Lawton's Seven Aneurysms: Tenets and Techniques for Clipping

To the Editor: The monograph by Dr Michael T. Lawton seeks to “preserve the art of aneurysm clipping” in an era “with fewer vascular neurosurgeons, diminishing microsurgical expertise, and possibly the extinction of a surgical art”. By describing in detail the surgical techniques for clipping the 7 most common aneurysms, Dr Lawton presents a step-by-step description of the technical steps and details required to operate on these basic aneurysms, a “process that depends equally heavily on in-depth knowledge of both anatomy and surgical technique and the indefinable quality of surgical finesse,” as Dr Robert Spetzler so eloquently writes in the book's foreword. The first section, The Tenets, explains the basic concepts of aneurysm microsurgery, ranging form handling the microscope, subarachnoid dissection, brain mobilization, contingency planning, and clipping strategies to dealing with intraoperative rupture. This is followed by a section, entitled The Approaches, on the 4 basic craniotomies and exposures necessary for successful clipping, namely, the pterional, the orbitozygomatic, the anterior interhemispheric, and the far-lateral approaches. The final section, The Seven Aneurysms, covers the aneurysm types that are the focus of this book, namely, the posterior communicating artery, middle cerebral artery, anterior communicating artery, ophthalmic, pericallosa, basilar bifurcation, and posterior inferior communicating artery. Each chapter presents the relevant microsurgical anatomy, followed by a description of the aneurysm projections, aneurysm dissection strategies, and clipping techniques for each of the 7 aneurysms. In each chapter, the anatomy of the parent vessel with its segments and branches and important anatomic variants is presented in an orderly fashion. The 240-page text is generously illustrated by 383 full-color intraoperative photographs to demonstrate surgical techniques as well as 77 high-quality drawings that display anatomy and spatial relationships, creating a hybrid between an atlas and a focused textbook. The book distills the author's 12-year experience with 2500 aneurysms into a series of easily accessible tutorials. The book is very concise and almost German in its style, reflecting Dr Lawton's no-nonsense manner and surgical style. The book is written in a clear and simple language, making it easy to read and easily understandable. The succinct text facilitates quick reading and easy reference. In summary, the book provides a step-by-step description of the surgery on the common simple variety of aneurysms rather than the uncommon complex ones that probably should be reserved to a few hands. I highly recommend it to any practicing neurosurgeon interested in aneurysm surgery. Torstein R. Meling Oslo, Norway