Nerves and nerve injuries
Correspondence Address: Source of Support: None, Conflict of Interest: None DOI: 10.4103/0028-3886.250710
Source of Support: None, Conflict of Interest: None
Editors : R. Shane Tubbs, Elias Rizk, Mohammadali M. Shoja, Marios Loukas, Nicholas Barbaro, Robert J. Spinner
Publisher : Academic Press, Elsevier
Published Date : 15th April 2015
Volumes : 2
Total Pages : 1764
The book 'Nerves and Nerve Injuries' is an attempt to refresh the magic of the stupendous original work of the same name created by Professor Sydney Sunderland, the knighted Australian anatomist, scientist, and experimental neurologist, in 1968. Professor Sunderland (1910-1993) recognized and famously described the five clinically recognizable and prognostically important stages of peripheral nerve damage while he treated and followed up Australian servicemen wounded in World War II.
The editors of the current book realized that considerable advancements have occurred in almost every facet in the world of nerves, that addition or modification of the original work would no longer do. They had to, therefore, create an encyclopaedic work from scratch.
The first chapter traces the history of the study of nerves from the Alexandrian times (300 BC) where surgeons often confused nerves with tendons. A fascinating account follows of how surgeons of the next few centuries used split tortoise tendons soaked in red wine, cotton and silk and even hair of women ('only for special cases', though) to mend injured nerves. Even the wavering decision to approximate a cut nerve took centuries. Blood letting and snappy stretching of nerves for many a centimeter to cure maladies were proven treatments. We wonder what future authors will write about the present time, about our own emerging and proven techniques that we seem to be so sure of! The second chapter describes in detail, the more rapid evolution of the classification of injuries and surgical techniques, during the last two centuries.
Two brief chapters on embryology encourage us to extrapolate, though with uncertainty, the knowledge derived from rats to humans. This is because working on the human embryos has always been difficult due to ethical issues. Like the original masterpiece, vast swathes of the book are dedicated to the anatomy of each of the cranial and peripheral nerves. There is also a description of the comparative anatomy of the plexuses of various animals, which is useful for those of us who are planning to do experimental studies.
The chapter on electrodiagnostic methods is a concise description of its principles and is illustrated with screenshots of the waveforms and the abnormalities seen in disease states.
Chapters eleven and twelve are specifically directed at non-anaesthetists and surgeons to help them deliver nerve blocks themselves for various procedures. Chapter 16 gives further details on ultrasound-guided regional anaesthesia. As ultrasound transforms into the portable third eye of the surgeon, with the resolution of its real-time imags often being better than that of magnetic resonance imaging, chapter 16 is a must-read for all clinicians.
Part I of the second volume extensively deals with nociception and management of pain. Part II of the same volume describes surgical exposure of the plexuses and nerves, and part III and IV constitute in-depth reviews of the technical aspects of nerve repair itself.
Part V deals with rehabilitation, and its psychological aspects. The case-based discussions illustrate the scenarios and strategies. A description of the utility of outcome measures in the treatment of nerve injuries and neuropathic pain is important for those who want to set up integrated, multidisciplinary nerve disease management units and for designing clinical trials. Chapter 45 is a very brief overview of the medicolegal aspects of nerve injury, touching upon accessory nerve injury, and neonatal brachial plexus injury, and the relevance of intraoperative nerve monitoring in thyroid surgery. Part VI deals with the pathology of the peripheral nerve.
Part VII of the second volume shines a light on the possible future of basic science related to nerve physiology and pathology, and dwells on stem cells, stromal cells, and tissue engineering, essentially to find a solution to the problem of how a large gap in an injured nerve may be managed. Incredibly, we turn to the tendons of a crab to isolate chitosan, one of the promising biomaterials for this purpose, not much a different source that the researchers of Alexandrian times looked at. Despite a multitude of manufacturing processes described on diverse materials, cells and growth factors, a clinically relevant breakthrough eludes us. Researchers interested in neurobionics will find the chapters on computer modelling of nerves and on electrode designs useful.
Obviously, this is a large and valuable compendium for which even a commentary would become unmanageably lengthy. We agree with the publisher that it serves as an up-to-date, and the go-to source for anatomists, experimental neurologists, neurosurgeons, and many others. As knowledge continues to explode, no book can completely describe the advancements and intricacies of any subject or even its subdomains, and this text is no exception. One will need to find dedicated references for many of the sections for pursuing a greater depth of understanding.
A surgeon engaged in nerve surgery may need to look elsewhere too for detailed diagrams and atlases, though the descriptions of the techniques are quite detailed. The text also lacks multimedia supplements like operative videos and web-based learning resources that are increasingly common accompaniments with textbooks. We recommend a personal copy of the book for anyone who intends to study the nerves with more than a passing passion and it is indeed a must-have in an academic library.