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Atlas of peripheral nerve surgery
  1. ROLFE BIRCH

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    Atlas of peripheral nerve surgery. By david g kline, alan r hudson, and daniel h kim (Pp235, £150). Published by Harcourt Publishers Limited, Philadelphia, 2001. ISBN 0-7216-7988-9.

    David Kline and Alan Hudson wrote Nerve injuries, a work of exceptional importance which was published in 1995. In this work they are joined by Daniel Kim and present an atlas of operative exposure with a discussion of methods of repair of nerves; this is a companion volume to the earlier work.

    Nineteen chapters describe the anatomical relations of the peripheral nerves in the upper and in the lower limb, of the brachial plexus, of the intrapelvic course of the femoral and sciatic nerves, and of the nerves of the abdominal wall. Five chapters describe methods of nerve transfer or of nerve repair, a further chapter is dedicated to neurolysis, one chapter is dedicated to intraoperative neurophysiological work, and there is chapter dedicated to technical questions for the treatment of nerve sheath tumours.

    There is a lengthy appendix, of some 100 pages, with photographs of anatomical dissections. These, from Dr Kim, are of the highest quality.

    This work is more than a surgical companion. The detailed description of the relation between peripheral nerve trunks and adjacent axial structures, the relation of anatomical variation makes it relevant to any clinicians engaged in the diagnosis of patients with disorders of peripheral nerves most especially to those engaged inclined towards interventional work. The descriptions of the course and relations of nerves of cutaneous sensation in the lower limb and of the nerves of the abdominal wall is particularly good and of direct relevance in the treatment of patients who have had accidental damage to those nerves. Too often these patients present with severe pain, and, because of ignorance, the importance of the distribution, and the location of those sensory disturbances, inappropriate treatment is commenced.

    The careful description of the exposure for operations of thoracic outlet syndrome serves to remind all of the potential seriousness of this procedure. I particularly liked the chapters describing exposure of the suprascapular and the circumflex nerves, of the course and variations of the sciatic and of the femoral nerves and most especially the account of David Kline's own operation, the posterior or subscapular approach to the most proximal segment of the spinal nerves passing to the brachial plexus and upper limb.

    Of the technical chapters describing intraoperative compound nerve action potential recordings, a particular contribution from David Kline is especially good.

    The work is greatly enhanced by Dr Kim's photographs of dissections. This is important and valuable work, I would suggest that it is essential reading for surgeons engaged in this work but that its interest extends well beyond that group. There are inevitably errors which will require attention when the work comes to revision, figure 1.11 does not demonstrate the correct relation of the spinal accessory nerve to the uppermost spinal nerves, figure 13.8 showing the course of the posterior interosseous nerve requires attention. Set against the whole these are very minor blemishes.

    The authors are to be congratulated on producing an important book which does indeed act as a “companion surgical dissection text or atlas” to their earlier work, which in fact goes well beyond.

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