Book Review

The Practice of Neurosurgery

Neurosurgery

N Engl J Med 1997; 336:142-143January 9, 1997

Article

The Practice of Neurosurgery
Edited by George T. Tindall, Paul R. Cooper, and Daniel L. Barrow. 3496 pp. in three volumes, illustrated. Baltimore, Williams & Wilkins, 1996. $595. ISBN: 0-683-08266-3

Neurosurgery
Second edition. Edited by Robert H. Wilkins and Setti S. Rengachary. 4271 pp. in three volumes, illustrated. New York, McGraw-Hill, 1996. $550. ISBN: 0-07-079991-1

Editing a comprehensive textbook on neurosurgery is a daunting task. The second edition of the work by Wilkins and Rengachary and the new textbook by Tindall, Cooper, and Barrow represent excellent efforts. The introduction to Wilkins and Rengachary's book relates the editors' use of updates to supplement the first edition over the past 10 years and their perceived need for a second edition to incorporate the advances in basic neuroscience and changes in our understanding and practice of neurosurgery. The editors have maintained the structure of the first edition, with extensive coverage of neurologic evaluation, diagnostic studies, and general perioperative care and four introductory chapters on historical aspects of neurosurgery. They have added many new subjects, expanding from 352 to 444 chapters. Much of this textbook is similar to the first edition. Of the first 148 chapters (volume 1), 83 have the same title and at least one of the same authors as in the first edition, 18 have the same title with different authors, and 47 are new. Some of the chapters have not been changed very much and do not cover some advances that might have been included by other authors. For instance, the chapter on cerebrospinal fluid has the same figures and tables and essentially the same text and does not refer to new techniques for the placement of spinal-drain catheters or to aspects of the interpretation of cerebrospinal fluid findings in the evaluation of patients with intracranial masses and AIDS. In contrast, the chapter on cerebrospinal fluid in the book by Tindall and colleagues mentions AIDS in regard to the analysis of cerebrospinal fluid. As another example of this point, the chapters on the blood–brain barrier in the two editions differ only in the addition of three paragraphs on the relevance of drug modification. The section on imaging for cerebral edema again covers computed tomography and positron-emission tomography but has not added anything regarding magnetic resonance imaging. In contrast, the other textbook prominently discusses the value of magnetic resonance, even including a magnetic resonance image as one of its figures.

The two textbooks have distinctly different organizations and emphases. Wilkins and Rengachary attempt comprehensive coverage of neurologic examination, diagnostic testing, and clinical neurosurgery, whereas Tindall and colleagues start with several chapters on selected aspects of neuroscience and diagnosis, but then focus on clinical neurosurgery and directly related topics. The chapters on neurologic examination and diagnostic testing in the book by Wilkins and Rengachary are for the most part thorough and well written but are not as comprehensive as those in standard neurology textbooks.

Throughout the book by Wilkins and Rengachary, chapters are grouped to cover certain basic aspects first, such as physiology, anatomy, and imaging, and then the clinical neurosurgical aspects. The other textbook covers many of these basic aspects, but usually more concisely and within chapters that are devoted primarily to descriptions of clinical neurosurgery. The chapter on the biochemistry of brain tumors is an exception, being very detailed but of unclear clinical relevance.

The book by Tindall and colleagues often covers a topic that can be approached in a variety of ways (e.g., trigeminal neuralgia) in a single chapter (by one author), whereas the other book breaks the subject into several small chapters, with each author presenting his or her own point of view. Many readers may find comparing the various approaches difficult.

Many topics related to clinical neurosurgery are covered differently in the two textbooks. Monitoring of intracranial pressure is covered more extensively by Tindall and colleagues. Wilkins and Rengachary include a chapter on brain biopsy for non-mass lesions that provides excellent coverage of the various conditions involved, along with aspects of decision making and details of the technique of open biopsy of the brain, whereas the other book contains an abbreviated discussion of these issues and focuses mainly on stereotactic techniques (a separate chapter on dementias discusses indications for biopsy).

The neuroendoscopy chapters have markedly different emphases, with Tindall and colleagues providing a more extensive discussion of the value of stereotactic guidance and of the variety of clinical settings for endoscopy. In a graphic example of the controversies in clinical neurosurgery, the book by Wilkins and Rengachary concludes that prophylactic antibiotics are not indicated, whereas the other book provides a persuasive argument in favor of their use.

Wilkins and Rengachary include an extensive discussion of clinical decision making in the management of meningiomas, whereas Tindall et al. focus on technical surgical considerations. Both textbooks recommend radiotherapy for all gliomas, but the former offers a uniquely scholarly chapter on its role. One ironic contrast is that although Wilkins and Rengachary describe only a nonsurgical treatment for hemifacial spasm (injections of botulinum toxin), Tindall et al. have an excellent chapter on hemifacial spasm (authored by Wilkins) that discusses several treatments (including suboccipital craniectomy for microvascular decompression).

Wilkins and Rengachary include a chapter on reflex sympathetic dystrophy (or sympathetically maintained pain) that argues that the syndrome is functional, whereas Tindall et al. present the syndrome as organic. In a seeming contradiction, the former book goes on to include chapters on the techniques of sympathectomies (primarily used for reflex sympathetic dystrophy).

The book by Tindall and colleagues has less overlap between chapters. For instance, both textbooks include chapters that address in some detail the use of intrathecal baclofen, administered through an implanted pump, for spasticity. In a separate chapter on movement disorders, Wilkins and Rengachary discuss the surgical treatment of spasticity without including this important approach, whereas Tindall et al. do not include a section on spasticity.

These textbooks provide excellent coverage of clinical neurosurgery through about 1993. Inevitably, the rapid technological developments in neurosurgery, particularly with regard to neuroendoscopy, frameless stereotaxy, and applications of radiosurgery, make any textbook immediately outdated to some extent. This fact only serves to emphasize the impossibility of relying on a textbook alone for guidance in clinical neurosurgery and the need to supplement one's knowledge with current, peer-reviewed journals. One or both of these books are essential for every neurosurgeon. If you only want one new textbook and already own the first edition of the book by Wilkins and Rengachary, I recommend buying the other textbook for its quite different approach, organization, and additional information.

Robert R. Goodman, M.D., Ph.D.
Columbia University, New York, NY 10032