Benndorf G.  Dural Cavernous Sinus Fistulas: Diagnosis and Endovascular Therapy. Series: Medical Radiology. Subseries: Diagnostic Imaging. Springer 2010, 326 pages, 742 illustrations, $219.00.

This is an extremely well-illustrated and comprehensive collection of the existing literature regarding dural cavernous sinus fistulas (CCFs).  It was a real pleasure to read, and I would recommend it to neuro-interventionalists and neuro-ophthalmologists of all levels of training and experience.  It would be a great resource for diagnostic neuroradiologists, but its focus on the clinical features and endovascular treatment of these complex lesions probably move it from the stack of required reading.

There are only 9 chapters in this 300-page book.   The anatomical and pathological images and descriptions are simply outstanding.  Dr. Benndorf begins with a historical chapter, well-illustrated (a consistent theme), including the evolution of the diagnosis of causes of pulsating exophthalmos.  This is followed by chapters on (2) the osseous anatomy of the cavernous sinus and environs, (3) the classification schemes for dural CCFs, (4) etiology and natural history, (5) an outstanding chapter on neuro-ophthalmologic symptoms and differential diagnosis, (6) radiological diagnosis, (7) endovascular treatment, (8) alternative treatments such as manual compression, surgery and radiation, and (9) hemodynamic aspects of dural CCFs.

I can only identify three limitations of this book, and both are minor and mitigated.  First, the recent introduction of ethyl vinyl alcohol co-polymer (EVAL) precluded much discussion in the therapeutic options.   While this liquid agent has some real potential (and danger) for use in this condition, the basic principles of transvenous approaches are handled well.  Second, there is no discussion of arterial approaches.  With the advent of EVAL, these approaches have some therapeutic potential.   The real contribution of this book is really the width and breadth of the anatomic and pathologic content, however.  What a great collection of dural CCFs in all their glory!  Finally, the actual pathological nature of these acquired lesions remains a mystery, and their origins remain a subject of speculation.   The existing literature is nicely summarized.

In summary, this is a very nice contribution to the literature.  I recommend this book to anyone with an interest in the angio-architecture of the cavernous sinuses as well as all the specialties mentioned above.  The anatomic and pathologic illustrations are more than worth it.