Nussbaum ES, Mocco J. Cerebral Revascularization: Microsurgical and Endovascular Techniques. Thieme 2011, 272 pages, 374 illustrations, $149.95.
Drs. Nussbaum and Mocco have put together an excellent text on cerebral revascularization, combining the efforts of 44 experts from the fields of Neurosurgery and Endovascular neurosurgery. The chapters are organized into 5 sections with the first section describing the historical perspective of microsurgical cerebral revascularization, and the indications for both microsurgical and endovascular revascularization. The second section and third sections, which by themselves comprise more than half the text, are devoted to surgical revascularization techniques and endovascular revascularization techniques respectively. These chapters are well written, concise (avoiding the common pitfalls of “too much” and “too little”) and represent tremendous teaching value. Its strengths are in the clarity of its photographs with appropriate labeling, brilliantly illustrated diagrams and easy-to-read, conversational prose. The authors share their vast experience and protocols, with adequate references to current literature. This experience should in theory also extend to sharing edifying personal complications or intra-operative “misadventures,” which is a candor rarely seen in current textbooks professing to teach.
From the first glance at the table of contents, the addition of a section (IV) written from the Neurocritical Care perspective appears to promise appropriate breadth of discussion. However, this section comes up disappointingly short. An illustration is the management of blood pressure during stroke. No specific blood pressure guidelines before or after tPA are provided. While this may reflect the absence of Class I, level A evidence, this should not preclude a discussion of the best available data. Furthermore, there is no reference to current AHA guidelines. A similar casualness is applied to the consideration of hyperglycemia during stroke with no mention of important prospective randomized controlled trials such as GIST-UK. A major oversight is the topic of malignant edema secondary to massive stroke. This deadly but treatable complication necessitates a discussion on the treatment of raised intracranial pressure, with a focus on indications and timing for decompressive hemicraniectomy and the relevant evidence. Instead, a largely irrelevant and brief discussion on vasospasm in the context of subarachnoid hemorrhage is inexplicably substituted into a chapter entitled “Stabilization of Patients with Acute Ischemic Stroke.”
Section V is a collection of miscellaneous topics including complex aneurysms, evolving open and endovascular technologies and physiologic imaging. The last chapter on “Physiological Imaging” is overly simplistic and ignores the many limitations of our current imaging modalities. The assertion that CT perfusion provides equivalent physiologic data to MRI is misleading at best. The CT perfusion parameters that characterize core versus penumbral tissue are not well elucidated and clearly not validated. One would best refer to more comprehensive reviews.
Despite its numerous flaws, this book is a good introduction for residents, fellows and those who are not well versed in the practice of Neurosurgery and Interventional Neuroradiology. The primary value is derived from the sections dealing with operative technique.
