J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.52.11.1318 on 1 November 1989. Downloaded from

1318 Book reviews In conclusion: this small book gives a the usefulness of many other types of sur- subject and is written by the best qualified neurosurgical approach to orbital diseases gery. They add "We do agree with Fields' authors. It is difficult to read because it must and tends to be mainly concerned with thought that the neurosurgical management have been difficult to write because the surgical aspects oforbital disease rather than of severe chronic pain remains in general in authors had to doubt politely the en- the wide variety of medical and paediatric an experimental phase in which respect we thusiasms of their friends and colleagues conditions that might affect it. say it resembles closely the non-neurosurg- who insisted that they had the answers where MD SANDERS ical management of such pain". That is bad none exist. news all round because it means that they are PATRICK D WALL not in a position to give us a straight answer Neurosurgical Treatment of Persistent Pain about the effect of surgery on pain. Introduction to Neuroimaging. By WILLIAM W Vol. II Pain and Headache. By JAN M GYBELS, How long does an experimental phase ORRISON, JR. (Pp 384; Illustrations: 489 MD, PhD and WILLIAM H SWEET MD, DSc, last? Let us take facet rhizotomy as an Radiog. Price: £43.50.) Edinburgh: Churchill DHC, FRCS Ed(Hon) Series Editor: Ph L example. This operation has been carried out Livingston, 1989. Gildenberg (Pp 442; Fig: 70; Price: since 1960 on tens of thousands ofback pain US$129.50; £88-20.) S Karger AG, Basel. patients. Unhappy about the literature, the The author's ambition is to introduce the 1989. authors turn to an expert Don Long, and neuroimaging modalities currently used and write "He has no follow-up assessment of particularly those which have an important This book is important because of its history patients thus treated at Hopkins since 1980 part to play in modern neuro-diagnosis. This and its authors. It is really a continuation of and consequently is not prepared to make a is reflected in the large proportion of the text the classic "Pain and the Neurosurgeon" statement on the indications for or results of devoted to magnetic resonance imaging and published in 1969 by White and Sweet which the operation. Neither are we". It would be computed tomography. A short nuclear was itself an update of White and Sweet's illegal to try a new drug for 30 years and be medicine chapter is mainly devoted to out- 1955 book on the subject. Sweet has an unwilling to make a statement. If we take moded conventional technetium scanning of extraordinarily wide experience of neuro- another example of reporting on the effects the brain, cerebrospinal fluid flow imaging surgery at Harvard, particularly related to of surgery, the authors doubt that there is and radionuclide cisternography. SPECT is pain. He has an encyclopaedic command of any difference in the effectiveness of two briefly but adequately portrayed, but inguest. Protected by copyright. the the literature and has maintained close touch types of trigeminal neuralgia surgical treat- opinion of the reviewer it would have been with basic scientists. His younger co-author ment particularly if long term follow ups are better to omit the former methods in favour of this book is head of neurosurgery at included. However when they purposely of a more detailed consideration of the Leuven with a very critical approach to his carry out a poll of postoperative complica- research implications and potential clinical wide experience of surgery and, in addition tions of microvascular decompression, applications of PET. he has contributed in substantial ways to which is reported to have a low complication To adequately cover the more common clinical neurophysiology by way of micro- rate, they find that 27 services have had 32 and important neurological conditions in a neuronography. deaths or permanently disabling sequelae. short text is always difficult, but the author This book provides as near to an The authors of this book are clearly most has generally managed to do so, and to authoritative statement on the role of persistent scholars but they are also include many uncommon conditions in neurosurgery for pain as you will get. gentlemen who do not wish to offend their differential diagnosis. In such a book, one However even here it is curiously difficult to colleagues. You therefore have to read be- might expect fundamental features to be unravel a clear answer. It is obvious that the tween the lines. When they conclude on presented to the exclusion of some quite role of neurosurgery is decreasing. One percutaneous compression of the trigeminal important details. Most of the description is reason for this is that newer drugs such as ganglion "These enthusiastic accounts may indeed concise and accurate; there are good Tregretol and new usage of old drugs such as initiate much wider use of the method" you references containing expanded accounts of morphine have successfully treated some begin to guess that it is going to be a long most of the briefly described conditions, and patients who would previously have been time before Gybel's or Sweet's patients have there is a good index which makes the book candidates for surgery. Others respond to the their trigeminal ganglia compressed. useful for reference. However, unfortunate electrical stimulation of peripheral nerves With all their careful critical approach to blanket statements are made which contain which Sweet and I introduced. Other groups the literature and to their own vast significant inaccuracies. These include for respond to cognitive-behavioural treatment experience, clear answers are not always example, that dural angiomatous malforma-http://jnnp.bmj.com/ programmes. The consequence is that sur- available even ifwritten in their gentlemanly tions are exclusively supplied from the geons see fewer patients who are more intrac- code. Some operations have simply not been external carotid artery (p 262), and that table than ever. Unfortunately the results in done on enough comparable patients, normally the thalamostriate and internal the literature of the success of surgical adequately examined and followed. Very few cerebral veins are the first ones to fill in intrusion often refer to patients who are no patients have been assessed by independent carotid angiography (p 272). Some condi- longer the subject of surgery. Intractable observers which must become the surgical tions are included in differential diagnosis patients include those with nerve damage equivalent of the double blind test of drugs. which are so rare as to be misleading, such as and the particularly sad group with Operations are assessed on the basis of metastases as a cause ofsuprasellar calcifica- iatrogenic nerve damage. rationale even when the rationale no longer tion, temporal glioma as a cause of middle on September 27, 2021 by Gybels and Sweet note ruefully that makes any sense. For example, central ear mass lesion, and free fat in CSF spaces Fields' 1987 book on pain contains only four myelotomies are treated as different opera- occurring in conditions other than a pages on all forms of surgery, that he omits tions at different levels because the surgeons ruptured dermoid. Occasionally, reliable mention ofsympathectomy, cordectomy and thought they were aiming at different targets. signs used in differential diagnosis are not cingulotomy and that he is sceptical about This book is undoubtedly the best on the mentioned, such as visualisation of the