Book Review

Skull Base Surgery: Anatomy, biology, and technology

N Engl J Med 1997; 336:1461May 15, 1997

Article

Skull Base Surgery: Anatomy, biology, and technology
Edited by Ivo P. Janecka and Klaus Tiedemann. 422 pp., illustrated. Philadelphia, Lippincott–Raven, 1997. $150. ISBN: 0-397-51716-5

This textbook joins a growing list of excellent books on one of the frontiers of modern surgery: surgery of the skull base. An anatomical domain that is the province of neither otolaryngologists nor neurosurgeons, the skull base is a complex and anatomically rich region, and surgery in this region has become a discipline unto itself. This textbook presents several interesting and worthwhile aspects not contained in other works on the subject. Several chapters are particularly deserving of mention. “Historical Antecedents of Skull Base Surgery,” by Goodrich, is a wonderful glimpse of the founding fathers of otoneurosurgery and their contributions. Those of us who perform these intricate and demanding operations are in awe of the insight and courage of these pioneers, who worked without the benefit of preoperative magnetic resonance imaging, angiography, the operative microscope, and good lighting. The marvelous collection of plates, photographs, and references will satisfy anyone interested in the history of medicine. “Classic References in Skull Base Surgery,” by Anand and Alemar, is another unique aspect. The chapter covers the classic references as they emerged over the past century to form the scientific basis of skull-base surgery.

“Gross Sectional Anatomy,” by Tiedemann, is devoted to thin-section, anatomical cadaveric preparations in the coronal, sagittal, and axial planes. It compares the gross frozen section with radiographs of that section, and a “plastinated” version of the identical section emphasizes the bones, myelinated nerves, and arteries. Despite the many times I have seen this anatomy and operated on this region, I found myself transfixed by these sections, which clearly demonstrate the relation among intricate anatomical structures. This chapter is marvelous.

Well-illustrated chapters on surgical techniques contain many excellent color photographs of intraoperative and postoperative cases. Janecka's chapter on facial translocation, a procedure he pioneered, clearly demonstrates the techniques involved and provides many illustrative examples. Because several of the authors are from different surgical disciplines in other countries, I occasionally had difficulty with the nomenclatures for some of the surgical procedures. This lack of standardization reflects the emerging multidisciplinary approach to the skull base. I hope that the International Skull Base Society will address this problem soon.

Educational grants from several instrument and technology companies are acknowledged by the editors, but it is unusual for entire chapters to be written by representatives of such companies, such as the chapters on plating and mesh systems, surgical localizers, and Xomed monitors. Perhaps the marriage of industry and medicine is inevitable, because revenues from patient care can no longer support research and development. The reader might use caution, however, in accepting the views put forth in these chapters and balance them against the experience of physicians more familiar with their application.

Jeffrey P. Harris, M.D., Ph.D.
University of California, San Diego, La Jolla, CA 92037