Cranial Base Surgery
Editors: JT Robertson, HB Coakham, JH Robertson
Published by: Churchill Livingstone, London, Edinburgh, New York, Philadelphia,
St Louis, Sydney, Toronto. 2000
ISBN Number: 0 443 056854
This book serves as an introduction for the inexperienced "skull-base
surgeon" and the "general neurosurgeon". The editors emphasise, in their
introduction, that due caution should be taken when attacking skull
base tumours and that skull base surgery should be seen as a team approach
and not be undertaken on an individual basis.
Views in the different chapters are mostly updated but the numerous
authors in between give it a slightly inhomogeneous presentation. However,
the editors have introduced excellent treatment/evaluation algorithms
in each chapter, being of support for the inexperienced surgeon.
The drawings are generally of good quality but too many are presented
in a standard fashion, upside/down and not in the OR-situation, where
the surgeon shall visualise the anatomy. Some of the drawings eg. in
chapter 8, should have been omitted or at least commented as they show
old fashioned retraction of brain not in accordance with skull base
techniques (Fig 19.5, pages 350-351). Only in the chapters of microvascular
decompression (30 and 31) and endoscopic assisted surgery (36) are high
quality coloured operative images used. The remaining operative photographs
are all black and white and in effect of limited benefit to the reader.
Overall, the book definitely lacks demonstration and discussion of modern
3-D imaging.
The chapter on neurophysiological monitoring (5) by Aage R Møller gives
a nice up to date review of these techniques. In combination with the
microvascular decompression chapters by Coakham and Jannetta/Resnick,
these should give an interested surgeon a good introduction to a field
most experienced microvascular surgeons can establish. The chapter on
neuroanaesthesia (6) by Wayne Hamm, is an outstanding review "from the
other side" of the OR-table and should definitely be consulted. The
chapter on craniopharyngioma (23) in contrast lacks updating with no
reference to 3rd ventriculostomy and the latest results from paediatric
literature. The chapter on petroclival meningiomas by Pieper and Al
Mefty (25) gives an easy presentation of a difficult topic. The short
chapter on dural arteriovenous fistulas (29) by Grote and Voigt gives
the newcomer an understanding and an introduction as to how these lesions
should be approached - and when not.
Reviews of chemotherapy (33) and radiosurgery (35) are given in two
nice chapters, bearing in mind that the development of these techniques
is fast and that "evidence" on long-term results of radiosurgery is
still limited due to lack of controlled studies and knowledge of natural
behaviour of the tumours treated. The endoscopic assisted chapter by
Fries and Perneczky (36) gives an introduction to this elegant adjuvant
technique, but it should have been pointed out that a long training
period in endoscopic technique is a prerequisite. The chapter on frameless
sterotaxy (37) does not give these techniques their "millennium" benefit.
The reason possibly being the very fast technical development. The reviewer,
as often before, notes the omission of a chapter on how a surgeon should
prepare for this type of surgery in a training programme and by rehearsal
on cadavers and today, of course, visual reality models. It is beneficial
that there are only a few OR-pictures as these are of no real teaching
value. The anatomy and visualisation of these techniques can only be
learned by working in a 3D space.
In conclusion, this books serves as an excellent introduction to a difficult
topic and should be carefully studied by any surgeon who plans on approaching
these lesions before the surgery is carried out. I recommend that this
book be kept on the library shelf of any department dealing with skull
base surgery and training of residents.
Prof. Jens Haase, MD
Department of Neurosurgery
Aalborg University Hospital,
Denmark.
