Historical Pearls in Neurosurgery

Sawyer Croley and Jaime Gasco

What is the oldest known major surgical procedure?

The historical roots of surgery can be traced all the way back to the Neolithic era in which prehistoric humans performed trephinations.1

How were these prehistoric surgeries performed?

Evidence from Peruvian and Incan skulls suggests trephinations were performed using a sharp stone to remove part of the skull and expose the dura mater.¹

Why were these early trephinations performed?

Various reasons have been proposed, including the relief of headaches, focal epilepsies, battle wounds, depression fractures, and even “to create a hole from which demons might escape.”¹

When was the first surgical manuscript written?

The earliest known written description of surgical procedures is known as the Edwin Smith papyri (ca. 4000 to 500 B.C.). The Edwin Smith papyrus is especially notable because it contains the first known description of meninges, sulci, and gyri.¹

What did the Greeks know about neurosurgery?

Hippocrates (460–370 B.C.), also known as the father of Western medicine, was the first to write about the relationship between head injuries and contralateral symptoms.¹

Who is credited with pioneering peripheral nerve suture?

Guido Lanfranchi of Milan published in 1296 a medical text titled Chirurgia Magna, in which he describes the benefits of suturing severed peripheral nerves.¹

When was the circle of Willis first described?

Thomas Willis published his description of this structure in 1664.²

When was the first account of hemostasis in neurosurgery published?

Silvester O’Halloran (1728–1807) was a surgeon of the pre-listerian era who advised digital compression of the scalp to maintain hemostasis while making skin incisions.1

Who published the first illustration of a subarachnoid hemorrhage?

Although he is better known for his description of the syndrome of Cheyne-Stokes respiration, John Cheyne also published the earliest illustration of a subarachnoid hemorrhage in Cases of Apoplexy and Lethargy.²

What is Joseph Lister known for today?

In the 1860s, he introduced the concept of antiseptic surgery using carbolic acid.²

Who is credited with being the first to successfully remove a brain tumor based solely on neurological signs?

On November 23, 1884, Sir Rickman Godlee successfully extracted an intracranial mass after diagnosing and localizing a patient’s brain tumor purely by neurological methods.¹

When did trephination, as the primary means to create an operating field, finally begin to fall out of vogue?

In 1889, a German surgeon named Wilhelm Wagner published his account of making an osteoplastic bone flap to enlarge the view of the surgical field.¹

What was Heinrich Quincke’s major contribution to medicine?

He developed the lumbar puncture as a treatment for relieving increased intracranial pressure.³

When was the Babinski sign first described?

French neurologist Joseph Babinski first described the Babinski sign in 1896 as a method of distinguishing organic from hysterical paralysis.²

Who is generally regarded as the “father of neurosurgery?”

Sir Victor Horsley (1857–1916) elevated the practice of neurosurgery to new heights and established the field as a separate surgical specialty.¹

What area of neurosurgery did Victor Horsley help popularize?

In 1906, Horsley and Robert Henry Clark published their first account of surgery in animals using a stereotactic apparatus, which quickly dawned the era of stereotactic neurosurgery.²

What were some of Victor Horsley’s other achievements?

• Performed the first pituitary adenoma operation in 1889 2

• Performed the first successful removal of an intradural spinal cord tumor¹

• Pioneered the concept of taking as wide a margin as possible with infiltrating tumors⁴

• Invented many instruments still used by modern practitioners including “bone wax” for controlling bleeding from diploe¹

Why were Camillo Golgi and Santiago Ramón y Cajal awarded the 1906 Nobel Prize in Physiology and Medicine?

For their contributions in microscopic anatomy, such as identifying individual fiber tracts, that greatly increased the understanding of the structure of the nervous system²

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