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Steroids in diseases of the central nervous system
Surg Neural 1991;35:165-7
Book Reviews
angioplasty and thrombolysis. These chapters tend to be more speculative and anecdotal in nature, with the authors, such as Robert F. Spetzler, M.D. (barbiturates), presenting their personal experiences with the use of an agent or technique. Of note, the chapter “Optimal Anesthetic Techniques for Patients at Risk of Cerebral Ischemia,” contributed by Robert W. McPherson, M.D., Jeffrey R. Kirsch, M.D., and Richard J. Traystman, Ph.D., lacks an adequate discussion of the cardiovascular conditions that frequently complicate anesthesia for patients at risk of cerebral ischemia. Overall, this book provides an enjoyable and informative reading experience. It’s a pleasure to read discussions of current research by acknowledged experts in the study and treatment of cerebral ischemia. The editors are to be congratulated on a fine addition to the series. Neurologists, neurosurgeons, and indeed any physician who is interested in the protection of the brain should appreciate this volume. PATRICIA PETROZZA, M.D. Winston-Salem, North Carolina
Steroids in Diseases of the Central System. Edited by Rudy Capildeo. 320 pages. York: Wiley-Liss, 1990.
Nervous $66.00.
New
One of the most important advances in neurosurgery was the application, some 30 years ago, of glucocorticoids in the management of peritumoral brain edema. This transformed the procedures of brain biopsy and craniotomy for resection of tumor, and must, by now, have saved thousands of lives. Inevitably, the dramatic success of steroid therapy led to widening of the indications, despite clear statements by French and Maxwell that steroid therapy was most effective when brain edema was chronic and focal and least effective when edema was acute and diffuse. Nevertheless, steroids were enthusiastically applied in cases of stroke, head injury, and spinal cord injury, and when doses that were effective in tumor cases failed to show similar benefit, the dose was increased, but benefit still could not be unequivocally shown. Enthusiasm gave way to disillusionment. Meanwhile, experimental evidence was accumulating that even higher doses of steroids might be effective in reducing lipid peroxidation and preserving membrane function. This led to further trials of “ultra-high” dose steroids in spinal cord injury and severe head injury. The spinal cord injury study has now shown some benefit for very high dose methylprednisolone given early and for 24 hours only, while the result of the head injury study should be available by the end of 1990. The appearance of this multiauthor review of the use of steroid therapy in CNS disorders is, therefore, very timely. The book derives from an international workshop held at the Royal Society of Medicine in London. It is presented in basic
167
sciences and clinical sections. Highlights of the basic sciences section are chapters on molecular mechanisms, steroid action on blood-brain barrier function, and a presentation on the new 21-aminosteroids that appear to confer the benefits of steroid therapy without any glucocorticoid action. In the section on brain tumors, there is convincing evidence that high dosing with 500 mg of methylprednisolone on alternate days can be continued for a year without impairing the function of the hypothalamopituitary axis, yet conferring clinical benefit. The section on head and spinal injury reviews the many clinical studies already reported, and reports a new study of steroid therapy in moderate head injury, in which benefit appeared to result from high-dose therapy in patients under 40 years of age. The section on steroid therapy for pain reviews treatment for both cancer pain and low back pain. A number of chapters review the results of steroid therapy for multiple sclerosis and their use in a wide range of neurological disorders, including Guillain-Barre syndrome, myasthenia gravis, stroke, headache, and a number of neuropathies. This handy little book might be compared, somewhat fancifully, to a convenience food. Attractively packaged and easily digested, its purchase will save the buyer the large number of trips to the medical library that would be needed to assemble the information contained within its covers. J. DOUGLAS MILLER, Edinburgh, Scotland
M.D.,
Ph.D.
Patient Care in Neurosurgery, Third Edition. By Nelson M. Oyesiku, M.D., and A. Loren Amacher, M.D. 317 pages. $37.50. Boston: Little, Brown and Company, 1990. This is the third edition of a book that is obviously popular with the residents in training in neurosurgery. It is written by a resident who is training under Dr. George Tindall at Emory, and by Dr. A. Loren Amacher from Danville, Pennsylvania, who has had extensive experience in training residents. The book is highly organized and well illustrated with various drawings, a book that can fit into the side pocket of a resident who is interested in looking up various normal figures and methods. There are many lined drawings showing methods such as measuring intracranial pressure, oxygen saturation, and things of that nature, but no illustrations of x-rays, CT scans, or MRIs. This is a book that has been useful to the neurosurgical training community, and from the observation of reading it, it is indicated to be a very useful and accurate volume. EBEN ALEXANDER, Winston-Salem, North
JR., M.D. Carolina
Book Reviews
angioplasty and thrombolysis. These chapters tend to be more speculative and anecdotal in nature, with the authors, such as Robert F. Spetzler, M.D. (barbiturates), presenting their personal experiences with the use of an agent or technique. Of note, the chapter “Optimal Anesthetic Techniques for Patients at Risk of Cerebral Ischemia,” contributed by Robert W. McPherson, M.D., Jeffrey R. Kirsch, M.D., and Richard J. Traystman, Ph.D., lacks an adequate discussion of the cardiovascular conditions that frequently complicate anesthesia for patients at risk of cerebral ischemia. Overall, this book provides an enjoyable and informative reading experience. It’s a pleasure to read discussions of current research by acknowledged experts in the study and treatment of cerebral ischemia. The editors are to be congratulated on a fine addition to the series. Neurologists, neurosurgeons, and indeed any physician who is interested in the protection of the brain should appreciate this volume. PATRICIA PETROZZA, M.D. Winston-Salem, North Carolina
Steroids in Diseases of the Central System. Edited by Rudy Capildeo. 320 pages. York: Wiley-Liss, 1990.
Nervous $66.00.
New
One of the most important advances in neurosurgery was the application, some 30 years ago, of glucocorticoids in the management of peritumoral brain edema. This transformed the procedures of brain biopsy and craniotomy for resection of tumor, and must, by now, have saved thousands of lives. Inevitably, the dramatic success of steroid therapy led to widening of the indications, despite clear statements by French and Maxwell that steroid therapy was most effective when brain edema was chronic and focal and least effective when edema was acute and diffuse. Nevertheless, steroids were enthusiastically applied in cases of stroke, head injury, and spinal cord injury, and when doses that were effective in tumor cases failed to show similar benefit, the dose was increased, but benefit still could not be unequivocally shown. Enthusiasm gave way to disillusionment. Meanwhile, experimental evidence was accumulating that even higher doses of steroids might be effective in reducing lipid peroxidation and preserving membrane function. This led to further trials of “ultra-high” dose steroids in spinal cord injury and severe head injury. The spinal cord injury study has now shown some benefit for very high dose methylprednisolone given early and for 24 hours only, while the result of the head injury study should be available by the end of 1990. The appearance of this multiauthor review of the use of steroid therapy in CNS disorders is, therefore, very timely. The book derives from an international workshop held at the Royal Society of Medicine in London. It is presented in basic
167
sciences and clinical sections. Highlights of the basic sciences section are chapters on molecular mechanisms, steroid action on blood-brain barrier function, and a presentation on the new 21-aminosteroids that appear to confer the benefits of steroid therapy without any glucocorticoid action. In the section on brain tumors, there is convincing evidence that high dosing with 500 mg of methylprednisolone on alternate days can be continued for a year without impairing the function of the hypothalamopituitary axis, yet conferring clinical benefit. The section on head and spinal injury reviews the many clinical studies already reported, and reports a new study of steroid therapy in moderate head injury, in which benefit appeared to result from high-dose therapy in patients under 40 years of age. The section on steroid therapy for pain reviews treatment for both cancer pain and low back pain. A number of chapters review the results of steroid therapy for multiple sclerosis and their use in a wide range of neurological disorders, including Guillain-Barre syndrome, myasthenia gravis, stroke, headache, and a number of neuropathies. This handy little book might be compared, somewhat fancifully, to a convenience food. Attractively packaged and easily digested, its purchase will save the buyer the large number of trips to the medical library that would be needed to assemble the information contained within its covers. J. DOUGLAS MILLER, Edinburgh, Scotland
M.D.,
Ph.D.
Patient Care in Neurosurgery, Third Edition. By Nelson M. Oyesiku, M.D., and A. Loren Amacher, M.D. 317 pages. $37.50. Boston: Little, Brown and Company, 1990. This is the third edition of a book that is obviously popular with the residents in training in neurosurgery. It is written by a resident who is training under Dr. George Tindall at Emory, and by Dr. A. Loren Amacher from Danville, Pennsylvania, who has had extensive experience in training residents. The book is highly organized and well illustrated with various drawings, a book that can fit into the side pocket of a resident who is interested in looking up various normal figures and methods. There are many lined drawings showing methods such as measuring intracranial pressure, oxygen saturation, and things of that nature, but no illustrations of x-rays, CT scans, or MRIs. This is a book that has been useful to the neurosurgical training community, and from the observation of reading it, it is indicated to be a very useful and accurate volume. EBEN ALEXANDER, Winston-Salem, North
JR., M.D. Carolina