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Neurosurgery of arteriovenous malformations and fistulas. A multimodal approach
  1. K O’Neill

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    Edited by Hans-Jakob Steiger, Robert Schmid-Elsaesser, Alexander Muacevic, Hartmut Bruckmann, and Berndt Wowra. Springer, New York, 2002, £228, pp 473. ISBN 3-2-11-83703-5

    This is an interesting text aimed solely at arteriovenous malformations but including the often forgotten arteriovenous fistulas. The authors consist of the Neurovascular Surgical Team at the Ludwig-Maximilians-Universität, Munich, in conjunction with the Chairman of Neuroradiology at the same institution and the Director of the Gamma Knife Centre in Munich. The spectrum of authors covers the multimodal approach described in the title of the book. The aim of the book is therefore to appeal to specialists of surgical, radiosurgical, and endovascular disciplines. Its aim is to highlight the evolution of treatment of arteriovenous malformations and arteriovenous fistulas since the first neurosurgical efforts to deal with occluding and excising these lesions. It illustrates the growth in what were initially adjuvant treatments, but are now part of a multimodal combination of treatments. I think the book does this very well. It begins by reiterating the basics with a literature review covering definitions, epidemiology, and clinical characteristics, as well as treatment options of AVMs and fistulas of the CNS, including brain and spine.

    It also considers the classification systems based on theory and the pathoanatomical relationship between morbid intervention and thus choice of treatment. It then goes on to discuss the result of the various modalities of surgery, embolisation, and radiosurgery in a detailed literature review. This is followed by an in depth analysis of the principles of surgery, endovascular, and gamma knife options. The relative risks and merits of each are compared. Finally, in true keeping with its clinical perspective, the book concludes with a number of case studies illustrating the combination of both surgical and endovascular approaches as well as exclusively endovascular, exclusively surgical, and finally major surgical cases.

    I found the book was well structured and illustrated, making for an easy and informative read. It would be a very welcome addition to the library of any neurovascular unit and it would be of interest to all the disciplines involved in treating these abnormalities.

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