Bambakidis NC, Dickman CA, Spetzler RF, Sonntag VKH, eds. Surgery of the Craniovertebral Junction. Thieme; 2012; 560 pages; $349.99.
This book addresses primarily the neurosurgeon/neurosurgery resident and provides a detailed review of surgery of the craniovertebral junction. The text is comprehensive, with separate sections on the foundations for surgical technique, surgical indications and decision making, surgical techniques, and, finally, on fixation and fusion techniques. The book is supplemented with a DVD that illustrates intraoperative findings and surgical techniques. In general, the book is very well written, and the text flows easily with very good illustrations, graphics, and intraoperative images. Anatomy is nicely illustrated, and the review of pathology at this level covers a wide range of diseases. The discussion of surgical techniques is all-inclusive, with emphasis on controversies. The radiology part of most chapters is sufficient; but while the other illustrations are consistently good throughout the book, the radiologic images vary in quality. Radiology image captions clearly describe the abnormalities; the majority of images, however, do not have annotations.
The first Section lays the foundations of surgical treatment. It starts with a comprehensive chapter on embryology, development, and classification of the craniovertebral junction. The subsequent chapter very clearly illustrates anatomy with images from a reference article from Surgical Neurology. This is followed by a discussion of surgical anatomy. Biomechanics of the craniovertebral junction is described in an easy-to-read chapter with multiple charts and illustrations. Chapter four is radiologic evaluation of the craniovertebral junction. The images in this chapter are clear, well annotated, and illustrate key points in evaluation of this level using the different modalities. Finally, this section has a chapter about neurologic findings in patients with craniovertebral junction disease, and emphasizes the neuropathologic mechanism of injury at this level.
The second section details the surgical indications and rationale behind decision-making for diseases of the craniovertebral junction. Pathologies described include congenital malformations, rheumatoid disease, traumatic injury, bone disorders, and primary osseous and metastatic neoplasm. There is also a chapter on the Chiari malformation. The discussion continues with management of intramedullary lesions of the high cervical cord. This is followed by a few chapters dealing with vascular pathology, including vertebral artery dissection and vascular insufficiency, arteriovenous malformations, aneurysms, and cavernous malformation. The final chapter in this section is about radiosurgical management of lesions of the craniovertebral junction. Common themes for this section include the easy-to-read chapters and up-to-date information. Authors describe their preferred surgical approach as well as different approaches, emphasizing the controversies as well as the pros and cons of each technique.
The third section is dedicated to the various surgical techniques. This is a very detailed, technical section with separate chapters for each approach (transoral, transphenoidal, etc.). The reader will find this section very helpful, with excellent illustrations of anatomy, intra-operative setup including patient positioning, intraoperative images, and a few radiologic studies. There is a detailed description of the each of the techniques—its pros and cons as well as the expected intra- and postoperative complications. As each chapter was written by a different author, the reader will realize that points are repeated throughout this section. This repetition proves helpful in emphasizing key concepts. The provided DVD is complementary to this section. It contains additional illustrations of the techniques, surgical anatomy, and a few cases with their intraoperative findings.
The final section is about fixation and fusion techniques. The discussion starts with biology of spinal fusion. This is an interesting chapter that covers bone anatomy and histology, bone growth factors and bone development, bone graft types, as well as more recent topics of bone morphogenic protein, gene therapy, and electromagnetic stimulation. This is followed by a discussion of techniques of bone harvesting from iliac crest to rib, fibular and calvarial grafts, and, finally, allografts. There is a discussion of the complications of such grafts followed by a few paragraphs about radiographic assessment of fusion (though no images are shown). The seven chapters that follow are dedicated to spinal fusion. The topics covered range from the general principles of spinal wire and cable fixation to more specific and detailed description of the different types/approaches. The final chapter deals with craniovertebral instability. This section is notable for the excellent illustrations and schematic diagrams and, as the prior section does, provides a very detailed description of the surgical techniques and intraoperative setup and findings. The radiologic images are sufficient and representative of the text.
To summarize, this book is very well written and should be on the shelf of all neurosurgeons/neurosurgery residents involved in the care of patients with disease at the craniovertebral junction. The neuroradiologist will find this book helpful in understanding how the surgeon approaches pathology at this level. The book is not, however, intended to be a comprehensive radiologic review of imaging of the craniovertebral junction in its normal, pathologic, or postoperative states.
