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Stereotactic radiosurgery has been with us for about 30 years. The pioneering work of Lars Leksell was carried out at the Karolinska Institute in Stockholm, but in the United Kingdom, the National Stereotaxic Radiosurgery Unit in Sheffield has now been active since 1985. In theory, indirect methods of treatment for neurosurgical conditions are to be preferred to direct open surgery and it already seems that in a number of areas indirect techniques have already largely replaced surgery as the treatment of choice, for example, in the endovascular coiling for the treatment of intracranial aneurysms where direct surgery seems destined to become a rare event for this condition in the not too distant future. It is therefore disappointing that the application of the stereotaxic technique to radiosurgery has not been more productive in this respect. However, some progress has been made. This review in the series Progress in Neurological Surgery sets down the current state of play in this field. The experience recorded in this volume is entirely North American and, as most of the conditions treated by this technique are rare, it would have been valuable to have included the by now quite extensive experience from the Scandinavian and the United Kingdom units. The papers in the volume, as is usual in this type of publication, are of variable quality and of variable value - one wonders at the need for a chapter on the technology and physics of the technique. On balance however it is an interesting volume and there are some useful data on the management of quite rare conditions. This may be particularly useful to the “modern” neurosurgeon who now has to discuss, using appropriate data, the alternatives to surgery with each patient as an integral part of the “informed consent” procedure. The chapters onPatient outcomes after Arteriovenous and Cavernous Malformations are potentially useful in this respect. The section on Frontiers of Radiosurgery is more problematic, and because of the small number of cases involved it is very difficult to form any useful conclusions about the place of this treatment technique in the management of these difficult conditions. One questions, for example, whether it will ever replace tried and tested surgical techniques in the treatment of disorders such as trigeminal neuralgia or the involuntary movement disorders.
Despite the persuasive data presented in at least some of the chapters in this volume it remains questionable whether the enormous expense of these dedicated machines is really justified in this modern age. We wait with some interest a future volume on the LINAC treatment of a similar spectrum of disorders.
The book is compact and well presented and can certainly be recommended for the departmental library.
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