Meningiomas of the Skull Base: Treatment Nuances in Contemporary Neurosurgery

Review by L Flood
Middlesborough, UK

As the subtitle suggests, this textbook is primarily aimed at neurosurgeons and neurologists, but it is also described as ‘welcomed by skull base surgeons and otolaryngologists’. A glance at the cover immediately shows why this topic is of such relevance to us. If only tumours at presentation were as small as shown, but one might notice how several sites involved are likely to present to ENT.

Most of us can distinguish the typical radiological appearance of a meningioma from that of a schwannoma, in the cerebellopontine angle, or will request a magnetic resonance imaging scan in most cases of anosmia. But how many of us, when faced with adult Eustachian tube obstruction, will confine ourselves to an endoscopic peek into the nasopharynx, or, at most, a random biopsy? That silent skull base meningioma could just be lurking there.

Having stressed its importance to our trainees and their seniors, it is high time to actually tell you something about the content of the book itself. The two editors, from Naples, have recruited an international authorship, mostly US or European (I counted 62), but have managed to retain a uniformity of style throughout. There is some repetition inevitably, but this book makes for easy reading or for just dipping into.

It is claimed that a splendidly bearded Italian surgeon, Durante, opened the batting with the resection of an olfactory groove meningioma (in 1884!). Amusingly, this is contradicted by other nationalities of author, who claim a variety of their own precedents. The book stresses technological advances such as endoscopy, computer-assisted surgery and radiosurgery, but also adjuvant therapies based on better understanding of molecular biology.

The text opens with two very daunting pages of abbreviations, which help when later reading of ‘ITGB1’, ‘PCOS’ or ‘QUANTEC’. Enjoying a few hours in an unusually sunny English garden, I began to appreciate just how varied the simple ‘mengioma’, christened by Harvey Cushing, now proves to be, especially when subjected to immunohistochemical analysis. A chapter on ‘Exogenous Factors Affecting Meningiomas’ was quite fascinating. In addition to the obvious genetic predispositions, such risk factors include ionising radiation (unsurprisingly), female sex hormones as in hormone replacement therapy or contraception, mobile telephone use (of legend), metabolic syndrome or obesity, and even smoking.

Chapters on surgical instrumentation, intra-operative neurophysiological monitoring and stereotactic radiosurgery precede a series each looking at a particular site of tumour. The sphenoid wing, the clivus and olfactory groove, and, above all, the posterior fossa, are the areas of interest for us. Chapters that follow deal with the territories of nightmares, such as the foramen magnum or cavernous sinus, to which our neurosurgical colleagues are only too welcome. The text closes with the management of recurrence and of complications, the latter with many a useful generic message for any intracranial intervention.

As one would expect from this publisher, this is a quality hardback book, profusely illustrated with masses of monochrome imaging, and colour operative photographs and diagrams. A few are a little small for easy examination, but this is inevitable I accept, if one is to pack in so much text and illustration. Scans are reproduced in sharp focus and demonstrate some impressive lesions. Some chapters carry references to papers published as recently as 2017, suggesting this is well up to date.

In conclusion, this is something different, which is surprisingly of value to more than just the neurotologist and skull base surgeon. It is an invaluable insight into current neurosurgical practice and an entertaining read throughout. It obviously belongs in every post-graduate library, but will surely appear in the neurology section. I do hope this review encourages our readers to seek this out.

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