In Re: Liu GT, Volpe N, Galetta SL. Neuro-Ophthalmology: Diagnosis and Management. Philadelphia: W.B. Saunders Co.; 2000

With the ever-increasing ability of imaging techniques to precisely localize abnormalities within pathways that allow vision and control eye movements, it is important that neuroradiologists have a clear idea of the anatomic and clinical correlates of these abnormalities. The textbook, Neuro-Ophthalmology: Diagnosis and Management, by Grant Liu, Nicholas Volpe, and Steven Galetta, gives the practicing radiologist a clear insight into the many clinical syndromes and ophthalmologic findings in the entire spectrum of neuro-ophthalmologic diseases. The preface of the book mentions the groups of physicians for whom the book was designed; they should have added “neuroradiologists”, because it would be a valuable reference for anyone whose practice includes the imaging of visual problems.

This book is divided into four sections: history and examinations; visual loss and disorders of the afferent visual pathway; efferent neuro-ophthalmic disorders; and headache, facial pain, and disorders of facial sensation. The middle two sections comprise the bulk of the book and will be of greatest interest to neuroradiologists. There is an attempt to incorporate imaging (particularly MR) into the diagnostic section of each topic. For someone looking for a complete survey of neuroimaging in these disorders along with a differential diagnosis, they will be dissatisfied with this book; however, it probably never was the intent of the authors to make MR and CT a strength of their work. With that in mind, the line drawings, patient pictures, fundoscopic photographs, tables, and the clinical descriptions of all lesions are informative and up-to-date. Neuro-anatomic displays and careful descriptions of structures such as the lateral geniculate body, retinotopic organization of the occipital cortex, and chiasmal anatomy are all excellent and will help the radiologist not only in the day-to-day consultation with ophthalmologic colleagues but will allow for greater insight when teaching residents and fellows in the nuances of MR interpretation in these various disorders.

Many of the clinical findings reported by the ophthalmologist or neurologist, such as saccades, skew deviation, INOs scintillating scotomas, etc., appear occasionally on an imaging request form. To the interpreting radiologist, the underlying anatomic basis for any of these findings may be either unknown or vague. In such instances, having this textbook nearby to answer a variety of such questions would be of unquestionable benefit. Of additional value is the inclusion of treatment choices for each of the described conditions.

Of course, in a book of this length (756 pages), one can always find a few items with which to quibble. For instance, in the section on aneurysms, there is a brief statement that endovascular embolization is an alternative for inoperable aneurysms. This point of view neglects the fact that endovascular approaches are increasingly recommended even for those patients whose aneurysms are “operable”. Also, there are abnormalities that are described well but are not illustrated, such as suprasellar arachnoid cysts, nasosphenoidal encephalocele, and Creutzfeld-Jacob disease. When discussing the workup of carotid disease, the authors should have shown examples of carotid sonography, color Doppler, and MR angiography of the carotid bifurcation; the authors only illustrate digital subtraction angiography. Surprisingly, an abnormality that is not infrequently encountered in neuro-ophthalmology, a dural arteriovenous fistula (DAVF), is not illustrated. It certainly would have been worthwhile to include angiographic images pre- and post DAVF embolization. This reviewer would hope that in future editions of this textbook more neuroimaging is added to each section wherein the diagnosis is being discussed. The inclusion of a neuroradiologist as one of the co-authors would assist in incorporating more state-of-the-art imaging into the material.

In summary, this is a well-crafted, highly informative, useful textbook. It fulfills all of its objectives and covers all aspects of neuro-ophthalmology that a neuroradiologist would find useful. It is recommended for all neuroradiology libraries, and this reviewer believes that for those whose work involves a significant amount of imaging for ophthalmologic disorders, a personal copy of this textbook would be highly worthwhile.