The development of modern neurosurgery is set out and discussed in the book. It includes mention of Sir Victor Horsley, National Hospital for Nervous Diseases, Queens Square, William McEwen, Glasgow and Harvey Cushing - "the father of neurosurgery" ...
Boston, USA. Cushing's British pupils were Norman Dott (my main mentor), Geoffrey Jefferson, Manchester and Hugh Cairns, Oxford. It is interesting that becoming a consultant neurosurgeon and senior lecturer in Edinburgh, on three occasions I was "headhunted" in Glasgow by Sloan Robertson, the Mount Sinai Hospital and medical school in New York, USA and the Harvard Medical School in Boston, USA. For particular reasons I declined these important offers. This is a brief outline, given more fully in the book, of some of the main disorders of the nervous system seen and requiring decisions of management by a neurosurgeon. It includes aetiology (cause), pathology (the scientific structures of disease), clinical syndromes (a combination of symptoms indicating a particular disease). Investigations, neurosurgical treatment, clinical outcome and prognosis (the effects on the patient). Regarding hydrocephalus, treat the cause, this may be a shunt procedure from a cerebral ventricle into the abdomen. A major condition for neurosurgeons is that of patients with head injuries. This is given in detail in the book, with case reports. Intra cerebral tumours, gliomas or metastases have a poor prognosis, whereas meningiomas and neurinomas can be successfully excised. The pituitary gland secretes hormones (a hormone is a substance secreted by certain glands which stimulates certain organs of the body), thus for example may cause acromegaly. An adenoma can affect vision. Small berry-like anomalies of arteries of the brain are called aneurysms, and these may rupture usually causing very severe headache and a variety of neurological signs. Very early investigation and treatment are required, to prevent recurrent bleeds. Transient ischaemic attacks (TIAs) are common, often due to occlusion of a main carotid artery supplying the brain. Verification of this can lead to an operation on the offending carotid artery. Strokes are due to occlusion of a cerebral or carotid artery, producing a typical syndrome of hemiplegia and with dominant cerebral hemisphere speech disturbance. It is very important to refer such a patient urgently (certainly less than a few hours) to an acute stroke unit for a decision for anti-thrombotic therapy. A neurosurgical operation is not indicated in the early phase. Operation on a patient with a very vascular tumour or anomaly may require specialised techniques to help control haemorrhage, such as hypothermia or hypotension. Several aspects of the symptom-complex of epilepsy are described. There are sometimes indications for neurosurgical treatment, especially for patients with temporal lobe epilepsy. Indeed this can result in a complete cure. Stereotactic neurosurgery is an elegant procedure, used mainly for patients with Parkinson's disease, intractable pain, temporal lobe epilepsy and for brain biopsies. Altered states of awareness are described:- coma, the persistent vegetative state (PVS), the locked in syndrome (LIS), and brain death. Protrusion of a lumbar intra vertebral disc is common and produces clinical features described in the text. Indications neurosurgical treatment are provided and the results of these are described. Cervical spondylosis is common in older people and the syndromes produced and their investigations, and for certain patients as is described in the text, operative treatment is required. There are different clinical syndromes resulting from cervical spondylotic myelopathy, some responding better than others to neurosurgical treatment. About 300 patients a year are seen in the UK with severe, sometimes devastating paralysis causing paraplegia or if the cervical spine is involved, tetraplegia. Such patients must be transferred as quickly as possible to a hospital with full facilities for their investigations and management, then a decision will be made regarding the possible necessity for a neurosurgical operation, for example removing a compressing blood clot or a disc protrusion compressing the spinal cord, or indeed if the vertebral column is seen to be dangerously unstable. The possible regeneration, or indeed cure of a damaged spinal cord, has been attempted, for example, for example using embryonic stem cells. Special mention is made of certain lumbar spine fracture dislocations, as the nerves in that region (cauda equina) will prolapse through tears in the membranes covering the spinal cord and if this is not dealt with properly there will be progressive and permanent neurological disabilities. Some patients with a paralysed urinary bladder and also those with a paralysed diaphragm can benefit from implanted electrodes for their electrical stimulation. Spinal neurinomas and meningiomas are to be excised, but growths outwith the membranes covering the cord are usually metastases- kidney, lung etc. Only palliative treatment is possible. Trigeminal neuralgia is treated by operative treatment if there has not been satisfactory response to drug therapy. I was awarded a British Council travelling fellowship to India, and from the Burmese government an invitation to help establish the first neurosurgical department in that country. In Harvard University in Boston, USA I gave lectures including one on radioactive Yttrium90 to treat selected patients with advancing diabetic retinopathy. Visiting professor or guest lecturer in several countries including Japan, Israel, Egypt, Peru and other South and North American medical schools and universities. I have represented the Society of British Neurological Surgeons in the World Federation of Neurological Societies. Other involvements of medical and of non-governmental organisations include the Royal Scottish Colleges of Surgery and Medicine, the Royal Society of Edinburgh, the Scottish Association of Neurological Sciences (founded by myself), the International Spinal Cord Society (Editor of Spinal Cord for some some 20 years), the media (press, television and radio) and the Scottish Trust for the Physically Disabled. There follows a chapter on Examinations and Examiners. The miscellany chapter includes interesting items:- the Norman Dott Trust, more pen portraits of people including Charles Drake (Canada), Ralph Cloward, Robert McLuin, Earl Walker (USA). Neurological disturbances of intestinal function, also "spot the ball", "playing chicken", becoming a honorary colonel in the Alabama National Guard, the Salmon Report, fundraising, pre-empting the NHS, a "hirsute problem", the Heimlich manoeuvre, an epidemic of ageing, an unwelcome experience and a tuneful ending. Profiles of two of my favourite artists, Rembrandt, and Gustav Mahler are included. Some aspects of the philosophy and understanding and experiences of life as a neurosurgeon are provided in the Epilogue. There are a number of apt aphorisms throughout the book. Brief mention of appointments, publications, medals and prizes, membership of medical learned societies and research grants. Reccommendations for further reading are provided. Also a glossary of medical terms and indices of people and subjects are included. There are a large number of illustrations.