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For neurosurgeons, head injuries are always with us. They exist like the drones of a bagpipe tune, unchanging in the background while the music goes on elsewhere. This is perhaps why the last major textbook to be published on the subject was that of Jennett and Teasdale in 1981. However, for that small, and diminishing, band of neurosurgical researchers, head injuries provide ideal “case material” for the investigation of new ideas on the ways that insults affect the nervous system and how outcomes might be improved. The fruits of that thinking and investigation are admirably covered in this new book. It represents a tripartite cooperation between those centres in the United Kingdom, Australia, and the United States which have a particular interest in the mechanisms of head injury and management of the patient. Although not all of the content is new, the chapters on the effects of injury at the cellular level represent a particularly useful summary of what has become a very complex pathophysiological process. Similarly the chapters on new methods of investigation in those with head injury, such as PET, SPECT, MR spectroscopy, and transcranial Doppler, represent, for the average neurosurgeon, a useful summary of the applications of new and rapidly developing technologies.
Although promising developments in the field of neuroprotection and perhaps eventually brain repair can be perceived on the distant horizon, of its nature, neuroprotection can at best prevent or minimise secondary damage. To achieve major miracles we will no doubt have to await the more distant promise of brain repair. If such treatments do eventually become available there is no doubt that any such techniques will prove difficult and very expensive. The non-specialist may turn therefore to the regrettably small section on prevention. In the United Kingdom the number of head injuries shows a small but welcome continuing decline, although not all countries are so fortunate. Head injury rates vary widely even in the so called “developed” world. On a recent visit to Amsterdam I was astounded to see, in such a cycle oriented city, not one single rider wearing a protective cycle helmet. Perhaps the time has come to make these compulsory. There is clearly much still to do in the way of head injury protection. Although seatbelts, airbags, and antilock brakes represent good solid progress, considering the remarkable survivals which occur in the high speed crashes in Formula One Grand Prix motor racing, there is clearly a lot more which could be achieved given the potential will and the financial investment.
The book is a welcome addition to the neurosurgical literature. It is well produced and beautifully presented. Although rather expensive it will no doubt become an indispensable companion for those of us who still have to care for these distressing and still too frequent cases.
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