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Neurological surgery
Journal o f the neurological Sciences Elsevier Publishing Company, Amsterdam - Printed in The Netherlands
607
Book Reviews Neurological Surgery (Proceedings of the 3rd International Congress of Neurological Surgery, Copenhagen, 23-27 August, 1965) (International Congress Series, No. 110), by A. C. DE VET, W. F. C. KENNEDYAND P. J. VIN~EN (Eds.), vii + 879 pages, illustrated, Excerpta Medica Foundation, Amsterdam, 1966, $ 40.--; £ 14.10.0. The 1st section of this record of the 3rd International Congress of Neurological Surgery is devoted to the subject of head injuries. Here there is food for the policy makers and the administrators stemming from some eloquent pleas for prevention, also for the development of more widespread training of the general surgeon in surgery of trauma to the head. The organization necessary to achieve early diagnosis is stressed and in this connection, echo-encephalography (which could easily be available in all hospitals) and angiography both play an important role. There is a timely reminder on the subject of the posterior fossa surface blood clots which, because of their relative rarity, tend to be forgotten. Glimpses of possible future developments come in a contribution describing "automatic diagnosis" made on statistical probabilities, scoring and weighting certain features of the semeiology to achieve this. Such glimpses are also to be seen in a description of automatic patient monitoring, or in references to the continuous recording of intracranial pressure and to equipment such as the "rheoencephalogram", the "pallencephalogram" and the "thermogram". The 2nd section is devoted to spinal injuries. The chief impression gained from this is that, statistically, there is no support for the individual clinician's conviction that he has seen isolated instances of startling improvement following surgery for traumatic paraplegia. This sec!ion implies a considerable indictment of current medical practice in that it brings out the fact that incomplete documentation, together with the failure to isolate critical problems and to formulate decisive questions to resolve them, leaves us far too long in a vague state of clinical "free-forall" and uncertainty. The "growing points" of clinical practice here include the possible use in minimizing cord damage of hypothermia, steroids, and dehydrating agents. There is also a decription of some initial attempts to apply the previous animal experiments on intercostal nerve anastomoses to the human paraplegic. The 3rd section, on the brain stem, seems to
have been the least spontaneously successful. The most startling claim in this section is that acetylcholine crystals injected into the grey matter of the cat's spinal cord could induce sleep. By stereotactic injections in cats a precisely definied "hypnogenic" area extending from pons to median forebrain bundle has been demonstrated. The 4th section amounts to a section of "free communications" under the heading of recent advances in neurosurgery. There is obviously a vivid current interest in gaining access to the anterior aspect of the upper two cervical vertebrae and to the clivus, foran impressivetechniqueof trans-cervical trans-clival craniotomy promoted considerable discussion. Ingenious technical developments include the induction heating of implanted steel pellets for the making of focal brain lesions, techniques for the direct current thrombosis of intracranial aneurysms, artificial embolization of vascular malformations and the removal of normal and pathological intracranial structures by freezing. The subject of chemotherapy of malignant intracerebral tumours also receives mention. Perhaps because it has so far shown so little real promise, it receives far less attention than its numerical importance justifies. To review a publication like this is a difficult task. One is beset by so many impressions: at one moment, international conferences such as this fill one with an impression of overwhelming tedium; at another, some new idea flashes and sets one's imagination aglow, or at another moment one is grateful for a convenient review of recent advances - - even if some of them have been first reported several years beforehand. One admires the administrative abilities of the organizers of these conferences and one respects the publishers who can produce an elegant printed version of it some 15 months after its conclusion, but when all is said "Who will buy this book?" Probably only libraries with a duty and desire to keep a complete record of neurosurgical publications. The private "student" of neurosurgical thought and progress will read the contributions which interest him in the individual scientific journals in which the same studies have undoubtedly already been reported, or in which they will soon appear in amplified form. As long as congresses like this continue, it seems that summaries of the papers, circulated in advance, are all that are really desired. A. JEFFERSON
J. neurol. Sci. (1968) 6:607-608
607
Book Reviews Neurological Surgery (Proceedings of the 3rd International Congress of Neurological Surgery, Copenhagen, 23-27 August, 1965) (International Congress Series, No. 110), by A. C. DE VET, W. F. C. KENNEDYAND P. J. VIN~EN (Eds.), vii + 879 pages, illustrated, Excerpta Medica Foundation, Amsterdam, 1966, $ 40.--; £ 14.10.0. The 1st section of this record of the 3rd International Congress of Neurological Surgery is devoted to the subject of head injuries. Here there is food for the policy makers and the administrators stemming from some eloquent pleas for prevention, also for the development of more widespread training of the general surgeon in surgery of trauma to the head. The organization necessary to achieve early diagnosis is stressed and in this connection, echo-encephalography (which could easily be available in all hospitals) and angiography both play an important role. There is a timely reminder on the subject of the posterior fossa surface blood clots which, because of their relative rarity, tend to be forgotten. Glimpses of possible future developments come in a contribution describing "automatic diagnosis" made on statistical probabilities, scoring and weighting certain features of the semeiology to achieve this. Such glimpses are also to be seen in a description of automatic patient monitoring, or in references to the continuous recording of intracranial pressure and to equipment such as the "rheoencephalogram", the "pallencephalogram" and the "thermogram". The 2nd section is devoted to spinal injuries. The chief impression gained from this is that, statistically, there is no support for the individual clinician's conviction that he has seen isolated instances of startling improvement following surgery for traumatic paraplegia. This sec!ion implies a considerable indictment of current medical practice in that it brings out the fact that incomplete documentation, together with the failure to isolate critical problems and to formulate decisive questions to resolve them, leaves us far too long in a vague state of clinical "free-forall" and uncertainty. The "growing points" of clinical practice here include the possible use in minimizing cord damage of hypothermia, steroids, and dehydrating agents. There is also a decription of some initial attempts to apply the previous animal experiments on intercostal nerve anastomoses to the human paraplegic. The 3rd section, on the brain stem, seems to
have been the least spontaneously successful. The most startling claim in this section is that acetylcholine crystals injected into the grey matter of the cat's spinal cord could induce sleep. By stereotactic injections in cats a precisely definied "hypnogenic" area extending from pons to median forebrain bundle has been demonstrated. The 4th section amounts to a section of "free communications" under the heading of recent advances in neurosurgery. There is obviously a vivid current interest in gaining access to the anterior aspect of the upper two cervical vertebrae and to the clivus, foran impressivetechniqueof trans-cervical trans-clival craniotomy promoted considerable discussion. Ingenious technical developments include the induction heating of implanted steel pellets for the making of focal brain lesions, techniques for the direct current thrombosis of intracranial aneurysms, artificial embolization of vascular malformations and the removal of normal and pathological intracranial structures by freezing. The subject of chemotherapy of malignant intracerebral tumours also receives mention. Perhaps because it has so far shown so little real promise, it receives far less attention than its numerical importance justifies. To review a publication like this is a difficult task. One is beset by so many impressions: at one moment, international conferences such as this fill one with an impression of overwhelming tedium; at another, some new idea flashes and sets one's imagination aglow, or at another moment one is grateful for a convenient review of recent advances - - even if some of them have been first reported several years beforehand. One admires the administrative abilities of the organizers of these conferences and one respects the publishers who can produce an elegant printed version of it some 15 months after its conclusion, but when all is said "Who will buy this book?" Probably only libraries with a duty and desire to keep a complete record of neurosurgical publications. The private "student" of neurosurgical thought and progress will read the contributions which interest him in the individual scientific journals in which the same studies have undoubtedly already been reported, or in which they will soon appear in amplified form. As long as congresses like this continue, it seems that summaries of the papers, circulated in advance, are all that are really desired. A. JEFFERSON
J. neurol. Sci. (1968) 6:607-608