Bartolomeo Panizza (1785-1867) and his contribution to the discovery of the visual cortex.

Bartolomeo Panizza (1785-1867) was an eminent anatomist and a pupil of Antonio Scarpa (1752-1832) at the University of Pavia. In 1855, before the revolutionary studies of Paul Broca (1824-1880) on aphasia that supported the theory of cortical localizations, Panizza delivered a lecture in Milan on the anatomy of the visual system, Osservazioni sul Nervo Ottico ("Observations on the optic nerve"). This lecture contains the first description of the cortical projection of the visual pathways in the occipital lobe, anticipating the revolutionary studies performed by Hermann Munk (1839-1912) in the late 19th century. The findings of Panizza questioned the assumption of the French physiologist, Marie-Jean-Pierre Flourens (1794-1867) who was defending the holistic concept of cerebral equipotentiality, which was widely accepted among the scientific community in the early 19th century. The present essay highlights the life and the scientific studies of Bartolomeo Panizza, with emphasis on the issue of cerebral localization that was simmering in the scientific community at that time.

Extreme Lateral Supracerebellar Infratentorial Approach: Surgical Anatomy and Review of the Literature.

OBJECTIVE: The extreme lateral supracerebellar infratentorial (ELSI) approach has the potential to access several distinct anatomical regions that are otherwise difficult to reach. We have illustrated the surgical anatomy through cadaveric dissections and provided an extensive review of the literature to highlight the versatility of this approach, its limits, and comparisons with alternative approaches. METHODS: The surgical anatomy of the ELSI has been described using 1 adult-injected cadaveric head. Formalized noninjected brain specimens were also dissected to describe the brain parenchymal anatomy of the region. An extensive review of the literature was performed according to each targeted anatomical region. Illustrative cases are also presented. RESULTS: The ELSI approach allows for wide exposure of the middle and posterolateral incisural spaces with direct access to centrally located intra-axial structures such as the splenium, pulvinar, brainstem, and mesial temporal lobe. In addition, for skull base extra-axial tumors such as petroclival meningiomas, the ELSI approach represents a rapid and adequate method of access without the use of extensive skull base approaches. CONCLUSIONS: The ELSI approach represents one of the most versatile approaches with respect to its ability to address several anatomical regions centered at the posterior and middle incisural spaces. For intra-axial pathologies, the approach allows for access to the central core of the brain with several advantages compared with alternate approaches that frequently involve significant brain retraction and cortical incisions. In specific cases of skull base lesions, the ELSI approach is an elegant alternative to traditionally used skull base approaches, thereby avoiding approach-related morbidity.