The American Association of Neurological Surgeons formed a publications committee several years ago with the intention of producing a series of monographs on the state of the art in various areas of neurosurgery and allied specialties. Each monograph is designed to address a specific disorder from the standpoints of anatomy, pathology, radiography, and operative treatment. This monograph is one of the latest in the series.
The diagnosis and radiographic presentation of the Chiari malformations have long been well established, and these topics are discussed clearly in the text. The clinical and operative treatment of these entities, however, continues to generate much controversy. This volume represents an admirable attempt to address these problems.
The monograph begins with the finest historical review of syringomyelia and the Chiari malformations that I have read to date. This extraordinarily complete chapter, by Lotbiniëre, includes an extensive bibliography and fine, pertinent illustrations; it is essential reading for anyone even remotely interested in the subject. Subsequent chapters deal with classification systems, pathogenesis, and imaging studies related to this subject. Chiari subgroups I through IV are discussed. Syringomyelia is commonly associated with the Chiari malformations, and chapters describing its complex etiology and pathology have appropriately been included. The etiology and pathogenesis of syringomyelia and hydromyelia have long been controversial among neurosurgeons, and a number of these theories are presented. I am not sure that any definitive answers are offered, but certainly some provocative thoughts and insights are voiced.
The operative treatment of these disorders is discussed by several outstanding experts, including Bernard Williams (whose recent death is noted in the introduction). Williams probably contributed as many original (albeit controversial) insights on this subject as anyone in our field, and his ideas are elegantly presented here.
The editors have assembled a superb group of contributors. The text is well organized and comprehensive, and the chapters are succinct and well illustrated. There is slight redundancy in that many of the same ideas are discussed by different authors. However, the work has been designed so that each chapter can stand alone. The reader does not have to go through the frustrating process of ferreting out information from a large, unwieldy, three-to-six-volume series on neurosurgery and orthopaedic surgery; for that reason alone, this volume will make a good addition to a personal library. It also will be useful for the practicing neurosurgeon and for the orthopaedic surgeon who is interested in the spine, and it will be an excellent reference for the house officer who is looking for a concise work on the medical and operative nuances of the Chiari malformations and syringomyelia.
James T. Goodrich, M.D., Ph.D.
Division of Pediatric Neurosurgery
Leo Davidoff Department of Neurological Surgery
Albert Einstein College of Medicine
Bronx, New York