Evolution of Neurosurgery in ancient times.

Neurosurgery Evolution: Origins to Modern Innovations (Part I)

Introduction 

Neurosurgery, the medical specialty that treats and repairs disorders and injuries of the nervous system, has a rich and fascinating history. From its origins in ancient civilizations to the modern innovations of the 21st century, the field has undergone a significant evolution that has revolutionized the care and outcomes of patients. In this article, let’s join UpSurgeOn to trace the historical development of neurosurgery from its beginnings.

The Ancient Beginnings of Neurosurgery

Ancient civilizations and cultures laid the groundwork for the development of neurosurgery by practicing basic forms of brain surgery. Here are some key milestones in the evolution of neurosurgery in ancient times:

The History of Trepanning. Source: BrainBook
  • Inca and Mayan Civilizations: Trepanation, a form of brain surgery that involves drilling holes in the skull to relieve pressure, was practiced by the Inca and Mayan civilizations of South America. There is archaeological evidence to suggest that the practice of trepanation dates back at least 7,000 years ago. [1] [2].
Ancient Egyptian neurosurgery Source: BrainBook
  • Ancient Egypt and Ancient Greece: Some knowledge of brain surgery existed in both ancient Egyptian and ancient Greek cultures. The Greek physician Galen made important contributions to the understanding of the nervous system, laying the groundwork for later advances in the field [1].
Ancient Roman Neurosurgery. Source: BrainBook
  • Cappadocia, Turkey: The earliest example of brain surgery can be traced back 6,000 years to Cappadocia in Turkey. During this time, the earliest form of surgery was in practice, with procedures on the brain and nervous system  [3]
  • Ancient Arabia: Significant contributions to the field of surgery, including brain surgery, were made by ancient Arabian physicians such as Al-Zahrawi. Al-Zahrawi’s work in the 10th century had an influence on later developments in the field.  [1].
History of Neurosurgery during Middle Ages. Source: BrainBook
  • Peruvian Andes: Evidence of trepanation has been found in 1,000-year-old skulls in the Andes Mountains of Peru. The practice evolved over time with the use of drills, cutting tools, and scrapers by doctors. Similar to modern medical training, some procedures were even performed on the dead. The practice of trepanation in the region came to an end with the arrival of the Spanish in the 16th century [4].

These ancient practices are rudimentary compared to modern neurosurgery. However, they demonstrate an early understanding and exploration of the brain and nervous system. The techniques and knowledge that were gained during this period would later contribute to the development of more advanced surgical procedures in the field of neurosurgery.

The Renaissance: A Turning Point in Neurosurgery

History of Neurosurgery during Renaissance. Source: BrainBook

The Renaissance, which lasted from the 14th to the 17th centuries, was a period of great intellectual and artistic growth in Europe. This era also witnessed significant advances in the field of medicine, including neurosurgery. Here are some of the key developments that occurred during the Renaissance and helped to shape modern neurosurgery:

  • The Role of Andreas Vesalius: The role of Andreas Vesalius: A seminal contribution to the understanding of human anatomy was made by Andreas Vesalius, a Flemish anatomist. His work “De humani corporis fabrica”, published in 1543, challenged the traditional teachings of Galen and laid the foundation for modern anatomical knowledge [6]. Vesalius’ detailed illustrations and accurate descriptions of the human body were instrumental in guiding neurosurgeons in their practice.
  • The Influence of Ambroise Paré:  Ambroise Paré, a French military surgeon, revolutionized the treatment of head injury during the Renaissance. He introduced the concept of primary wound closure, the suturing of the scalp after a cranial injury, which led to improved patient outcomes [6]. Paré laid the foundation for modern neurosurgery with his innovative techniques and emphasis on the importance of cleanliness and hygiene in surgical procedures.
  • The Development of the Frontotemporal Craniotomy: During the Renaissance, neurosurgeons refined the frontotemporal craniotomy, a surgical procedure in which a portion of the skull is removed to gain access to the brain. This procedure allowed neurosurgeons to safely and effectively treat a variety of diseases of the brain, including tumors and abscesses [8]. Advances in frontotemporal craniotomy during this period marked a significant step forward in neurosurgery.
  • The Contributions of Hieronymus Fabricius: Hieronymus Fabricius, an Italian anatomist during the Renaissance, made important discoveries in the field of neuroanatomy. He was the first to describe the cranial nerves and how they function, allowing neurosurgeons to better understand the complex network of nerves in the brain [6]. Fabricius’s work laid the foundation for developing more precise and targeted surgical techniques.
  • The Integration of New Technologies: The Renaissance period saw the integration of new technologies, such as the microscope, into the practice of medicine. This allowed neurosurgeons to observe and study the intricate structures of the brain in greater detail, leading to further advancements in surgical techniques and patient care [8].

The Renaissance was a turning point in the development of neurosurgery. The contributions of individuals such as Vesalius, Paré, and Fabricius, and the development of the frontotemporal craniotomy, paved the way for the birth of modern neurosurgery. These advances in understanding, techniques, and technologies set the stage for further advances in the field, leading to the remarkable innovations that we see in neurosurgery today.

19th century: The Dawn of Modern Neurosurgery

History of Neurosurgery. Source: Rasmussen University

During the 19th century, a number of important advances in a variety of fields laid the foundation for the modern practice of neurosurgery. These developments in bacteriology, cerebral localization, and anesthesia enabled safer and more effective surgical interventions on the brain and nervous system  [10].

  • Bacteriology: The understanding of bacteria and infection control has had a profound impact on the practice of neurosurgery. The work of Louis Pasteur and Joseph Lister in the late 19th century led to the development of antiseptic techniques. These techniques significantly reduced the risk of infection during surgery  [10].
  • Cerebral Localization: A key development in neurosurgery was the concept of cerebral localization, which refers to the mapping of specific functions to different areas of the brain. This understanding enabled surgeons to perform more precise and targeted procedures, minimizing damage to healthy brain tissue [10].
  • Anesthesia: The development of anesthesia, particularly the use of ether and chloroform, revolutionized surgery, allowing patients to endure procedures without pain or discomfort. This advance made it possible to perform more complex and prolonged operations, including those on the brain and nervous system [11].
  • Skull Base Surgery: In the 19th century, the French anatomist Jean Cruveilhier made significant contributions to the field of skull base surgery, which involves the removal of tumors and other lesions at the base of the skull. His work laid the foundation for later development of this specialty [1].
  • Clinic-Pathological Correlation: The early neurosurgeon was a clinician-neurologist who diagnosed and localized brain lesions on the basis of the clinical history and neurological examination. Clinicopathologic correlation of brain lesions led to the diagnosis of brain tumors, vascular lesions, and spinal disorders [12].
  • Ventriculography: In 1918, Walter Dandy introduced ventriculography, a technique that involved the injection of air into the brain’s ventricles to visualize the brain’s internal structures. This innovation allowed for better diagnosis and planning of surgical procedures [12].

These advancements in the 19th century set the stage for the rapid progress and innovation that would follow in the 20th and 21st centuries. Today, neurosurgery continues to evolve, with new techniques, technologies, and treatments being developed to improve patient outcomes and quality of life.

To explore more the evolution of Neurosurgery in Modern eras, read the second part HERE

Conclusion

The development of neurosurgery has been a dynamic and continuously evolving journey through history. It has progressed from ancient practices such as trepanation to significant advancements in the 19th century, including breakthroughs in bacteriology, cerebral localization, anesthesia, and surgical techniques. These advancements laid the foundation for the emergence of modern neurosurgery. This field has consistently adapted and evolved over time, demonstrating its commitment to innovation and growth. UpSurgeOn’s surgical simulation technologies were created with the mission of empowering neurosurgeons to do their mission with confidence, precision and skill. Let’s embark on the journey to explore the transformative power of surgical simulation with UpSurgeOn and stay ahead in the ever-evolving field of surgery!


References: 

  1. Nikova, A., & Birbilis, T. (2017). The basic steps of evolution of brain surgery. Maedica, 12(4), 297.
  2. Arani, M. G., Fakharian, E., & Sarbandi, F. (2012). Ancient legacy of cranial surgery. Archives of trauma research, 1(2), 72.
  3. https://www.ancient-origins.net/ancient-technology/brain-surgery-ancient-times-00869
  4. Nuwer, R. (2013, December 20). 1,000 Years Ago, Patients Survived Brain Surgery, But They Had To Live With Huge Holes in Their Heads. Smithsonian Magazine. https://www.smithsonianmag.com/smart-news/1000-years-ago-patients-survived-brain-surgery-but-they-had-live-with-huge-holes-in-their-heads-180948185/
  5. Florkin, M. (2023, May 28). Andreas Vesalius. Encyclopedia Britannica. https://www.britannica.com/biography/Andreas-Vesalius
  6. Park, M. T., Mignucci-Jiménez, G., Houlihan, L. M., & Preul, M. C. (2022). Management of injuries on the 16th-century battlefield: Ambroise Paré’s contributions to neurosurgery and functional recovery. Neurosurgical Focus53(3), E2.
  7. Britannica, T. Editors of Encyclopaedia (2023, January 1). Ambroise Paré. Encyclopedia Britannica. https://www.britannica.com/biography/Ambroise-Pare
  8. Ormond, D. R., & Hadjipanayis, C. G. (2014). The history of neurosurgery and its relation to the development and refinement of the frontotemporal craniotomy. Neurosurgical Focus, 36(4), E12.
  9. The Editors of Encyclopaedia Britannica. (1998, July 20). Hieronymus Fabricius ab Aquapendente | Anatomy, Embryology, Physiology. Encyclopedia Britannica. https://www.britannica.com/biography/Hieronymus-Fabricius-ab-Aquapendente
  10. Laing, R. (1998). A History of Neurosurgery. Journal of Neurology, Neurosurgery, and Psychiatry, 64(2), 284.
  11. Kirollos, Ramez W., and others, ‘The history of neurosurgery’, in Ramez Kirollos, and others (eds), Oxford Textbook of Neurological Surgery (Oxford, 2019; online edn, Oxford Academic, 1 Oct. 2019), https://doi.org/10.1093/med/9780198746706.003.0001, accessed 26 Oct. 2023.
  12. Muzumdar, D. (2012). Neurosurgery in the past and future. An appraisal. Annals of Medicine and Surgery, 1, 13-15.
  13. Britannica, T. Editors of Encyclopaedia (2023, March 6). Jean Cruveilhier. Encyclopedia Britannica. https://www.britannica.com/biography/Jean-Cruveilhier
  14. Ullmann, A. (2023, September 24). Louis Pasteur. Encyclopedia Britannica. https://www.britannica.com/biography/Louis-Pasteur
  15. Amr, S. S., & Tbakhi, A. (2007). Abu Al Qasim Al Zahrawi (Albucasis): pioneer of modern surgery. Annals of Saudi medicine27(3), 220–221. https://doi.org/10.5144/0256-4947.2007.220
  16. BrainBook. (2020a, September 20). The history of trepanning. YouTube. https://youtu.be/IsmnZA26tOo
  17. BrainBook. (2020, September 26). Ancient Egyptian neurosurgery. YouTube. https://youtu.be/joJJNh_DCmI?list=PLpZaKncB6MGDuQ04CFNHHhLrzWKX4isIN
  18. BrainBook. (2020d, October 10). Roman Medical History: History of Neurosurgery. YouTube. https://youtu.be/LaUlYLJnUqA
  19. BrainBook. (2020c, October 3). Middle ages surgery: History of neurosurgery. YouTube. https://youtu.be/JSh2ag1gfS4
  20. BrainBook. (2016, October 25). The history of surgery: A bloody (and painful) timeline. YouTube. https://youtu.be/ezZf_mOqyFU
  21. Rasmussen University. (2016, October 25). The history of surgery: A bloody (and painful) timeline. YouTube. https://youtu.be/ezZf_mOqyFU

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