Controversies in Skull Base Surgery

Review by L Flood
Middlesborough, UK

I had imagined that filling an A4 sized textbook of almost 300 pages would prove a challenge to the authors, if they were to stick to the title. This could easily have proven to be just another standard neurosurgical textbook, even if it did come with the print quality, characteristic layout and superb illustrations we would expect from this publisher. I need not have worried. This is the latest in a series of ‘Controversies in’ from Thieme. Chapter titles closing with a question mark, or featuring such words as ‘options’, ‘alternatives’ or ‘versus’ reassured me. There is a wide range of topics covered and a substantial list of contributors, promoting lively and informed debate, rather than the ‘how I do it’ approach.

There is a consistent style, with most chapters providing case examples, conclusions and recommendations for further study (i.e. research, which I really do like to see). The lesions that are covered, of interest to us as neurotologists or anterior skull base surgeons, include vestibular schwannoma, olfactory groove or petroclival meningioma, pituitary adenoma, and sinonasal malignancy. Four chapters on vestibular schwannoma discuss controversies around its natural history, the relative merits of single-session versus hypofractionated radiosurgery, the management options for residual tumour after subtotal resection, or the strategies for the young patient with well preserved hearing. That last topic proved particularly thought-provoking, and all were typical of the approach throughout the book.

A final section, comprising nine chapters, covers ‘Surgical Approaches and Techniques’, and again offers debate and controversies, rather than descriptions and recipes, as promised. The role of antibiotics, the need for lumbar spinal drainage or the place of cerebral revascularisation each rates a chapter. The authorship is almost exclusively neurosurgical, so it was interesting to see a chapter here on whether an otolaryngologist’s input was of value to their work. I confess to amusement as I know many of my contemporaries in our field who sometimes almost reverse that question, as they tackle a pituitary or anterior skull base sinonasal tumour single-handed. Multidisciplinary team work can be an interpersonal and logistical nightmare, and the authors do also discuss the ‘billing challenges’. Our readers will be pleased to learn that, after what was a very balanced argument, the conclusion is favourable.

This book is of the quality we would expect from this pub- lisher and has met the challenge of its title. It is of greatest relevance to neurosurgeons obviously, but I would recommend it to anyone in our specialty working in skull base surgery.

Amazon Link: Controversies in Skull Base Surgery
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