Book Review: Youmans and Winn Neurological Surgery, Seventh Edition, 4-Volume Set

In reviewing the seventh edition of the Neurological Surgery by Youmans and Winn, the first question arising is whether we still need an all-encompassing textbook, an opera omnia, on Neurosurgery. Ours is an age of specialization and even of ultraspecialization. Being early addressed to a subspecialty is a today’s general trend for young neurosurgeons and this is certainly functional to the rapid gathering of a wealth of experience to ensure optimal patient outcome. Nevertheless neurosurgeons, especially those young doctors who did not live in a time when neurosurgeons were able to deal with most of the neurosurgical diseases, run the risk of losing a more comprehensive understanding of our discipline—its great beauty as well as its pitfalls. The intent of providing an encyclopedic overview of neurological surgery is clearly stated by the authors, and we recognize that this textbook is, in its own right, an essential reference guide to both the experienced and nascent clinician. The first edition of Neurological Surgery by Julian Youmans appeared in 1973. Since then on, and for each generation of neurosurgeons, the “Youmans” represented a comprehensive textbook highlighting the state of the art of neurosurgery, the techniques and technology of that generation’s contribution to neurosurgery. Almost 5 decades have passed from that first edition, and the textbook has expanded to 415 chapters and 5000 pages. By looking through all the editions, we can understand the long journey made by our knowledge and the breadth reached by our current practice of neurosurgery. The second question concerns what a textbook, with ambition to be considered the bible of the craft of neurosurgery of the present and next generation, should communicate. If great attention should be paid to the rise of the technological aspects on which our discipline is increasingly dependent, all these innovations make sense if able to improve patient safety and postoperative quality of life. To this purpose, this seventh edition dedicates a good number of pages to relevant, but elsewhere overlooked, themes such as “Improving patient safety,” “Complication avoidance in neurosurgery,” or “Coagulation in neurosurgery.” Also, more traditional issues are discussed under original and modern perspectives (ie, chapter 24, “Brain Retraction”). The description of pitfalls and complications is always very difficult. Summarizing in few pages all the circumstances in which minimal variations from what we plan may result in an unexpected event with serious implications on the patient’s healing perspectives, is a great challenge. Equally complicated would be trying to describe the emotional consequences that these events may have in the immediacy and on the subsequent choices. Can a textbook explain to young neurosurgeons that mastering surgical techniques is sometimes insufficient and that our results depend substantially on our decision-making? Probably no. Nonetheless, Neurological Surgery by Youmans and Winn makes an attempt to explain to the reader this fundamental issue of the discipline with its “complication avoidance” sections and especially with the foreword of Henry Marsh, a wonderful declaration of love and an epitome of the essence of neurosurgery. A wide section is dedicated to the surgical anatomy as crafted by Albert Rhoton and his colleagues. The section is combined with relevant clinical cases and relative videos that make surgical anatomy much more intelligible. The majority of chapters also contain related surgical videos, which are all very well prepared with a suitable length, correct magnification, and appropriate commentaries. Even though an increasing number of video collections and multimedia publications are available on the web, this selected well-prepared electronic material remarkably helps the understanding of several neurosurgical procedures. Videos on perioperative techniques such as patient positioning are also provided, as well as other supplementing basic sciences and clinical topics. Great attention is paid by the authors to radiological anatomy, with introductory overviews of brain and spine imaging and other relevant techniques for diagnosis contained within each subspecialty section.Other investigational techniques and, in particular, those that are ancillary to the surgical procedure such as neurophysiology and functional neuroimaging are also described in detail. Controversies in clinical practice, an issue that is really relevant in this textbook, are presented very clearly in a dedicated section and at the beginning of all introductory chapters for each of the 12 sections. These introductory chapters, written by each section editor, review the contents of the section and provide thoughtful comments while presenting main controversies on the topic. The textbook contains interesting incursions in the fields of neuroanesthesia, neurointensive care, and neurourology. All this material represents an important contribution that can greatly help the cultural growth of neurosurgeons. Being able to understand and even handle anesthesiology techniques is crucial to recognize the risks of surgery and greatly improve surgical performance. Similarly, a chapter dedicated to the role of the neurosurgeon in intensive care reminds us that such medical expertise is a basic and indispensable requirement. The textbook also tries to dominate the uncountable knowledge provided by basic science investigations through some chapters that address themes of obvious interest. Of course, this is an overwhelming task and well beyond the purpose of the authors.