Gray matters A biography of brain surgery

Neurosurgeon Schwartz's excellent debut intersperses details about the history of brain surgery with background on what it's like to perform the procedure. He traces neurosurgery's origins to Yale University doctor Harvey Cushing's pioneering operations in the early 20th century; chronicles the development of stereotactic radiosurgery (targeting tumors with radiation), hemicraniectomies (removing part of the skull to accommodate brain swelling), and other techniques; and highlights horrific methods from the field's past (early lobotomies involved blindly swiping a "butter knife--like instrument" back and forth to disconnect the frontal lobe from the rest of the brain). Discussing the difficult decisions neurosurgeons face daily, Schwartz recounts making tough calls about how aggressive to be during surgery, noting that attempts to remove tumors in sensitive areas risk causing "blindness, deafness, or an inability to swallow." Schwartz's frank reflections on the devastation he feels after unsuccessful procedures attest to the psychological toll of the profession ("I know I did my best for her at the time. It's just that my best wasn't good enough"), and he cleverly elucidates various procedures with celebrity case studies. For instance, he uses actor Michael J. Fox's thalamotomy to discuss how the operation inserts electrodes into the brain to disrupt misfiring neurons in people with Parkinson's disease. Sweeping and consistently captivating, this impresses. Photos. (Aug.)

An informative study of modern brain surgery. Schwartz, a leading neurosurgeon and professor of minimally invasive neurosurgery at Weill Cornell Medicine, traces the turbulent history of his field, from the days when the chances of survival from an operation were poor to recent significant breakthroughs. Neurosurgery was one of the last areas of medicine to develop, beginning in the late 1800s, simply because of the inherent difficulty of working with the brain and the inadequacy of the available tools. For a long time, the only way to reach the brain was to break the skull, a process that could easily do more harm than good. Eventually, the discipline progressed, as scientists and doctors increased their understanding of the functions and parts of the brain and how to manipulate them effectively. Schwartz's career has stretched from the days of boring holes through bone to noninvasive entry methods, such as through the nasal cavity, a technique he pioneered. Brain surgery often takes many hours, and every surgeon, writes the author, has lost patients. You must accept it and move on, but it never gets easier. Much of neurosurgery deals with head traumas caused by falls, collisions, or violence. Schwartz has worked on many such cases, but his specialty is removing tumors in the difficult areas at the bottom of the brain. With improvements like microscopic cameras, MRIs, and endoscopic tools, the success rate has dramatically improved. Schwartz provides anecdotes and case studies to give the story a human dimension, and he notes that surgery to address even strokes and Parkinson's disease is becoming possible. While parts of the text are inevitably technical, the author is warm and insightful, making the book accessible to general readers as well as specialists. Mixing expertise with storytelling, Schwartz provides a remarkable account of a crucial but misunderstood field. Copyright (c) Kirkus Reviews, used with permission.