Book Review

Surgery of Cranial Base Tumors

N Engl J Med 1993; 329:215-216July 15, 1993

Article

Surgery of Cranial Base Tumors
Edited by Laligam N. Sekhar and Ivo P. Janecka. 870 pp., illustrated. New York, Raven Press, 1993. $225. ISBN: 0-88167-877-5

The border zone between the brain and the body -- known as the skull base -- has long been an area of doom. Patients who had tumors in this area and surgeons who ventured into this area faced poor prognoses and poor outcomes. But recent advances in diagnostic, anesthetic, and surgical techniques have opened up this frontier to those with the proper skill and training and, probably necessarily, the proper colleagues. Teamwork that involves radiologists, angiographers, anesthesiologists, otorhinolaryngologists, neurosurgeons, plastic surgeons, oral surgeons, and ophthalmologists is essential to the proper care of patients with cranial-base tumors. Sekhar and Janecka have collaborated with a world-class group of authors, many of whom have helped push into this new surgical arena, to present a comprehensive view of skull-base surgery as of 1992.

Beginning with the basics of preoperative evaluation, neuroradiologic techniques, and intraoperative monitoring, the authors discuss the advances in patient care that have made skull-base surgery possible. Without good tumor localization, without adequate blood-flow evaluation, and without good perioperative monitoring, preoperative planning would be a mystery and many of the potential neurologic complications would be vastly more frequent.

A section on anatomy is included to stress the critical importance of knowledge of the anatomy in skull-base surgery. Although this section adds very little to what can already be found in an anatomy textbook, the photographs are of excellent quality and worth viewing, even by knowledgeable surgeons.

The third and fourth sections are the real strength of this book. Specific surgical approaches are discussed by experts in the field in a style that implies, “Here's how I do it -- the good with the bad.” Photographs, charts, graphs, and drawings illustrate the major steps and the results obtained. Although the quality of the chapters varies and there is the repetition that is unavoidable with multiple authors, the editors have done an outstanding job overall in holding the book to high standards.

The final section on rehabilitation and complications clearly does not get the emphasis it deserves. Although each surgical chapter gives its own overview of complications, a book in which less than 5 percent of the pages are devoted to an overview of this topic is flawed and incomplete. In a field in which, just a few years ago, the complications prevented surgery, it is hard to believe that rehabilitation is not a crucial part of care for some patients.

Overall, this book is an excellent, well-written, beautifully illustrated atlas of skull-base surgery. It is one of the bestedited textbooks in this exciting new field and certainly the most comprehensive. It is written for the practicing surgeon, but it can also be appreciated by residents in the field. It will be a valuable source of information for many years to come, not only because of its factual content, but also because of the multidisciplinary approach it embodies.

David M. Vernick, M.D.
Harvard Medical School, Boston, MA 02115