Intracranial Arteriovenous Malformations, 1st Edition
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Preface
The important thing in science is not so much to obtain new facts as to discover new ways of
thinking about them.
—Sir William Bragg (1862–1942)
During the past twenty years, great strides have been made in the management of intracranial
arteriovenous malformations. This success has resulted not so much from greater understanding
of the pathophysiology or anatomy of the lesions as it has from new technologies applied in their
management. The greatest advances have been multifactorial. Endovascular therapy, which
improves our ability to resect complex lesions, is probably the most important cause for
the reduction in the incidence of postoperative hemorrhage. Intraoperative angiography, which
allows confirmation of complete resection, again reduces the incidence of postoperative
hemorrhage. Improvements in surgical instrumentation, such as microscopes and the bipolar
cautery, have made microsurgery more effective. Improved surgical approaches have allowed
the successful resection of more complex lesions. Surgical planning has been facilitated by more
sophisticated preoperative imaging, including angiography, magnetic resonance imaging,
magnetic resonance angiography, computed tomography angiography, and functional magnetic
resonance imaging. Stereotactic radiosurgery has provided an avenue for the treatment of deep,
small arteriovenous malformations. The perioperative care of our patients has been enhanced
with advances in anesthesia and the creation of neurointensive care units. Each of these param-
eters is thoroughly reviewed in this volume, and, more importantly, all are coordinated into a
cohesive management scheme.
In this text we seek to document current understanding of the management of intra-
cranial arteriovenous malformations and to define advances in the field. We begin with a
review of the anatomy, classification, and pathophysiology of arteriovenous malformations.
We then progress to detailed discussion of diagnosis and management. Preoperative evalua-
tion with diagnostic and functional imaging as well as surgical planning is reviewed in detail.
We conclude with consideration of future directions for treatment. A review of these chapters
will enable the reader to provide the patient with better preoperative risk analyses, a thorough
review of the treatment options and their risks, and a general outline of a specific treatment
regimen. Selecting patients for therapy or not, and then selecting the appropriate therapy
are the greatest challenges presented to the treating physician. Once treatment is recom-
mended, integration of the complex modalities is essential. The authors of these chapters
provide the reader with such insight.
Each arteriovenous malformation presents clinical challenges on the basis of its size and
location. These issues, which play a large part in our success in treating these lesions, are dealt
with in individual chapters. The authors thoroughly discuss the surgical nuances of arteriove-
nous malformations in specific locations. The application of endovascular therapy as curative
or, more commonly, as an adjuvant therapy is reviewed. Current understanding of the limits
and complications of stereotactic radiosurgery, as well as the promise of future applications, is
presented. Risks and benefits for each form of therapy are fully detailed. Finally, the appli-
cation of each treatment modality is integrated into treatment algorithms based on history,
location, size, and risk benefit analysis. It is the intent of the editors and authors to provide
the reader with a framework for understanding and treating these complex lesions.
This volume is designed for all individuals involved in the management of intracranial
arteriovenous malformations. It is the only text that comprehensively reviews the subject. The
authors have provided an extensive and thorough discussion of the scientific data from
the literature in a prose that is easily readable and understandable for clinical application. The
reader is offered an integrated system, including medical management, anesthesia, radiation
therapy, neuroradiology, endovascular therapy, and microsurgery, for the management of one
iv Preface
of the most challenging lesions presented to physicians involved in the care of patients with
neurologic disease.
We are indebted to the members of our families for the time they gave up with us so that
this volume could be created. We thank Mr. Robert Gallavan and Ms. Jessica Kazmier at our
institutions for their dedicated assistance. We are grateful for the skillful editorial guidance of
Ms. Arlene Stolper Simon, who spent countless hours editing chapters and working with the
authors. Finally, we acknowledge the support and direction provided by our Informa Health-
care USA team, Ms. Vanessa Sanchez and Mr. Alan Kaplan.
Philip E. Stieg
H. Hunt Batjer
Duke Samson
Contents
Preface . . . . iii
Contributors . . . . xiii
SECTION I: ANATOMY AND PHYSIOLOGY
1. Surgical Anatomy 1
Helder Tedeschi, Evandro de Oliveira, Wen Hung Tzu, and Albert L. Rhoton, Jr.
Introduction . . . . . . 1
Frontal Lobe AVMs . . . . . . 1
Parietal Lobe AVMs . . . . . . 2
Temporal Lobe AVMs . . . . . . 3
Occipital Lobe AVMs . . . . . . 5
Mediobasal Temporal Lobe AVMs . . . . . . 5
Interhemispheric Parafalcine and Callosal Region AVMs . . . . . . 9
Basal Ganglia Region AVMs . . . . . . 11
AVMs of the Posterior Fossa . . . . . . 18
References . . . . . . 19
2. Pathology and Genetic Factors 21
Ronald F. Moussa, John H. Wong, and Issam A. Awad
Pathology . . . . . . 21
Genetic Factors . . . . . . 25
References . . . . . . 27
3. Hemodynamic Properties 31
Michael Morgan
Introduction . . . . . . 31
Hemodynamic Effect within the Interstices of an AVM . . . . . . 32
Hemodynamic Effect on Cerebral Blood Vessels in the Presence of an AVM . . . . . . 33
Hemodynamic Effect on the Microcirculation of the Brain Associated
with an AVM . . . . . . 37
Autoregulation and Reactivity to Changes in PaCO2 . . . . . . 38
Hemodynamic Effect on Cerebral Blood Vessels
at the Time of AVM Ablation . . . . . . 40
Hemodynamic Effect on the Brain at the Time of AVM Ablation . . . . . . 40
Arterio-Capillary-Venous Hypertensive Syndromes . . . . . . 41
References . . . . . . 42
4. Use of Modeling for the Study of Cerebral Arteriovenous Malformations 49
William L. Young, Erzhen Gao, George J. Hademenos, and Tarik F. Massoud
Introduction . . . . . . 49
Importance of Modeling for AVMs . . . . . . 49
Specific Modeling Attempts–Model Construction . . . . . . 50
Model Applications . . . . . . 55
Long-Term Objectives of Computational Modeling . . . . . . 58
Animal Modeling . . . . . . 59
Summary . . . . . . 61
Appendix 1. Description of a Computational AVM Model . . . . . . 61
Appendix 2. Mathematical and Computational Approach . . . . . . 63
Appendix 3. Vascular Stress . . . . . . 67
References . . . . . . 68
v
vi Contents
SECTION II: CLINICAL PRESENTATION AND DIAGNOSTIC EVALUATION
5. Natural History 73
Bernard R. Bendok, Christopher Eddleman, Joseph G. Adel, M. Jafer Ali,
H. Hunt Batjer, and Stephen L. Ondra
Introduction . . . . . . 73
Presenting Symptoms . . . . . . 73
Morbidity and Mortality Related to Hemorrhage . . . . . . 75
AVMs in the Gravid Woman . . . . . . 77
Anatomical Factors Influencing the Natural History of AVMs . . . . . . 77
Spontaneous Regression . . . . . . 78
References . . . . . . 79
6. Classification and Grading Systems 81
Kai U. Frerichs, Philip E. Stieg, and Robert M. Friedlander
Introduction . . . . . . 81
Classification and Grading Parameters . . . . . . 81
Grading Scales . . . . . . 84
Discussion . . . . . . 91
References . . . . . . 92
7. Radiographic Diagnosis 95
R. Anthony Murray and Eric J. Russell
Introduction . . . . . . 95
Epidemiology and Natural History . . . . . . 95
Therapeutic Options and Classification . . . . . . 96
Computed Tomography . . . . . . 97
Magnetic Resonance Imaging and Angiography . . . . . . 98
Conventional Angiography . . . . . . 105
Angiographically Occult AVMs . . . . . . 109
Conclusion . . . . . . 109
References . . . . . . 110
8. Functional Evaluation and Diagnosis 115
Shervin R. Dashti, Jeffrey L. Sunshine, Robert W. Tarr, and Warren R. Selman
Introduction . . . . . . 115
Parenchymal Function . . . . . . 115
Relative Perfusion . . . . . . 118
Blood Pressure and Flow Analysis . . . . . . 119
Invasive Provocation . . . . . . 120
Conclusion . . . . . . 120
References . . . . . . 120
SECTION III: BASIC CONSIDERATIONS
9. Decision Analysis for Asymptomatic Lesions 123
James McInerney and Robert E. Harbaugh
Introduction . . . . . . 123
Decision Analysis and Markov Modeling for the Treatment
of Asymptomatic AVMs . . . . . . 124
Data Collection . . . . . . 127
Sensitivity Analysis . . . . . . 130
Conclusion . . . . . . 132
References . . . . . . 133
10. Multimodality Therapy: Treatment Algorithms 135
Philip E. Stieg, Vallabh Janardhan, and Howard A. Riina
Introduction . . . . . . 135
Pathology of the AVM . . . . . . 135
Location of the AVM . . . . . . 136
Natural History . . . . . . 136
Contents vii
Patient Characteristics . . . . . . 137
Diagnostic Imaging . . . . . . 137
Management Options . . . . . . 138
Decision Analysis for the Management of
Unruptured AVMs . . . . . . 140
Decision Analysis for the Management of Ruptured AVMs . . . . . . 140
Conclusions . . . . . . 141
References . . . . . . 141
11. Surgical Principles 145
Christopher C. Getch, Christopher Eddleman, Melanie K. Swope, and
H. Hunt Batjer
Introduction . . . . . . 145
Preoperative Imaging . . . . . . 145
Embolization . . . . . . 149
Anesthesia . . . . . . 149
Neurosurgical Emergency: Intracranial Hemorrhage
Related to AVM Rupture . . . . . . 151
Surgical Resection . . . . . . 152
Conclusion . . . . . . 157
References . . . . . . 157
12. Endovascular Principles 159
Charles J. Prestigiacomo and John Pile-Spellman
Introduction . . . . . . 159
Historical Perspective . . . . . . 159
Role of Endovascular Therapy . . . . . . 160
Hemodynamic Considerations and Staging of Embolization . . . . . . 165
Anesthetic Considerations and Monitoring . . . . . . 166
Functional Testing . . . . . . 167
Equipment . . . . . . 168
Strategy and Technique . . . . . . 171
Outcomes . . . . . . 172
Complications and Complication Avoidance . . . . . . 172
Future Directions . . . . . . 174
References . . . . . . 174
13. Radiosurgical Principles 177
Susan C. Pannullo, Jordan Abbott, and Robert Allbright
Introduction . . . . . . 177
History of Radiosurgery for AVMs . . . . . . 177
Radiobiology of AVM Radiosurgery . . . . . . 177
Pathologic Changes of AVMs After Radiosurgery . . . . . . 178
Radiosurgery Platforms . . . . . . 178
Stereotactic Radiosurgery Technique . . . . . . 178
Evaluation of Treatment Response . . . . . . 182
Complications . . . . . . 183
Combined Modality Management of AVMs . . . . . . 183
Single Fraction Versus Fractionated Therapy . . . . . . 183
Future Directions for AVM Radiosurgery . . . . . . 184
References . . . . . . 184
14. Combined Therapy: The Team Approach 189
C. Michael Cawley, III, Harry J. Cloft, Nelson M. Oyesiku, and Daniel L. Barrow
Introduction . . . . . . 189
Goals of Therapy . . . . . . 189
Therapeutic Strategies . . . . . . 190
Remedies for Palliation . . . . . . 196
Conclusion . . . . . . 198
References . . . . . . 198
viii Contents
SECTION IV: THERAPEUTIC MANAGEMENT
15. Anesthetic Considerations 201
Tomoki Hashimoto and William L. Young
General Considerations . . . . . . 201
Cerebral Circulatory Changes in Patients with AVMs . . . . . . 202
Anesthetic Management During Surgery . . . . . . 203
Anesthetic Management During Interventional
Neuroradiologic Procedures . . . . . . 206
References . . . . . . 211
16. Supratentorial Lobar Arteriovenous Malformations 215
John E. Wanebo, Jeffrey G. Ojemann, and Ralph G. Dacey, Jr.
Introduction . . . . . . 215
General Considerations . . . . . . 215
Frontal Lobe AVMs . . . . . . 228
Temporal Lobe AVMs . . . . . . 231
Parietal Lobe AVMs . . . . . . 233
Occipital Lobe AVMs . . . . . . 235
References . . . . . . 237
17. Perisylvian Arteriovenous Malformations 243
Harold J. Pikus and Roberto C. Heros
Introduction . . . . . . 243
Presentation . . . . . . 244
Diagnostic Studies . . . . . . 244
Management . . . . . . 246
Results . . . . . . 254
References . . . . . . 254
18. Supratentorial Periventricular Arteriovenous Malformations 259
Charles J. Prestigiacomo and Robert A. Solomon
Introduction . . . . . . 259
Epidemiology, Presentation, and Natural History . . . . . . 259
Anatomical Considerations . . . . . . 260
Evaluation of Patients with Periventricular AVMs . . . . . . 262
Therapeutic Options . . . . . . 263
Surgical Approaches . . . . . . 264
Conclusions . . . . . . 269
References . . . . . . 270
19. Corpus Callosum Arteriovenous Malformations 273
Vallabh Janardhan, Howard A. Riina, and Philip E. Stieg
Introduction . . . . . . 273
Epidemiology . . . . . . 273
Anatomy of the Corpus Callosum . . . . . . 274
Functions of the Corpus Callosum and Callosal Syndromes . . . . . . 275
Clinical Presentation . . . . . . 275
Classification/Grading Systems for AVMs of the Corpus Callosum . . . . . . 277
Treatment . . . . . . 278
Summary . . . . . . 282
References . . . . . . 283
20. Arteriovenous Malformations of the Cerebellar Vermis
and Hemispheres 285
Andrew D. Fine, Curtis L. Beauregard, and Arthur L. Day
Introduction . . . . . . 285
Cerebellar Surface Anatomy and Vascular Supply . . . . . . 285
Cerebellar Functional Anatomy . . . . . . 288
Clinical Presentation . . . . . . 289
Classification and Risk Stratification . . . . . . 289
Contents ix
Treatment . . . . . . 290
Summary . . . . . . 295
References . . . . . . 296
21. Infratentorial Cerebellopontine Angle Arteriovenous Malformations 299
Giuseppe Lanzino and L. Nelson Hopkins
Introduction . . . . . . 299
Regional Anatomy . . . . . . 299
Clinical Presentation . . . . . . 302
Diagnosis . . . . . . 303
Therapy . . . . . . 304
Surgical Technique . . . . . . 305
Complications . . . . . . 310
Summary . . . . . . 311
References . . . . . . 312
22. Brainstem Arteriovenous Malformations 315
Steven D. Chang and Gary K. Steinberg
Introduction . . . . . . 315
Natural History . . . . . . 315
Classification of Brainstem AVMs . . . . . . 315
Arterial Supply and Venous Drainage . . . . . . 316
Clinical Presentation . . . . . . 316
Indications and Contraindications for Surgery . . . . . . 316
Potential Risks . . . . . . 317
Preoperative Preparation . . . . . . 317
Anesthetic Technique . . . . . . 317
Surgical Approaches and Positioning . . . . . . 319
Closure Techniques and Postoperative Management . . . . . . 323
Special Perioperative Equipment/Techniques . . . . . . 323
Stereotactic Radiosurgery . . . . . . 324
Embolization . . . . . . 324
Clinical Outcome . . . . . . 326
Complications and Complication Avoidance . . . . . . 327
Summary . . . . . . 327
References . . . . . . 327
23. Intraoperative and Postoperative Angiography 329
Michael A. Lefkowitz, Fernando Vinuela, and Neil Martin
Introduction . . . . . . 329
Intraoperative Angiography . . . . . . 329
Intraoperative Embolization . . . . . . 336
Postoperative Angiography . . . . . . 337
References . . . . . . 341
24. Associated Aneurysms 343
Bernard R. Bendok, Christopher C. Getch, and H. Hunt Batjer
Introduction . . . . . . 343
Classification . . . . . . 343
Incidence . . . . . . 343
Pathophysiology . . . . . . 344
Natural History . . . . . . 344
Management . . . . . . 344
Conclusions . . . . . . 348
References . . . . . . 349
25. Arteriovenous Malformations in Pregnancy 351
Eli M. Baron, Sumon Bhattacharjee, Robert Wienecke, and Christopher M. Loftus
Introduction . . . . . . 351
Epidemiology . . . . . . 351
Physiologic Changes Associated with Pregnancy . . . . . . 351
Radiologic Diagnosis of AVM in Pregnancy . . . . . . 352
x Contents
Medical Management . . . . . . 353
Surgical Management . . . . . . 354
Embolization and Radiosurgical Procedures . . . . . . 355
Ethical Considerations . . . . . . 355
Conclusions . . . . . . 355
References . . . . . . 356
26. Diagnosis and Management of Pediatric Arteriovenous Malformations 359
Jeffrey P. Greenfield and Mark M. Souweidane
Introduction . . . . . . 359
Epidemiology . . . . . . 359
Developmental Biology of AVMs in Children . . . . . . 359
Natural History . . . . . . 360
Presentation and Evaluation of AVMs in Children . . . . . . 361
Considerations for Intervention . . . . . . 363
Timing of Intervention . . . . . . 363
Preoperative Embolization . . . . . . 364
Stereotactic Radiosurgery . . . . . . 365
Surgical Technique . . . . . . 366
Complications Avoidance . . . . . . 366
Outcomes . . . . . . 367
References . . . . . . 368
27. Management of Residual Arteriovenous Malformations 371
Daniel P. McCarthy, Stefan A. Mindea, Bernard R. Bendok,
Christopher C. Getch, and H. Hunt Batjer
Introduction . . . . . . 371
Residual Malformations after Endovascular Embolization . . . . . . 372
Residual Malformations after Radiosurgery . . . . . . 375
Residual Malformations after Microsurgical Resection . . . . . . 378
Conclusion . . . . . . 380
References . . . . . . 380
SECTION V: SPECIAL PROBLEMS
28. Critical Care Management 383
Mark R. Harrigan and B. Gregory Thompson
Introduction . . . . . . 383
Neurological Monitoring and Imaging . . . . . . 383
Perioperative Cerebral Edema . . . . . . 384
Cardiovascular Management . . . . . . 386
Pulmonary Management . . . . . . 387
Fluids and Electrolytes . . . . . . 387
Nutrition and Diabetic Management . . . . . . 388
Infectious Disease . . . . . . 389
Sedation and Analgesia . . . . . . 389
Glucocorticoids . . . . . . 390
Thrombotic Complications . . . . . . 390
Seizure Prophylaxis and Treatment . . . . . . 390
References . . . . . . 390
29. Surgical Complications 393
Sean D. Lavine and Steven L. Giannotta
Introduction . . . . . . 393
Preoperative Considerations . . . . . . 393
Intraoperative Considerations . . . . . . 395
Postoperative Considerations . . . . . . 400
Summary . . . . . . 403
References . . . . . . 403
Contents xi
30. Endovascular Therapy: Indications, Complications, and Outcome 407
Adnan H. Siddiqui, P. Roc Chen, and Robert H. Rosenwasser
Introduction . . . . . . 407
Cerebrovascular Malformations . . . . . . 407
Natural History of AVMs . . . . . . 408
Indications for Treatment . . . . . . 408
Management Principles for Endovascular Treatment . . . . . . 417
Complications: Avoidance and Management . . . . . . 422
The Jefferson Hospital for Neuroscience Experience . . . . . . 424
Summary . . . . . . 424
References . . . . . . 424
31. Radiosurgical Complications 429
Alan C. Hartford, Paul Chapman, Philip E. Stieg,
Christopher S. Ogilvy, and Jay S. Loeffler
Historical Background . . . . . . 429
Risk of Hemorrhage . . . . . . 430
Transient Effects on Normal Brain Tissue . . . . . . 434
Radionecrosis and Other Long-Term Effects . . . . . . 440
Conclusions . . . . . . 446
References . . . . . . 447
SECTION VI: FUTURE CONSIDERATIONS
32. Endovascular Techniques 451
Harry J. Cloft and Jacques E. Dion
Introduction . . . . . . 451
Microcatheters . . . . . . 452
Embolic Materials . . . . . . 452
Reduction of Complications . . . . . . 454
Conclusion . . . . . . 455
References . . . . . . 455
33. Radiosurgery 457
Douglas Kondziolka, L. Dade Lunsford, and John C. Flickinger
Introduction . . . . . . 457
Radiobiology of Vascular Malformation Radiosurgery . . . . . . 457
Indications for AVM Radiosurgery . . . . . . 458
Clinical Experience . . . . . . 458
Stereotactic Radiosurgery Technique . . . . . . 458
AVM Obliteration . . . . . . 461
Postradiosurgery Effects . . . . . . 461
Repeat Radiosurgery . . . . . . 463
Staged Volume Radiosurgery . . . . . . 463
Future Roles for AVM Radiosurgery . . . . . . 463
Summary . . . . . . 465
References . . . . . . 465
34. Molecular Biology of Arteriovenous Malformations 469
Michael L. DiLuna, Turker Kilic, Issam A. Awad, and Murat Gunel
Introduction . . . . . . 469
Angiogenesis and Vasculogenesis . . . . . . 469
Mendelian Forms of AVMs . . . . . . 471
Molecular Information on Sporadic AVMs . . . . . . 475
Future Research . . . . . . 479
References . . . . . . 479
35. Surgical Approaches 483
Daniel P. McCarthy, Bernard R. Bendok, Christopher C. Getch, and H. Hunt Batjer
Introduction . . . . . . 483
Drug Delivery Systems . . . . . . 483
xii Contents
Surgical Instrumentation . . . . . . 484
Anatomical, Physiological, and Operatively Integrated Imaging . . . . . . 486
Advanced Operating Suite . . . . . . 488
Conclusion . . . . . . 489
References . . . . . . 489
Index . . . . 491
Contributors
Jordan Abbott Department of Neurological Surgery, Weill Medical College of Cornell University,
NewYork-Presbyterian Hospital, New York, New York, U.S.A.
Joseph G. Adel Department of Neurological Surgery, Feinberg School of Medicine, Northwestern
University, Chicago, Illinois, U.S.A.
M. Jafer Ali Department of Neurological Surgery, Feinberg School of Medicine, Northwestern
University, Chicago, Illinois, U.S.A.
Robert Allbright Division of Radiation Oncology, Department of Radiology, Weill Medical
College of Cornell University, NewYork-Presbyterian Hospital, New York, New York, U.S.A.
Issam A. Awad Department of Neurological Surgery, Feinberg School of Medicine, Northwestern
University, Chicago, Illinois, and Evanston Northwestern Healthcare, Evanston, Illinois, U.S.A.
Eli M. Baron Department of Neurosurgery, Temple University School of Medicine, Philadelphia,
Pennsylvania, U.S.A.
Daniel L. Barrow Department of Neurosurgery, Emory University School of Medicine, Atlanta,
Georgia, U.S.A.
H. Hunt Batjer Department of Neurological Surgery, Feinberg School of Medicine, Northwestern
University, Chicago, Illinois, U.S.A.
Curtis L. Beauregard Southeast Neuroscience Center, Houma, Louisiana, U.S.A.
Bernard R. Bendok Department of Neurological Surgery, Feinberg School of Medicine,
Northwestern University, Chicago, Illinois, U.S.A.
Sumon Bhattacharjee Neuroscience Group of Northeast Wisconsin, Neenha, Wisconsin, U.S.A.
C. Michael Cawley, III Departments of Neurosurgery and Neuroradiology, Emory University
School of Medicine, Atlanta, Georgia, U.S.A.
Steven D. Chang Department of Neurosurgery and the Stanford Stroke Center, Stanford
University School of Medicine, Stanford, California, U.S.A.
Paul Chapman Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical
School, Boston, Massachusetts, U.S.A.
P. Roc Chen Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia,
Pennsylvania, U.S.A.
Harry J. Cloft Departments of Radiology and Neurosurgery, Mayo Clinic College of Medicine,
Rochester, Minnesota, U.S.A.
Ralph G. Dacey, Jr. Department of Neurological Surgery, Washington University School of
Medicine, St. Louis, Missouri, U.S.A.
Shervin R. Dashti Department of Neurosurgery, Case Western Reserve University School of
Medicine, and University Hospitals of Cleveland, Cleveland, Ohio, U.S.A.
Arthur L. Day Cerebrovascular Center, Department of Neurological Surgery, Harvard Medical
School, Brigham and Women’s Hospital, Boston, Massachusetts, U.S.A.
Evandro de Oliveira Department of Neurosurgery, State University of Campinas - UNICAMP,
São Paulo, Brazil
Michael L. DiLuna Department of Neurosurgery, Yale University School of Medicine,
New Haven, Connecticut, U.S.A.
xiii
xiv Contributors
Jacques E. Dion Departments of Radiology and Neurosurgery, Emory University Hospital,
Atlanta, Georgia, U.S.A.
Christopher Eddleman Department of Neurological Surgery, Feinberg School of Medicine,
Northwestern University, Chicago, Illinois, U.S.A.
Andrew D. Fine Neurosurgery and Spine Specialists, Sarasota, Florida, U.S.A.
John C. Flickinger Departments of Neurological Surgery and Radiation Oncology,
The Center for Image Guided Neurosurgery, University of Pittsburgh Medical Center,
Pittsburgh, Pennsylvania, U.S.A.
Kai U. Frerichs Cerebrovascular Center, Department of Neurosurgery, Harvard Medical School,
Brigham and Women’s Hospital, Boston, Massachusetts, U.S.A.
Robert M. Friedlander Cerebrovascular Center, Department of Neurosurgery, Harvard Medical
School, Brigham and Women’s Hospital, Boston, Massachusetts, U.S.A.
Erzhen Gao Supertron Technologies Inc., Newark, New Jersey, U.S.A.
Christopher C. Getch Department of Neurological Surgery, Feinberg School of Medicine,
Northwestern University, Chicago, Illinois, U.S.A.
Steven L. Giannotta Department of Neurosurgery, University of Southern California,
Los Angeles, California, U.S.A.
Jeffrey P. Greenfield Department of Neurological Surgery, Weill Medical College of
Cornell University, NewYork-Presbyterian Hospital, New York, New York, U.S.A.
Murat Gunel Department of Neurosurgery, Yale University School of Medicine, New Haven,
Connecticut, U.S.A.
George J. Hademenos Science Department, Richardson High School, Richardson, Texas, U.S.A.
Robert E. Harbaugh Department of Neurosurgery, The Pennsylvania State University, Hershey,
Pennsylvania, U.S.A.
Mark R. Harrigan Department of Neurosurgery, University of Alabama, Birmingham,
Alabama, U.S.A.
Alan C. Hartford Section of Radiation Oncology, Department of Medicine, Dartmouth-Hitchcock
Medical Center, Dartmouth Medical School, Lebanon, New Hampshire, U.S.A.
Tomoki Hashimoto Department of Anesthesia and Perioperative Care, UCSF Center for
Cerebrovascular Research, University of California, San Francisco, California, U.S.A.
Roberto C. Heros Department of Neurological Surgery, University of Miami, Miami,
Florida, U.S.A.
L. Nelson Hopkins Departments of Neurosurgery and Radiology, Toshiba Stroke Research
Center, School of Medicine and Biomedical Sciences, University at Buffalo, State University of
New York, Buffalo, New York, U.S.A.
Vallabh Janardhan Division of Interventional Neuroradiology, Department of Radiology,
Weill Medical College of Cornell University, NewYork-Presbyterian Hospital, New York,
New York, U.S.A.
Turker Kilic Vascular and Oncological Neurosurgery, Gamma-Knife Radiosurgery,
Marmara School of Medicine, Istanbul, Turkey
Douglas Kondziolka Departments of Neurological Surgery and Radiation Oncology,
The Center for Image Guided Neurosurgery, University of Pittsburgh Medical Center,
Pittsburgh, Pennsylvania, U.S.A.
Giuseppe Lanzino Departments of Neurosurgery and Radiology, Illinois Neurological Institute,
University of Illinois College of Medicine at Peoria, Peoria, Illinois, U.S.A.
Sean D. Lavine Departments of Neurological Surgery and Radiology, Columbia University,
College of Physicians and Surgeons, New York Neurological Institute, New York,
New York, U.S.A.
Contributors xv
Michael A. Lefkowitz Long Island Neurological Associates, New Hyde Park,
New York, U.S.A.
Jay S. Loeffler Department of Radiation Oncology, Northeast Proton Therapy Center,
Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A.
Christopher M. Loftus Department of Neurosurgery, Temple University School of Medicine,
Philadelphia, Pennsylvania, U.S.A.
L. Dade Lunsford Departments of Neurological Surgery and Radiation Oncology,
The Center for Image Guided Neurosurgery, University of Pittsburgh Medical Center,
Pittsburgh, Pennsylvania, U.S.A.
Neil Martin Division of Neurosurgery, UCLA School of Medicine, University of
California–Los Angeles, Los Angeles, California, U.S.A.
Tarik F. Massoud University Department of Radiology, University of Cambridge School of
Clinical Medicine, Cambridge, U.K.
Daniel P. McCarthy Department of Neurological Surgery, Feinberg School of Medicine,
Northwestern University, Chicago, Illinois, U.S.A.
James McInerney Department of Neurosurgery, The Pennsylvania State University, Hershey,
Pennsylvania, U.S.A.
Stefan A. Mindea Department of Neurological Surgery, Feinberg School of Medicine,
Northwestern University, Chicago, Illinois, U.S.A.
Michael Morgan Department of Neurosurgery, School of Advanced Medicine,
Macquarie University, Sydney, Australia
Ronald F. Moussa Department of Neurosurgery, Yale University School of Medicine,
New Haven, Connecticut, U.S.A.
R. Anthony Murray Department of Radiology, Northwestern Memorial Hospital, Chicago,
Illinois, U.S.A.
Christopher S. Ogilvy Department of Neurosurgery, Massachusetts General Hospital,
Harvard Medical School, Boston, Massachusetts, U.S.A.
Jeffrey G. Ojemann Department of Neurosurgery, University of Washington/Children’s Hospital
and Regional Medical Center, Seattle, Washington, U.S.A.
Stephen L. Ondra Department of Neurological Surgery, Feinberg School of Medicine,
Northwestern University, Chicago, Illinois, U.S.A.
Nelson M. Oyesiku Department of Neurosurgery, Emory University School of Medicine, Atlanta,
Georgia, U.S.A.
Susan C. Pannullo Department of Neurological Surgery, Weill Medical College of
Cornell University, NewYork-Presbyterian Hospital, New York, New York, U.S.A.
Harold J. Pikus Department of Neurological Surgery, University of Miami, Miami, Florida, U.S.A.
John Pile-Spellman Departments of Radiology, Neurosurgery, and Neurology, New York
Neurological Institute, Columbia University Medical Center, NewYork-Presbyterian Hospital,
New York, New York, U.S.A.
Charles J. Prestigiacomo Departments of Neurological Surgery and Radiology, Neurological
Institute of New Jersey, New Jersey Medical School, University of Medicine and Dentistry of
New Jersey, Newark, New Jersey, U.S.A.
Albert L. Rhoton, Jr. Department of Neurological Surgery, University of Florida College of
Medicine, Gainesville, Florida, U.S.A.
Howard A. Riina Departments of Neurological Surgery, Neurology, and Radiology,
Weill Medical College of Cornell University, NewYork-Presbyterian Hospital, New York,
New York, U.S.A.
xvi Contributors
Robert H. Rosenwasser Department of Neurosurgery, Division of Cerebrovascular Surgery and
Interventional Neuroradiology, Thomas Jefferson University Hospital, Philadelphia,
Pennsylvania, U.S.A.
Eric J. Russell Department of Radiology, Northwestern Memorial Hospital, and the Northwestern
University Feinberg School of Medicine, Chicago, Illinois, U.S.A.
Warren R. Selman Department of Neurosurgery, Case Western Reserve University School of
Medicine, and Department of Neurological Surgery, University Hospitals of Cleveland, Cleveland,
Ohio, U.S.A.
Adnan H. Siddiqui Department of Neurosurgery, Thomas Jefferson University Hospital,
Philadelphia, Pennsylvania, U.S.A.
Robert A. Solomon Department of Neurological Surgery, New York Neurological Institute,
Columbia University Medical Center, NewYork-Presbyterian Hospital, New York,
New York, U.S.A.
Mark M. Souweidane Department of Neurological Surgery, Weill Medical College of Cornell
University, NewYork-Presbyterian Hospital, New York, New York, U.S.A.
Gary K. Steinberg Department of Neurosurgery and the Stanford Stroke Center, Stanford
University School of Medicine, Stanford, California, U.S.A.
Philip E. Stieg Department of Neurological Surgery, Weill Medical College of Cornell University,
NewYork-Presbyterian Hospital, New York, New York, U.S.A.
Jeffrey L. Sunshine Department of Radiology, Case Western Reserve University School of
Medicine, and Division of Magnetic Resonance Imaging, University Hospitals of Cleveland,
Cleveland, Ohio, U.S.A.
Melanie K. Swope Department of Neurological Surgery, Feinberg School of Medicine,
Northwestern University, Chicago, Illinois, U.S.A.
Robert W. Tarr Division of Neuroradiology, Department of Radiology, Case Western Reserve
University School of Medicine, and University Hospitals of Cleveland, Cleveland, Ohio, U.S.A.
Helder Tedeschi Department of Neurosurgery, State University of Campinas - UNICAMP,
São Paulo, Brazil, and University of Florida, Gainesville, Florida, U.S.A.
B. Gregory Thompson Department of Neurosurgery, University of Michigan, Ann Arbor,
Michigan, U.S.A.
Wen Hung Tzu Department of Neurosurgery, University of São Paulo School of Medicine,
São Paulo, Brazil, and University of Florida, Gainesville, Florida, U.S.A.
Fernando Vinuela Department of Radiological Sciences, Endovascular Therapy Service, UCLA
School of Medicine, University of California–Los Angeles, Los Angeles, California, U.S.A.
John E. Wanebo Department of Neurosurgery, National Naval Medical Center, Bethesda,
Maryland, U.S.A.
Robert Wienecke Neuroscience Specialists, Oklahoma City, Oklahoma, U.S.A.
John H. Wong Department of Neurosurgery, Yale University School of Medicine, New Haven,
Connecticut, U.S.A.
William L. Young Departments of Anesthesia and Perioperative Care, Neurological Surgery, and
Neurology, UCSF Center for Cerebrovascular Research, University of California, San Francisco,
California, U.S.A.
