furthermore, laser offers the possibility of a special maneuver, namely reduction of the volume of a tumoral mass through vaporization. Its application is not restricted to traditional neurosurgery but extends also to stereotactic and vascular neurosurgery. Laser surgery has also influenced the anesthesiologic techniques. At the same time new instrumentation has been introduced: CUSA ultrasonic aspiration, echotomography, and Doppler flowmeter. I have had the chance to utilize these new technologies all at a time and have come to the conclusion that we are facing the dawn of a new methodology which has already shown its validity and lack of inconveniences, and whose object is to increase the precision of neurological surgery. The technological development is still going on, and some improvements are to be foreseen. Laser scalpel is splitting the initial laser surgery into NO TOUCH and TOUCH surgery with laser. As new instrumentarium will be developed, a variable and tunable beam will become available. For example, in a few years Free Electron Laser will further add to the progress in this field.
From the Meeting on "Advanced Technology in Neurosurgery", held in Milan on May, 29 - June, 1, 1985
Since the introduction of electrosurgery the techniques of surgery on the nervous system have passed through further improvements (bipolar coagulation, microscope), even if the procedure was not substantially modified. Today, laser represents a new "discipline", as it offers a new way of performing all basic maneuvers (dissection, demolition, hemostasis, vessel sutures). Furthermore, laser offers the possibility of a special maneuver, namely reduction of the volume of a tumoral mass through vaporization. Its application is not restricted to traditional neurosurgery but extends also to stereotactic and vascular neurosurgery. Laser surgery has also influenced the anesthesiologic techniques. At the same time new instrumentation has been introduced: CUSA ultrasonic aspiration, echotomography, and Doppler flowmeter. I have had the chance to utilize these new technologies all at a time and have come to the conclusion that we are facing the dawn of a new methodology which has already shown its validity and lack of inconveniences, and whose object is to increase the precision of neurological surgery. The technological development is still going on, and some improvements are to be foreseen. Laser scalpel is splitting the initial laser surgery into NO TOUCH and TOUCH surgery with laser. As new instrumentarium will be developed, a variable and tunable beam will become available. For example, in a few years Free Electron Laser will further add to the progress in this field.
In this issue of Neurosurgery Clinics, guest editor Dr. Michael T. Lawton brings his considerable expertise to the topic of Update on Open Vascular Surgery. The field of open vascular neurosurgery has undergone significant change as endovascular technologies have advanced and endovascular market share has grown. In this issue, top experts in the field explore various responses to these trends, providing valuable information to neurosurgeons aspiring to stay current with contemporary management of aneurysms, brain arteriovenous malformations, cavernous malformations, and bypass techniques. Contains 15 practice-oriented topics including wide neck and bifurcation aneurysms: balancing open and endovascular therapies; application of big data in vascular neurosurgery; rethinking cerebral bypass surgery; AI, machine learning and cavernous malformations; the transcavernous approach in vascular neurosurgery; and more. Provides in-depth clinical reviews on open vascular surgery, offering actionable insights for clinical practice. Presents the latest information on this timely, focused topic under the leadership of experienced editors in the field. Authors synthesize and distill the latest research and practice guidelines to create clinically significant, topic-based reviews.
Since the introduction of electrosurgery the techniques of surgery on the nervous system have passed through further improvements (bipolar coagulation, microscope), even if the procedure was not substantially modified. Today, laser represents a new "discipline", as it offers a new way of performing all basic maneuvers (dissection, demolition, hemostasis, vessel sutures). Furthermore, laser offers the possibility of a special maneuver, namely reduction of the volume of a tumoral mass through vaporization. Its application is not restricted to traditional neurosurgery but extends also to stereotactic and vascular neurosurgery. Laser surgery has also influenced the anesthesiologic techniques. At the same time new instrumentation has been introduced: CUSA ultrasonic aspiration, echotomography, and Doppler flowmeter. I have had the chance to utilize these new technologies all at a time and have come to the conclusion that we are facing the dawn of a new methodology which has already shown its validity and lack of inconveniences, and whose object is to increase the precision of neurological surgery. The technological development is still going on, and some improvements are to be foreseen. Laser scalpel is splitting the initial laser surgery into NO TOUCH and TOUCH surgery with laser. As new instrumentarium will be developed, a variable and tunable beam will become available. For example, in a few years Free Electron Laser will further add to the progress in this field.
This book is a detailed resource on the technical aspects of pediatric neurosurgery that relate to vascular malformations of the brain and spinal cord. It introduces concepts relevant to cerebrovascular system development and the classification of vascular malformations. Information on a range of disorders is then provided with an emphasis placed on answering frequently asked questions in relation to a particular condition. Therefore, enabling the reader to systematically improve their understanding of how approach treating patients utilizing techniques such as ultrasound and spinal angiography. The chapters, authored by experts in their respective field, provide a standard of care based on current diagnostic and management guidelines for pediatric neurosurgical diseases. Pediatric Vascular Neurosurgery: Technical Nuances in Contemporary Pediatric Neurosurgery (Part 2) is a comprehensive overview of how to approach diagnosing and treating a range of vascular malformations encountered in pediatric patients. The problem-solving approach of this work makes it a valuable addition to the literature and suitable for use by residents, fellows and consultants within pediatrics and allied specialities, including Neurosurgery, Neurology, Neuro-anesthesia, Neuro-critical care and advanced health care providers amongst others.
In this issue of Neurosurgery Clinics, guest editor Dr. Michael T. Lawton brings his considerable expertise to the topic of Update on Open Vascular Surgery. The field of open vascular neurosurgery has undergone significant change as endovascular technologies have advanced and endovascular market share has grown. In this issue, top experts in the field explore various responses to these trends, providing valuable information to neurosurgeons aspiring to stay current with contemporary management of aneurysms, brain arteriovenous malformations, cavernous malformations, and bypass techniques. Contains 15 practice-oriented topics including wide neck and bifurcation aneurysms: balancing open and endovascular therapies; application of big data in vascular neurosurgery; rethinking cerebral bypass surgery; AI, machine learning and cavernous malformations; the transcavernous approach in vascular neurosurgery; and more. Provides in-depth clinical reviews on open vascular surgery, offering actionable insights for clinical practice. Presents the latest information on this timely, focused topic under the leadership of experienced editors in the field. Authors synthesize and distill the latest research and practice guidelines to create clinically significant, topic-based reviews.
This concise, easy-to-use book offers expert insights into current controversies in vascular neurosurgery with a view to providing the practitioner with authoritative practical guidance that will assist in the management of difficult disease entities. While vascular neurosurgery has undergone unprecedented advances during the past decade, enabling safer and easier access to previously untreatable pathology, this progress has been accompanied by confusion as to what constitutes best, or even acceptable, practice. Here, experts in the field discuss the various tools available and explain how best to use them when confronted by different pathologies, drawing upon their personal experience. Each chapter focuses on a specific case that is discussed by two experienced surgeons; a third author then evaluates the case, highlighting the available evidence and pearls in the treatment of that particular disease. The authors have been carefully chosen to provide a truly balanced viewpoint on paradigms that they themselves use. They therefore have a sound understanding of the thought processes of surgeons when dealing with challenging diseases for which there may be no single correct path. Furthermore, they are well placed to identify not only appropriate uses of new treatment options and technologies but also circumstances in which their use is best avoided. The ultimate benefactor of this book will be the patient: our biases as physicians should never become a patient’s morbidity.