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Vertebrobasilar arterial occlusive disease: Medical and surgical management
Book Reviews
to coincide with this breakpoint. Further investigation of the effects of hypercapnia and hypertension on the CSFPP provides evidence that the breakpoint marks the onset of autoregulatory failure. By following this extensive presentation of their clinical and experimental study, the authors conclude that the use of CSFPP as an indicator of craniospinal elastance is limited primarily because of the variability of the pulsatile change in cerebral blood volume among patients and the fact that there is no method available for reliable quantitative measurement of this variable. The remainder of the text reviews the production, circulation, and absorption of CSF. Factors that affect this system as well as the relation of increasing ICP and the compensatory abilities of the craniospinal system are also discussed. The authors also present a model for the study of CSF dynamics. The appendices provide information such as the volume pressure relationships of a closed sphere, a mathematical description of the strain exerted on the cerebral arterial wall and the computation of the constant pressure term, P0, and the elastance coefficient, El, by various methods. Although this book has considerable value to the scientist ok mathematician with a devoted interest in CSF dynamics, it has little application for the practicing neurosurgeon. H A R O L D J. COLBASSANI, JR., M.D. GEORGE T. TINDALL, M.D. Atlanta, Georgia
Handbook of Physiology, Section I: The Nervous System, Vol. III, The Sensory Processes, Parts I and II. E d i t e d by J o h n M. B r o o k h a r t and V e r n o n B. M o u n t c a s t l e ; V o l u m e E d i t o r , Ian D a r i a n - S m i t h . $ 275.00. B e t h e s d a , M a r y l a n d : A m e r i c a n Physiological Society, 1984. This two-part set is section 1, volume III of a multiple-volume treatise on the nervous system published by the American Physiological Society. It is a complex but palatable compilation of currently recognized concepts and of advances made in the field of sensory neurophysiology during the past two decades. The authors were chosen from three continents and from the fields of both psychologic and neurologic physiology, thus making the work truly international and multidisciplinary. Volume lII begins with a thorough and fascinating review of the historical and philosophical foundations of the investigation of the senses. Next, the roles played by the thalamus and the brainstem reticular core in the reception and modulation of sensory input are discussed. With this historical and anatomical foundation, the remainder of the volume deals with each of the sensory systems individually, including vision, hearing, somatic sensation, the perception of the body in space, taste, and hemispheric specialization. With the exception of the chapter on hemispheric specialization, the volume contains a disappointing lack of true clinical correlation. Although many of the hemispheric dysfunction
Surg Neurol 1985;23:205-9
207
and disconnection syndromes and their anatomical bases are discussed in this chapter, the advent and refinement of evoked potentials in the clinical assessment of neural pathways should have led the authors of the remaining chapters to a discussion of the anatomic and physiologic bases for evoked potentials in the evaluation of sensory pathways and their dysfunction. The presence of such a discussion would have made this volume a more useful addition to the library of the clinical neuroscientist. Despite these omissions, the volume is well organized, and the printing and graphics are excellent. Volume III will be of value to the practicing neurosurgeon or the neurosurgical resident as a current, comprehensive reference on sensory neurophysiology, and will be invaluable to the neuroscientist who is actively investigating sensory processes. CHARLES L. B R A N C H , JR., M.D. Winston-Salem, North Carolina
Vertebrobasilar Arterial Occlusive Disease: Medical and Surgical Management. E d i t e d by R a m o n B e r g u e r , M . D . , P h . D . , and R a y m o n d D. B a u e r , M . D . 336 pp., illus., $45.00. N e w Y o r k , R a v e n Press, 1984. This book is a multiauthored compilation of papers and reports delivered at the First International Conference on Vertebrobasilar Occlusive Vascular Disease. The editors attempt to present a consolidated volume of information that has been gathered over the last decade concerning vertebrobasilar disease. Among the many topics covered in the book, the investigation and treatment of patients afflicted with this form of vascular disease are also considered. The book is divided into four major sections: (a) Clinicopathologic Considerations in Vertebrobasilar Disease; (b) Noninvasive Diagnostic Techniques; (c) Invasive Diagnostic Studies and Treatment Techniques; and (d) Surgical Treatment of Vertebrobasilar Occlusive Disease. Each of these sections has chapters that vary in the extent of presentation and scope, a problem that often occurs in multiauthored texts. The illustrations are of good quality and the references at the end of each chapter useful. The first section efficiently reviews the basic vertebrobasilar vascular anatomy and pathology. In addition, the clinical and epidemiologic aspects of posterior circulation ischemia are discussed in relation to their specific pathophysiology. The "locked in" syndrome is discussed in a concise manner, including a case report of a patient that had a complete recovery. The major noninvasive diagnostic techniques considered in section 2 include: (a) Brainstem Auditory Evoked Potentials; (b) Visual Evoked Potentials; (c) Cochlear and Vestibular Otologic Evaluations; (d) Computed Tomographic Scanning; (e) Doppler and Ultrasound Vascular Imaging; and (f) Nuclear Magnetic Resonance (NMR) Imaging. Although the first five of these techniques are quite commonly used, the future of N M R imaging in this disease process is still unknown. The chapter discussing N M R is quite technical, but it also intro-
208
Surg Neurol 1985;23:205-9
duces several cases that point to its possible future utility in the evaluation of vertebrobasilar ischemia. Section 3 summarizes the current state-of-the-art techniques used in posterior circulation angiography, along with an overview of positron emission tomographic (PET) scanning and vertebrobasilar transluminal balloon angioplasty. Both standard and digital angiography are reviewed in their ability to assist in the management of patients with vertebrobasilar vascular occlusive disease. The potential use of PET in studying in vivo brain metabolism and derangements thereof in vertebrobasilar disease is well outlined. Transluminal balloon catheter angioplasty techniques in the treatment of intracranial cerebrovascular occlusive disease are reviewed while the major hazards associated with these techniques are stressed. The fourth section covers the history of vertebrobasilar surgery along with a brief overview of the surgical techniques and their indications. Proximal as well as distal vertebral endarterectomy and reconstruction are discussed along with selection of the patients and the surgical technique. Surgical options in patients with combined carotid and vertebrobasilar occlusive disease, which poses difficult therapeutic alternatives, are very well summarized. Current bypass procedures for posterior circulation ischemia are also presented along with their indications. Overall this book is a valuable addition to the cerebrovascular literature, filling the void that has existed in regard to the practical management of patients with vertebrobasilar occlusive disease. The book will be useful as a current general reference on the topic of management of vertebrobasilar occlusive disease by neurologists, neurosurgeons, vascular surgeons and neuroradiologists. The price for this book is quite reasonable. MASSIMO S. F I A N D A C A , M.D. GEORGE T. TINDALL, M.D. Atlanta, Georgia
The Dandy-Walker Syndrome. By A.J. R a i m o n d i , K. Sato, and T. S h i m o j i . 82 pp., U S $34.75, D M 69, SFr. 58. Basel: S. K a r g e r , 1984. This brief monograph provides an excellent review of this uncommon malformation. The authors have summarized all that has been written about this condition and conclude that the malformation results from developmental failure of the embryonic roof of the fourth ventricle. They report in detail on the 37 patients with this syndrome that they have managed. All of their patients were under 2 years of age at the time of diagnosis. Many of their patients had associated abnormalities with 75% having hypertelorism and 40.5% having dysgenesis of the corpus callosum. Their patients were treated by a shunting procedure consisting of a cystoperitoneal or ventriculoperitoneal or combined cystoperitoneal and ventriculoperitoneal shunt. The outcome in their group of patients was not favorable: 25 of their 37 patients had an I.Q. of 69 or less. They describe the diagnostic studies in these patients. Most of their patients were investigated in the era before computed
Book Reviews
tomography scanning and for this reason the primary diagnostic test utilized was a cerebral angiogram. They point out the difficulties in differentiating between the D a n d y - W a l k e r cyst and a posterior fossa arachnoid cyst. With the advent of computed tomography scanning and particularly the use of computed tomography-metrizamide scans, the differentiation between these two entities can now be readily made. This is an excellent text for individuals interested in hydrocephalus and in particular in the D a n d y - W a l k e r syndrome; it very adequately summarizes the literature on the subject and succinctly and clearly presents the authors' experience with a large number of cases of this syndrome. H A R O L D J. H O F F M A N Toronto, Ontario, Canada
Neurosurgical Management for the House Officer. By A l l a n H . F r i e d m a n , M . D . , and R o b e r t H . W i l k i n s , M . D . 169 pp. $10.95. B a l t i m o r e - L o n d o n : W i l l i a m s & W i l k i n s , 1984. This book fills the void as the long-awaited manual for the house officer, new to the trenches in neurosurgery. Instead of providing a cookbook approach to clinical medicine, the authors have gone beyond this to offer a precise and basic explanation behind the everyday neurosurgical problems that we see. Within this brief but complete manual, all aspects of neurosurgery are addressed and are well referenced. This is accomplished with little redundancy, avoiding extensive discussion in some of the more controversial aspects of neurosurgery. There are several chapters that I would have liked to see in this book but were not included. One chapter might have been devoted to neurosurgical emergencies, such as cerebellar hemorrhage, acute spinal cord compression, herniation, and cervical fractures. Perhaps also an appendix of neurosurgical appliances, such as shunts, tongs, and head-holders, would be helpful for those middle-of-the~night consultations. This manual is a tribute to the Duke tradition in neurosurgical education, and I believe it should be carried in the coat pocket of all physicians new to neurosurgery. L I N D A STERNAU, M.D. Cleveland Metropolitan General Hospital
Intracranial Pressure V E d i t e d by S. Ishii, N . N a g a i , and M. B r o c k . 914 pp. N e w Y o r k : S p r i n g e r - V e r l a g , 1983. This book reports the proceedings from the Fifth International Symposium on Intracranial Pressure. The book is divided into 11 sessions and represents contributions from many authorities in the field. The sessions range from the basic dynamics
to coincide with this breakpoint. Further investigation of the effects of hypercapnia and hypertension on the CSFPP provides evidence that the breakpoint marks the onset of autoregulatory failure. By following this extensive presentation of their clinical and experimental study, the authors conclude that the use of CSFPP as an indicator of craniospinal elastance is limited primarily because of the variability of the pulsatile change in cerebral blood volume among patients and the fact that there is no method available for reliable quantitative measurement of this variable. The remainder of the text reviews the production, circulation, and absorption of CSF. Factors that affect this system as well as the relation of increasing ICP and the compensatory abilities of the craniospinal system are also discussed. The authors also present a model for the study of CSF dynamics. The appendices provide information such as the volume pressure relationships of a closed sphere, a mathematical description of the strain exerted on the cerebral arterial wall and the computation of the constant pressure term, P0, and the elastance coefficient, El, by various methods. Although this book has considerable value to the scientist ok mathematician with a devoted interest in CSF dynamics, it has little application for the practicing neurosurgeon. H A R O L D J. COLBASSANI, JR., M.D. GEORGE T. TINDALL, M.D. Atlanta, Georgia
Handbook of Physiology, Section I: The Nervous System, Vol. III, The Sensory Processes, Parts I and II. E d i t e d by J o h n M. B r o o k h a r t and V e r n o n B. M o u n t c a s t l e ; V o l u m e E d i t o r , Ian D a r i a n - S m i t h . $ 275.00. B e t h e s d a , M a r y l a n d : A m e r i c a n Physiological Society, 1984. This two-part set is section 1, volume III of a multiple-volume treatise on the nervous system published by the American Physiological Society. It is a complex but palatable compilation of currently recognized concepts and of advances made in the field of sensory neurophysiology during the past two decades. The authors were chosen from three continents and from the fields of both psychologic and neurologic physiology, thus making the work truly international and multidisciplinary. Volume lII begins with a thorough and fascinating review of the historical and philosophical foundations of the investigation of the senses. Next, the roles played by the thalamus and the brainstem reticular core in the reception and modulation of sensory input are discussed. With this historical and anatomical foundation, the remainder of the volume deals with each of the sensory systems individually, including vision, hearing, somatic sensation, the perception of the body in space, taste, and hemispheric specialization. With the exception of the chapter on hemispheric specialization, the volume contains a disappointing lack of true clinical correlation. Although many of the hemispheric dysfunction
Surg Neurol 1985;23:205-9
207
and disconnection syndromes and their anatomical bases are discussed in this chapter, the advent and refinement of evoked potentials in the clinical assessment of neural pathways should have led the authors of the remaining chapters to a discussion of the anatomic and physiologic bases for evoked potentials in the evaluation of sensory pathways and their dysfunction. The presence of such a discussion would have made this volume a more useful addition to the library of the clinical neuroscientist. Despite these omissions, the volume is well organized, and the printing and graphics are excellent. Volume III will be of value to the practicing neurosurgeon or the neurosurgical resident as a current, comprehensive reference on sensory neurophysiology, and will be invaluable to the neuroscientist who is actively investigating sensory processes. CHARLES L. B R A N C H , JR., M.D. Winston-Salem, North Carolina
Vertebrobasilar Arterial Occlusive Disease: Medical and Surgical Management. E d i t e d by R a m o n B e r g u e r , M . D . , P h . D . , and R a y m o n d D. B a u e r , M . D . 336 pp., illus., $45.00. N e w Y o r k , R a v e n Press, 1984. This book is a multiauthored compilation of papers and reports delivered at the First International Conference on Vertebrobasilar Occlusive Vascular Disease. The editors attempt to present a consolidated volume of information that has been gathered over the last decade concerning vertebrobasilar disease. Among the many topics covered in the book, the investigation and treatment of patients afflicted with this form of vascular disease are also considered. The book is divided into four major sections: (a) Clinicopathologic Considerations in Vertebrobasilar Disease; (b) Noninvasive Diagnostic Techniques; (c) Invasive Diagnostic Studies and Treatment Techniques; and (d) Surgical Treatment of Vertebrobasilar Occlusive Disease. Each of these sections has chapters that vary in the extent of presentation and scope, a problem that often occurs in multiauthored texts. The illustrations are of good quality and the references at the end of each chapter useful. The first section efficiently reviews the basic vertebrobasilar vascular anatomy and pathology. In addition, the clinical and epidemiologic aspects of posterior circulation ischemia are discussed in relation to their specific pathophysiology. The "locked in" syndrome is discussed in a concise manner, including a case report of a patient that had a complete recovery. The major noninvasive diagnostic techniques considered in section 2 include: (a) Brainstem Auditory Evoked Potentials; (b) Visual Evoked Potentials; (c) Cochlear and Vestibular Otologic Evaluations; (d) Computed Tomographic Scanning; (e) Doppler and Ultrasound Vascular Imaging; and (f) Nuclear Magnetic Resonance (NMR) Imaging. Although the first five of these techniques are quite commonly used, the future of N M R imaging in this disease process is still unknown. The chapter discussing N M R is quite technical, but it also intro-
208
Surg Neurol 1985;23:205-9
duces several cases that point to its possible future utility in the evaluation of vertebrobasilar ischemia. Section 3 summarizes the current state-of-the-art techniques used in posterior circulation angiography, along with an overview of positron emission tomographic (PET) scanning and vertebrobasilar transluminal balloon angioplasty. Both standard and digital angiography are reviewed in their ability to assist in the management of patients with vertebrobasilar vascular occlusive disease. The potential use of PET in studying in vivo brain metabolism and derangements thereof in vertebrobasilar disease is well outlined. Transluminal balloon catheter angioplasty techniques in the treatment of intracranial cerebrovascular occlusive disease are reviewed while the major hazards associated with these techniques are stressed. The fourth section covers the history of vertebrobasilar surgery along with a brief overview of the surgical techniques and their indications. Proximal as well as distal vertebral endarterectomy and reconstruction are discussed along with selection of the patients and the surgical technique. Surgical options in patients with combined carotid and vertebrobasilar occlusive disease, which poses difficult therapeutic alternatives, are very well summarized. Current bypass procedures for posterior circulation ischemia are also presented along with their indications. Overall this book is a valuable addition to the cerebrovascular literature, filling the void that has existed in regard to the practical management of patients with vertebrobasilar occlusive disease. The book will be useful as a current general reference on the topic of management of vertebrobasilar occlusive disease by neurologists, neurosurgeons, vascular surgeons and neuroradiologists. The price for this book is quite reasonable. MASSIMO S. F I A N D A C A , M.D. GEORGE T. TINDALL, M.D. Atlanta, Georgia
The Dandy-Walker Syndrome. By A.J. R a i m o n d i , K. Sato, and T. S h i m o j i . 82 pp., U S $34.75, D M 69, SFr. 58. Basel: S. K a r g e r , 1984. This brief monograph provides an excellent review of this uncommon malformation. The authors have summarized all that has been written about this condition and conclude that the malformation results from developmental failure of the embryonic roof of the fourth ventricle. They report in detail on the 37 patients with this syndrome that they have managed. All of their patients were under 2 years of age at the time of diagnosis. Many of their patients had associated abnormalities with 75% having hypertelorism and 40.5% having dysgenesis of the corpus callosum. Their patients were treated by a shunting procedure consisting of a cystoperitoneal or ventriculoperitoneal or combined cystoperitoneal and ventriculoperitoneal shunt. The outcome in their group of patients was not favorable: 25 of their 37 patients had an I.Q. of 69 or less. They describe the diagnostic studies in these patients. Most of their patients were investigated in the era before computed
Book Reviews
tomography scanning and for this reason the primary diagnostic test utilized was a cerebral angiogram. They point out the difficulties in differentiating between the D a n d y - W a l k e r cyst and a posterior fossa arachnoid cyst. With the advent of computed tomography scanning and particularly the use of computed tomography-metrizamide scans, the differentiation between these two entities can now be readily made. This is an excellent text for individuals interested in hydrocephalus and in particular in the D a n d y - W a l k e r syndrome; it very adequately summarizes the literature on the subject and succinctly and clearly presents the authors' experience with a large number of cases of this syndrome. H A R O L D J. H O F F M A N Toronto, Ontario, Canada
Neurosurgical Management for the House Officer. By A l l a n H . F r i e d m a n , M . D . , and R o b e r t H . W i l k i n s , M . D . 169 pp. $10.95. B a l t i m o r e - L o n d o n : W i l l i a m s & W i l k i n s , 1984. This book fills the void as the long-awaited manual for the house officer, new to the trenches in neurosurgery. Instead of providing a cookbook approach to clinical medicine, the authors have gone beyond this to offer a precise and basic explanation behind the everyday neurosurgical problems that we see. Within this brief but complete manual, all aspects of neurosurgery are addressed and are well referenced. This is accomplished with little redundancy, avoiding extensive discussion in some of the more controversial aspects of neurosurgery. There are several chapters that I would have liked to see in this book but were not included. One chapter might have been devoted to neurosurgical emergencies, such as cerebellar hemorrhage, acute spinal cord compression, herniation, and cervical fractures. Perhaps also an appendix of neurosurgical appliances, such as shunts, tongs, and head-holders, would be helpful for those middle-of-the~night consultations. This manual is a tribute to the Duke tradition in neurosurgical education, and I believe it should be carried in the coat pocket of all physicians new to neurosurgery. L I N D A STERNAU, M.D. Cleveland Metropolitan General Hospital
Intracranial Pressure V E d i t e d by S. Ishii, N . N a g a i , and M. B r o c k . 914 pp. N e w Y o r k : S p r i n g e r - V e r l a g , 1983. This book reports the proceedings from the Fifth International Symposium on Intracranial Pressure. The book is divided into 11 sessions and represents contributions from many authorities in the field. The sessions range from the basic dynamics