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Differential diagnosis in neuro-oncology
  1. Ian Whittle

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    Edited by Jerzy Hildebrand and Michael Brada (Pp 298, £59.50). Published by Oxford University Press, Oxford, 2001. ISBN 0-19-263213-2

    This book is written by two very experienced, eminent, and respected European neuro-oncologists. The aim of the book as described in the introduction is assisting in the correct diagnosis and therapeutic management of patients with neurological syndromes due to neoplastic conditions. The neurological syndromes in cancer patients cover the spectrum of neuro-oncological sites and each chapter is broken down into subheadings of introduction, clinical presentation, main aetiologies, investigations, treatment, and appropriate references. The neurological syndromes covered are altered consciousness, cognitive and behavioural disorders, epileptic seizures, cerebellar dysfunction, visual alterations, cranial nerve and brain stem lesions, spinal cord lesions, diffuse lesions of the peripheral nervous system, focal lesions of the peripheral nervous system, muscle disorders and fatigue, endocrine disorders, and treatment of the main neurological malignant diseases.

    Overall this gives a very compact and user friendly description of the major clinical features and disorders encountered in the practice of clinical neuro-oncology. The strength of the book lies clearly in the widespread experience of the two authors. They have been able to include common and rarer neurological syndromes into an easily digestible and coherent clinical classification. In particular for neurosurgeons this book will offer a great deal since it provides major insights into non-surgical courses of neurological syndromes seen in patients with cancer. This applies particularly to problems related to chemotherapy and radiotherapy, as well as paraneoplastic syndromes, which are well covered.

    While the book will be a useful reference tool for the surgeon, it is rather weak on neurosurgical aspects in neuro-oncology. For example, under neurosurgical therapy of glioma (p 227) it is stated that “optimal resection (of gliomas) should achieve tumour removal without morbidity.” This is despite morbidities of 10–24% being described in most current series in the literature. There are also allusions to the use of neuronavigation tools in neurosurgery, which will make tumour removal “easier and more complete.” However, at this stage there is no evidence for this. There is also an imbalance in the role of resection versus biopsy in gliomas. A recent Cochrane review found that there is no evidence in the literature to show that survival outcomes are better in patients who have resection rather than biopsy for malignant glioma. On p 223 it is also suggested that histologically glioblastomas are homogeneous—it is clearly not the case since they are heterogeneous.

    There are also minor points in terms of preparation of the book, such as reference 38 in the treatment of gliomas—this is dated 1977 rather than 1997. Some of the plates are labelled incorrectly and the subheading in the myopathy section is under cognitive and behavioural disorders. These are, however, minor quibbles. The depth of coverage of medical and radiation neuro-oncology, the excellent core reference list, and numerous useful illustrations and algorithms make this a “must have” book. Do not be put off by the atrocious book cover—what on earth is it?!

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