Neurosurgery Case Review: Questions and Answers. Remi Nader and Abdulrahman J. Sabbagh (authors). Thieme 2010, 462 pages, 524 illustrations, $129.95.
Although not written with neuroradiologist in mind, Neurosurgery Case Review by Drs. Nader and Sabbagh presents material in a case by case format, challenging the reader to answer questions is (usually 6 to 12 per case) relative to image interpretation, diagnosis, and patient management. The answer to each is highlighted in a bullet type narrative. The material is divided into three sections, (1) Intracranial Pathology, (2) Spinal and Peripheral Nerve Pathology, and (3) Neurology. A total of 113 cases are shown with the number of cases shown in parenthesis. Representative material from the following are shown: Brain Tumors — phacomatoses; (4) meningioma (6); Pituitary tumors (3); Gliomas (3); Malignant intracranial neoplasmas, non gliomas (5); Miscellaneous intracranial tumors (5); AVMs (3); Aneurysms (7); IC hemourahage (3); Cerebral ischemia (1); Extracranial vascular disease (4); Head trauma (8); Hydrocephalus (4); Pediatric brain tumors/ neurovascular disease/ trauma/ development disorders (15), Stereotactic and functional neurosurgery (9); Spine trauma (6); Degenerative spine (6); Spinal tumors, vascular disease and infection (8); Peripheral nerve pathology (7); and topics in Neurology (6). The selection of material is appropriate as an overview of surgical/medical approaches to these diseases.
The book does not challenge the reader to formulate a differential diagnosis of the case because the title of each separate case identifies the diagnosis, so from that standpoint the book is not as challenging as it could otherwise have been. With that minor drawback notwithstanding, the material which follows is educational and particularly so for many neuroradiologists whose contributions to patient care basically stop after a description of the images and an interpretation is rendered. Only on occasion will we delve into the operative considerations or the difficulties encountered during surgery. In essence, therefore, the book lets the radiologist deal in a theoretical manner with preoperative, operative, and post operative considerations.
A few examples will suffice. In a case of subependymal giant cell astrocytoma, the reader is asked to enumerate associated lesions, describe and justify an operative approach, describe (based on the intraoperative photographs) the vascular structure seen, how to deal with an unexpected part of the operation, and name structures seen on photographs during the intraventricular exploration. In a case of scaphocephaly, the reader sees and is questioned about the various surgical options, the incidence of hydrocephalus in syndromic and non-syndromic craniostenosis, and the timing of head growth vs. brain growth. In a case of thoracic disc herniation, the reader is questioned on the various potential approaches and the expected outcomes for each approach. There are pages and pages of examples where the reader is taken well beyond image interpretation.
There are a few issues worth pointing out in this review. The attempt to construct a mnemonic of an intraventricular lesion — “CENTRAL MS” stretches credulity that this is really necessary. The description of a post traumatic cord myelomalacia (atrophic cord, high T2 signal) as a syrinx is inaccurate, and the insistence that a myelogram requires an overnight stay in a hospital is dated.
In summary, it is worthwhile to view case material and analyze the entire clinical situation as the neurosurgeon does. For these days, when either going to the operating room and/or formulating approaches to lesions is not practical, this book offers an alternative means of informing the radiologist of some of the issues facing the neurosurgeon.