230 Book Reviews

D I E T R A N S D U R A L E E C H O E N Z E P H A L O G R A P H I E

By H. R. MULLER.

Hans Huber, Bern, Stuttgart and Vienna.

164 pp. 1971 (German with English summary). Price: Sfr. 43; $12.65

MOST of the problems encountered in ultrasonic encephalog- raphy result from the necessity for the energy, whether transmitted or reflected, to traverse the variably scattering medium of the skull twice. Although Tanaka in Japan showed in 1957 that, by removing the skull, it was possible to acquire much more information from the underlying brain the technique of transdural echoencephalography did not attract wide attention until Muller developed a simple A-scan technique for use during routine craniotomies. This monograph lucidly describes the technique developed by Muller and the clinical experience he has gained.

In an introduction Professor Levy who is Dr. Muller's neurosurgical colleague, acknowledges the assistance that he receives from this technique during craniotomies and especially when he is faced with uncertainties about the location, size and probable pathology of an intracerebral lesion which is not visible on the surface.

After brief chapters describing the principles of pulse-echo techniques and the historical background of echoence- phalography through the skull and after removal of the skull, Dr. Muller describes in detail the simple modifica- tions he has made by means of which any investigator with a conventional A-mode echoencephalograph can explore the underlying brain through the dura exposed by a craniotomy.

The longest chapter is devoted to his clinical experience with 50 cases of which the majority had brain tumours. Twenty illustrative cases are described with succinct clinical and pathological summaries and excellent illustrations of the corresponding echograms. This chapter makes fascinat- ing reading for any neurologist or neurosurgeon, and it is clearly manifest what a lot of information can be made available to the neurosurgeon by this 10 min procedure. Even when the craniotomy has been preceded by radio- logical contrast studies, transdural echoencephalography usually can provide additional information at a time when it is of great value to the neurosurgeon. The reliability of the procedure is attested by the fact that in every ease examined the pathological process was localized ultrasonically even in one case where the tumour could not be localized by con- ventional methods until the patient's death 2½ yr later.

In addition to a comprehensive bibliography relevant to the monograph, the last chapter is devoted to a very com- plete bibliography of all the literature pertaining to the wider field of ultrasonic encephalography.

This book is strongly recommended to clinical echo- encephalographers who may not appreciate how easily, by means of the technique described, they could greatly increase the usefulness of their echoencephalographic equipment to the benefit of their neurosurgical colleagues.

D. N. WHITE

U L T R A S O N I C S I N C L I N I C A L D I A G N O S I S

By P. N. T. WELLS (Editor).

Churchill Livingstone, 1972. 187 pp. £3.00 or $10.75. (English)

IN THE preface of this small volume Dr. Wells states that it is intended as "a review, a textbook, a reference book, and a source of references." While the first and last of the objectives are satisfactorily achieved, efforts at the others unfortunately, fall far short of the mark.

The early chapters by Dr. Wells on basic principles and descriptions of the method are quite well thought out and are an excellent condensation of his earlier, more compre- hensive text on this same subject.

Similarly, the final chapter by Dr. Hill, is an excellent summary which fairly presents the current state of know- ledge concerning the biologic effects of diagnostic ultrasound. The difficulties of assessing possible damage, and the sources of error in previous attempts are clearly indicated.

Concerning the chapters dealing with clinical application, there is apparent very wide variance in the quality of presentations.

Dr. White's chapter on echoencephalography is an accu- rate reporting of the difficulties which accompany both

A-mode and B-scan studies through the intact calvarium. The final portion of the chapter deals with an automated midline computer technique which is at present a highly provocative topic among echoencephalographers.

Dr. Donald's acknowledged expertise in obstetrical and gynecologic ultrasound is well exhibited in his chapter. Mosl of the major applications are indicated and the only im- provement which would seem desirable would be more illustrations and expanded text.

The very brief chapter on echo-ophthalmology seems unnecessarily complex in its explanation of physical princi- ples and far too limited in its discussion of important aspects of clinical practice, particularly high resolution B-scanning of the orbital contents.

In the chapter dealing with echocardiography, the text must be regarded as seriously deficient in a number of areas. Concerning recording methods, the strip chart recorder which allows presentation of all intracardiac echoes with superior resolution, is not mentioned. The analogue