1 History of Skull Base Anatomy and Its Eponyms The earliest records of anatomic dissections on human beings date to the third century BC and are from Alexandria, Egypt. The eponyms and descriptions of several anatomic structures are still associated with these early anatomists, who probably also performed vivisections. Despite their observations, Galenic theories, based on observations in animals, dominated the study of human anatomy for more than 1,500 years. It is known that Galen performed dissections on animals only, and the arbitrary application of his observations to humans led to erroneous descriptions of human anatomy. In the Western world, the origin of modern human anatomy can be traced back to the University of Bologna, Italy, during the Middle Ages when Mondino de’ Luzzi (1270–1326) and his pupil Guido da Vigevano (1280–1349) “restored” anatomy from Galen’s dogmas.1 Guido introduced the use of anatomic illustrations, creating a milestone in the development of anatomy as a scientific and artistic field. Cadaver dissections, as a scientific method for the description and understanding of the human body, gave rise to the recognition of anatomy as a specific field of medical science. The development of modern anatomy occurred during the Renaissance, with the establishment of many anatomy theaters, such as the one in Padua, Italy.2 During the Italian Renaissance, many multitalented men of genius contributed to the artistic and scientific advancement of anatomy, such as Donatello (1386–1466), who is considered the first artist who dissected human bodies, Michelangelo (1475–1564), Eustachius (1500–1574), Vesalius (1514–1564), and Leonardo da Vinci (1452–1519). Leonardo is considered the founder of physiological anatomy.3,4 The exponential development of medicine following the 18th century entailed the development of descriptive and functional anatomy, particularly in the study of the brain, including the most recent and amazing neuroscientific discoveries. Here is a selective list of anatomists whose names are still associated with discoveries and theories in skull base anatomy and its related neurovascular structures: • Erasistratus (304–250 BC): Egyptian physician who coined the word meninges. • Herophilus of Chalcedon (ca. 335–280 BC): Greek physician considered to be the father of anatomy for his advocacy of animal and human dissections.5,6 Founder, together with Erasistratus, of the medical school of Alexandria. His name is associated with the torcular herophili (torcular in Latin means “winepress”). The torcular herophili is the point at which the superior sagittal sinus, straight sinus, and occipital sinus meet at the inner side of the occipital protuberance7,8 (although the precise definition of the torcular is not the convergence of the sinuses itself but the bony concavity where the dural convergence is located). • Galen of Pergamon (129–200/216): Greek physician and philosopher, who served as the physician and surgeon to the gladiators of the Roman Empire. Among other descriptions, Galen identified seven pairs of cranial nerves, assigning each pair terminations and functions, but no names. According to Galen, the optic nerve was the first pair, and the facial and vestibulocochlear nerves were grouped together into the same pair. He failed to identify the glossopharyngeal, vagus, and accessory nerves as separate cranial nerves, instead grouping them together as well.9 Among other identified structures that are credited to him is the vein of Galen. • Leonardo da Vinci (1452–1519): Italian genius and polymath. In the field of skull base anatomy, Leonardo holds the distinction of being the first anatomist to produce anatomic diagrams showing the cranial nerves and optic chiasm.4 • Berengario da Carpi (ca. 1460–1530): Italian physician and author of the first modern textbook of neurotraumatology, The Treatise on Fractures of the Calvaria or Cranium, published in 1518. In his book, Berengario not only described an entire set of surgical instruments to be used for cranial operations to treat head traumas, but also systematically reviewed the existing literature and added many personal cases to explain the mechanisms, classification, and medical and surgical treatments.10 • Bartolomeus Eustachius (ca. 1500–1574): Italian anatomist who described several structures of the internal ear. The auditory or pharyngotympanic tube, the eustachian tube, is named for him.11 • Andreas Vesalius (1514–1564): Belgian anatomist and physician and professor of anatomy in Padua, Italy. He is very well known in the history of medicine as the author of De Humani Corporis Fabrica (“On the Fabric of the Human Body”), one of the most influential modern textbooks of human anatomy, published in 1543. In skull base anatomy, the foramen of Vesalius, that is, the sphenoidal emissary foramen, is named for him. This foramen is an anatomic variant (not always present, but consistently symmetrical when present) of an aperture of the great wing of the sphenoid bone, medial to the foramen ovale, crossed by a small vein (vein of Vesalius) that enables communication between the cavernous sinus and the pterygoid plexus.12 • Gabriele Falloppio (Fallopius) (1523–1562): Italian physician and anatomist who described the canal through which the facial nerve traverses the petrous part of the temporal bone, from the internal acoustic meatus to the stylomastoid foramen (facial canal, or fallopian canal). • Arcangelo Piccolomini (1525–1586): Italian anatomist known for being the first to differentiate between the white and gray matter of the brain (in 1586) and for his description of the origins and terminations of some intracranial nerves, especially of the acoustic nerve. • Costanzo Varolio (1543–1575): Italian anatomist and papal physician considered to be one of the first physicians to examine the base of the brain and the cranial nerves. The description of the formation of the pons (then defined as pons Varolii) is named for Varolio.13 • Thomas Willis (1621–1675): English anatomist and physician who described the physiological function of the arteries at the base of the brain and its anatomic connections. Also introduced the word neurology. His name is linked to one of the best known structures in anatomy, the circle (or polygon) of Willis, historically considered to be the first depiction of the brain arteries (published in 1664),14 although several anatomists described the basal circle before Willis.15 The first portrayal was provided more than 50 years earlier by Julius Casserius (1552–1616),16 an Italian anatomist and one of the six great Vesalian anatomists. Casserius’ engravings showing the first detailed circle of arteries at the base of the brain were published posthumously in 1627. • Johann Friedrich Meckel, the Elder (1724–1774): German anatomist, physician, and botanist. Meckel’s cave is named for him, as he wrote his undergraduate dissertation on the trigeminal nerve and the meningeal space containing the trigeminal ganglion over the petrous bone.17 • Jacques-René Tenon (1724–1816): French surgeon who provided the first description of the membrane enveloping the eyeball, the so-called capsule of Tenon. • Johann Gottfried Zinn (1727–1759): German anatomist and botanist who provided detailed descriptions of the anatomy of the human eye. The annulus of Zinn
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