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Objective: The lenticular was an instrument introduced by Galen to facilitate cutting the bone of the cranium. Illustrations of the instrument first appeared in the 16th century during the Renaissance. These illustrations have been widely used, but the instrument's shape seems ill-adapted to its function. Archaeological research in Rimini, Italy, unearthed a similar instrument with a shape that seems more suitable for the function of cutting cranial bone. The object of this study was to evaluate the efficacy of these two instruments for cutting the bone of the cranium., Methods: Replicas of the two instruments were obtained. Trepanation was performed in the left parietal region of a sheep's head. In addition, the application of the instruments in the literature was analyzed., Results: The Roman lenticular cut the cranium with ease. The Renaissance instrument failed to cut the bone and only separated the dura mater from the bone. The lenticular had been used to cut bone up to the 13th century. In contrast, the Renaissance instrument was not used to cut bone but to smooth roughened bony surfaces and to remove spicules of bone that were in contact with the dura., Conclusions: Analysis of illustrations in medical publications should be undertaken with the same rigor as applied to analysis of text.

In this paper, the authors trace the history of cranial temporary resection, described by Wilhelm Wagner (1848-1900) in 1889, which changed the paradigm of the cranial opening from trephining to the craniotomy. The objective of the temporary resection was to obtain wide openings in the skull, keeping the cranial flap attached to the soft tissues to maintain bone vitality. The cranial temporary resection was reproduced by the authors in an anatomical study faithfully following the original technique, demonstrating the feasibility of the surgical procedure as described by Wagner. Surgical steps include a large omega-shaped skin incision and a beveled cut of the bone with the chisel and mallet until reaching the dura mater, lifting the bone flap en bloc along with all superficial soft tissues. A literature review shows that the temporary cranial resection became a great success at that time because it allowed physicians to improve a number of constraints of the cranial opening using the crown trephine: bone vitality; a wide cranial window; easy, safe, and quick surgery; and economy of surgical instruments. The crude, primitive proposal of the temporary resection was ameliorated to quickly build the successful model of the modern craniotomy.

Background: Glioblastoma multiforme remains a therapeutic challenge. We offer a historical review of the outcomes of patients with glioblastoma from the earliest report of surgery for this lesion through the introduction of modern chemotherapeutics and aggressive approaches to tumor resection., Methods: We reviewed all major surgical series of patients with glioblastoma from the introduction of craniotomy for glioma (1884) to 2020., Results: The earliest reported craniotomy for glioblastoma resulted in the patient's death less than a month after surgery. Improved intracranial pressure management resulted in improved outcomes, reducing early postoperative mortality from 50% to 6% in Harvey Cushing's series. In the first major surgical series (1912), the mean survival was 10.1 months. This figure did not improve until the introduction of radiotherapy in the 1950s, which doubled survival relative to those who had surgery alone. The most recent significant advance, chemotherapy with the alkylating agent temozolomide, extended survival by 2.5 months compared with surgery and radiotherapy alone (14.6 and 12.1 months, respectively). This protocol remains the standard regimen for newly diagnosed glioblastoma. The innovative treatments being investigated have yet to show a survival benefit., Conclusions: With advancements in localization, imaging, anesthesia, surgical technique, control of cerebral edema, and adjuvant therapies, outcomes in glioblastoma improved incrementally from Cushing's time until the introduction of magnetic resonance imaging enabled better degrees of resection in the 1990s. Modest improvements came with the advent of biomarker-driven targeted chemotherapy in the first decade of the current century., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Surgical procedures undergone in life, autopsies and anatomical preparations can all leave clearly identifiable traces on human skeletal remains. Several studies on skeletons from archeological contexts have identified traces of these practices. However, the distinction between medical/forensic autopsy and anatomical dissections for scientific research can be challenging. We report the case of a middle-aged female skeleton from the cemetery of the church of San Biagio (Ravenna, Italy), dating back to the 17th-19th centuries, that shows signs of a complete craniotomy. In an attempt to clarify the reason for this practice, we analyzed all pathological and non-pathological markers on the skeleton. We carried out anthropological analyses and osteometric measurements to determine the biological profile and the cranial capacity of the individual. Paleopathological investigation and analyses of traumatic injury patterns were carried out using both a morphological and a microscopic approach. While we observed that the craniotomy was performed with a rip saw, we identified perimortem blunt force trauma to the frontal bone and an osteolytic lesion on the inner surface of the frontal bone. No other pathology was recognizable on the skeleton. Our differential diagnosis confidently proved that the craniotomy was due to an autoptsy procedure and was not the result of an anatomical dissection. We believe that, among other possible reasons, failed surgery could likely be the motive behind the ordering of the autopsy.

Ambroise Paré was celebrated surgeon of the 16th century whose practical accomplishments, books, and ideas transformed surgery and was a precursor for the later development of neurosurgery. He developed many surgical innovations related to wound management, arterial ligation for the prevention of hemorrhage during limb amputations, and the treatment of war-related head and spine injuries. He maintained that a surgeon should operate gently to reduce pain and improve outcome, and he dedicated his career to the wounded, sick, and poor. He also served 4 consecutive French monarchs-Henri II and his 3 sons François II, Charles IX, and Henri III. As a Huguenot (a Reformed Protestant) by faith, he lived in an environment dominated by Catholicism. Hence, his practice and life were sometimes hindered by political circumstances and religious prejudice. In this historical vignette, we will discuss the professional accomplishments of Ambroise Paré that influenced the future development of neurosurgery, including his descriptions of phantom-limb pain and peripheral nerve injury, his innovations in neurotraumatology, and the saws he invented for use in skull surgery. We will also highlight Paré's broad neurosurgical contributions to the field. Finally, we will discuss his personal life during the difficult and dangerous political circumstances of 16th century France., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Francesco Durante was born in Sicily, precisely Letojanni Gallodoro. He contributed to the history of neurosurgery in not only Italy but the whole world. In June 1884, he removed a left frontal meningioma, describing a personal technique of craniotomy with a discontinuous osteotangential section flap. It was the first such operation to be performed in any country after which the patient had a long survival. The important and pioneering contribution made by Durante to the history of neurosurgery is testified by his Treaty on Pathology and Surgical Therapy. Durante's procedure for craniotomy remained the best for several years. His contributions are still valid in medicine today, within not only the neurosurgical community but also other surgical disciplines, because he also developed innovative practices in the fields of oncology, general surgery, and orthopedics in addition to designing special surgical instruments., (Copyright © 2019. Published by Elsevier Inc.)

Objective: To review Dr. Harvey Cushing's influence on Mr. Norman Dott's work on acromegaly and other subjects surrounding the pituitary gland such as pituitary research, treatment modalities, and research dissemination. Dott was the first Professor of Neurosurgery in Scotland during 1947 and was considered a pioneer of the understanding and treatment modalities for pituitary disorders such as acromegaly. During 1923, he published an article regarding pituitary physiology that won him the award for the Rockefeller Fellowship Trust, to travel to Boston Massachusetts, giving him the opportunity to train under Cushing's supervision for the years of 1923-1924. However, similarities can be seen between Dott's physiology project that was completed before he ever met Cushing, as well as his treatment suggestions for acromegaly, after he had finished his training under Cushing's supervision., Methods: This was a historical perspective based on literature review. We reviewed Norman Dott's archives held by University of Edinburgh Library or online sources and we compared these with the work Cushing had previously performed in a chronological fashion. Cushing's work on the pituitary gland and acromegaly can be largely found online, in biographical books, and in other secondary sources. The search included words such as "transsphenoidal surgery," "x-ray," "Harvey Cushing," "Norman Dott," "Acromegaly," "Annual Meetings," and "Pituitary physiology." We excluded any primary sources that were not published between 1900 and 1960 regarding either pituitary physiology or the treatments for acromegaly., Conclusions: Sir Norman Dott was the first Professor of Neurosurgery in Scotland during 1947 and is well known for his pioneering work on intracranial aneurysms. Although less well known for his contribution to pituitary pathologies, we would like to share his contribution in this regard and correlate it with Cushing's influence., (Crown Copyright © 2019. Published by Elsevier Inc. All rights reserved.)

The discovery of nearly 180-year-old cranial measurements in the archives of 19th century American physician and naturalist Samuel George Morton can address a lingering debate, begun in the late 20th century by paleontologist and historian of science Stephen Jay Gould, about the unconscious bias alleged in Morton's comparative data of brain size in human racial groups. Analysis of Morton's lost data and the records of his studies does not support Gould's arguments about Morton's biased data collection. However, historical contextualization of Morton with his scientific peers, especially German anatomist Friedrich Tiedemann, suggests that, while Morton's data may have been unbiased, his cranial race science was not. Tiedemann and Morton independently produced similar data about human brain size in different racial groups but analyzed and interpreted their nearly equivalent results in dramatically different ways: Tiedemann using them to argue for equality and the abolition of slavery, and Morton using them to entrench racial divisions and hierarchy. These differences draw attention to the epistemic limitations of data and the pervasive role of bias within the broader historical, social, and cultural context of science., Competing Interests: The authors have declared that no competing interests exist.

Aim: Currently, neurosurgery has gone through moments of great renewal, however, in the first half of the 20th century, unwanted outcome after surgical approach had occurred. The aim of this historical overview of a picture of the musicians is to show the development of Neurosurgery in 20 century., Methods: History of neurosurgery in the first half of the 20th century and the current was investigated through PubMed. A brief tour of some of the major landmarks of contemporary neurosurgery was also made., Results: A musician picture was found which taken in 1928. Two of the musicians suffered neurosurgical disorder, and operated in 1937, both immediately died without gaining conscious at early postoperative period., Conclusion: We described the role of neurosurgery in the lives of two famous musicians, George Gershwin and Maurice Ravel. A picture taken 1928, shows the developing of Neurosurgery from first half of 20th century to current.

Introduction: Dr. Collin S. MacCarty (1915-2003) invented the MacCarty keyhole, which is now widely used as the starting burr hole for orbitozygomatic craniotomy. We present a historical vignette on MacCarty's life and chronicle his contributions to neurosurgery., Methods: A detailed search for articles relating to the biography and professional career of Dr. MacCarty was conducted on PubMed and Google Scholar by using the key words "Collin MacCarty" and "MacCarty keyhole." References found in those articles were also reviewed., Results: On September 20, 1915, Collin MacCarty was born in Rochester, Minnesota. MacCarty was exposed to the medical field at an early age. He witnessed legendary surgeons like Alfred Adson perform brain and spine operations. Expectedly, MacCarty pursued a career in neurosurgery. He was influenced by Walter Dandy as a house office at Johns Hopkins and completed his neurosurgical training at the Mayo Clinic under Adson. In a distinguished career in neurosurgery at the Mayo Clinic, MacCarty served many important roles, including Chairman of the Department of Neurosurgery from 1963 to 1975 and President of the American Association of Neurological Surgeons. He was world-renowned for his vast experience with meningiomas. In 1961, MacCarty described a burr hole to expose the periorbita and frontal dura while approaching intraorbital meningiomas. This burr hole became immortalized as the "MacCarty keyhole" and is used widely today in frontotemporal orbitozygomatic approaches., Conclusions: Collin S. MacCarty was an influential neurosurgeon. Among a multitude of contributions, he is most well-known for inventing the "MacCarty keyhole" which is widely implemented nowadays as the starting point for orbitozygomatic approaches., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Trepanation, the process of making a burr hole in the skull to access the brain, is an ancient form of a primitive craniotomy. There is widespread evidence of contributions made to this practice by ancient civilizations in Europe, Africa, and South America, where archaeologists have unearthed thousands of trepanned skulls dating back to the Neolithic period. Little is known about trepanation in China, and it is commonly believed that the Chinese used only traditional Chinese medicine and nonsurgical methods for treating brain injuries. However, a thorough analysis of the available archeological and literary evidence reveals that trepanation was widely practiced throughout China thousands of years ago. A significant number of trepanned Chinese skulls have been unearthed showing signs of healing and suggesting that patients survived after surgery. Trepanation was likely performed for therapeutic and spiritual reasons. Medical and historical works from Chinese literature contain descriptions of primitive neurosurgical procedures, including stories of surgeons, such as the legendary Hua Tuo, and surgical techniques used for the treatment of brain pathologies. The lack of translation of Chinese reports into the English language and the lack of publications on this topic in the English language may have contributed to the misconception that ancient China was devoid of trepanation. This article summarizes the available evidence attesting to the performance of successful primitive cranial surgery in ancient China., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Clara Haskil (January 7, 1895-December 7, 1960) was one of the most famous female pianists of the 20th century. In her life and work she set new standards in piano playing. However, her career was beset by poor health and the adversities of two world wars. In her lifetime Haskil had three major disorders: juvenile scoliosis requiring treatment in her adolescence, a tumor of the sellar region requiring surgery at age 47 years, and a traumatic brain injury causing her death at the age of 65. Her medical history illustrates the development of surgical methods and rehabilitation in medicine before and after World War II. At an early age, she spent a year in a nursing home for orthopedic diseases due to scoliosis. In 1942, when she was 47 years old, she displayed the first symptoms of a suprasellar brain tumor: headache and hemianopsia. The famous surgeon Marcel David performed surgery on her without general anesthesia while Haskil mentally played a Mozart piano concerto as a neuronal representation to control her memory and mental abilities. Only 3 months after that operation she played a Mozart piano concerto at a concert that began her career as a great interpreter of Mozart. Her neurologic rehabilitation was remarkable and highlighted new methods in the field. In 1960, she traveled to Brussels for a concert. In the train station she stumbled on the stairs and hit her head on one of the steps. Skull fracture and intracranial hematoma were diagnosed. Doctors tried to operate on her but she lost consciousness and died. Haskil created new styles in piano playing, and her medical history offers indications of new concepts in neurosurgery., (Georg Thieme Verlag KG Stuttgart · New York.)

Background: There has been no study of craniotomies of famous musicians throughout history. This subject was investigated., Methods: The key search words were "neurosurgery and music" and the names of composers. We used digital catalogs such as PubMed as well as university libraries., Results: We found 4 musicians from the twentieth century with different neurosurgical diseases: Maurice Ravel, George Gershwin, Clara Haskil, and Pat Martino., Conclusions: Neurosurgical operations affected the musical careers and lives of mentioned musicians and two of them died. Neurosurgeons can understand the effect of limited diagnostic tools such as magnetic resonance imaging and computed tomography at the time on the poor outcome of 2 musicians., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Craniotomy can be defined as the neurosurgical procedure aimed at achieving a wide cranial opening with the final purpose of performing a surgical therapeutic manoeuvre within the intracranial space. The current surgical technique for craniotomy is the final result of the development of the procedure since its introduction at the end of the 19th century. The very first wide cranial approach was introduced in 1889 by Wagner, and described as a 'temporary cranial resection'. This procedure could be named today as 'osteoplastic craniotomy with pedicle bone flap'. The final result of the procedural development of the craniotomy is the 'osteoplastic craniotomy with free bone flap', used widely around the world. In this paper, we review the historic evolution of craniotomy from a technical perspective., (Copyright © 2016 Sociedad Española de Neurocirugía. Publicado por Elsevier España, S.L.U. All rights reserved.)

Neurosurgical treatment of diseases dates back to prehistoric times and the trephination of skulls for various maladies. Throughout the evolution of trephination, surgery and religion have been intertwined to varying degrees, a relationship that has caused both stagnation and progress. From its mystical origins in prehistoric times to its scientific progress in ancient Egypt and its resurgence as a well-validated surgical technique in modern times, trephination has been a reflection of the cultural and religious times. Herein we present a brief history of trephination as it relates religion, culture, and the evolution of neurosurgery., (Copyright © 2016 Elsevier Inc. All rights reserved.)

At early history of neurosurgery, the use of extended craniotomy was dictated by poor illumination, inadequate visualization, and the lack of accurate diagnosis. The technological progress development and the emergence of highly informative neuroimaging, microscopy, and neuroendoscopy minimized neurosurgical approaches and, accordingly, approach-associated complications. At present, the fundamental philosophy of minimally invasive surgery is of particular topicality because this surgery contributes to rapid recovery of patients and reduces the period of hospital treatment. The aim of the article is to provide a brief historical overview of the evolution of surgical approaches to the skull base, ranging from extended craniotomy to minimally invasive interventions.

The authors trace the etymology and historical significance of galea or epicranial aponeurosis. In ancient Greece, galea referred to a helmet worn by soldiers, typically made of animal hide or leather. Throughout antiquity, physicians referred to all soft tissue between the skin and the skull as panniculus, a standard established by Galen of Pergamon. A manual of surgery in the Middle Ages referred to the entire scalp as a "great panicle that is called pericranium." During the early Renaissance, Leonardo da Vinci famously and stylistically analogized the dissection of the cranium with the peeling of an onion. Not until 1724 would the tendinous sheath connecting the frontalis and occipitalis muscles be defined as "Galea tendinosa cranii." By 1741, the convention of referring to the galea as an aponeurosis was well established. Harvey Cushing's wartime experiences at Army Base Hospital No. 5 reinforced the surgical significance of the galea. Operative mortality was significantly diminished due to "closure of the wounds with buried sutures in the galea." This operative nuance was then passed from teacher to pupil and has now become one of the tenets of modern neurosurgical practice.

The surgical treatment of meningiomas located at the base of the anterior cranial fossa is often challenging, and the evolution of the surgical strategy to resect these tumors parallels the development of craniotomy, and neurosurgery in general, over the past century. Early successful operations to treat these tumors were pioneered by prominent figures such as Sir William Macewen and Francesco Durante. Following these early reports, Harvey Cushing made significant contributions, allowing a better understanding and treatment of meningiomas in general, but particularly those involving the anterior cranial base. Initially, large-sized unilateral or bilateral craniotomies were necessary to approach these deep-seated lesions. Technical advances such as the introduction of electrosurgery, the operating microscope, and refined microsurgical instruments allowed neurosurgeons to perform less invasive surgical procedures with better results. Today, a wide variety of surgical strategies, including endoscopic surgery and radiosurgery, are used to treat these tumors. In this review, the authors trace the evolution of craniotomy for anterior cranial fossa meningiomas.

Cranioplasty, one of the oldest surgical procedures used to repair cranial defects, has undergone many revolutions over time to find the ideal material to improve patient prognosis. Cranioplasty offers cosmetic and protective benefits for patients with cranial defects. The first primitive cranioplasty procedures date back to 7000 bc and used metal and gourds to repair cranial defects. Cranioplasty was first documented by Fallopius who described repair using gold plates; the first bone graft was documented by van Meekeren. The first significant improvement for this procedure began with experimentation involving bone grafts in the late 19th century as a more natural approach for repairing cranial defects. The next impetus for advancement came because of wartime injuries incurred during World Wars I and II and involved experimentation with synthetic materials to counter the common complications associated with bone grafts. Methyl methacrylate, hydroxyapatite, ceramics, and polyetheretherketone implants among other materials have since been researched and used. Research now has shifted toward molecular biology to improve the ability of the patient to regenerate bone using bone growth factors. This paper reviews the evolution of materials used over time in addition to the various advantages and pitfalls associated with each change. It is important for neurosurgeons to be mindful of how these techniques have evolved in order to gain a better understanding of this procedure and how it has been adapted.

There is evidence that the neurosurgical procedure of cranioplasty is as ancient as its better-known counterpart, trephination. With origins in pre-Incan Peru, cranioplasty remains an important reconstructive procedure for modern craniofacial surgery teams to master. Solutions to the often challenging problem of repairing skull defects continue to evolve to improve patient outcomes. Throughout recorded history, advances in cranioplasty have paralleled major military conflicts due to survivorship after trephination or decompressive craniectomy. Primitive skull coverings used in Peru were later replaced during the Middle Ages by grafts obtained in animals and humans. Improved survivorship secondary to advances in anesthesia and battlefield medicine during the Crimean War and the American Civil War allowed the use of tantalum and acrylic cranioplasty to evolve during World Wars I and II. In the modern era of the Iraq and Afghanistan conflicts, greater survivorship after cranial injury due to improvements in protective armor, medical evacuation, and early "far-forward" neurosurgical treatment have occurred. Consequently, the last decade has seen great advancement in cranial defect reconstruction, including custom-fabricated alloplast implants and the emergence of regenerative cranial treatments such as distraction osteogenesis, protected bone regeneration, and free tissue transfers. Comprehensive rehabilitation after neurotrauma has emerged as the new standard of care.

Both the history of headache and the practice of craniotomy can be traced to antiquity. From ancient times through the present day, numerous civilizations and scholars have performed craniotomy in attempts to treat headache. Today, surgical intervention for headache management is becoming increasingly more common due to improved technology and greater understanding of headache. By tracing the evolution of the understanding of headache alongside the practice of craniotomy, investigators can better evaluate the mechanisms of headache and the therapeutic treatments used today.

The history of neurosurgery is filled with descriptions of brave surgeons performing surgery against great odds in an attempt to improve outcomes in their patients. In the distant past, most neurosurgical procedures were limited to trephination, and this was sometimes performed for unclear reasons. Beginning in the Renaissance and accelerating through the middle and late 19th century, a greater understanding of cerebral localization, antisepsis, anesthesia, and hemostasis led to an era of great expansion in neurosurgical approaches and techniques. During this process, frontotemporal approaches were also developed and refined over time. Progress often depended on the technical advances of scientists coupled with the innovative ideas and courage of pioneering surgeons. A better understanding of this history provides insight into where we originated as a specialty and in what directions we may go in the future. This review considers the historical events enabling the development of neurosurgery as a specialty, and how this relates to the development of frontotemporal approaches.

Cranioplasty is a unique procedure with a rich history. Since ancient times, a diverse array of materials from coconut shells to gold plates has been used for the repair of cranial defects. More recently, World War II greatly increased the demand for cranioplasty procedures and renewed interest in the search for a suitable synthetic material for cranioprostheses. Experimental evidence revealed that tantalum was biologically inert to acid and oxidative stresses. In fact, the observation that tantalum did not absorb acid resulted in the metal being named after Tantalus, the Greek mythological figure who was condemned to a pool of water in the Underworld that would recede when he tried to take a drink. In clinical use, malleability facilitated a single-stage cosmetic repair of cranial defects. Tantalum became the preferred cranioplasty material for more than 1000 procedures performed during World War II. In fact, its use was rapidly adopted in the civilian population. During World War II and the heyday of tantalum cranioplasty, there was a rapid evolution in prosthesis implantation and fixation techniques significantly shaping how cranioplasties are performed today. Several years after the war, acrylic emerged as the cranioplasty material of choice. It had several clear advantages over its metallic counterparts. Titanium, which was less radiopaque and had a more optimal thermal conductivity profile (less thermally conductive), eventually supplanted tantalum as the most common metallic cranioplasty material. While tantalum cranioplasty was popular for only a decade, it represented a significant breakthrough in synthetic cranioplasty. The experiences of wartime neurosurgeons with tantalum cranioplasty played a pivotal role in the evolution of modern cranioplasty techniques and ultimately led to a heightened understanding of the necessary attributes of an ideal synthetic cranioplasty material. Indeed, the history of tantalum cranioplasty serves as a model for innovative thinking and adaptive technology development.

In the 19th century, Dr. Odilon Marc Lannelongue was a pioneering French surgeon who introduced a surgical technique for the treatment of craniosynostosis. In 1890, Dr. Lannelongue performed correction of sagittal synostosis by strip craniectomy. From his procedure, multiple techniques have been developed and endorsed for this condition, ranging from simple suturectomies to extensive calvarial vault remodeling. In addition, even today, endoscopically aided strip craniectomy is performed as a surgical treatment of craniosynostosis. This article describes the life and works of the surgeon who revolutionized the management of craniosynostosis.

In 1915, faced with 2 patients with large skull defects, W. Wayne Babcock, an obstetrician-gynecologist-turned-general surgeon, operating in a modest North Philadelphia hospital, did something extraordinary: he went to the hospital kitchen to look for a cranial graft. Based heavily on archival and other primary sources, the authors tell the remarkable tale of the "soup bone" cranioplasties of the Samaritan Hospital and place these operations within the context of the early modern American hospital.

Introduction: Skull trepanation is an ancient and often religious act found in remains from around the world. However, cranioplasty for the surgical treatment of skull pathologies is a relatively recent phenomenon. In this paper, we focus on the account of skull injury and cranioplasty in medieval Persia., Materials and Results: Herein, we describe and translate the over 500-year-old writings of the Persian physician Baha al-Dowleh Razi regarding cranioplasty in an excerpt from his book entitled Khulasat al-Tajarib (Summary of Experiences). This early writer detailed the methods and indications for cranioplasty including the use of xenographs. Additionally, we attempt to trace this early understanding of skull surgery and follow its possible spread to Europe., Conclusions: It is such early experiences and methods of cranial surgery on which we base our current understanding of neurosurgery.

The frontotemporal, so-called pterional, approach has evolved with the contribution of many neurosurgeons over the past century. It has stood the test of time and has been the most commonly used transcranial approach in neurosurgery. In its current form, drilling the sphenoid wing as far down as the superior orbital fissure with or without the removal of the anterior clinoid, thinning the orbital roof, and opening the Sylvian fissure and basal cisterns are the hallmarks of this approach. Tumoral and vascular lesions involving the sellar/parasellar area, anterior and anterolateral circle of Willis, middle cerebral artery, anterior brainstem, upper basilar artery, insula, basal ganglia, mesial temporal region, anterior cranial fossa, orbit, and optic nerve are within the reach of the frontotemporal approach. In this article, we review the origins, evolution, and modifications of the frontotemporal approach and update the discussion of some of the related derivative procedures.

Humphrey Ridley, M.D. (1653-1708), is a relatively unknown historical figure, belonging to the postmedieval era of neuroanatomical discovery. He was born in the market town of Mansfield, 14 miles from the county of Nottinghamshire, England. After studying at Merton College, Oxford, he pursued medicine at Leiden University in the Netherlands. In 1688, he was incorporated as an M.D. at Cambridge. Ridley authored the first original treatise in English language on neuroanatomy, The Anatomy of the Brain Containing its Mechanisms and Physiology: Together with Some New Discoveries and Corrections of Ancient and Modern Authors upon that Subject. Ridley described the venous anatomy of the eponymous circular sinus in connection with the parasellar compartment. His methods were novel, unique, and effective. To appreciate the venous anatomy, he preferred to perform his anatomical dissections on recently executed criminals who had been hanged. These cadavers had considerable venous engorgement, which made the skull base venous anatomy clearer. To enhance the appearance of the cerebral vasculature further, he used tinged wax and quicksilver in the injections. He set up experimental models to answer questions definitively, in proving that the arachnoid mater is a separate meningeal layer. The first description of the subarachnoid cisterns, blood-brain barrier, and the fifth cranial nerve ganglion with its branches are also attributed to Ridley. This historical vignette revisits Ridley's life and academic work that influenced neuroscience and neurosurgical understanding in its infancy. It is unfortunate that most of his novel contributions have gone unnoticed and uncited. The authors hope that this article will inform the neurosurgical community of Ridley's contributions to the field of neurosurgery.

Pituitary surgery is a recent development in neurosurgery and most of the surgical techniques concerned have been described within the last century. We provide a historical perspective by reviewing the major steps in the development of this neurosurgical subspecialty through the ages. We concentrate on the most important figures whose advances in the study of the physiology and anatomy of the pituitary are most significant. This journey into the past will demonstrate that our current knowledge is the summation of a long road of investigation.

Variability in brain treatment, as a part of the Egyptian mummification process, is poorly appreciated in the literature, as variability in the details of excerebration have not been addressed comprehensively nor with respect to social, geographic, and temporal variation. The description of Egyptian mummification commonly used in the popular and academic literature is derived largely from accounts by Herodotus and Diodorus Siculus. However, this normative description does not acknowledge the existence of a wide range of mummification techniques practiced and so stifles the study of geographic and chronological changes in the practice and their causes. Therefore, the goal of this study is to use the classical description as a hypothesis for empirical testing, using published literature and primary radiographic data, with a specific focus on the practice of excerebration. Three primary treatments of the brain in mummification, and their variation over time and across social strata, are discussed in relation to their treatment in the literature, their radiological indicators, and their technical considerations. In order to examine Egyptian mummy excerebration, this study makes use of two samples: (1) a literature-based sample of 125 mummies, and (2) a sample of 6 mummies examined directly using computed tomography. In spite of an apparent high degree of variability, the literature continues to focus on modern and classical stereotypes rather than the rich variability in the Egyptian mummification tradition. Detailed, large-scale examination of this and other mummification traditions, and their meanings, is required to further our understanding of this important early complex society., (Copyright © 2011 Elsevier GmbH. All rights reserved.)

Berengario da Carpi was one of the most famous physicians of the 16th century, a recognized master of anatomy and surgery, an emblematic "Renaissance man" who combined his medical experience and engineering knowledge to design new surgical instruments, and effectively used the arts of writing and drawing to describe state-of-the-art medicine and provide illustrations of anatomical structures. His greatest contribution to medicine was to write the most important work on craniocerebral surgery of the 16th century, the Tractatus de Fractura Calvae sive Cranei (Treatise on Fractures of the Calvaria or Cranium), in which he described an entire set of surgical instruments to be used for cranial operations to treat head traumas that became a reference for later generations of physicians. This was a systematic treatise covering the mechanisms, classification, and medical and surgical treatment of head traumas, and can be considered a milestone in the history of neurotraumatology.

Trephinations in Neolithic people have been described all over the world. The reasons for these operations however are not always clear. In the present paper the authors describe the rare case of a Neolithic skull (dated to 1940 cal BC [calibrated before Christ]) showing the combination of a trephination combined with a healed depressed skull fracture. The authors conclude that at least in some cases such operations have been performed for "purely" medical reasons., (© Georg Thieme Verlag KG Stuttgart · New York.)

Although he was not the first man to operate on the brain, Sir Victor Horsley was the world's first surgeon appointed to a hospital post to perform brain surgery, which happened in 1886 at the National Hospital for Neurology and Neurosurgery, Queen Square, London. The authors examined the patient records between 1886 and 1899 and found 151 operations performed by Sir Victor Horsley at the National Hospital, including craniotomies, laminectomies, and nerve divisions. The authors present the outcome data and case illustrations of cerebral tumor resections and laminectomies from the nineteenth century. Outcomes and notable pioneering achievements are highlighted.

Craniosynostosis, the premature closure of cranial sutures, has been known to exist for centuries, but modern surgical management has only emerged and evolved over the past 100 years. The success of surgery for this condition has been based on the recognition of scientific principles that dictate brain and cranial growth in early infancy and childhood. The evolution of strip craniectomies and suturectomies to extensive calvarial remodeling and endoscopic suturectomies has been driven by a growing understanding of how a prematurely fused cranial suture can affect the growth and shape of the entire skull. In this review, the authors discuss the early descriptions of craniosynostosis, describe the scientific principles upon which surgical intervention was based, and briefly summarize the eras of surgical management and their evolution to present day.

Surgery for cranial deformity was associated with significant surgical morbidity during the early part of the 20th century. For this reason, Harvey Cushing was initially not in favor of surgical treatment of craniosynostosis. Later in his career, Cushing began to operate on these children, although it never became a major focus of his practice. Several examples of his patients with cranial deformity are presented, and his limited role in the development of this field is discussed.

Hephaestus is best known as the Greek god of metalworking, fire, and fine arts. As the only Olympian deity not endowed with physical perfection, he has been considered misfortunate among the Olympians. However, textual analysis of his myths reveals that Hephaestus was highly regarded by Greeks for his manual skills and intelligence. Furthermore, one of the myths about Hephaestus indicates that he performed the first recorded craniotomy. This text asserts that Hephaestus intentionally performed the craniotomy to remove a mass growing inside Zeus' head, thereby relieving him of an excruciating headache. The successful craniotomy resulted in the birth of the goddess Athena. From a neurosurgical perspective, the story is allegorical. Nonetheless, it represents the surgical management of intracranial ailments, which is thought to have been reported in Greece centuries later by Hippocrates.

During the Middle Ages, the work of Middle Eastern physicians such as Avicenna, Albucasis, and Rhazes was of paramount importance in guarding the knowledge that had been accumulated throughout history, particularly the contributions of Greek and Roman scholars, and it is well known that the Arabic versions of all of the works by Hippocrates and Galen by Islamic and Arabic scholars are the only copies that have survived until now. In addition to preserving this wealth of knowledge, these Middle Eastern scholars made significant contributions of their own to both medicine and neurosurgery. Many points regarding ancient Arabic and Islamic science need to be discussed and clarified, such as cadaver dissections, anatomic studies, neurosurgical practice and instruments, Arabic translations of Hippocratic and other works, and the influence of the Islamic civilization on Western civilization, especially the Renaissance., (Copyright © 2010 Elsevier Inc. All rights reserved.)

Maurice Ravel (1875-1937), the great impressionist-classicist composer of many popular compositions, such as the Boléro, suffered from a progressive disease and died following an exploratory craniotomy by Clovis Vincent. The history of his progressive dementia and the contribution of a car accident, following which he was unable to function, have received a certain amount of interest in the neurological literature previously, but his deadly craniotomy was not evaluated from a neurosurgery perspective. The car accident in 1932, with the probable consequence of a mild-to-moderate traumatic brain injury, could be the key event in his life, triggering the loss of his ability to compose. It is clear that he never recovered from his injury and within a year he became completely unable to function. His dementia progressed dramatically. This event needs to be kept in mind. In 1937, Ravel died after the craniotomy performed by Vincent, but only a speculative, retrospective diagnosis is possible since an autopsy was not undertaken.

Jacopo Berengario was born in Carpi, a medieval city close to Modena (northern Italy), circa 1460. He studied medicine at Bologna University and, in 1489, graduated in philosophy and medicine. He was appointed lecturer in anatomy and surgery at the same university, a position that he maintained for 24 years. Between 1514 and 1523, Berengario published some important anatomic and surgical works, which gave considerable fame to him.Commentaria... supra Anatomiam Mundini (Commentary... on the Anatomy of Mondino), published in 1521, constitutes the first example of an illustrated anatomic textbook ever printed. The anatomic illustrations were intended for explaining the text. Artistically speaking, the plates are typical examples of the Renaissance period and worthy of the greatest consideration.De Fractura Calvae sive Cranei (On Fracture of the Calvaria or Cranium), published in Bologna in 1518, is the first treatise devoted to head injuries ever printed. It is a landmark in the development of cranial surgery that went through numerous editions. The text was prepared in 2 months and dedicated to Lorenzo de' Medici, Duke of Urbino, who experienced a skull injury in the occipital region. Berengario wanted to demonstrate to other physicians his knowledge of anatomy and his expertise on the brain and head traumas. The book includes the illustration of an entire surgical kit or a corpus instrumentorum for performing cranial operations, which appeared for the first time in a printed book. However, Berengario's highly commendable aim was to indicate to the reader the step-by-step procedure of craniotomy for management of skull fractures along with the sequential use of the previously presented instruments.

For any new technology to gain acceptance, it must not only adequately fill a true need, but must also function optimally within the confines of coexisting technology and concurrently available support systems. As an example, over the first decades of the 20th century, a number of drill designs used to perform cranial bone cuts appeared, fell out of favor, and later reappeared as certain supportive technologies emerged. Ultimately, it was the power source that caused one device to prevail. In contrast, a brilliant imaging device, designed to demonstrate an axial view of the lumbar spine, was never allowed to gain acceptance because it was immediately superseded by another device of no greater innovation, but one that performed optimally with popular support technology. The authors discuss the factors that have bearing on the evolution of neurosurgical technology.

Stereotactic neurosurgery has a rich history, beginning with the first stereotactic frame described by Horsley and Clarke in 1908. It is now widely used for delivery of radiation, surgical targeting of electrodes, and resection to treat tumors, epilepsy, vascular malformations, and pain syndromes. These treatments are now available due to the pioneering efforts of neurosurgeons and scientists in the beginning of the 20th century. Their efforts focused on the development of stereotactic instruments for accurate lesion targeting. In this paper, the authors review the history of the stereotactic apparatus in the early 20th century, with a focus on the fascinating people key to its development.

The first report of intra-cerebral tumor surgery was provided by Bennett & Goodle, in London, 1884. Worldwide this kind of surgery was performed in France by Chipault, in Italy by Durante, in the United States by Keen and in Deutchland by Krause & Oppenheim. Lavista in Mexico City operated on intra-cerebral tumor in 1891, and the report was printed in 1892. In the same publication, Lavista exhibited the first cases of epilepsy surgery. Since now, it is the first report of this kind of surgery in the Spanish-speaking world.

In ancient times, awake craniotomy was used for trepanation to treat seizures and remove a variety of morbid conditions or even to permit the escape of evil air. In modern times, this technique was initially used for removal of epileptic foci with simultaneous application of brain mapping with electrical current. Further developments brought this technique into use for resection of tumors involving functional cortex. Recently, awake craniotomy has been described as an approach for removal of supratentorial tumors nonselectively, regardless of the involvement of eloquent cortex. It has been used in North America since the 1980s, then Europe, and recently has spread into Asia. Its spread to Asia could have significant impact based on the large population of patients and the low resource utilization associated with awake craniotomy.