Peter J Hamlyn (2 results)

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Amsterdam, Elsevierm 1999, 4°, XIX, 271 pp., zahlr. farb. Abbildungen, orig. Pappband. First Edition! "Compression of a cranial nerve as it crosses between the brain stem and the base of skull by a blood vessel has been implicated in the production of a wide variety of syndromes. Conditions as apparently disparate as trigeminal neuralgia, hemifacial spasm, deafness, vertigo, torticollis and hypertension have all been ascribed to this same pathology. In each instance the relevant cranial nerve has been described as being compressed by blood vessels normal in all respects other than their position. Indeed, it is likely from the literature reviewed in this text, that well in excess of 50000 surgical explorations of the posterior fossa have been undertaken in patients suffering from one or more of these conditions in bids to reverse the symptoms. However, review of the same literature shows little consensus to exist as to the reality of the compression in these conditions. In the presence of alternative treatments, it is perhaps a wonder therefore that such major surgical undertakings have gained such widespread acceptance. Driven by the successful outcome for many patients the procedure has become well established in trigeminal neuralgia where it appears to offer good quality relief of a durable nature. Unfortunately the results in other conditions have often failed to match these and even for trigeminal neuralgia the basic anatomical evidence upon which the treatment is based has remained wanting. This alone would be remarkable enough. It is all the more so when it is appreciated that the possibility was first clearly raised in the early 1930's and that the conditions implicated include problems as common as hypertension and senile presbycussis. The attempt here has been to review the current status of neurovascular compression in the production of the various syndromes to which it has been applied and to explore the anatomical and clinical evidence upon which it is based. The literature is extensive and the bibliography is as a result extensive. However, it leaves many substantial gaps in the data required to form even the most basic of conclusions and as such substantial new anatomical work is presented. In Part 1 the subject of neurovascular compression is reviewed as a whole and the pitfalls of study design considered. Part 2 then deals with disorders of trigeminal nerve function, Part 3 with those affecting the seventh and eighth cranial nerve bundles and Part 4 with those disorders relating to vagal, glossopharyngeal, accessory and hypoglossal nerve function. Finally in Part 5 an attempt is made to judge the current status of these procedures in the various disorders to which they have been applied and to set this in the context of the available alternatives. This last section also details the more recent advances in the field and outlines valuable areas on which future work might most profitably focus." Preface.