Tuesday, September 20, 2016

LabKitty Recommends: Neuroanatomy To Color and Study

poritsky and freeman
Harper/Perennial publishes a series of coloring books on technical topics that provide a creative way to learn complex material. Having a student actively participate in the presentation promotes retention. Such pedagogy is routinely applied in the classroom, but H/P's use of interactive content in print was innovative. A co-opting of the familiar childhood pastime, albeit the subject matter detailed and mature (perhaps "graphic textbook" might be a better descriptor than "coloring book").

Many of the series offerings are in anatomy. The flagship is arguably The Human Brain Coloring Book, assembled by neuroscientists Marian Diamond, Arnold Scheibel, and Lawrence Elson and illustrated by Cinthea Vadala and Janice Aspelin Schwegler. These are respected names in the field. (Diamond published the first study of Einstein's brain. What made Einstein smart? Short answer: We don't know. Longer answer: Go here.) More to the point, anatomy has always been a visual subject and THBCB continues a tradition we can follow back to Leonardo's parchments and Galen's sand drawings.

But it's not what I came here today to recommend.



A lesser-known alternative to Diamond et al. is Neuroanatomy to Color and Study by Ray Poritsky and Barbara Freeman (both of Case Western; emeritus Poritsky supplied the illustrations). Whereas I have repeatedly found all of the Harper/Perennial graphic textbooks in bookstores and libraries, I stumbled across NtC&S by accident (a colleague passed along an extra copy he had received). Which is a shame, because Poritsky and Freeman have produced one of the finest collections of anatomical illustrations ever. That's a bold claim but it is, I believe, justified.

NtC&S covers the standard neuroanatomy buffet: cellular neurophysiology, spinal cord, cerebrum, cerebellum, sensory and motor systems, cranial nerves, ventricles, blood supply, and a brief tour of neurotransmitters. The text borrows the familiar Harper/Perennial format, with a pictorial depiction on the right page facing a textural summary on the left. Yet, the result is noteworthy not for the layout or its selection of topics but rather for the presentation of the material.

Beyond the mind-boggling complexity of the brain (by some estimates it has 15,000 named parts), the challenge of neuroanatomy is twofold. The first is understanding how it all fits together. Evolution got a million-year head start on the wretched anatomy student, and the current layout of the brain often makes about as much sense as a Mozart opera.

Three-dimensional spatial relationships are particularly difficult to grasp. Anatomy resources usually attack this problem using sections (although see Lennart Heimer's text for a counterpoint, which includes spectacular white matter preparations painstakingly extruded from specimens using frozen dissection). Coronal, cross, sagittal, oblique. However, visualizing serial reconstructions is a difficult skill to master. In recent years, a number of applications have appeared that assemble slice data into volumetric shapes that can be rotated and zoomed. Impressive nerdcraft to be sure, but these are no substitute for a world-class medical illustrator. Here Poritsky shines.

For an exemplary example, look no further than his presentation of the hippocampus. The three dimensional topology, the course of the structure within the ventricles, the relation of the alveus to the fimbria and fornix, the relation of the dentate and parahippocampal gyrus to the divisions of entorhinal cortex -- these are conveyed here in print even better than the real thing (the hippocampus being one of the few internal brain structures that can be yanked out whole). This is a recurring theme the reader will discover again and again in NtC&S.

The second great challenge of neuroanatomy is circuitry. As Jack Sparrow might say, a brain isn't gyri and sulci, fissures and lobes, tubercles and striae. Those are what a brain needs. What a brain is -- what it really is -- is circuitry.

Alas, circuitry is impossible to glean from gross dissection and so it falls to the purview of textbooks. This can be done abstractly, with a nuclei or region of interest represented by a dot and its efferent/afferent connections drawn as arrows (what is often called "arrow anatomy"). There's nothing wrong with that. But Poritsky shows us circuitry in context.

A simple demonstration: How many students have looked at the bulge of a pons and never wondered why. It's bulgy because a bazillion cortical efferents squeeze through there, many sending axon collaterals to targets in the brainstem and cerebellum (cf. NtC&S's summary of the pyramidal system). Circuitry is why the brain looks the way it does, the lesson being. It's what makes gyri gyrated, striae striated, and prominences prominent. And it's what a good medical illustrator will illustrate. Poritsky's treatment here is again superb.

Distressingly, NtC&S is suffering a bit of a PR problem on Amazon. As of this writing, the current edition has received but two reviews, one of which only complains about the quality of the printing (Poritsky's delicate pencil sketches might give the impression of poor printing if you are expecting color glossies or bold schematics). This is difficult to reconcile with my thoroughly positive impression of the text. Although I suppose its organization could be improved, the only real complaint I can muster concerns the comical interludes scattered throughout in which Poritsky uses cartoon hippos or other silliness to introduce a selected anatomy concept. These feel jarringly out of place given the presentation's overall mature tone.

In the end, my most succinct recommendation of Neuroanatomy to Color and Study is this: I could not bring myself to color it. Doing so was not only unnecessary but it somehow seemed disrespectful. I wouldn't even call Poritsky and Freeman a "coloring book." I would simply call it a collection of first-rate medical illustrations. The work is more properly compared with Netter or Gray than titles like Human Brain Coloring Book or Fisch's Neuroanatomy: Draw It to Know It. It's an excellent source for learning neuroanatomy, not through gimmick or novelty but through outstanding presentation. It's a gem that deserves to be better known by students and teachers alike.

Check out Neuroanatomy to Color and Study on Amazon.

1 comment: