It is an honor to be invited to write the foreword to this valuable supplement. As I read through the many excellent articles included, I am left with very mixed feelings. On the one hand, it makes me extremely proud to see the phenomenal advances that my colleagues in neurosurgery, neuroradiology, neuroimaging, and neurology are bringing into the cerebrovascular field, which has been the love of my professional career. At the same time, it makes me sad to realize that I personally will not be able to continue to enjoy the application of these exciting advances to help our patients for much longer. We surely have come a long way since a few colleagues from my generation chose this career path stimulated by the phenomenal accomplishments of giants, such as Drake, Sundt, Yaşargil, and a few others. Not to be forgotten, of course, are the contributions of neurologists, such as my mentor, C. Miller Fisher, who not only laid for us a solid clinical foundation, but also encouraged surgeons to undertake such operations as carotid endarterectomies and even bypass grafts to circumvent carotid occlusion.
In commenting about this supplement, I will begin by giving my opinion as to what it is not. This is not a comprehensive textbook of vascular neurosurgery; obviously, it could not possibly be a comprehensive textbook considering the restrictions in number of pages. What this supplement contains is an excellent, comprehensive, and multidisciplinary discussion of the advances and innovations in diagnostic and surgical approaches to neurovascular disease. I use the word “surgical” advisedly in full awareness of the fact that the more rapidly advancing developments have undoubtedly been in endovascular neurointervention, which I consider a surgical discipline. The editors of this supplement, Drs Levy and Bendok, should be heartily congratulated, not only for their excellent contributions to the supplement, but also for their thoughtful choice of authors.
As mentioned earlier and can be predicted from the title of the supplement, the emphasis of each article is in new developments. With this in mind, the readers should not be disappointed if they do not find in Dr Lawton's article, for example, a comprehensive discussion of open microsurgery for aneurysms; rather, the article appropriately concentrates on new developments such as the use of minimally invasive craniotomies, the management of recurrence after coiling, and bypasses for aneurysms. Likewise, Dr Levy's article on endovascular therapy for aneurysms concentrates on advances in imaging, catheters, wires, coils, and liquid embolics, as well as stents. This continues to be the pattern throughout the subsequent articles.
The readers should not be disappointed to find considerable overlap in the different articles. For example, Dr Barrow's article on the surgical treatment of intracranial dural fistulas has a very good discussion on endovascular therapy for these fistulas, which of course is covered again, certainly in a more comprehensive manner, in the article by Dr Arthur and his colleagues on the endovascular treatment of these fistulas.
Several of the articles discuss not only currently used developments, but also ideas of potentially significant impact in the future. A good example of this is the discussion by Dr Kondziolka and colleagues of “potential pharmacologic interventions” with neuroprotective agents to decrease the incidence of adverse reactions to radiosurgery related to radiation necrosis.
There are several good discussions in different articles of important topics such as the choice of carotid endarterectomy vs carotid stenting by Dr Harbaugh and colleagues and recent trials of minimally invasive and thrombolytic therapy for spontaneous intracerebral hemorrhage by Dr Awad and colleagues. Currently available data from recent trials of decompressive hemicraniectomy are nicely discussed by Dr Ogilvy and his coauthors.
The supplement ends with thoughtful and excellent discussions by Drs Hopkins and Spetzler and their colleagues on the evolution of the endovascular paradigm and its future and the training of vascular neurosurgeons.
Throughout, the supplement is beautifully illustrated, and the illustrations on the different endovascular devices will be particularly useful for those of us who are not experts on endovascular techniques. Each article is very well referenced, and these references will serve as an invaluable resource to those interested in this field.
Overall I would give this supplement an A+, and I congratulate, once again, the editors of the supplement as well as the editorial leadership of Neurosurgery for regaling us with this wonderful volume.
The author has no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article.