- Email: [email protected]
The Vertebral Artery: Pathology and Surgery
Mayo Clin Proc, November 1987, Vol 62
the related discussion include no mention of the right gastric artery. The pancreaticoduodenal arcades are incompletely depicted in this line drawing, and the discussion is likewise incomplete. Because the book specifically addresses problems of the visceral vasculature, more than one simple line drawing of the anatomy seems warranted. This anatomic area is complex and gives rise to many of the dilemmas faced by internists, radiologists, and surgeons who deal with these problems. Medical students or residents using this book as the basis for an understanding of the visceral anatomy would be poorly served by this section. The next section, "The Angiographic Diagnosis of Visceral Vascular Disease," is a long chapter. The authors seem to devote more time to discussing the clinical disease states than to presenting the radiographic findings themselves. I would have preferred more detail concerning the various angiographic findings associated with intestinal and renal ischemia. As an example, a meandering artery is not specifically shown on the roentgenograms that demonstrate intestinal ischemia. Furthermore, the section on ischemia of the large bowel is confusing. No clear distinction is made between acute and chronic ischemia, and the entity of ischemic colitis is not truly distinguished from acute ischemia seen with ligation of the inferior mesenteric artery. In the United States, ischemic colitis is recognized as somewhat of a different entity, with large-artery involvement being an infrequent precursor. In general, the rest of the book is good as a review. The concise chapter on acute mesenteric ischemia presents up-to-date material. The section on chronic mesenteric ischemia, however, is too short; many of the subtleties of surgical reconstructions are either mentioned only briefly or addressed superficially. The sections on nonatherosclerotic vascular diseases and visceral artery aneurysms are good, and the chapters on renal artery disease and renal artery reconstruction are well written and informative. These latter chapters are written by both vascular surgeons and urologists with national reputations in the field of renal artery reconstruction; this multidisciplinary approach adds to the appeal of these chapters as reference sources. In summary, this book is a review of diseases of the visceral arteries and the operative techniques currently available to correct them. Per-
BOOK REVIEWS
1064
haps separate volumes on the intestinal arteries and the renal arteries would have allowed a more thorough presentation. The book should be useful for medical students and residents interested in these disease processes, although it is difficult to imagine that more than a handful of medical students would have a specialized interest in visceral artery disease states at such an early stage in their careers. Surgeons involved in these vascular reconstructions might consider this a good review of current practice but would probably find little new material. The cost of the book would probably make it a prohibitive personal purchase for medical students and residents. Kenneth J. Cherry, Jr., M.D. Section of Vascular Surgery
The Vertebral Artery: Pathology and Surgery, by Bernard George and Claude Laurian, 258 pp, with illus, $105, New York, SpringerVerlag, 1987 This concise monograph is the fruition of collaborative efforts by a neurosurgeon and a vascular surgeon and is an example of the type of progress that can be made by the cooperation between these related disciplines. Both authors are acknowledged experts in the field of vertebral artery reconstruction. The monograph begins with a detailed discussion of the anatomic features of the vertebral artery and then in sequence discusses the following topics: congenital abnormalities, arteriovenous malformations, tumors, trauma, and occlusive disease of the vertebral artery itself. In a rather unusual format, the authors have presented the techniques for each of the aforementioned disease processes in separate sections. This arrangement causes no problem once the reader becomes aware of the organization. The depth of the interest of the authors in research on the vertebral artery is indicated by the extensive bibliography and the details of the historical background. The book is well illustrated, and specific cases are discussed in detail. In my opinion, the most interesting section of the book is that relating to surgical procedures on the distal extracranial vertebral artery. The
Mayo Clin Proc, November 1987, Vol 62
authors have the most extensive experience in the world in this area and are obviously experts on this subject. In this material, they provide the best description available to date in the English literature relating to the surgical exposure of the distal extracranial vertebral artery. Much of this work has previously been reported in the French literature, but only condensed translations have been available in English. This section itself justifies purchase of the book. Thoralf M. Sundt, Jr., M.D. Department of Neurologic Surgery
Cerebral Blood Flow: Physiologic and Clinical Aspects, edited by James H. Wood, 792 pp, with illus, $79, New York, McGraw-Hill Book Company, 1987 Most multiauthoröd books are characterized by nonuniformity in quality, having excellent chapters written by some authors, mediocre chapters by others, and poor chapters contributed by the rest. Frequently, little cohesion is present between chapters on various related subjects, and repetition of information from one chapter to the next may be evident. In these respects, Cerebral Blood Flow, edited by James H. Wood, is atypical. Dr. Wood enlisted the help of 89 authors to write the 46 chapters in the nine sections that constitute this work. Most of the authors are wellknown authorities in the field on which they write. All the chapters are uniformly excellent, well written, and well referenced. The subjects of the chapters flow smoothly from one to another, and little redundant material is present. The chapters are adequately illustrated, and the art work is consistently good. The historical chapter by Anthony Bell is fascinating, well researched, and well written. He describes the evolution of knowledge regarding the function and circulation of the brain from its first mention in 2800 BC by the Egyptian physician Imhotep. The book is worth having for this chapter alone. The section on cerebrovascular anatomy describes in detail the arterial and venous systems of the brain in separate chapters. This section also presents the gross pathologic anatomy and light and electron microscopic features of brain
BOOK REVIEWS
1065
ischemia with clinical anatomic correlations. This information is basic enough to be useful to medical students but also of sufficient detail to be valuable to clinicians and basic scientists. Next, four chapters summarize the current information on cerebrovascular physiology and consider the mechanisms that regulate and influence cerebral blood flow: variation of perfusion pressure and metabolism, ionic and eicosanoid regulation of vascular smooth muscles, neural innervation, and blood rheology. Clinical methods for measurement of cerebral blood flow are discussed in five chapters. Detailed descriptions are provided of all the methods currently used clinically—xenon clearance, xenon inhalation, xenon-enhanced computed tomographic scanning, single photon-emission tomography, and positron-emission tomography. These clear and informative chapters should enable clinicians to understand these methods so that they may interpret contemporary clinical research reports on the subject. Experimental methods are also discussed, including the hydrogen clearance, microsphere, and autoradiographic techniques. The advantages and limitations of each of these methods are clearly presented. The section on imaging of cerebral circulation discusses ultrasonography, computed tomographic scanning, intravenous digital subtraction angiography, intra-arterial digital angiography, and conventional angiography. The advantages, methods, and pitfalls for each technique are discussed. This section should be extremely useful for clinicians who must choose which diagnostic test is most appropriate in patients who have symptoms of ischemia. Fourteen chapters on cerebrovascular pathophysiology discuss important basic science aspects of subarachnoid hemorrhage, ischemia, embolism, migraine, hypertensive encephalopathy, and arteriovenous malformations. The concepts of focal ischemic thresholds, ischemic penumbra, and cerebral steal are presented in a clear and scholarly manner. After this basic science information, the next section consists of chapters on the medical management of transient ischemia, vasospasm, and ischemic stroke. The concepts and methods described are clinically useful. The last section, "Surgical and Interventional Methods," presents "state-of-the-art" material on surgical techniques. Carotid endarterectomy and the use of intraoperative cerebral blood flow mea-
the related discussion include no mention of the right gastric artery. The pancreaticoduodenal arcades are incompletely depicted in this line drawing, and the discussion is likewise incomplete. Because the book specifically addresses problems of the visceral vasculature, more than one simple line drawing of the anatomy seems warranted. This anatomic area is complex and gives rise to many of the dilemmas faced by internists, radiologists, and surgeons who deal with these problems. Medical students or residents using this book as the basis for an understanding of the visceral anatomy would be poorly served by this section. The next section, "The Angiographic Diagnosis of Visceral Vascular Disease," is a long chapter. The authors seem to devote more time to discussing the clinical disease states than to presenting the radiographic findings themselves. I would have preferred more detail concerning the various angiographic findings associated with intestinal and renal ischemia. As an example, a meandering artery is not specifically shown on the roentgenograms that demonstrate intestinal ischemia. Furthermore, the section on ischemia of the large bowel is confusing. No clear distinction is made between acute and chronic ischemia, and the entity of ischemic colitis is not truly distinguished from acute ischemia seen with ligation of the inferior mesenteric artery. In the United States, ischemic colitis is recognized as somewhat of a different entity, with large-artery involvement being an infrequent precursor. In general, the rest of the book is good as a review. The concise chapter on acute mesenteric ischemia presents up-to-date material. The section on chronic mesenteric ischemia, however, is too short; many of the subtleties of surgical reconstructions are either mentioned only briefly or addressed superficially. The sections on nonatherosclerotic vascular diseases and visceral artery aneurysms are good, and the chapters on renal artery disease and renal artery reconstruction are well written and informative. These latter chapters are written by both vascular surgeons and urologists with national reputations in the field of renal artery reconstruction; this multidisciplinary approach adds to the appeal of these chapters as reference sources. In summary, this book is a review of diseases of the visceral arteries and the operative techniques currently available to correct them. Per-
BOOK REVIEWS
1064
haps separate volumes on the intestinal arteries and the renal arteries would have allowed a more thorough presentation. The book should be useful for medical students and residents interested in these disease processes, although it is difficult to imagine that more than a handful of medical students would have a specialized interest in visceral artery disease states at such an early stage in their careers. Surgeons involved in these vascular reconstructions might consider this a good review of current practice but would probably find little new material. The cost of the book would probably make it a prohibitive personal purchase for medical students and residents. Kenneth J. Cherry, Jr., M.D. Section of Vascular Surgery
The Vertebral Artery: Pathology and Surgery, by Bernard George and Claude Laurian, 258 pp, with illus, $105, New York, SpringerVerlag, 1987 This concise monograph is the fruition of collaborative efforts by a neurosurgeon and a vascular surgeon and is an example of the type of progress that can be made by the cooperation between these related disciplines. Both authors are acknowledged experts in the field of vertebral artery reconstruction. The monograph begins with a detailed discussion of the anatomic features of the vertebral artery and then in sequence discusses the following topics: congenital abnormalities, arteriovenous malformations, tumors, trauma, and occlusive disease of the vertebral artery itself. In a rather unusual format, the authors have presented the techniques for each of the aforementioned disease processes in separate sections. This arrangement causes no problem once the reader becomes aware of the organization. The depth of the interest of the authors in research on the vertebral artery is indicated by the extensive bibliography and the details of the historical background. The book is well illustrated, and specific cases are discussed in detail. In my opinion, the most interesting section of the book is that relating to surgical procedures on the distal extracranial vertebral artery. The
Mayo Clin Proc, November 1987, Vol 62
authors have the most extensive experience in the world in this area and are obviously experts on this subject. In this material, they provide the best description available to date in the English literature relating to the surgical exposure of the distal extracranial vertebral artery. Much of this work has previously been reported in the French literature, but only condensed translations have been available in English. This section itself justifies purchase of the book. Thoralf M. Sundt, Jr., M.D. Department of Neurologic Surgery
Cerebral Blood Flow: Physiologic and Clinical Aspects, edited by James H. Wood, 792 pp, with illus, $79, New York, McGraw-Hill Book Company, 1987 Most multiauthoröd books are characterized by nonuniformity in quality, having excellent chapters written by some authors, mediocre chapters by others, and poor chapters contributed by the rest. Frequently, little cohesion is present between chapters on various related subjects, and repetition of information from one chapter to the next may be evident. In these respects, Cerebral Blood Flow, edited by James H. Wood, is atypical. Dr. Wood enlisted the help of 89 authors to write the 46 chapters in the nine sections that constitute this work. Most of the authors are wellknown authorities in the field on which they write. All the chapters are uniformly excellent, well written, and well referenced. The subjects of the chapters flow smoothly from one to another, and little redundant material is present. The chapters are adequately illustrated, and the art work is consistently good. The historical chapter by Anthony Bell is fascinating, well researched, and well written. He describes the evolution of knowledge regarding the function and circulation of the brain from its first mention in 2800 BC by the Egyptian physician Imhotep. The book is worth having for this chapter alone. The section on cerebrovascular anatomy describes in detail the arterial and venous systems of the brain in separate chapters. This section also presents the gross pathologic anatomy and light and electron microscopic features of brain
BOOK REVIEWS
1065
ischemia with clinical anatomic correlations. This information is basic enough to be useful to medical students but also of sufficient detail to be valuable to clinicians and basic scientists. Next, four chapters summarize the current information on cerebrovascular physiology and consider the mechanisms that regulate and influence cerebral blood flow: variation of perfusion pressure and metabolism, ionic and eicosanoid regulation of vascular smooth muscles, neural innervation, and blood rheology. Clinical methods for measurement of cerebral blood flow are discussed in five chapters. Detailed descriptions are provided of all the methods currently used clinically—xenon clearance, xenon inhalation, xenon-enhanced computed tomographic scanning, single photon-emission tomography, and positron-emission tomography. These clear and informative chapters should enable clinicians to understand these methods so that they may interpret contemporary clinical research reports on the subject. Experimental methods are also discussed, including the hydrogen clearance, microsphere, and autoradiographic techniques. The advantages and limitations of each of these methods are clearly presented. The section on imaging of cerebral circulation discusses ultrasonography, computed tomographic scanning, intravenous digital subtraction angiography, intra-arterial digital angiography, and conventional angiography. The advantages, methods, and pitfalls for each technique are discussed. This section should be extremely useful for clinicians who must choose which diagnostic test is most appropriate in patients who have symptoms of ischemia. Fourteen chapters on cerebrovascular pathophysiology discuss important basic science aspects of subarachnoid hemorrhage, ischemia, embolism, migraine, hypertensive encephalopathy, and arteriovenous malformations. The concepts of focal ischemic thresholds, ischemic penumbra, and cerebral steal are presented in a clear and scholarly manner. After this basic science information, the next section consists of chapters on the medical management of transient ischemia, vasospasm, and ischemic stroke. The concepts and methods described are clinically useful. The last section, "Surgical and Interventional Methods," presents "state-of-the-art" material on surgical techniques. Carotid endarterectomy and the use of intraoperative cerebral blood flow mea-