Cranial neuroimaging and clinical neuroanatomy: Magnetic resonance imaging and computed tomography

Book Reviews

out pertinent points. The last section is especially important for it lays bare the most current research in tumor biology and lights the path for future progress--both theoretical and clinical. The neurosurgeon will enjoy and benefit from this book, not as a "how-to" volume, but as a valuable information compendium. Neurologists, neuro-oncologists, and neurobiologists will be interested in its well-organized scheme and current information. Any student of the neurodisciplines should find this mandatory reading. This book is highly recommended. CHARLES E. RAWLINGS III, M.D. Winston-Salem, North Carolina

Spine: State of the Art Reviews, Spinal Fusion. Edited by D i e t e r G r o b , M.D. Philadelphia: Belfus and H a n l e y , Inc., 1992. Dr. Grob is the editor of this volume entitled Spine: State of the Art Reviews, Spinal Fusion. Like the preceding issues, it is a well-written and timely publication. As neurosurgical interest in spinal disease and instrumentation continues to grow, the topics discussed in this text will be integrated into the core of neurosurgical training for spinal surgery. As with the other volumes in this series, the 12 individual chapters have been written by orthopedic surgeons and independently address separate topics in spinal fusions. Overall the chapters are concise, well-illustrated, and referenced. They discuss all of the clinically encountered spinal fusion problems, techniques, and instrumentation. The topics include: biomechanics, anterior and posterior fusion of the cervical, thoracic and lumbar spines, the complications of spinal fusion, and a review of selected instrumentation systems. Additionally, some of the more difficult issues are discussed such as spondylolisthesis, and percutaneous instrumentation and fusion. The use of spinal fusion and instrumentation in these situations is clearly presented by the various authors. Dr. Punjabi and Dr. White have written an excellent review of the biomechanical principles of spinal fusion and instrumentation. This is an outstanding chapter and clearly presents a complex topic that is fundamental to the understanding of spinal surgery. The chapter on anterior cervical fusions by Muller is also noteworthy for its presentation of the various fusion and instrumentation techniques. Particularly well covered are screw fixation techniques of the cervical spine, including odontiod fractures. The chapter on fusions for metastatic disease, by Roy-Camille, provides an orthopedic point of view to the treatment of pain and instability. In counterpoint to neurosurgical publications, reconstruction and fusion are stressed as part of the operative planning. The summary chapter on complications by Dr. Grob is candid and informative. This volume is an excellent collection of monographs on spinal fusion. As neurosurgical involvement in this field increases, series like this will become more valuable to neurosurgical education. This text would be a useful addition to the library of any neurosurgeon or resident whose practice includes spinal fusion. R. PATRICK JACOB, M.D. Gainesville, Florida

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Cranial Neuroimaging and Clinical Neuroanatomy: Magnetic Resonance Imaging and Computed Tomography. 2nd edition, revised and expanded. H a n s - J o a c h i m K r e t s c h m a n n and W o l f g a n g Weinrich. 375 pages. N e w Y o r k : T h i e m e Medica Publishers, Inc., 1992. I S B N 0 - 8 6 5 7 7 - 3 9 2 - 0 . $225.00. As a radiologist, I have been requested to review this book presumably because the word "imaging" is in the title. This is, in fact, more of a neuroanatomy atlas intended to be geared toward the interpretation of radiologic images. Unfortunately, however, there are only about 46 out of 596 figures that are actually computed tomography (CT) or magnetic resonance (MR) images, and these are quite small in size compared to the much larger anatomic drawings. Therefore, I cannot recommend this book as a radiologic reference and in fact, far better books are available dealing with normal neuroimaging. Not included in the 46 cross-sectional images are an additional 23 radiographs of skull sections that are intended to correspond to bony anatomy as might be viewed on plain films or CT bone windows. This is a curious addition and somewhat artificial as one will never view a radiograph of a single section of a skull. Skull film interpretation is of course more difficult because of overlapping structures. For the coronal and axial cuts, I would have preferred CT bone windows that are viewed all the time and would certainly have been available and a valuable addition to a book that supposedly concerns itself with neuroimaging. The book is organized into ten chapters. The introduction deals with imaging objectives and background. The various standard planes of section are described and defined. The chapter on neuroimaging offers simple explanations of computed tomography and magnetic resonance imaging and even includes a small section on positron emission tomography (PET) and single-photon emission computed tomography (SPECT) (although no images of PET or SPECT are shown). Imaging strategies and advantages of the different modalities are dis cussed. The remainder of this large section consists of annotated anatomic line drawings in various planes along with CT and MR images at corresponding levels. As mentioned previously, the CT and MR images are only a fraction of the size of the diagrams, which detracts from their usefulness. The remainder of this book, and what I consider to be it's strength, is devoted to neuroanatomy. There is a section dealing with the various compartments of head and neck anatomy. The diagrams are good, using colors to highlight different structures, but this section suffers from a lack of a imaging correlation. Subsequent sections deal with cerebrospinal fluid (CSF) spaces and vascular territories. Strangely, the cerebellar vascular territories are not considered. Cranial nerves are considered next, but the discussion suffers from being somewhat user-unfriendly. To locate a structure discussed in the text, one must go back many pages to a remote section and in most cases, the referenced figures are drawings, not radiologic images. The following sections are divided by different regions of the brain such as the cerebral cortex, basal ganglia, diencepha-

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Surg Neurol 1993;40:439-43

Ion, and mesencephalon. The diagrams are good but are by no means exceptional or unique. They are intended to correspond to what one might see on M R or CT imaging, however, I would have preferred to see actual CT or MR images rather than so many drawings. There is a good section on neurofunctional units with colored representations of fiber tracts belonging to various systems such as visual, auditory, and gustatory. This book is primarily oriented toward drawings and figures and there is relatively little text; what text there is is well written. This book should by no means be construed as an imaging text despite its title. The vast majority of the figures are drawings that in my opinion do not really capture the flavor of actual CT and MR images, which are underrepresented in this book. This book may be useful to neurosurgeons desiring to review neuroanatomy, however, I suspect that much of this material is already present on their bookshelves. LAWRENCE G I N S B E R G , M.D. Winston-Salem, N o r t h Carolina

Psychosurgery: Damaging the Brain to Save the Mind. By J o a n n Ellison R o d g e r s . 241 pages. $ 2 0 . 0 0 S c r a n t o n , P e n n s y l v a n i a : H a r p e r Collins, 1992. I S B N 0-06-016405-0. The beginnings of neurosurgery was well into the second quarter of the 20th century by the time most of us who were involved in World War II were attracted to the field of neurosurgery. We were attracted by the great progress that had been made and the prospect for future development. Little did any of us truly realize the great prospects that were ahead since, at that time, there was no single drug for the treatment of hypertension, there were no psychotrophic drugs such as Thorazene or Rauwolfia or any of the more modern drugs; Sulphanilomide and Penicillin had just come on the scene. As a resident during the 1940s, I observed the treatment of psychiatric disease with electric shock and with prefrontal lobotomies or leucotomies, even observing Walter Freeman performing a transorbital "ice pick" operation at the Hartford Retreat. When I became the Director of Neurosurgery at Wake Forest University School of Medicine in 1949, during the first few years I did perform a few very carefully selected lobotomies and, in fact, there were some real benefits to some of the patients. I was not reassured by the knowledge of the psychiatrists as to which patients would or would not benefit by such a procedure, and selected most of the cases myself. I was offended, in fact, by Valenstein's book, Great and Desperate Cures. The Rise and Decline of Psychosurgery and Other Radical Treatments for Mental Illness (New York: Basic Books, 1986) and by subsequent books published on that same subject. When I saw the advertisement for Joann Ellison Rodgers' book, Psychosurgery: Damaging the Brain to Save the Mind. I was anxious to read it and review it. My only argument with this book is its title. It goes far beyond the field of psychosurgery.

Book Reviews

Joann Ellison Rodgers is obviously a cultured, intelligent, skillful journalist who has been willing to devote endless hours to educating herself about psychiatry, neurosurgery, and many of the great advances in medicine. She writes well and in an imaginative way; this is an "easy-to-read" but stimulating book. The author does not seek to diminish the revulsion that many individuals felt throughout the 1950s and 1960s regarding psychosurgery but seeks to clearly understand why this revulsion occurred. She repeatedly points out that many of these patients were desperately ill psychiatric patients with chronic disease. There was a beginning to this type of treatment, as she so clearly documents, starting with John Fulton and C. F. Jacobsen experimenting on the famous chimpanzees, Becky and Lucy. She describes how this went through the development of prefrontal lobotomy on humans first by Moniz and Lima and subsequently all over the world; literally hundreds of thousands of these procedures were done. She presents all this information in a most interesting fashion and seeks to put herself in the position of an individual from that time to understand better how things developed. Thereafter, the author skillfully outlines what she calls a new psychotherapy explaining and investigating the various ways in which other experiments have been cautiously carried out for the benefit of patients. She devoted a long educational period for herself to write the chapter "Frontiers: Psychosurgery of the Future" that includes gene implants and gene therapy with chemistry of bad habits, growing new tissues in the brain, and the various imaging techniques now available that may enable neuroscientists literally to map the brain. She makes a special study of the patients who have displayed extremely violent behavior and the various efforts that have been made by psychiatrists and surgeons to benefit these people by surgery. An entire chapter of about 30 pages is devoted to an individual named Matthew who had encephalitis as a child and developed extremely violent behavior, so much so that he had to be transferred from one psychiatric institution to another. Finally by surgery on the limbic system, which she outlined in a detailed manner by her observation of the patient, both before, during, and after his surgery, she further emphasizes not only her understanding of the problem but the understanding that others should have regarding the right of these patients to undergo such a procedure. I was particularly intrigued by her long interview with Dr. Tom Ballentine, who has been one of the most vocal neurosurgeons over the years in the championing o f surgery of the cingulum for behavioral disorders, which gives an added perspective to the international efforts that Dr. Ballentine and the group of psychiatrists and surgeons at Brook General Hospital in London have made to carry this project through. She expressed hopes that an institute with such a reputation as Johns Hopkins might form a working group further the progress of surgery for the relief of certain mental disorders. As the author points out, it will be a long time before many of the sworn opponents of surgery for mental disease are satisfied, even by the change in the name of psychosurgery to Neurosurgical and Related Interventions (NRI) as has been suggested by some. But whatever the future, there are now entirely different controls over such procedures with institu-