Therapeutic approaches Giant Intracranial Aneurysms

This book is published as one of a series entitled Foundations ofNeurological Surgery and is a clearly produced volume. The early sections on laser types and laser physics read easily and are well illustrated, but the one which follows on the interaction oflaser light with neural tissue is a little less clear but quite comprehensive. The section on benign supratentorial tumours is more of a mature appraisal of the approaches to these problems rather than a detailed account of the neurosurgical laser, but the well established technique of applying defocused laser to the skull base after meningioma excision, the high power density laser vapourisation of tumours, and the sharp focused dissection *from the falx and sagittal sinus, are included. Salcman's account of the laser surgery of glial tumours is comprehensive in the technical aspects, the different tumour types treated and in the comparison of laser with non laser techniques by operative results and follow up. There is a good account of the value of the laser for glomusjugulare tumours and also in the excision of craniopharyngiomas, both of which the reviewer can confirm. The paediatric chapter overlaps that on the treatment of congenital abnormalities, the latter containing the better account of laser resection of lipomyelomeningoceles, but the former gives an excellent description -of the laser excision of low brainstem gliomas in children. Patrick J Kelly's short account of stereotactic laser resection of deep-seated cerebral gliomas underestimates the importance of this method which he has pioneered, and the section on intraspinal tumours which follows it gives insufficient detail on ,microsurgical laser technique and results in the treatment of intramedullary tumours. There is a short section on making DREZ lesions and myelotomy with the surgical laser in the treatment of pain. The book ends with a good physical explanation and illustrated account of the Nd:YAG in the treatment of AVMs, and a .brief survey of laser in microsurgical anastamosis of small vessels and nerves in experimental studies. For the first volume of the Foundations of Neurological Surgery series this sets quite a high level.