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Raised intracranial pressure. A clinical guide
Surg Neurol 1991;36:317-8
317
Book Reviews
Raised Intracranial Pressure. A Clinical Guide. By Brian N o r t h and Peter Reilly. 109 pages. $55.00. S t o n e h a m : B u t t e r w o r t h s , 1990. This book deals with the subject of intracranial pressure. It does so in a concise but thorough manner. While the purpose of the book is to provide a guide for those individuals who may be interested but not that familiar with the clinical problems associated with raised intracranial pressure, it is likely more experienced workers will find much of interest in it. The book's 10 chapters range from the anatomy and physiology of cerebrospinal fluid to the indications for intracranial pressure monitoring. Potentially difficult concepts, such as elastance and compliance, are clearly explained. The relationship of intracranial pressure to cerebral blood flow is delineated. The role of cerebrovascular resistance in determining cerebral blood flow is given appropriate weight; but, interestingly, perhaps the more useful concept clinically of cerebral perfusion pressure is not defined until the glossary. The reasons for the enigma that raised intracranial pressure in the absence of a mass lesion produces few symptoms and signs are thoroughly discussed. The various devices used to measure intracranial pressure are described. The wide availability of these devices makes it unlikely that someone would have to assemble the apparatus described by the authors in order to begin monitoring intracranial pressure. While the authors overall prefer the subdural catheter, other monitoring systems are described equally well, and situations are cited in which their use may be appropriate. The accompanying illustrations are clear and enhance the text. The reader who wishes to pursue further some aspect of the problem of raised intracranial pressure will find the selected but complete list of references helpful. This highly readable book should be available to anyone who is interested in intracranial pressure and who is involved in the care of patients who might have raised intracranial pressure. FRANKLIN C. WAGNER, Jr., M.D. Sacramento, California
Traumatic Transtentorial Herniation and its M a n a g e m e n t . By Brian T. A n d r e w s , M.D., and Lawrence H. Pitts, M.D. 146 pages. $40.00. M o u n t Kisco, N e w York: F u t u r a P u b l i s h i n g C o m p a n y , 1991. I read this book with great interest because of my background: I began in neurosurgery in the 1940s and 50s, before routine intratracheal intubation, before Mannitol, before the corn© 1991 by ElsevierSciencePublishingCo., Inc.
puted tomography (CT) scan, and before routine measurement of intracranial pressure. I thought I might be reading again about cutting the tentorium in cases of severe head injuries. This was, in fact, written about and done often in the late 50s, in conjunction with the multiple burr holes and explorations that were carried out on all serious head injuries. In reading this book, I do not believe there was any mention of cutting the tentorium, although the authors have gone through over 150 cases in which multiple burr holes were done on acutely injured patients, sometimes before CT scans were performed, to ascertain whether some patients could be salvaged in this way. Cutting the tentorium was common practice. Pitts and Andrews have been in the thick of taking care of the most severely injured patients, have kept good records on their patients, have written about what they are doing, and have freely discussed what they have done at national meetings. They have had heated arguments with those who disagreed with them, and though there have been many disagreements, there has never been a disagreeable episode. In fact, I sense some alteration in their opinion about the value of multiple burr holes before doing CT scans. They are not certain that this is the way to do it, but have really given it a good try. They have made frequent reference to the evaluation of patients with the background of Posner and Plum's classic book on stupor and coma. Their anatomical drawings, particularly in the first chapter, are clear, and they have clearly outlined their own preference for the way patients should be handled. The number of patients salvaged by multiple burr holes may not be very great because the mortality rate with transtentorial herniation is so high, but one cannot controvert the great effort these surgeons and their colleagues have made. Andrews and Pitts have clearly outlined all aspects of their treatment and evaluation of patients and what can be expected of patients who do survive. They have given a clear discussion of the value of declaring brain death when it does occur, and judicious advice about the treatment of the relatives who are on hand. The quotations in the bibliography are excellent. Both the mature surgeon who has taken care of patients with severe head trauma for years and the surgeon in training who is faced with many of the issues expressed in this book will profit from reading the clear and succinct text. If I had any suggestions to make for improvement, I would have favored giving due credit to Henri Duret who, in 1878, so clearly described hemorrhages in the brain stem of experimental animals in whom he ingeniously created supratentorial pressure and demonstrated hemorrhages which we often see in patients who have severe head injuries with intracranial pressure and transtentorial herniation. EBEN ALEXANDER, JR., M.D. Winston-Salem, North Carolina 0090-3019/9l/S3.50
317
Book Reviews
Raised Intracranial Pressure. A Clinical Guide. By Brian N o r t h and Peter Reilly. 109 pages. $55.00. S t o n e h a m : B u t t e r w o r t h s , 1990. This book deals with the subject of intracranial pressure. It does so in a concise but thorough manner. While the purpose of the book is to provide a guide for those individuals who may be interested but not that familiar with the clinical problems associated with raised intracranial pressure, it is likely more experienced workers will find much of interest in it. The book's 10 chapters range from the anatomy and physiology of cerebrospinal fluid to the indications for intracranial pressure monitoring. Potentially difficult concepts, such as elastance and compliance, are clearly explained. The relationship of intracranial pressure to cerebral blood flow is delineated. The role of cerebrovascular resistance in determining cerebral blood flow is given appropriate weight; but, interestingly, perhaps the more useful concept clinically of cerebral perfusion pressure is not defined until the glossary. The reasons for the enigma that raised intracranial pressure in the absence of a mass lesion produces few symptoms and signs are thoroughly discussed. The various devices used to measure intracranial pressure are described. The wide availability of these devices makes it unlikely that someone would have to assemble the apparatus described by the authors in order to begin monitoring intracranial pressure. While the authors overall prefer the subdural catheter, other monitoring systems are described equally well, and situations are cited in which their use may be appropriate. The accompanying illustrations are clear and enhance the text. The reader who wishes to pursue further some aspect of the problem of raised intracranial pressure will find the selected but complete list of references helpful. This highly readable book should be available to anyone who is interested in intracranial pressure and who is involved in the care of patients who might have raised intracranial pressure. FRANKLIN C. WAGNER, Jr., M.D. Sacramento, California
Traumatic Transtentorial Herniation and its M a n a g e m e n t . By Brian T. A n d r e w s , M.D., and Lawrence H. Pitts, M.D. 146 pages. $40.00. M o u n t Kisco, N e w York: F u t u r a P u b l i s h i n g C o m p a n y , 1991. I read this book with great interest because of my background: I began in neurosurgery in the 1940s and 50s, before routine intratracheal intubation, before Mannitol, before the corn© 1991 by ElsevierSciencePublishingCo., Inc.
puted tomography (CT) scan, and before routine measurement of intracranial pressure. I thought I might be reading again about cutting the tentorium in cases of severe head injuries. This was, in fact, written about and done often in the late 50s, in conjunction with the multiple burr holes and explorations that were carried out on all serious head injuries. In reading this book, I do not believe there was any mention of cutting the tentorium, although the authors have gone through over 150 cases in which multiple burr holes were done on acutely injured patients, sometimes before CT scans were performed, to ascertain whether some patients could be salvaged in this way. Cutting the tentorium was common practice. Pitts and Andrews have been in the thick of taking care of the most severely injured patients, have kept good records on their patients, have written about what they are doing, and have freely discussed what they have done at national meetings. They have had heated arguments with those who disagreed with them, and though there have been many disagreements, there has never been a disagreeable episode. In fact, I sense some alteration in their opinion about the value of multiple burr holes before doing CT scans. They are not certain that this is the way to do it, but have really given it a good try. They have made frequent reference to the evaluation of patients with the background of Posner and Plum's classic book on stupor and coma. Their anatomical drawings, particularly in the first chapter, are clear, and they have clearly outlined their own preference for the way patients should be handled. The number of patients salvaged by multiple burr holes may not be very great because the mortality rate with transtentorial herniation is so high, but one cannot controvert the great effort these surgeons and their colleagues have made. Andrews and Pitts have clearly outlined all aspects of their treatment and evaluation of patients and what can be expected of patients who do survive. They have given a clear discussion of the value of declaring brain death when it does occur, and judicious advice about the treatment of the relatives who are on hand. The quotations in the bibliography are excellent. Both the mature surgeon who has taken care of patients with severe head trauma for years and the surgeon in training who is faced with many of the issues expressed in this book will profit from reading the clear and succinct text. If I had any suggestions to make for improvement, I would have favored giving due credit to Henri Duret who, in 1878, so clearly described hemorrhages in the brain stem of experimental animals in whom he ingeniously created supratentorial pressure and demonstrated hemorrhages which we often see in patients who have severe head injuries with intracranial pressure and transtentorial herniation. EBEN ALEXANDER, JR., M.D. Winston-Salem, North Carolina 0090-3019/9l/S3.50