Al-Mefty O. Controversies in Neurosurgery II. Thieme; 2014; 456 pgs.; $159.99

Given the proliferation of publications dealing with clinical issues involving care of patients with neurological disorders, it is natural that we now have a 2014 book entitled Controversies in Neurosurgery II, edited by Dr. Al-Mefty, a neurosurgeon at Brigham and Women’s Hospital in Boston. He has included over 100 authors, many of whom are well known neurosurgeons, as contributors to the book. This is a follow-up to a similarly titled book published 12 years ago.

The fact that publications like this one continue to be produced highlights 2 points: controversies continue to mount, and evidence-based medicine is lacking in many (if not most) areas of clinical care. The weird-looking cover—in which the brain resembles a punctured basketball—aside, the book has much to offer to the neuroradiologist.

For our specialty, understanding the surgical approaches to diseases we deal with on a daily basis is important. It not only helps in interpreting postoperative studies but lets us know those features on preoperative studies that are critical to mention, because those findings may influence the surgical approach.

There are 23 topics covered in separate chapters. Each topic/chapter begins with a very short (usually 1–2 sentences) history followed by a couple of imaging studies. Although it is not essential to the concept of the book and its contents, a number of the images are not optimal. One is immediately struck, upon opening the book to the first case (surgical removal of Tuberculum on sella meningioma: endoscopic vs. microscopic), that the initial image, a coronal post-gadolinium MRI, is of low resolution, with a blue tint. Why was this and a few other images (eg, trigeminimal schwannona) not converted to grayscale? Also, the brightness and contrast settings on many figures are poor, while some images are simply distorted, such as a right-sided CN V schwannoma. It is hard to fathom why one would go through the trouble of writing the book without optimizing the preoperative images.

These chapters describe and illustrate the advantages and disadvantages of different approaches, with drawings when appropriate. Nicely, there is a section at the end of each chapter, called “Moderator,” in which another author tries to weigh the options presented earlier in the chapter to come up with a “verdict.”

Topics (Chapter Count)

• Meningiomas, in various strategic locations (4)
• Schwannomas, vestibular and trigeminal (2)
• Pituitary adenomas (2)
• Craniopharyngiomas (2)
  • Gliomas in eloquent areas of the brain (1)
  • Colloid cysts (1)
• Aneurysms (4)
  • Giant unruptured (1)
  • Basilar (1)
• Ateriovenous malformations in eloquent areas (1)
• Other topics: carotid stenosis, trigeminal neuralgia, deep brain stimulation, artificial discs, clinical trials

Each instance, of course, has a different clinical story and a different set of images.

Take the chapter entitled “Management of Unruptured Anterior Communicating Aneurysm: Coiling vs. Clipping vs. the Natural History”: here, three neuroradiologists (Drs. Bharatha, Krings, and Ter Brugge) begin with a discussion of the endovascular treatment of these aneurysms. This discussion is followed by another, written by Dr. Krist, on surgical clipping, which in turn is followed by a section on the natural history of unruptured aneurysms. This chapter, like all the others, as mentioned earlier, concludes with a 1½-page moderator opinion, and in this case, it is moderated by Dr. Spetzler, on a patient with a 7 mm asymptomatic anterior communicating artery aneurysm. Not only does he discuss the options, along with advantages/disadvantages of coiling vs. clipping, he also neatly points out the dilemma faced when one is analyzing data compiled from retrospective vs. prospective data (the numbers/conclusions and decisions based on those two types of studies can vary significantly). Furthermore, his discussion, like those of the other moderators, is written in a conversational manner, making the information and his conclusions easy to understand. This format is repeated throughout the book.

While this book is aimed primarily at neurosurgeons, a neuroradiologist can derive useful/practical information from it and put it into daily use as he/she consults with neurosurgical colleagues.