The Evidence for Neurosurgery

Ghogawala Z, Krishnaney AA, Steinment MP, eds. The Evidence for Neurosurgery. TFM Publishing Ltd; 2012; 350 pages; $150.00.

The Evidence for Neurosurgery, edited by Drs. Zoher Ghogawala, Ajit A. Krishnaney, and Michael P. Steinment with contribution of over 80 authors, takes an entirely different approach to publications in neurosurgery by discussing diseases and procedures with the intent of presenting evidence for the value of neurosurgery in each instance. There are six clinical sections: Spine, Functional, Tumors, Pediatric, Vascular, and Trauma, with an introductory chapter on Clinical Evidence. The latter clearly defines many of the terms in analysis today such QALY, various types of trials, levels of clinical evidence, meta-analysis, grades of recommendation based on clinical trials, and more. This chapter is a good starting point for the material which follows.

Spinal Neurosurgery covers surgery/treatments for spondylolisthesis, spondylotic myelopathy, lumbar fusions, T spine fractures, transpedicular instrumentation for fusion, inter-body grafts, various orthoses, osteoporotic vertevral fractures, mets to the spine, and artificial discs. How a decision is made on the surgical treatment of various spinal diseases is, as we all know, highly individualized and experiential, and probably more influenced by one’s training rather than a close inspection of published outcome data. Nonetheless, these authors do try to give some basis for rationalizing a given approach.

Functional Neurosurgery covers temporal lobectomies for MTS, neuromodulation procedures for movement disorders and psychiatric conditions, and the treatment (stimulation) for chronic pain syndromes. The Tumor section discusses in a similar manner procedures and comparative effectiveness for brain metastases, pituitary tumors, glioblastoma treatment, vestibular schwannoma treatment options, and procedures for low grade tumor resection.

Pediatric Neurosurgery includes the approaches and rationales for the abnormalities associated with the Chiari I abnormalities (tonesillar decompression, dealing with associated syrinx cavities, scoliosis), meningomyelocoeles, medulloblastiomas, and hydrocephalus in children. The Vascular Neurosurgery section deals with many of the ongoing controversies in neurosurgery and in Neurointerventional Radiology, such as the approach to ruptured and un-ruptured aneurysms, dealing with AVMs, extracranial carotid stenosis, approaches to intracranial vascular disease, and cerebral hemorrhage. In Neurotrauma, the timing of decompression in SCI, the role of cranial decompression in brain injuries, and the treatment of raised intracranial pressure constitute this section.

Of course there are other NSG issues not addressed in this book. However, major items of importance are covered, but some of the thornier issues in neurosurgery—such as postoperative complications in the brain the spine—are not.

In this highly concise book, one has the rationales for surgical treatment in a wide range of lesions. It helps the neuroradiologist form a basis for discussing exactly why in a given patient a certain procedure or approach was or will be used. While you may not often get a solid reason why a surgeon decided on a specific treatment, this book allows one to understand the relative or reported efficacy of the proposed treatment. This book is strongly recommended, particularly for those neuroradiologists who actively engage their neurosurgeons in preoperative planning. Knowledge of the material in this book would also be a strong tool in the day-to-day teaching of fellows and residents.

The Evidence for Neurosurgery