Correlative neurosurgery (2nd ed.)

422 Correlative neurosurgery (2nd ed.). - - E. A. Kahn, E. C. Crosby, R. C. Schneider and J. A. Taren. (C. C. Thomas, Springfield, III., 1969, 693 p., $31.50). Fextbooks of neurological surgery offering in one volume an authoritative overview of this large and enlarging field are few. The present volume, which is the second edition of a book originally published in 1955, comes out revised and brought up to date to reaffirm its unique position in the spectrum of such books. This deserved position is plainly derived from the original policy of correlative presentation of clinical neurosurgical topics and neuroanatomy, the senior authors bringing to their respective areas vast erudition and experience. Like the first, the second edition is aimed at "young neurosurgeons who have finished their formal training". With a prescient contemporary touch, the neurosurgical authors, male, by appropriately inscribing the volume, have explicitly, elegantly and affectionately recorded their intellectual debt to their neuroanatomical mentor, a tiny lady. Three o f the early chapters offer reviews of the diagnostic methods of radiology of the skull, EEG and brain scanning. K. A. Kooi discusses EEG in relation to focal disorders of the brain. A diagram conveys the standard electrode placements in use at the University of Michigan. The genesis and regulation of cerebral electrical activity, scalp-cortex-depth relations, and electrographic signs of cerebral disorder are outlined. Of interest is the addition of alterations of evoked activity to the familiar disturbances of wave form, amplitude and frequency of spontaneous activity as electrographic signs of disordered brain function. The pioneering and detailed life work of B. K. Bagchi on the electrographic diagnosis and localization of brain tumors, brought up to the present with previously unpublished data, is usefully summarized in words and figures. The presentation of radiology of the skull by J. P. Holt is brief but offers some interesting clinical material. Throughout the book, X-ray films have been reproduced as negatives. The authors and publisher are to be congratulated on this policy which maximizes the communicative value of the excellent radiographic reproductions. The chapter on brain scanning gives a brief exposition of the theoretical background and of diagnostic experience with this procedure which has established itself as a diagnostic method in the detection of intracranial mass lesions. The main organization of the book is by neuroanatomicat domains. Approximately one-third of the book is devoted to considerations of expanding intracranial lesions. The essential information a neurosurgical textbook must offer on this subject is continually expanded and sustained by the explicit sharing of the personal experience of the senior authors and by discussion of clinical-neuroanatomical relationships. Of the chapters on expanding lesions, the most useful to the intended reader may be those on the neoplasms of the base of the brain and posterior fossa since these lesions are relatively infrequent. A modern consideration of pituitary endocrine function is given by G. H. Lowrey. The responsibility for discussing meningiomas fell to J. A. Taren, an undertaking which he has carried offvalidly in the face o f an inhibiting literature that comprises such all-time monographs as that of Cushing and Eisenhardt (1938), or chapters such as Davidoff's in Pack and Ariel's Treatment o f cancer and allied disorders (1959). S. M. Farhat has written a lucid and appropriate

BOOK REVIEWS clinical review of the evolving subject of extracranial and intracranial vascular disease. In the area of treatment of intracranial aneurysms, one misses references to the results of major recent statistically controlled studies. In an engaging style. E. L. Odeku reflecls on the neurosurgical challenge of an indigenous African setting (Nigeria) and unveils the unfamiliar: some lesions, such as cerebral tuberculoma, are familiar but infrequent in this part of the world. Others, however, are unfamiliar by their nature: machete blows to tile skull, Burkitt's malignant lymphoma. Still others, once said to be infrequent in Africans, such as tumors of the brain or skull, are coming to be familiar there through the studies by neurosurgical pioneers of Africa. himselE L. F. Levy and others. The discussion of the surgery of convulsive seizures and allied disorders may be of interest to electroencephalographers. Written jointly by R. C. Schneider, Elizabeth C. Crosby and Hazel Calhoun, this chapter is new to the second edition. It is the longest chapter in the book. marking the authors' personal interest and the stabilization of this intervention in the standard armamentarium of neurosurgical therapies. The collaborative authorship of neurosurgeon and neuroanatomists highlights the essential requirement of the surgery of seizures, namely fundamental reliance on basic sciences for adequate individual case analysis. Surgical indications and pre-operalive localization of the discharging process are based essentially on the criteria of the Montreal school. Operations are carried out mainly under general, mo re recently neuroleptic anesthesia. Anterior temporal lobectomy is generally limited to a maximal distance of 6 cm, which is equated with the position of the vein of Labbd. This reviewer has found the position of Labb~'s vein to be so variable that he believes its use as a landmark for the preservation of the anterior-most fibers of Meyer's loop should be completely abandoned in favor of distance measurements from the tip of the middle fossa. In a series of 51 cases confined primarily to patients with unilateral temporal EEG loci, the results compared "favorably with other reports in the literature". The material is organized under cerebral lobar headings which include the timbic lobe and insula. Case reports of expanding and atrophic epileptogenic lesions serve as points of departure tbr anatomical summaries and functional clinical-anatomical correlation. The neuroanatomists speak for their own discipline and for neurophysiology. Throughout the chapter, the authors forward the thesis with which they have become identified in previous contributions: focal epileptogenic lesions discharging over projection pathways may activate distant cortical areas: the functional properties of these distant cortical areas may dominate the symptomatology of the seizure pattern. Although this thesis is readily accepted, the inclusion of cases with subacute expanding and inflammatory lesions introduces some softness into the framework of their documentation. In any event, with the combined use of clinical, EEG or gamma-encephalographic information, correct anatomical localizations were achieved pre-operatively. The chapter is enhanced by an extensive list of references. There is no discussion of electrocorticography. B. R. DeJong's presentation o f basal ganglia disorders directs attention to subcortical or basal cerebral neoplasms and trauma as an etiology of some of these disturbances. Various common movement disorders are reviewed, and the Elect~'oe#lceph. ~/i;~ Veurophysi+,/.. 1971, 31 : 422 423

BOOK REVIEWS possible role and nature of beneficial neurosurgical interventions is noted in a few weU-chosen words. His pithy presentation suggests an epilogue of stereotaxic neurosurgery. Anatomical considerations follow. G. Guiot and his associates present the principles of stereotaxic thalamotomy in the form of a review of their approach and experience. The neurosurgical treatment of congenital anomalies of the skull and of the brain, spinal cord and their membranes are described by J. A. Taren and E. A. Kahn with a minimum of the soul-searching which seems to be the current fashion in relation to these difficult topics. C. F. List contributes a highly informative review of the interesting and often complex anomalies of the cranio-vertebral junction. He has rendered signal service by publishing clearly conceived illustrations defining the eponymic lines roentgenologists have developed to visualize abnormal relationships of basal skull and rostral spine. The collaboration of neurosurgeon and anatomist is again fruitfully emphasized in a chapter on pain by Taren, Kahn and Tryphena Humphrey. Not unexpectedly, the neurosurgeon's interest in the spine is entrusted to Schneider's pen. It is most satisfying to find in a compact locus a summary of his influential contributions to the understanding and treatment of trauma to the spinal column and its contents. This book is not significantly impaired by minor technical imperfections, such as the absence of Fig. 15 and 16 from the chapter on brain scanning. The references which appear to stop in 1966, are generous in number and well chosen. Numerous cross-referencesto anatomical illustrations permit maximal use of these excellent visual aids. One wishes that page numbers could be appended to the figure numbers in a future edition for more rapid perusal of these crossreferences. The publication of this book furnishes a conspectus of the accomplishments of the school of neurological surgery founded at the University of Michigan by Max Peer and so ably developed by Edgar A. Kahn and his associates and students. To the perceptive reader, Kahn's writing will convey the depth of the sense of engagement of a distinguished era of neurosurgery which accepted and was impelled by the challenge of the surgical eradication of brain neoplasia. The rigors of the struggle with the unequal weapons of insufficient basic understanding and evolving surgical technique are apparent from the inclusion of reports of earlier cases in which steroid replacement therapy depended on units of adrenal cortical extract and fluids were administered by subcutaneous clysis facilitated by hyaluronidase. The young neurosurgical reader, to whom the courage and endurance of that period may be growing increasingly remote, will find in Kahn's chapters some of the elements of his heritage as a surgical specialist. These chapters are further distinguished by Kahn's clarity and exceptional candor, by his evident desire to impart the hard lessons of experience so characteristic of Kahn as a talented teacher to whom it is important that his students never make the same errors. This volume is highly successful in the articulated presentation of clinical and relevant neuroscience material. As such, it has already proved its usefulness to this reviewer in the areas of undergraduate and resident teaching. Many neurosurgical sections and the readily available neuroanatomical discussion will prove useful not only to the young neurosur-

423 geon developing his practice, but also to colleagues in the clinical neuroscience disciplines allied to neurosurgery. MARK RAYPORT

Medical College of Ohio, Toledo, Ohio 43614 (U.S.A.) Electroenceph. clin. Neurophysiol., 1971, 31 : 422-423

Contemporary research methods in neuroanatomy. - - W. J. H. Nauta and S. O. E. Ebbemon (Editors). (Proc. Internat. Conference, San Juan, Puerto Rico, 1969; Springer-Verlag, Berlin, Heidelberg, New York, 1970, 386 p., 190 Fig., U.S. $27.00). Were the golden days of Golgi morphology already numbered by the turn of the century? This is the question asked by the Scheibels at the beginning of the book, and the symposium (of which the book is a condensation) clearly gives an optimistic answer. Why was there a silencing of Golgi studies for more than a decade after their last distinguished advocates, Lorento de N6 and O'Leary, had turned to other techniques? The Scheibels seem to be right when they say "The Golgi method had literally supplied a detailed map of freeway systems before automobiles had been developed to use them". Neurophysiology, behaviour research and information theory had to develop to the point where this reservoir of data could become functionally meaningful before the Golgi technique was once more pressed into service. Now the Golgi study has again become fashionable: this is the first monograph which gives a detailed survey of the different techniques and applications of this method as it is used today. It is an account of how Golgi studies can contribute to a complete and better understanding of electron-microscopic pictures, microphysiological findings, developmental neurology, neuronal circuitry and model building and even neuropathological concepts. The book gives a detailed description of the different techniques for the impregnation of axons, dendrites and synapses, their scopes, advantages and pitfalls. It also discusses in great detail the results of selective silver impregnation of degenerating nerve fibres. Prominence is given to electron-microscopic studies of Golgi preparations which throw new light on the very nature of the impregnation process itself. The book ends with three chapters--not directly connected with the main topic on autoradiographic methods with thymidine-H 3, on fluorescence microscopy and on the counting of neurones. Besides being indispensable to neuroanatomists, the book should be consulted by neurophysiologists who make recordings from the CNS and, not content with mere results, wish to include them in an appropriate morphological system. H. PETSCHE

Brain Research Institute, Austrian Academy of Sciences, Vienna (Austria) Electroenceph. clin. Neurophysiol., 1971, 31 : 423