GRAY MATTERS

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.