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Neurosurgery is a field where millimeters matter and precision saves lives. Among the many delicate techniques we use, microanastomosis stands as a cornerstone—one that has defined cerebrovascular surgery for decades. Yet, in recent years, it has been overshadowed by newer interventions, often perceived as too challenging or too time-consuming in the fast-paced world of modern neurosurgery. But the truth is, microanastomosis is more relevant today than ever. With the rise of ultramicroneurosurgery, powered by high-magnification exoscopes and cutting-edge visualization tools, we are entering a new era of surgical precision. Whether it’s salvaging the penumbra in stroke patients, performing complex bypasses for aneurysms, or preserving crucial neural structures in skull base surgery, the ability to restore and reconstruct microvascular pathways is an invaluable skill that every young neurosurgeon must master. This book is our effort to bring microanastomosis back to the forefront of neurosurgery. It is not just a technical manual but a roadmap—showing how this skill can transform outcomes in the operating room. Through personal experience, case studies, and technological insights, I hope to inspire the next generation of neurosurgeons to embrace and refine this essential craft.

If you are holding this book, you are already on the path to mastering one of the most intricate yet rewarding techniques in neurosurgery. Let’s keep this art alive.

It is with great enthusiasm and a profound sense of purpose that I present “Progress in Neurosurgery Update – Volume 2.” This volume is the culmination of extensive collaboration, meticulous research, and the collective expertise of dedicated professionals in the field of neurosurgery.

Our primary objective is to equip the next generation of neurosurgeons with the knowledge, skills, and confidence essential for excelling in this intricate and demanding specialty. This manual also reflects the core values of the Neurosurgery Academy and Research Foundation: a commitment to excellence, innovation, and education. We believe that teaching and mentoring are integral to the advancement of neurosurgery, and this book stands as a testament to that belief. By sharing our knowledge and experience, we aspire to inspire continuous learning and foster a spirit of collaboration within the neurosurgical community