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Intervertebral Fusion Using Carbon Fiber Reinforced Polymer Implants

Editors: John W. Brantigan 653 pages Quality Medical Publishing, St. Louis, MO (2006)
The use of manufactured spinal interbody fusion devices has been a recent development, a fact that is frequently taken for granted by surgeons trained in the modern era of spinal neurological or orthopedic surgery. One of the pioneers in this eld, John Brantigan, was instrumental in the development of the rst such devices, carbon ber cages, in the 1980s. This text outlines the full spectrum of topics concerning these implants, including their history, indications, biomechanics, and surgical application. The text is well-written, accessible to surgeons at all levels of training, and is lled with beautiful color photos and gures. Several chapters in the book are particularly noteworthy. Chapter 2, contributed by Wolfgang Rauschling, is lled with fantastic color sections of the human spinal column that brilliantly illustrate both the normal and pathological anatomy. Chapter 8, Transfusion Management, is a highly detailed and informative discourse with information that is vital for all surgeons but seldom found in neurosurgical texts. It outlines pre-, intra-, and postoperative strategies for avoiding and administering blood product replenishment. Chapter 22, by Boriani et al., is a wonderfully illustrated and comprehensive discussion of vertebrectomy reconstruction for tumor removal and describes techniques for en bloc tumor removal. There are four excellent subsequent chapters on Patient Education and six on Surgical Techniques. Also included in the book are two DVDs containing narrated surgical videos from Drs. Brantigan, Taneichi, Lauryssen, and Fraser, which make for an excellent review of nuances for various interbody techniques in the cervical and lumbar spine, particularly for surgeons who are not familiar with the precise techniques for proper carpentry of interbody devices. One obvious drawback of this text is that it focuses on only a single product line of spinal implants: carbon reinforced interbody implants. These devices are essentially exclusively manufactured, marketed, and sold by Depuy Spine, Inc. (Raynham, MA), a subsidiary of Johnson and Johnson. Furthermore, the senior author, John Brantigan, has been intimately involved in the design, manufacture, and Food and Drug Administration approval of these devices; he also has nancial interests in the product. Despite

these concerns, all of these potential conicts of interest are fully disclosed in the Preface, and the authors seem to maintain a respectable level of objectivity throughout most of the text. Overall, this is a highly readable and informative text written by well-respected authorities in spinal surgery. Although the meticulous attention to detail may be excessive for neurosurgeons-in-training, this text will serve as a valuable reference and a delightful read for those with a special interest in spinal column reconstruction. Michael Y. Wang, M.D. Miami, Florida

THIEME Atlas of Anatomy Series: Volume 3: Head and Neuroanatomy

Authors: Michael Schuenke, Erik Schulte, Udo Schumacher, Lawrence Ross, Edward Lamperti, Markus M. Voll, Karl H. Wesker 412 pages Thieme Medical Publishers, New York, NY (2007)
Thieme Medical Publishers recently published the Thieme Atlas of Anatomy series. Head and Neuroanatomy is a revised translation of the German edition authored by Michael Schuenke, M.D., Ph.D., Erik Schulte, M.D., and Udo Schumacher, M.D. This atlas contains 1182 illustrations and 72 tables among its more than 400 pages. The remaining anatomy books in the series are General Anatomy and Musculoskeletal System and Neck and Internal Organs. The objective of the authors and publisher is to create an atlas suitable for the needs of students and lecturers. Specically, the atlas is designed to facilitate mastery of the extensive information presented in the text amidst the rigors of a busy academic schedule. The information is considered accurate and up-to-date. This atlas is designed to be unique in that topics are presented in a comprehensive manner. Illustrations and legends, which comprise the majority of most atlases, are accompanied by explanatory text and summarizing tables. Additionally, clinical scenarios assist with integration and correlation of anatomic information. Presenting illustrations with text allows for in-depth explanations and descriptions of anatomic structures, but the resulting book is large, heavy, and, therefore, minimally portable. One advantage of a large book is that its sizeable pages allow for small details to be illustrated at a scale that remains easy to visu-

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alize. Structures of disparate sizes can be easily distinguished and represented in a single drawing. Thus, their functional and structural relationship to each other can be depicted at the same time as their difference in scale can be appreciated. The table of contents is clear and concise, bringing ease to the initial search for a specific neuroanatomy topic. The text is much more abundant than typical anatomy atlases and is presented in an enticing format that is easy to read. The translation from German to English shows no major or consistent flaws in grammar or flow, and maintains faith to the authors original insights and intentions. Central to a review of an atlas of neuroanatomy is an evaluation of the illustrations and gures. The cross-sectional and threedimensional anatomic renderings are crisp and colorful. The anatomic relationship of structures within individual figures appears accurate in terms of scale and positional relationship. Labels for the figures are clear and well-planned. Additional information, such as physical examination ndings in oculomotor palsies, is thoroughly depicted by both tables and illustrations. Each neuroanatomy topic receives adequate attention throughout the text, making the atlas a complete source for anatomic illustrations of the head and cranial central nervous system. Head and Neuroanatomy supplements large, clear illustrations with detailed explanations and clinical correlations. This provides the reader with amounts of information beyond what is normally found in an atlas of anatomy. Although the text throughout the atlas is rich with detail, the index is difcult to navigate. Some subjects are found in unexpected places within the index, requiring a prolonged search, and subtopics are organized in a confusing method involving varying numbers of dashed lines. This may limit ease of use for those intending it as an occasional reference. However, students of anatomy courses and frequent readers of the atlas will certainly become familiar with the book and will benet greatly from its abundance of information. The reference section lists mostly foreign titles, which will be of little use to the majority of English-speaking readers. Although this may not be signicant to most students of neuroanatomy, other readers, such as basic scientists and clinical neuroscientists, who wish to review a specic topic further may be disappointed. Overall, Head and Neuroanatomy offers a unique and thoughtful approach to the subject of human neuroanatomy. The authors intended the atlas to serve as the ideal atlas of anatomy for students who are required to master massive amounts of information while balancing a busy course schedule. I consider this goal to be met by the authors and recommend the book as a primary source of learning for students whose coursework requires significant knowledge of neuroanatomy. For the purposes of a student of neuroanatomy, this atlas is a superior source of learning compared with those that offer only illustrations and labels. Other readers interested in anatomic explanations and detail, with supplemental clinical correlations, may also benefit from this atlas. The drawback of the text is that its abundance of information mandated a larger, more cumbersome book. Those searching for a portable text or

intending to use the atlas as an infrequent reference should probably consider other selections. James B. Elder, M.D. Los Angeles, California

Current Diagnosis & Treatment in Neurology

Editor: John C.M. Brust 601 pages McGraw-Hill, New York, NY (2007)
The successful practice of neurosurgery rests upon a thorough understanding of neurology. This is especially true today, as advances in neurosurgery have enabled surgeons to effectively treat a growing spectrum of neurological conditions, such as Parkinsons disease, epilepsy, and dystonia. To that end, this concise, comprehensive, and practical neurology text will prove very useful. Current Diagnosis & Treatment in Neurology is a rst edition, multi-author text edited by John C.M. Brust, M.D. Dr. Brust, a professor of neurology at Columbia University College of Physicians & Surgeons and the director of the Department of Neurology at Harlem Hospital Center in New York, has assembled a stellar group of writers from across the United States, particularly Columbia University College of Physicians & Surgeons, to create this work. To review the scope of neurology is a sizable task, albeit one that Dr. Brust has admirably accomplished. The text is divided into two sections: Neurologic Investigations, which reviews electroencephalography, electromyography, nerve conduction studies, evoked potentials, and neuroradiology, and Neurologic Disorders, which encompasses the spectrum of pathologic conditions faced by the neurologist, such as epilepsy, stroke, movement disorders, headache, dementia, multiple sclerosis, motor neuron diseases, and sleep disorders. The chapters are nicely integrated and almost never redundant despite this being a multi-author text. A summary of key diagnostic elements usually introduces the specic topics each chapter encompasses. The text is usable and management-oriented. Numerous tables beautifully highlight the main points, while black and white photographs clearly illustrate classic radiographic findings. To enhance readability, the more esoteric information is also relegated to the tables. The voluminous, crossreferenced index allows rapid access to the topic of interest. The key to Dr. Brusts success is that he doesnt stray from the goal of creating a concise yet comprehensive review of neurology. In summary, Current Diagnosis & Treatment in Neurology is a well-written text covering the many facets of neurology in a detailed, yet succinct and digestible, format. Although primarily written for generalists, I strongly recommend this thoughtfully designed book to any student or physician caring for patients with neurological disorders. Laurence Davidson, M.D. Los Angeles, California

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Adams and Grahams Introduction to Neuropathology

Editors: David I. Graham, James A.R. Nicoll, Ian Bone 464 pages Hodder Education, London, United Kingdom (2006) Adams and Grahams Introduction to Neuropathology, published by Hodder Arnold in 2006, is the third published edition of this book. The rst two versions were published in 1988 and 1994, respectively. This third edition is a comprehensive rewrite of the book, which was deemed necessary due to the lengthy time interval between the second edition and the present text. The primary goal of this introduction to neuropathology, as outlined in the editions preface, is to provide information regarding common and important central nervous system diseases. The target audience is clinicians in training, as well as basic scientists whose research may benet from a reference containing human clinical and pathological correlations. The material is organized into pathological categories such as bacterial infections, intoxications, tumors, and paraneoplastic syndromes, each of which comprises a separate chapter. One difference between this and the second edition is the expansion from 18 to 21 chapters, reecting recent advances in the eld of neuropathology. New chapters include Peroxisomal and Mitochondrial Disorders, Lysosomal Diseases and the Leukodystrophies, Disorders of the Bony Coverings of the Brain and Spine, and The Law and Forensic Neuropathology. The table of contents lists only the chapter titles and authors, in contrast to the index, which offers detail adequately organized for nding a topic of interest. The black and white illustrations, including radiology images and transmission electron micrographs, are sharp and detailed, and are framed in a manner that allows adequate context for the evaluation of the images. Extraneous information, such as dates or time stamps, often found in x-rays is absent. Schematic representations, such as a drawing of a cross-section of the brainstem showing cranial nerve nuclei, are often presented and correlate well with their partner images. The color images are also clear and sharp, with distinct colors and obvious labels, and the method of tissue preparation is indicated for each gure. Moreover, the descriptions of a specic neuropathology nding presented in the gure legends and subject of the text are well-represented by the images. The examples that the images are intended to illustrate are easy to visualize, although the level of magnication of the micrographs is not always clearly indicated. Each chapter is well organized and contains sufcient detail to provide a comprehensive introduction to the topic reviewed. The text is well-written and easy to read, and the tables clarify subtopics by condensing vital information in a well-organized format. Each chapter devotes adequate length and a sufcient number of images, including supplemental illustrations and tables, to the neuropathological category being discussed. The bibliography is referenced only infrequently throughout the book,

with references listed alphabetically as suggestions for further reading. Overall, this is a very practical text offering an introduction to pathological ndings of the central nervous system organized by category of disease. The book provides relevant clinical and radiological information, as well as guidance in the differential diagnosis of neurological diseases. The book itself is light, thin, and portable, and the text is very readable. I highly recommend this book to physicians and scientists desiring a handy neuropathology reference which, at the very least, can be used to guide further reading on a specic central nervous disease. Clinical trainees in specific fields, including pathology, neurology, forensic medicine, psychiatry, and neurosurgery, are likely to benet most from using this book as a reference or to study for their respective written boards. The editors stress that this book is an introduction to neuropathology intended to promote a closer working relationship between physicians and basic scientists from different specialties. They also intend the information to serve as a basis for clinicians and pathologists to work towards maximizing the potential of surgical specimens for diagnostic or research purposes. Toward these ends, the authors should consider their efforts a success. James B. Elder, M.D. Los Angeles, California

Neurosurgical Operative Atlas: Neuro-Oncology

Editor: Behnam Badie 337 pages Thieme Medical Publishers, New York, NY (2006)
Despite its title, this volume is not a true atlas but rather a multiauthor, edited volume that covers a number of neurosurgical techniques relevant to the operative treatment of brain tumors. Those looking for an illustrated guide to surgery are likely to be disappointed. This volume is perhaps more comparable to a technique book, such as the venerable Rands Microneurosurgery or the work of Schmidek and Sweet, rather than a traditional surgical atlas. Aimed at residents in training, this book totals 337 pages divided among 36 chapters organized into seven sections covering sellar and parasellar tumors, intraventricular tumors, spinal and peripheral nerve tumors, malignant brain tumors, surgical management of meningiomas, posterior fossa tumors, and skull base approaches. Each chapter is generally divided into sections covering patient selection, preoperative management, operative technique, and postoperative management. The authors are, with a few exceptions, recognized leaders in their eld. A number of weaknesses are evident in this book. The gures are taken from a variety of different sources and artists; as such, there is no unifying graphic theme. That being said, the quality of the illustrations is generally high. The most glaring omission, however, is the lack of footnotes or references, which are essential to the serious study of the eld, especially for those who are beginning their surgical training.

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Some topics are unevenly covered or covered in a redundant fashion. A few rather large gaps in presentation are made, particularly on the topic of primary brain tumors in which there is no serious treatment of selection of operative corridors for deep-seated primary tumors. In addition, there is no mention of modern techniques such as diffusion-tensor fiber tracking, functional magnetic resonance imaging, superselective Wada testing, etc., as guides to the surgical approach. The stereotactic biopsy is not covered, and only a rudimentary discussion of radiosurgery is presented. Fortunately, this book is strongest in its discussion of technically demanding methods for operative resection of cranial base tumors and meningiomas. These approaches comprise more than half the length of the book, and there are a number of chapters that are well suited for this books approach. In particular, chapters authored by Drs. Al-Mefty, Samii, Day, Spetzler, and Robertson are well constructed and contain particularly relevant details. Residents preparing for these complex cranial operative cases would be well served by reviewing these chapters. At a cost of $250, this book is likely to be too expensive for its intended audience of residents in training. For institutional libraries, however, it is a worthwhile purchase to complement other treatments of neuro-oncology. Joseph C.T. Chen, M.D., Ph.D. Los Angeles, California

of strokes, genetic considerations, cardiogenic embolism, and coagulation disorders that cause stroke. Chapter 15 deals with neurosurgical lesions such as aneurysms and arteriovenous malformations. Chapter 16 considers causes of intracranial hemorrhage, followed by a chapter on strokes in children and young adults. Chapter 18 treats a heterogeneous group of diseases, including venous thrombosis, pituitary apoplexy, and spinal cord vascular diseases. The remaining chapters deal with treatment options, including antithrombotic medications, surgical interventions, emergency management of suspected stroke patients, treatment of acute ischemic stroke, treatment of hemorrhagic stroke, and management of patients with recent stroke. The volume concludes with a nal chapter dealing with the rehabilitation and return of stroke patients to society. The chapters are well illustrated, with color gures included before the rst chapter. Each chapter is also referenced with a bibliography included with each chapter. In addition, there is a comprehensive index included at the end of the volume. The volume is easy to read and clinically relevant, and the subject matter is well organized. This volume should be a welcome addition to the libraries of both practicing clinical neuroscientists and those at various stages in their training. Charles Y. Liu, M.D., Ph.D. Los Angeles, California

Principles of Cerebrovascular Disease

Author: Harold P. Adams, Jr. 564 pages McGraw-Hill Professional, New York, NY (2006)
This is a single-author volume dedicated to cerebrovascular diseases from a recognized leader in neurology and cerebrovascular diseases. As listed in the acknowledgements, however, the author has enlisted help and contributions from numerous people, including neurosurgeons, neurologists, pathologists, and radiologists. There is no question about the clinical and economic impact of cerebrovascular diseases world-wide. Rather than being a neuroscience text, the purpose of this volume is to provide clinical insight and utility to practicing physicians. Therefore, details of basic science are included in a clinical context rather than being comprehensively considered. The author has organized the volume similar to the course and evaluation of a hypothetical patient with cerebrovascular diseases. There are 564 total pages organized into 25 chapters. The volume begins with three chapters on the classication, terminology, and pathophysiology of stroke, epidemiology of stroke, and organizing resources for stroke management. It is followed by a chapter on carotid disease and transient ischemic attacks. Chapters 6 and 7 consider the clinical manifestation of ischemic and hemorrhagic stroke, respectively, and are followed by a chapter on the diagnostic studies for evaluating patients with cerebrovascular disease. The next six chapters deal with atherosclerotic disease, no inammatory arteriopathies, infectious and inammatory causes

Surgical Management of Spinal Cord Injury: Controversies and Consensus

Editor: Arun P. Amar 256 pages Blackwell Publishing Limited, Oxford, United Kingdom (2007)
This text summarizes and discusses the major issues surrounding the management of patients with spinal cord injury. A particular emphasis is placed on using scientic data to support the opinions expressed in the various chapters. The text consists of 14 chapters, each of which was contributed by very well known spinal surgeons, general surgeons, emergency room physicians, and neurologists. The target audience appears to be residents and practicing surgeons faced with managing patients with spinal cord injury, and many of the chapters provide practical advice based on either scientic evidence or the authors experience. The book is very well illustrated and attractively packaged. Overall, the quality of the chapters is excellent. The discussions of the pathophysiology of spinal cord injury, pharmacotherapy, and radiographic workup are thorough and easily read, even if they do not provide much in the way of novel content. There are two chapters dealing with biomechanical considerations of spinal injury and stabilization, a critical topic for the practitioner. Dr. Watkins chapter on decision making is an excellent treatise that is particularly recommended for residents and fellows interested in spinal surgery. Other excellent reviews are provided dealing with pediatric patients and those with penetrating injuries. Much of the practical advice provided in these chapters represents recommendations based on literature review, and most of the rec-

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ommendations are consistent with other published guidelines and treatment strategies. Excellent reviews of the literature regarding the radiographic workup, timing of decompression, and role of delayed surgery for patients with persistent decits will aid in surgical decision making. I found two chapters to be problematic. The authors of the chapter dealing with vascular injury were very dogmatic in recommending aggressive diagnostic workup of vascular injuries in patients with cervical spine fractures, stating that such a workup and consequent treatment with anticoagulation represent the standard treatment. This statement is offered despite the acknowledged lack of evidence supporting the practice and despite very different recommendations from other evidencebased reviews. Similarly, strong recommendations for the use of multimodality electrophysiological monitoring are made in the following chapter, again without any evidence presented to indicate that outcomes are improved through the use of monitoring.

The author of the monitoring chapter recommends a wake-up test or aborting surgery as a reasonable response to alterations in electrophysiological response. Given the potential morbidity of either of these interventions, more evidence to suggest that this response is warranted is needed to convince readers that there is utility in electrophysiological monitoring during decompression and stabilization of the spinal cord injured patient. Despite these two caveats, I believe this book would be a valued addition to the library of residency training programs and for those training to become spinal surgeons. The use of literature review, description of important basic principles, and inclusion of practical advice from established practitioners will make this text useful as a teaching tool. The vast majority of the chapters provide balanced and comprehensive reviews of relevant topics for the surgical care of patients with spinal cord injury. Daniel K. Resnick, M.D. Madison, Wisconsin

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