The Tenth Nerve

Combining a humane perspective, lively anecdotes, and a deep curiosity about the uncharted territories of the human brain, The Tenth Nerve is a richly fascinating memoir that will fill you with wonder. “The scalpel can only go so deep, and technical skill can only take one so far.” In this absorbing narrative, Dr. Chris Honey, an accomplished neurosurgeon at Vancouver General Hospital, weaves his personal journey together with case studies that reflect the thrill of scientific discovery and the limitations of medicine. Operating on a terminally ill child amid an Ebola outbreak in Liberia, he questions his preconceptions about what it means to "win" against a disease. Reflecting on his own path into neurosurgery, he brings to life a relatively new, high stakes field of medicine—one that historically demanded emotional detachment and often attracts extreme personalities. With a compassionate eye, he traces the courage and determination of several patients suffering from mysterious, unrecognized illnesses, and invites us into the operating room with Dr. Honey and his team to witness the extraordinary discovery—involving the tenth cranial nerve—of an entirely new disease and its cure. And, outside the OR, an unusual friendship with a former patient alters his perspective on clinical detachment, and what "quality of life" really means. Riveting and dramatic, The Tenth Nerve offers a rare window into the world of a pre-eminent neurosurgeon and seven exceptional patients that made him a better doctor.

Ronald Brisman, M.D. This book will discuss three areas where the The multiplicity of procedures with varying neurosurgeon may provide an important degrees of risks and benefits sometimes re contribution to the relief of intractable pain: quires a sequential approach, but always an trigeminal and other facial neuralgias, chronic individual one, matching an appropriate treat noncancer pain, and cancer pain. By one ment plan or procedure for a particular patient intervention, the neurosurgeon often may pro at a specific time in his or her illness. vide long-lasting pain relief. New techniques, The neurosurgical chapters in this book which have developed since the 1970s and represent my experience with several hundred continue to evolve, dominate the neurosur patients during a 12-year period from 1975 gical armamentarium because they are not only through 1987. I have relied heavily on the effective, but safe. These include percutaneous works of others, which have been quoted from radio frequency electrocoagulation for trigem the neurosurgical literature, but this book is inal neuralgia, spinal stimulation for chronic not meant to be encyclopedic. noncancer pain, and intraspinal morphine in At least as important as knowing when to fusion for cancer pain. operate is knowing when not to do so, and this Sometimes a procedure relieves pain but the is particularly true of the treatment of pain. pain recurs; it may be necessary to repeat the Most patients with pain do not require neuro procedure, which in the case of radiofrequency surgical intervention.

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The region of the skull base was long considered a surgical barrier because of its complex anatomy. With few exceptions, the region immediately beyond the dura or bony skull base constituted a "no man's land" for the surgeon working from the other direction. A major reason for this was the high morbidity associated with operative procedures in that area using traditional dissection techniques. This situation changed with the advent of the operating microscope. Used initially by ear, nose and throat specialists for resective and reconstructive surgery of the petrous bone and parana sal sinuses, the operating microscope was later introduced in other areas, and neurosurgeons began using it in the mid-1960s. With technical equality thus established, the groundwork was laid for taking a new, systematic, and interdisciplinary approach to surgical problems of the skull base. Intensive and systematic cooperation between ear, nose and throat surgeons and neurologic surgeons had its origins in the departments of the University of Mainz bindly supported by our chairmen Prof. Dr. Dr. hc Kurt Schiirmann (Department of Neurosurgery) and Prof. Dr. W. Kley (Depart ment of Ear, Nose and Throat Diseases, Head and Neck Surgery). The experience gained from this cooperation was taught in workshops held in Hannover from 1979 to 1986, acquiring a broader interdisciplinary base through the participation of specialists from the fields of anatomy, patholo gy, neuroradiology, ophthalmology, and maxillofacial surgery.