Microelectrode Recording in Movement Disorder Surgery

The last decade has seen resurgence in the field of movement disorder surgery with large number of patients being treated with deep brain stimulation. Microelectrode recording (MER) has for long been considered by purists to be the gold standard of physiological localization. The near demise of movement disorder surgery in the mid 1960s resulted in only a few centres retaining expertise in this field. However with the revival of movement disorder surgery increasing numbers of neurosurgeons are using MER as a means of target identification. The publication of this book at this time is therefore opportune and welcome. The book has chapters on the principles of MER and other physiological localizing techniques which for neurophysiologists might be quite basic but for neurosurgeons working in this field will be educational. The chapter on equipment and components will be particularly useful for those who are contemplating the addition of MER in their departments. Apart from technical details of the required components it includes a comparison of the commercially available systems though this is slightly directed at the US market. I found the chapter on ‘‘Microrecording in the Primate MPTP Model’’ particularly interesting and a useful update on current thinking regarding the pathophysiology of movement disorders. As a neurosurgeon I found the chapters on signal processing and data analysis difficult to follow but these will probably be of greater interest to neurophysiologists. The physiological localization of each of the currently used stereotactic targets are dealt with in detail by separate authors and there is a wealth of information for newcomers to this field. Some of the subsequent chapters revisit these areas and tend to be descriptions of individual surgical techniques which readers may or may not find useful. Despite the title this is more than a book on MER techniques – there is a lot of information on imaging methods, surgical techniques, computer integration and clinical outcomes. The debate in the penultimate chapters on the need for MER demonstrates the polarization of views on this subject and will leave the uninitiated confused. If ever there was an example of ‘‘never the twain shall meet’’ it is this. Kim Burchiel however brings all of this to ground in his concluding chapter and leaves the reader wondering about the future of MER. As in all multi-author books the standard of writing is variable but in general it is a well presented and readable book with a huge number of references. The quality of some of the photographs could have been better and there are some typographical errors (including the spelling of my name in one of the references!!) but these do not detract from what is otherwise a good publication. The book is a welcome addition to my library and I think – it is a must for any department undertaking movement disorder surgery – whether they are believers or non-believers in the need for MER.