Neurosurgical Operative Atlas Neuro Oncology.40

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N EUROSURGERY VOLUME 61 | NUMBER 3 | SEPTEMBER2007 | E662

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Intervertebral Fusion Using Carbon Fiber ReinforcedPolymer ImplantsEditors: John W. Brantigan653 pages Quality Medical Publishing, St. Louis, MO (2006)

The use of manufactured spinal interbody fusion devices hasbeen a recent development, a fact that is frequently taken forgranted by surgeons trained in the modern era of spinal neurolog-ical or orthopedic surgery. One of the pioneers in this eld, JohnBrantigan, was instrumental in the development of the rst suchdevices, carbon ber cages, in the 1980s. This text outlines thefull spectrum of topics concerning these implants, including theirhistory, indications, biomechanics, and surgical application.

The text is well-written, accessible to surgeons at all levels of training, and is lled with beautiful color photos and gures.Several chapters in the book are particularly noteworthy. Chapter2, contributed by Wolfgang Rauschling, is lled with fantasticcolor sections of the human spinal column that brilliantly illus-trate both the normal and pathological anatomy. Chapter 8,Transfusion Management, is a highly detailed and informativediscourse with information that is vital for all surgeons but sel-

dom found in neurosurgical texts. It outlines pre-, intra-, andpostoperative strategies for avoiding and administering bloodproduct replenishment. Chapter 22, by Boriani et al., is a won-derfully illustrated and comprehensive discussion of vertebrec-tomy reconstruction for tumor removal and describes techniquesfor en bloc tumor removal. There are four excellent subsequentchapters on Patient Education and six on Surgical Techniques.

Also included in the book are two DVDs containing narratedsurgical videos from Drs. Brantigan, Taneichi, Lauryssen, andFraser, which make for an excellent review of nuances for vari-ous interbody techniques in the cervical and lumbar spine, par-ticularly for surgeons who are not familiar with the precise tech-niques for proper carpentry of interbody devices.

One obvious drawback of this text is that it focuses on only asingle product line of spinal implants: carbon reinforced interbodyimplants. These devices are essentially exclusively manufactured,marketed, and sold by Depuy Spine, Inc. (Raynham, MA), a sub-sidiary of Johnson and Johnson. Furthermore, the senior author,

John Brantigan, has been intimately involved in the design, man-ufacture, and Food and Drug Administration approval of thesedevices; he also has nancial interests in the product. Despite

these concerns, all of these potential conicts of interest are fullydisclosed in the Preface, and the authors seem to maintain arespectable level of objectivity throughout most of the text.

Overall, this is a highly readable and informative text writtenby well-respected authorities in spinal surgery. Although themeticulous attention to detail may be excessive for neurosur-geons-in-training, this text will serve as a valuable reference anda delightful read for those with a special interest in spinal column

reconstruction.Michael Y. Wang, M.D.Miami, Florida

THIEME Atlas of Anatomy Series:Volume 3: Head and NeuroanatomyAuthors: Michael Schuenke, Erik Schulte, Udo Schumacher,Lawrence Ross, Edward Lamperti, Markus M. Voll, Karl H. Wesker 412 pages Thieme Medical Publishers, New York, NY (2007)

Thieme Medical Publishers recently published the Thieme Atlasof Anatomy series. Head and Neuroanatomy is a revised trans-

lation of the German edition authored by Michael Schuenke,M.D., Ph.D., Erik Schulte, M.D., and Udo Schumacher, M.D.This atlas contains 1182 illustrations and 72 tables among itsmore than 400 pages. The remaining anatomy books in the seriesare General Anatomy and Musculoskeletal System and Neck and Internal Organs .

The objective of the authors and publisher is to create an atlassuitable for the needs of students and lecturers. Specically, theatlas is designed to facilitate mastery of the extensive informationpresented in the text amidst the rigors of a busy academic sched-ule. The information is considered accurate and up-to-date. Thisatlas is designed to be unique in that topics are presented in acomprehensive manner. Illustrations and legends, which com-prise the majority of most atlases, are accompanied by explana-tory text and summarizing tables. Additionally, clinical scenariosassist with integration and correlation of anatomic information.

Presenting illustrations with text allows for in-depth explana-tions and descriptions of anatomic structures, but the resultingbook is large, heavy, and, therefore, minimally portable. Oneadvantage of a large book is that its sizeable pages allow forsmall details to be illustrated at a scale that remains easy to visu-


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alize. Structures of disparate sizes can be easily distinguished andrepresented in a single drawing. Thus, their functional and struc-tural relationship to each other can be depicted at the same timeas their difference in scale can be appreciated.

The table of contents is clear and concise, bringing ease tothe initial search for a specific neuroanatomy topic. The text is

much more abundant than typical anatomy atlases and is pre-sented in an enticing format that is easy to read. The translationfrom German to English shows no major or consistent flaws ingrammar or flow, and maintains faith to the authors originalinsights and intentions.

Central to a review of an atlas of neuroanatomy is an evalua-tion of the illustrations and gures. The cross-sectional and three-dimensional anatomic renderings are crisp and colorful. Theanatomic relationship of structures within individual figuresappears accurate in terms of scale and positional relationship.Labels for the figures are clear and well-planned. Additionalinformation, such as physical examination ndings in oculomo-tor palsies, is thoroughly depicted by both tables and illustrations.Each neuroanatomy topic receives adequate attention throughoutthe text, making the atlas a complete source for anatomic illus-trations of the head and cranial central nervous system.

Head and Neuroanatomy supplements large, clear illustrationswith detailed explanations and clinical correlations. This pro-vides the reader with amounts of information beyond what is nor-mally found in an atlas of anatomy. Although the text throughoutthe atlas is rich with detail, the index is difcult to navigate.Some subjects are found in unexpected places within the index,requiring a prolonged search, and subtopics are organized in aconfusing method involving varying numbers of dashed lines.This may limit ease of use for those intending it as an occasionalreference. However, students of anatomy courses and frequentreaders of the atlas will certainly become familiar with the book

and will benet greatly from its abundance of information. Thereference section lists mostly foreign titles, which will be of littleuse to the majority of English-speaking readers. Although thismay not be signicant to most students of neuroanatomy, otherreaders, such as basic scientists and clinical neuroscientists, whowish to review a specic topic further may be disappointed.

Overall, Head and Neuroanatomy offers a unique andthoughtful approach to the subject of human neuroanatomy.The authors intended the atlas to serve as the ideal atlas of anatomy for students who are required to master massiveamounts of information while balancing a busy course sched-ule. I consider this goal to be met by the authors and recom-mend the book as a primary source of learning for studentswhose coursework requires significant knowledge of neu-roanatomy. For the purposes of a student of neuroanatomy, thisatlas is a superior source of learning compared with those thatoffer only illustrations and labels. Other readers interested inanatomic explanations and detail, with supplemental clinicalcorrelations, may also benefit from this atlas. The drawback of the text is that its abundance of information mandated a larger,more cumbersome book. Those searching for a portable text or

intending to use the atlas as an infrequent reference shouldprobably consider other selections.

James B. Elder, M.D.Los Angeles, California

Current Diagnosis & Treatment in NeurologyEditor: John C.M. Brust 601 pages McGraw-Hill, New York, NY (2007)

The successful practice of neurosurgery rests upon a thoroughunderstanding of neurology. This is especially true today, asadvances in neurosurgery have enabled surgeons to effectivelytreat a growing spectrum of neurological conditions, such asParkinsons disease, epilepsy, and dystonia. To that end, thisconcise, comprehensive, and practical neurology text will provevery useful.

Current Diagnosis & Treatment in Neurology is a rst edition,multi-author text edited by John C.M. Brust, M.D. Dr. Brust, a

professor of neurology at Columbia University College of Physicians & Surgeons and the director of the Department of Neurology at Harlem Hospital Center in New York, has assem-bled a stellar group of writers from across the United States, par-ticularly Columbia University College of Physicians & Surgeons,to create this work. To review the scope of neurology is a sizabletask, albeit one that Dr. Brust has admirably accomplished.

The text is divided into two sections: Neurologic Investiga-tions, which reviews electroencephalography, electromyogra-phy, nerve conduction studies, evoked potentials, and neuroradi-ology, and Neurologic Disorders, which encompasses thespectrum of pathologic conditions faced by the neurologist, suchas epilepsy, stroke, movement disorders, headache, dementia,

multiple sclerosis, motor neuron diseases, and sleep disorders.The chapters are nicely integrated and almost never redundantdespite this being a multi-author text. A summary of key diagnos-tic elements usually introduces the specic topics each chapterencompasses. The text is usable and management-oriented.Numerous tables beautifully highlight the main points, whileblack and white photographs clearly illustrate classic radi-ographic findings. To enhance readability, the more esotericinformation is also relegated to the tables. The voluminous, cross-referenced index allows rapid access to the topic of interest. Thekey to Dr. Brusts success is that he doesnt stray from the goal of creating a concise yet comprehensive review of neurology.

In summary, Current Diagnosis & Treatment in Neurology is a

well-written text covering the many facets of neurology in adetailed, yet succinct and digestible, format. Although primarilywritten for generalists, I strongly recommend this thoughtfullydesigned book to any student or physician caring for patientswith neurological disorders.

Laurence Davidson, M.D.Los Angeles, California

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Adams and Grahams Introductionto NeuropathologyEditors: David I. Graham, James A.R. Nicoll, Ian Bone 464 pages Hodder Education, London, United Kingdom (2006)

Adams and Grahams Introduction to Neuropathology , pub-lished by Hodder Arnold in 2006, is the third published editionof this book. The rst two versions were published in 1988 and1994, respectively. This third edition is a comprehensiverewrite of the book, which was deemed necessary due to thelengthy time interval between the second edition and the pres-ent text.

The primary goal of this introduction to neuropathology, asoutlined in the editions preface, is to provide information regard-ing common and important central nervous system diseases. Thetarget audience is clinicians in training, as well as basic scientistswhose research may benet from a reference containing humanclinical and pathological correlations. The material is organizedinto pathological categories such as bacterial infections, intoxi-

cations, tumors, and paraneoplastic syndromes, each of whichcomprises a separate chapter.

One difference between this and the second edition is theexpansion from 18 to 21 chapters, reecting recent advances inthe eld of neuropathology. New chapters include Peroxisomaland Mitochondrial Disorders, Lysosomal Diseases and theLeukodystrophies, Disorders of the Bony Coverings of the Brainand Spine, and The Law and Forensic Neuropathology.

The table of contents lists only the chapter titles and authors,in contrast to the index, which offers detail adequately organizedfor nding a topic of interest. The black and white illustrations,including radiology images and transmission electron micro-graphs, are sharp and detailed, and are framed in a manner that

allows adequate context for the evaluation of the images.Extraneous information, such as dates or time stamps, often foundin x-rays is absent. Schematic representations, such as a drawingof a cross-section of the brainstem showing cranial nerve nuclei,are often presented and correlate well with their partner images.The color images are also clear and sharp, with distinct colorsand obvious labels, and the method of tissue preparation is indi-cated for each gure. Moreover, the descriptions of a specicneuropathology nding presented in the gure legends and sub-

ject of the text are well-represented by the images. The examplesthat the images are intended to illustrate are easy to visualize,although the level of magnication of the micrographs is notalways clearly indicated.

Each chapter is well organized and contains sufcient detail toprovide a comprehensive introduction to the topic reviewed. Thetext is well-written and easy to read, and the tables clarifysubtopics by condensing vital information in a well-organizedformat. Each chapter devotes adequate length and a sufcientnumber of images, including supplemental illustrations andtables, to the neuropathological category being discussed. Thebibliography is referenced only infrequently throughout the book,

with references listed alphabetically as suggestions for furtherreading.

Overall, this is a very practical text offering an introduction topathological ndings of the central nervous system organized bycategory of disease. The book provides relevant clinical and radi-ological information, as well as guidance in the differential diag-

nosis of neurological diseases. The book itself is light, thin, andportable, and the text is very readable.I highly recommend this book to physicians and scientists

desiring a handy neuropathology reference which, at the veryleast, can be used to guide further reading on a specic centralnervous disease. Clinical trainees in specific fields, includingpathology, neurology, forensic medicine, psychiatry, and neuro-surgery, are likely to benet most from using this book as a ref-erence or to study for their respective written boards.

The editors stress that this book is an introduction to neu-ropathology intended to promote a closer working relationshipbetween physicians and basic scientists from different specialties.They also intend the information to serve as a basis for cliniciansand pathologists to work towards maximizing the potential of sur-gical specimens for diagnostic or research purposes. Towardthese ends, the authors should consider their efforts a success.

James B. Elder, M.D.Los Angeles, California

Neurosurgical Operative Atlas: Neuro-OncologyEditor: Behnam Badie 337 pages Thieme Medical Publishers, New York, NY (2006)

Despite its title, this volume is not a true atlas but rather a multi-author, edited volume that covers a number of neurosurgicaltechniques relevant to the operative treatment of brain tumors.

Those looking for an illustrated guide to surgery are likely to bedisappointed. This volume is perhaps more comparable to a tech-nique book, such as the venerable Rands Microneurosurgery orthe work of Schmidek and Sweet, rather than a traditional surgi-cal atlas.

Aimed at residents in training, this book totals 337 pagesdivided among 36 chapters organized into seven sections cover-ing sellar and parasellar tumors, intraventricular tumors, spinaland peripheral nerve tumors, malignant brain tumors, surgicalmanagement of meningiomas, posterior fossa tumors, and skullbase approaches. Each chapter is generally divided into sectionscovering patient selection, preoperative management, operativetechnique, and postoperative management. The authors are, witha few exceptions, recognized leaders in their eld.

A number of weaknesses are evident in this book. The guresare taken from a variety of different sources and artists; as such,there is no unifying graphic theme. That being said, the quality of the illustrations is generally high. The most glaring omission,however, is the lack of footnotes or references, which are essen-tial to the serious study of the eld, especially for those who arebeginning their surgical training.


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Some topics are unevenly covered or covered in a redundantfashion. A few rather large gaps in presentation are made, par-ticularly on the topic of primary brain tumors in which there isno serious treatment of selection of operative corridors fordeep-seated primary tumors. In addition, there is no mention of modern techniques such as diffusion-tensor fiber tracking, func-

tional magnetic resonance imaging, superselective Wada test-ing, etc., as guides to the surgical approach. The stereotacticbiopsy is not covered, and only a rudimentary discussion of radiosurgery is presented.

Fortunately, this book is strongest in its discussion of techni-cally demanding methods for operative resection of cranial basetumors and meningiomas. These approaches comprise more thanhalf the length of the book, and there are a number of chaptersthat are well suited for this books approach. In particular, chap-ters authored by Drs. Al-Mefty, Samii, Day, Spetzler, andRobertson are well constructed and contain particularly relevantdetails. Residents preparing for these complex cranial operativecases would be well served by reviewing these chapters.

At a cost of $250, this book is likely to be too expensive for itsintended audience of residents in training. For institutionallibraries, however, it is a worthwhile purchase to complementother treatments of neuro-oncology.

Joseph C.T. Chen, M.D., Ph.D.Los Angeles, California

Principles of Cerebrovascular DiseaseAuthor: Harold P. Adams, Jr.564 pages McGraw-Hill Professional, New York, NY (2006)

This is a single-author volume dedicated to cerebrovascular dis-eases from a recognized leader in neurology and cerebrovascu-

lar diseases. As listed in the acknowledgements, however, theauthor has enlisted help and contributions from numerous peo-ple, including neurosurgeons, neurologists, pathologists, andradiologists. There is no question about the clinical and eco-nomic impact of cerebrovascular diseases world-wide. Ratherthan being a neuroscience text, the purpose of this volume is toprovide clinical insight and utility to practicing physicians.Therefore, details of basic science are included in a clinical con-text rather than being comprehensively considered. The authorhas organized the volume similar to the course and evaluation of a hypothetical patient with cerebrovascular diseases. There are564 total pages organized into 25 chapters. The volume beginswith three chapters on the classication, terminology, and patho-physiology of stroke, epidemiology of stroke, and organizingresources for stroke management. It is followed by a chapter oncarotid disease and transient ischemic attacks. Chapters 6 and 7consider the clinical manifestation of ischemic and hemorrhagicstroke, respectively, and are followed by a chapter on the diag-nostic studies for evaluating patients with cerebrovascular dis-ease. The next six chapters deal with atherosclerotic disease, noinammatory arteriopathies, infectious and inammatory causes

of strokes, genetic considerations, cardiogenic embolism, andcoagulation disorders that cause stroke. Chapter 15 deals withneurosurgical lesions such as aneurysms and arteriovenous mal-formations. Chapter 16 considers causes of intracranial hemor-rhage, followed by a chapter on strokes in children and youngadults. Chapter 18 treats a heterogeneous group of diseases,

including venous thrombosis, pituitary apoplexy, and spinal cordvascular diseases. The remaining chapters deal with treatmentoptions, including antithrombotic medications, surgical interven-tions, emergency management of suspected stroke patients, treat-ment of acute ischemic stroke, treatment of hemorrhagic stroke,and management of patients with recent stroke. The volume con-cludes with a nal chapter dealing with the rehabilitation andreturn of stroke patients to society. The chapters are well illus-trated, with color gures included before the rst chapter. Eachchapter is also referenced with a bibliography included witheach chapter. In addition, there is a comprehensive indexincluded at the end of the volume. The volume is easy to readand clinically relevant, and the subject matter is well organized.This volume should be a welcome addition to the libraries of both practicing clinical neuroscientists and those at variousstages in their training.

Charles Y. Liu, M.D., Ph.D.Los Angeles, California

Surgical Management of Spinal Cord Injury:Controversies and ConsensusEditor: Arun P. Amar 256 pages Blackwell Publishing Limited, Oxford, United Kingdom (2007)

This text summarizes and discusses the major issues surroundingthe management of patients with spinal cord injury. A particular

emphasis is placed on using scientic data to support the opin-ions expressed in the various chapters. The text consists of 14chapters, each of which was contributed by very well knownspinal surgeons, general surgeons, emergency room physicians,and neurologists. The target audience appears to be residentsand practicing surgeons faced with managing patients with spinalcord injury, and many of the chapters provide practical advicebased on either scientic evidence or the authors experience.The book is very well illustrated and attractively packaged.

Overall, the quality of the chapters is excellent. The discussionsof the pathophysiology of spinal cord injury, pharmacotherapy,and radiographic workup are thorough and easily read, even if they do not provide much in the way of novel content. There aretwo chapters dealing with biomechanical considerations of spinalinjury and stabilization, a critical topic for the practitioner. Dr.Watkins chapter on decision making is an excellent treatise thatis particularly recommended for residents and fellows interestedin spinal surgery. Other excellent reviews are provided dealingwith pediatric patients and those with penetrating injuries. Muchof the practical advice provided in these chapters represents rec-ommendations based on literature review, and most of the rec-

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ommendations are consistent with other published guidelinesand treatment strategies. Excellent reviews of the literatureregarding the radiographic workup, timing of decompression,and role of delayed surgery for patients with persistent decitswill aid in surgical decision making.

I found two chapters to be problematic. The authors of the

chapter dealing with vascular injury were very dogmatic in rec-ommending aggressive diagnostic workup of vascular injuries inpatients with cervical spine fractures, stating that such a workupand consequent treatment with anticoagulation represent thestandard treatment. This statement is offered despite theacknowledged lack of evidence supporting the practice anddespite very different recommendations from other evidence-based reviews. Similarly, strong recommendations for the use of multimodality electrophysiological monitoring are made in thefollowing chapter, again without any evidence presented to indi-cate that outcomes are improved through the use of monitoring.

The author of the monitoring chapter recommends a wake-up testor aborting surgery as a reasonable response to alterations inelectrophysiological response. Given the potential morbidity of either of these interventions, more evidence to suggest that thisresponse is warranted is needed to convince readers that there isutility in electrophysiological monitoring during decompression

and stabilization of the spinal cord injured patient.Despite these two caveats, I believe this book would be a val-ued addition to the library of residency training programs and forthose training to become spinal surgeons. The use of literaturereview, description of important basic principles, and inclusionof practical advice from established practitioners will make thistext useful as a teaching tool. The vast majority of the chaptersprovide balanced and comprehensive reviews of relevant topicsfor the surgical care of patients with spinal cord injury.

Daniel K. Resnick, M.D.Madison, Wisconsin


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Neurosurgical Operative Atlas Neuro Oncology.40