Book reviews

tion to technological detail. T
good reference material but fox
ing. The index is appalling and;
to list dyskinesia, dystonia, on-
receptors. Some can be found
ings if you search for them. It
such blemishes in an otherwist
tion, but I think UK readers
prefer Gerald Stem's recent
though not confined to therapy
its practical issues, and is a mo:
work of reference.

his makes for clarity-that is all except th
r boring read- author himself points out, th
inter alia, fails may be destroyed while th
-off effects, or remains intact and the term "t
as sub-head- "brain stem death" seems moi
is sad to find The best way to practise

e useful colla- anticipate problems before the
at least, will way, complications are preve
text, which effects if they occur are mi
embraces all book approaches the subject

re satisfactory manner. I am sure neurosurgei
and in particular trainees,

JMS PEARCE valuable. It should sell well d
relatively expensive for its
another edition along the sam
vascular topics should be cor
future.

Some Pitfalls and Problems in
Neurosurgery. Series: Progress in
Neurological Surgery, Vol. 13. Editor: j c
DE VILLIERS. (Pp 208; Price: £82.50.) Basel,
Karger, 1990.

This book is the thirteenth in the series
"Progress in Neurological Surgery."
Unlucky for some, perhaps, but the thir-
teenth edition which covers transphenoidal
operations, frontal and temporal basal
tumours, CSF shunts, spinal intramedullary
lesions, lumbar discs, and brain death, should
not prove a disappointment to the editor, Dr
de Villiers. "Pitfalls" are interpreted as a
complication which may result from incorrect
interpretation of clinical signs and investiga-
tions, or occur as a result of the operative
procedure.
The first chapter is an excellent review of

the problems encountered with the radiology
of pituitary tumours and transphenoidal sur-
gery. The text accurately describes the nasal
complications following operation (usually
omitted from other descriptions) and advises
on the ways of minimising these. Surpris-
ingly, the author fails to mention the need for
steroid cover during an anaesthetic or
operative procedure in these patients with
potential pituitary insufficiency. There
follows a rather disappointing chapter on
frontal and basal tumours. The radiological
examples are all based on angiography, air
encephalography and early generation CT
scanning. Much information with useful
advice is buried within a very detailed text
which makes heavy reading. Again there is no
emphasis on the need for steroid cover during
operation on suprasellar tumours. Shunt
complications bedevil us all. A chapter on the
ways of minimising these provides practical
advice. Perhaps the text should have included
some mention of the advantages and dis-
advantages of the newer variable pressure
valves.
The next chapter provides helpful infor-

mation on spinal intramedullary tumours,
incorporating a detailed description of sur-
gical technique. A subsequent chapter on
lumbar disc prolapse is full of gems often
omitted from more standard texts. Interest-
ing text, however, inevitably contains con-
troversy. I was surprised by an introductory
sentence stating that "confirmatory tests"
(i.e. confirming the clinical findings) "will be
required by the majority". Surely in this day
and age, all patients should undergo at least a
CT scan if not myelography? Classic root
signs do not necessarily result from disc
protrusion at the expected level. The "out-
patient" operative procedure for disc removal
will also raise some eyebrows.
The final chapter on the diagnosis of

cerebral death by the editor is a model of

e title. As the
ie "cerebrum"
ie brain stem
brain death" or
re appropriate.
surgery is to

ty arise. In this
nted and their
inimised. This
in a pragmatic
ons at all levels,
, will find it
lespite seeming
size. Perhaps

e lines covering
nsidered in the

KW LINDSAY

Pain Syndromes in Neurology. Edited by
HOWARD L FIELDS. (Pp 286; Price: £39.50.)
Guildford, Butterworth Scientific Ltd. ISBN
0-407-011242-2. 1989.

Much of the most severe chronic intractable
pain seen in pain clinics is neuropathic rather
than nociceptive pain and whereas mechan-
isms of pain with an intact nervous system
have been extensively investigated, mechan-
isms of neuropathic pain are poorly under-
stood, and have received much less attention.
This book is particularly concerned with
these mechanisms of neuropathic pain and
with treatment, but also considers peripheral
nociceptive mechanisms and cancer pain,
much of which has a nociceptive basis. The
editor, Fields, opens with a succinct over-
view of pain transmission in the normal and
damaged nervous system. This is an excellent
introduction for the newcomer to this subject.
Raja and colleagues next consider hyper-
algesia and receptor sensitisation, covering
both neurophysiological and chemical
aspects.
Devor and Rappaport review experimental

peripheral nerve injury. Perhaps the single
most important fact to emerge from all the
work on peripheral nerve injury is that
damage to sensory axons frequently leads to
ectopic impulse generation, and this is a likely
basis for at least some of the pain experienced
with such lesions. Burchiel considers the
effects of deafferentation and this is linked
with a discussion of the place of the dorsal
root entry zone lesion operation described by
Nasholt. A prominent effect of deafferenta-
tion is disinhibition of central neurones with
the development of chronic abnormal
repetitive neuronal discharges. This explains
the common failure ofablative surgery. More
damage may lead to more pain. A separate
chapter by Watson is devoted to post herpetic
neuralgia, dealing with clinical features and
treatment rather than possible underlying
mechanisms of pain.
The involvement of the sympathetic

nervous system in peripheral nerve injury and
in the obscure reflex sympathetic dystrophy
syndromes is discussed in two chapters.
Roberts and Kramis consider mechanisms
and offer several interesting ideas but we are
far from understanding these abnormal
states. Payne provides a clinical description of
reflex sympathetic dystrophy and considers
treatment options. The frequent total failure
of treatment is under-emphasized here.
Asbury surveys pain in peripheral

neuropathies, drawing attention to the
different mechanisms.

In a masterly review, Tasker considers the
place of surgery for pain, both of nociceptive
and neuropathic type. Stimulation
procedures in spinal cord and brain are also
discussed and there is brief mention of spinal
and intraventricular opiate installation. The
literature is comprehensively reviewed and
the author admits, with honesty, the influence
of personal bias. The unpredictability of
results and variability of success of the same
procedure in different surgical hands are the
two main messages which emerge here. Por-
tenoy considers cancer pain, in which the
multiplicity of possible causes and mechan-
isms is stressed and thus the need for careful
clinical assessment. The final chapter, again
by Portenoy deals with the drug treatment of
chronic pain.

Neurologists and neurosurgeons will find
much of interest and relevance to their clin-
ical practice here. The authors have been well
chosen and present difficult subjects clearly,
and the book has the advantage ofbeing fairly
short. It should find a place in all departmen-
tal libraries. The book is not complete in its
coverage; those wanting to find full accounts
of pain of myelopathic, brainstem, or
thalamic origin will be disappointed. These
topics are only briefly considered in the
chapter by Tasker. Perhaps correctly, in a
book of this length, the emphasis is on the
more common painful neurological condi-
tions and this is a small criticism. Overall, the
book can be highly recommended.

JW SCADDING

Plasticity and Morphology of the Cen-
tral Nervous System. A Challenge for
Psychiatry of the Nineties. Edited by C L
CAZZULLO, E SACCHETTI, G CONTE, G INVER-
NIZZI AND A VITA. (Pp 256; Price: DFI 154.00;
US$70.00; UK£40.00). Dordrecht: Kluwer
Academic Publishers Group, 1990. ISBN 0-
7462-0094-3

The title of this book is misleading. It is not
about neuroanatomy at all, which is what one
might expect. It is a heterogeneous collection
ofpapers presented at a conference on schizo-
phrenia in Milan in 1987. The majority ofthe
papers are not even about schizophrenia.
There is one on phenylketonuria, one on
eating disorders and nine (out of 24) on
affective disorders. The topics covered
include the genetics of depression among the
Amish population in Pennsylvania, CT scan
findings in schizophrenics, the description
of a new battery of psychometric tests
and glucose-6-phosphate dehydrogenase
deficiency in psychosis.

Altogether it is a curious mixture. Equally
puzzling is why it has taken three years for the
book to be published, because it is not printed
but an amalgam of different type-written
manuscripts, a process which I had always
assumed speeded up publication. More
serious, though, is the fact that some of these
contributions would not have passed the
refereeing process of even a moderately pres-
tigious journal. With five editors available
one might have expected a higher standard.
In fact, bypassing the refereeing process is
not always a bad thing. I have long believed
that the reason why we rarely seen papers of
the quality of those written by German,
French and British neurologists in the first

1112

 o
n

 A
p
ril 5

, 2
0
2

1
 b

y g
u
e

st. P
ro

te
cte

d
 b

y co
p
yrig

h
t.

h
ttp

://jn
n
p
.b

m
j.co

m
/

J N
e

u
ro

l N
e

u
ro

su
rg

 P
sych

ia
try: first p

u
b

lish
e

d
 a

s 1
0

.1
1

3
6

/jn
n

p
.5

3
.1

2
.1

1
1
2
-a

 o
n
 1

 D
e
ce

m
b
e
r 1

9
9
0
. D

o
w

n
lo

a
d
e
d
 fro

m
 

http://jnnp.bmj.com/