Famous personalities from different parts of world contributing to stereotactic and functional neurosurgery

Sir Victor Alexander Haden Horsley(1857 –1916) (A) and Robert Henry Clarke(1850-1926) (B)

· The first 3D targeting technique for human neurosurgery was described in a seminal paper published in Brain in 1908 by Victor Horsley (British neurophysiologist and neurosurgeon) and Robert Clarke (British physiologist)

· They used an apparatus with an electrode guide based on the 3D cartesian coordinate system and described lesioning targets in a monkey brain based on skull landmarks.

· Their apparatus was built from brass and costed them £300.

· They coined the term “stereotaxis” which is derived from the Greek words stereos meaning “3D” and taxis meaning “orderly arrangement.

· Sir victor horsley considered the father of the functional neurosurgery excision of the epileptogenic brain tissue for treatment of the focal epilepsy.

Aubrey T Mussen(1873-1975)

· He was born in Montreal,Canada in 1873 and is one among the pioneers of stereotaxy

· He designed the first human stereotaxic apparatus in 1918.

· He worked on elaboration of cytoarchitectural atlas of brainstem and thalamus of monkey.

· He foresaw immense potential of the stereotaxic technique for surgery in human 30 years earlier than it was first apllied to man.

· He also worked as neuropathologist to London’s Medical research committee.

· Spiegel was a conservative Vienna trained experimental neurologist, Henry T. Wycis was a neurosurgeon born in New jersy

· They described the first use of stereotactic devices in humans with the stereoencephalotome in 1947.Speigel and Wycis performed the first stereotactic surgery on a patient with Huntington s chorea.

· They described stereotaxy in relation to landmarks inside of the skull by using radiographs (the ventricles using pneumoencephalograms and the calcified pineal gland).

· Their apparatus was similar to the Horsley and Clarke version with an electrode carrier suspended above the head, to be adjusted in all 3 planes independently.

· They coined to term “stereoencephalotomy” to describe intracranial surgery 3D targeting based on the brain itself

Jean Talairach(1911-2007)

· Jean Talairach was a French psychiatrist and neurosurgeon Talairach moved to Paris after completing medical school to specialize in psychiatry. He was interested in neuroanatomy, and he found work in the Sainte Anne Hospital. · He subsequently switched from psychiatry to neurosurgery, with the specific task of developing a stereotactic frame.

· In 1949 he published his initial experiments using a frame based on a rectangular coordinate system that involved grids through which electrodes could be inserted.

· The apparatus was designed for targeting the temporal lobes for epilepsy and allowed lateral access.

· To decrease distortion even more, he used the apparatus in a large operating room (called the “chapel”) so the x-ray tube was placed up to 5 m away from the grids.

· In 1952, Talairach proposed the use of the anterior and posterior commissures as reference points for the brain coordinate system. He subsequently used his frame and reference points to map first the gray nuclei and then the entire telencephalon.

HirotaroNarabayashi(1922-2001)

· He was born in Kobe into a long line of physicians originally from Nagasaki and was a prominent Japanese neurosurgeon.

· HirotaroNarabayashi developed a frame adapted from the original Horsley and Clarke orthogonal design in Japan.

· He graduated from the University of Tokyo School of Medicine just after World War II and joined Professor Y. Uchimura’s Department of Psychiatry.

· Narabayashi’s first application of his own instrument was a pallidotomy in an athetoid child in 1951

· On June 4, 1952, when the first pallidotomy on Parkinson’s disease was successfully accomplished. Immediately after injection of a small amount of oil wax (procaine-oil and bee’s wax), the patient’s tremor and rigidity were almost completely abolished

· He published “Procain oil blocking of the globus pallidus” in 1956.

Lars Leksell(1907-1986)

· Born in Fassberg, Sweden in 1907, Lars Leksell attended medical school at the Karolinska Institute in Stockholm.

· Initially working in electrophysiology for his doctoral thesis, Leksell would eventually identified the motor innervation of the muscle spindle in his publication in 1945.

· Known as the father of stereotactic radiosurgery.

· In 1948, he developed an arc-centered stereotactic frame based upon the original model built by Spiegel and Wycis in 1947.

· Leksell introduced an improved sterotactic frame in 1949, the Leksell Sterotactic system. The advantage of the frame was it's ability to attach surgical instruments .

· The first operation with the "gamma knife" was in 1960 during the first human sterotactic proton beam operation. Creating what is still the gold-standard for radiosurgery today, Leksell installed the first gamma unit in Stockholm in 1968. Over the rest of his career, Leksell treated 762 patients with the "Gamma Knife".

Irving S Cooper(1922-1985)

· Irving S. Cooper was born in Atlantic City, New Jersey in 1922, performed his neurosurgical training at the Mayo Clinic in Rochester, Minnesota and also received his doctorate in neurophysiology.

· Irving Cooper in 1951 while attempting pedunculotomy injured anterior choroidal artery accidentally and the patient postop got relieved of the tremor and the rigidity in the opposite side.

· Dr. Cooper to begin to purposely ligate the Anterior Choroidal Artery to reduce tremor.

· He developed the first cryosurgical probe to be used in the brain. After this crucial development, Dr. Cooper began to successfully and effectively treat patients with Parkinson's disease, essential tremor, Wilson disease, chorea, Tourette syndrome,.

· Using this as a building block, Dr. Cooper went on to continue to expand the field of functional neurosurgery. For example, in 1979, he implanted a deep brain stimulator in a patient who had chronic pain and spasticity and then continued to research the topic and publish his results on Deep Brain Stimulation until his death in 1985.

Alim Louis Benabid

· Alim Louis Benabid was born May 2, 1942 in Grenoble, France

· He is a French emeritus professor, neurosurgeon and member of the French Academy of Sciences, who has had a global impact in the development of deep brain stimulation (DBS) for Parkinson's disease and other movement disorders.

· Benabid's group had first used DBS in the thalamus as early as 1987.

· The first permanent implant subthalamic nucleus stimulator to treat all cardinal signs of Parkinson's disease was performed by Dr. AlimBenabid in Grenoble, France in 1993

· He has published 523 scientific papers . He has given 18 honorary lectures and received 23 medals and prizes (including the Robert A. Pritzker Prize from MJFF).

Dr. Gilles Bertrand(left) with the late Dr. Herbert Jasper(right)(1906-1999)

· Dr Herber.Jasper was a Canadian psychologist ,physiologist, anatomist and neuroogist

· DrGilles Bertrand was born in Montreal, Quebec on August the 5th,1924 and is renowned neurosurgeon.

· They carried out pioneering work on cellular unit recording of the human thalamus in awake patients operated on for Parkinson's Disease.

· Dr Gilles Bertrand was the first to introduce computers to stereotactic surgery for the treatment of Parkinsonian tremor.

· The first thalamotomy was performed by Bertrand in 1959.

· The original Leksell apparatus was modified in depth by Gilles Bertrand to the point that, aside from the basic principle, it became a different and more versatile device. One striking improvement was the possibility of taking lateral x-rays to verify the position of an intracranial probe .

Rolf Hassler( 1914-1984)

· Rolf Hassler was a German pathologist who made important discoveries on the pathophisiology and treatment of Parkinson's disease.

· In 1950 Hassler and Reichert reported the successful treatment of the Parkinson's disease by ventral thalamotomy.

· By 1954 Hassler and Reichert defined their thalamic targets more precisely targeting ventrolateral nucleus of thalamus, Ventral oralis posterior part was recommended for the tremor and Ventral oralis anterior part was recommended for the rigidity.