Atlas of Neurotology and Lateral Skull Base Surgery

Review by L Flood
Middlesborough, UK

There is a real potential for confusion here, with many a similar title on the market. Even just from Thieme, we have Atlas of Skull Base Surgery and Neurotology (Jackler) and Otology, Neurotology, and Lateral Skull Base Surgery: An Illustrated Handbook (Buchman and Adunka), not to mention the output of others.

Such an atlas requires years of clinical photography, a science that has been progressively transformed by the advent of digital photography. Initially, nothing could compare with 35 mm slide film, but many of us will recall the green radiology images created by the photography of an X-ray film on a viewing screen using Kodak Ektachrome. So we tried tungsten-balanced film and got blue X-rays instead. Both appear here occasionally in this atlas. The solution proved to be Kodak Rapid Process Copy Film, which, despite its name, still required a 14-second exposure and a sturdy camera mount! All can now be corrected by digitising the slides, and processing can transform any collection. Unfortunately, there is much need for that in many of the illustrations presented here.

Now microscope photography of cadaver dissection is generally well presented. Operative images vary far more in quality, but the only two endoscopic views I could find (vestibular neurectomy) show just what can be achieved. Glomus tumour surgery or temporal bone resection are always going to be challenging subjects to capture visually, and certainly prove so here.

This atlas does carry a useful text, however. Every procedure is described in a numbered, stepwise fashion, ranging from the simplest cortical mastoidectomy to temporal bone resection. The opening chapters are a nice introduction to mastoidectomy and facial nerve anatomy, using cadaver dissection. It would have helped orientate the novice to clarify somewhere that we are seeing a right ear, however. Translabyrinthine surgery was then attractively presented, in what is an excellent chapter. The first disquiet came with the following chapter on glomus tympanicum surgery, which desperately needed some illumination. The chapters then take us through every conceivable approach to the skull base, and to such techniques as microvascular nerve decompression, sac surgery, facial nerve repair and hearing rehabilitation with implants.

Each chapter does come with bullet-pointed ‘Tips and Pearls’. These vary in value, but few would doubt that ‘A surgeon doing carotid body tumor surgery must know the various techniques of dealing with bleeding from the carotid artery before embarking on the surgery’. Minor errors are bound to creep past the proof readers, but I was particularly puzzled by the advice in Chapter 30. We are told that, for the transzygomatic approach, the ‘Surgeon sits in front of patient’, with an illustration of a man indeed doing just that. Strangely, over the page, we read ‘Surgeon shifts to the anterior position and sits in front of the patient’. Even more obscurely, this is accompanied by an exact copy of the earlier photograph.

Nevertheless, this book deserves praise for trying to use an atlas of applied anatomy instruction, employing cadaver and surgical images, and not just relying on the customary series of colour diagrams. The challenge remains to provide the quality of images needed, which is not universal here. The text does present surgical steps for each approach, in an easily followed and accessible style, and it is worth considering the value for money presented by its price. Like the legendary ‘curate’s egg’, this is good in parts, many parts in fact. It has much to recommend it, but could have been so much better.