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Advanced Neurosurgical Navigation.
  1. ROBERT MACFARLANE

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    Advanced Neurosurgical Navigation. By eben alexander iiiand robert j maciunas. (Pp 605, DM398.00). Published by Thieme, New York, 1999. ISBN 3-13-115391 1.

    The quest for a means of accurate localisation of structures during neurosurgery has taxed the minds of clinicians from early in the history of the specialty, starting with Zernov’s encephalometer more than a century ago. Just as the solution to the mariners’ problem of determining longitude from which it partly takes its name, neuronavigation ("the surgeon’s sextant”) has relied on the advent of new technologies to provide solutions to an age old puzzle.

    Advances In Neuronavigation begins by tracing the history of stereotaxis from a Cartesian coordinate system devised by Clarke and Horsley at the beginning of this century, through ventriculography, stereotactic brain atlases, and CT/MR frame based stereotaxis. The final part of the first section discusses the roots of image guided frameless stereotaxis through the integration of high speed graphics computers, informatics, biotechnology, and robotics.

    The remainder of the text is divided into four sections. The first concerns the creation of maps from CT, MRI, MRA, PET, and various types of functional imaging. The following section discusses clinical applications of stereotaxis, beginning with different authors’ experiences of their own favoured frames, the biopsy of difficult lesions such as those in the brainstem or posterior fossa, and finally experience with different image guidance systems and their integration with the operating microscope and endoscope. There then follows a series of chapters devoted toradiosurgery, and to image guidance in epilepsy and functional surgery. The final section is entitledFrontiers in Neurosurgical Navigation and considers, among other topics, intraoperative MRI, telepresence in neurosurgery, and robotics.

    The incorporation of new technology is likely to alter surgical practice radically over the coming decade and equipment that seemed at the cutting edge of technology only a few years ago, such as the mechanical arm, has already passed into near obsolescence at a bewildering rate. This volume provides an excellent account of the developments which have occurred in neuronavigation, and a thought provoking insight into the wider applications of equipment of which many of us use only a fraction of the potential capability. The title of the book should perhaps have included the word cranial, as there is almost no discussion of the impact that this technology has had in surgery of the spine. This aside it is an excellent book although, like the technology it chronicles, one which is likely to date quite rapidly.

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