Al-Zahrawi (936-1013 AD): On the Surgical Treatment of Neurological Disorders by the Father of Operative Surgery.

BACKGROUND: Medical knowledge during the medieval ages flourished under the influence of great scholars of the Islamic Golden age such as Ibn Sina (Latinized as Avicenna), Abu Bakr al-Razi (Rhazes), and Abu al-Qasim Khalaf ibn al-Abbas al-Zahrawi, known as Albucasis. Much has been written on al-Zahrawi's innovation in various disciplines of medicine and surgery. In this article, we focus for on the contributions of al-Zahrawi toward the treatment of neurological disorders in the surgical chapters of his medical encyclopedia, Kitab al-Tasrif (The Method of Medicine). METHODS: Excerpts from a modern copy of volume 30 of al-Zahrawi's Kitab al-Tasrif were reviewed and translated by the primary author from Arabic to English, to further provide specific details regarding his neurosurgical knowledge. In addition, a literature search was performed using PubMed and Google Scholar to review prior reports on al-Zahrawi's neurosurgical instructions. RESULTS: In addition to what is described in the literature of al-Zahrawi's teachings in cranial and spine surgery, we provide insight into his diagnosis and management of cranial and spinal trauma, the devices he used, and prognostication of various traumatic injuries. CONCLUSIONS: Al-Zahrawi was a renowned physician during the Islamic Golden age who made significant contributions to the diagnosis and treatment of neurological conditions, particularly cranial and spinal cord injuries. He developed innovative surgical techniques for trephination and spinal traction, which are still used in modern neurosurgery. His insights make him worthy of recognition as an important figure in the history of neurological surgery.

Cranial Surgery in Italy During the Bronze Age.

Skull vault trepanation is a surgical practice that has been found in prehistoric human remains. We carried out a review of the literature on cranial trepanations performed during the Bronze Age in Italy. In total, 19 individuals, most of whom were adult males, with 33 trepanations have been reported, including a new specimen from the Italian Middle Bronze Age (1700-1400 BCE), found at Grotta della Monaca (Calabria). The evidence of cranial trepanations is geographically uneven across Italy, with the highest occurrence in Sardinia. Several trepanation techniques were applied in Italy during this period, where the drilling method was the most common solitary technique utilized. The survival rate of 79.3% in Bronze Age Italy suggests that trepanation was carried out with remarkable success. This analysis gives further insight into ancient human behavior and enhances our knowledge of surgical practices in antiquity, shedding light on the origins of neurosurgery.

A Study on Head Wounds in Kitab al-'Umda fi Sina'a al-Jiraha by Ibn al-Quff.

The aim of this study is to investigate the knowledge on head wounds contained in the Kitab al-'Umda fi Sina'a al-Jiraha, written by Ibn al-Quff in the thirteenth century. This study was based on a copy of the Kitab al-'Umda fi Sina'a al-Jiraha, printed in 2 volumes in Da'ira al-Ma'arif al-Uthmaniyya in Hyderabad in 1356/1937-38 and reprinted by the Institute for the History of Arabic-Islamic Science at the Johann Wolfgang Goethe University. This printed copy was compared with the manuscript of Istanbul University Rare Works Library, Arabic Manuscripts, A 4749. Relevant chapters were translated from Arabic to English, after which they were thoroughly examined. Obtained knowledge is presented in the Results section and is compared in the Discussion section with other reports of this subject. The first chapter classified head wounds into 6 types: the first 3 types are conservatively treated and the remaining 3 types are surgically treated. This chapter also presents information on how to proceed when there is a head wound-related hemorrhage, which medications should be used, and which are the adequate treatment protocols. The second chapter discusses the symptoms and signs that follow head blow and fall injuries. The characteristics and noteworthy circumstances of skull fractures as well as the surgical treatment methods are included in the fifteenth chapter, which is concluded with surgery-related complications. The present study shows that Ibn al-Quff benefited from his predecessors' knowledge and made some considerable contributions to this subject.

Legacy of Syriac-Aramaic Scholars in Transmitting Neurosurgical Knowledge Between Antiquity and the Middle Ages.

The link between ancient Greek medicine and the Arabic translation period in the 9th century cannot be understood without studying the contributions of Syriac scholars. With their mastery of Greek and the related Semitic languages of Syriac and Arabic, they initiated a scientific translation process with methods that prevail to this day. In this paper, we reviewed Hunayn Ibn Isshaq's Ten Treatises on the Eye to elucidate the original contributions of the Syriac physicians to the field of neurologic surgery. We analyzed the oldest known diagram of orbital anatomy along with Hunayn's genuine ideas on the optic nerve anatomy and pathology, optic chiasm, afferent pupillary reflex, and papilledema and venous congestion. We also reviewed the neurosurgical elements found in the Syriac Book of Medicines including the thought process in localizing neurologic deficits based on clinical experience and anatomic dissections and the earliest recorded description of brachial plexus pathology.

Abu Al-Qasim Al-Zahrawi (936-1013 CE), Icon of Medieval Surgery.

Abu al-Qasim Al-Zahrawi (936-1013 common era [CE]), also known in the West as Albucasis, was a great Arab physician and surgeon of the late 10th and early 11th centuries CE. He is best known for his surgical knowledge and expertise. His greatest contribution to medicine is the Kitab al-Tasrif, which includes thirty treatises on medical sciences. His early and great contributions to the field of surgery were seminal. For his endeavors in this field, a number of surgeons and scholars have dubbed him the "Father of Operative Surgery".

Wounds in the Head from Kitab al-Dhakhira fi 'Ilm al-Tibb by Thabit b. Qurra in the Ninth Century.

OBJECTIVE: Kitab al-Dhakhira fi 'Ilm al-Tibb is one of Thabit b. Qurra's most noteworthy books on medicine in Arabic in the ninth century. This study aims to present and discuss the section subtitled "wounds in the head" in the 24th chapter of Kitab al-Dhakhira considering the information in the literature. MATERIALS AND METHODS: This study is primarily based on a copy of Kitab al-Dhakhira edited by Dr. G. Sobhy and printed in al-Matba'at al-Amiriyya, Cairo in 1928. It is compared with the manuscript, which is in the Sehit Ali Pasa Collection, nr. 2028, in the Süleymaniye Manuscript Library in Istanbul, Turkey. The 24th chapter was first translated into English and then examined. The acquired knowledge from the chapter is discussed in this study by comparing it with that on this subject from the literature regarding the history of medicine. RESULTS: The 24th chapter, entitled "On Wounds and Wounds in the Head and Hemorrhage from Them and from Other Wounds and on Gently Drawing Arrowhead/Spearhead and Thorn," includes a section subtitled "wounds in the head." This section provides information regarding steps to be taken if the head is simply wounded or if there is an accompanying swelling, how to control hemorrhage, which medicines should be used for treatment, and how to bandage wounds in the head, but unfortunately, it specifies no details regarding surgical interventions for such wounds. CONCLUSIONS: Kitab al-Dhakhira presents interesting knowledge regarding wounds in the head, reflecting the medical paradigm of that era.

An Early Description of Using Oral Route for the Management of Cervical Vertebra Fracture by Ibn al-Quff in the Thirteenth Century.

OBJECTIVE: This study presents information regarding the treatment of fractures and dislocations of the vertebrae, including the use of the oral route for upper cervical fractures, presented in certain chapters of the book titled Kitab al-'Umda fi Sina'a al-Jiraha (Ibn al-Quff, thirteenth century ad). METHODS: A printed copy of the second volume of the book was studied. Chapters 22 ("On treatment of vertebral fractures") and 33 ("On treatment of vertebral dislocation") of the seventeenth treatise of this book were translated from Arabic into English. Each section is presented (in full text) in the Results section of this article. The findings were compared with the relevant literature and discussed to determine whether Ibn al-Quff presented novel information compared with that presented by his predecessors. RESULTS: The writings of Ibn al-Quff regarding vertebral dislocations seem to summarize information derived from his predecessors. Moreover, he modified certain approaches, previously described for vertebral dislocations, and used them for correcting vertebral fractures. Ibn al-Quff introduced the most novel use of a bridlelike instrument for anterior cervical fracture through the oral route. By introducing the device in the mouth, he described a pushing maneuver to the cervical vertebrae from the ventral site and a simultaneous pulling maneuver by cupping on the neck from the dorsal site. CONCLUSIONS: The use of the oral route introduced by Ibn al-Quff may be one of the earliest examples of novel, practical, and advanced treatment for cervical vertebral fracture.

[History of world neurosurgery].

In 5000 BC, South American tribes digged the bones in the living head to seek ways to communicate with the gods, which was primitive trephination and may be the first neurosurgical behavior. In 2600 BC, Imhotep in ancient Egypt took the brain out of the head from the nose, for a better preserve of the mummy, which was a prototype of modern transsphenoidal surgery. And the development of anatomy in ancient Greek laid a solid foundation for neurosurgery. From 500 to 1500 AD, the rise of religion and the occurrence of war, prompted a large number of craniocerebral trauma, which contributed greatly to the early development of neurosurgery as a distinct specialty. In 1861, Brocca astutely localized the language function to the third left frontal convolution in a series of studies, which was considered to be of landmark importance in the understanding of cerebral localization. In 1878, William Macewen performed a successful surgery to remove an en plaque meningioma with intrathecal anesthesia, representing the first modern neurosurgical operation. However, the contributions of the Americans, starting with Harvey Cushing, exerted a definitive force. Portuguese Moritz performed the first cerebral angiogram on a living schizophrenia patient in 1926. And he established the Moniz-Lima prefrontal leucotomy for the treatment of schizophrenia, for which he won the Nobel Prize in Physiology and Medicine in 1949. In 1968, the Swiss scholar Yassagir firstly carried out neurosurgical surgeries under the microscope. China's neurosurgery was founded by Zhao Yicheng in 1952 in Tianjin, and the gap in neurosurgery between China and the world gradually narrowed after 60 years of development.

Intrarectal Anesthesia in Neurosurgery.

In the early days of modern neurologic surgery, the inconveniences and potential dangers of general anesthesia by chloroform and ether using the so-called "open-drop technique" led to the quest for alternative methods of anesthesia. This became all the more necessary, since patient positioning and the surgical arrangements often hindered the use of a drop bottle. One approach to solve this problem was intrarectal ether application. The present article aims to shed light on this original, less well-known anesthesia technique in the neurosurgical field.

Two cases of 16th century head injuries managed in royal European families.

In Europe, during the 16th century, there were a number of prominent general surgeons adventurous enough to consider operating on the brain for head injuries. From the time of Hippocrates, operating on the skull and brain was considered both treacherous and too dangerous to be undertaken except on rare occasions. Operating on a member of a royal court was considered even more exceptional because if the outcome was poor, the surgeon could lose a hand or limb, or, even worse, be beheaded. The authors present two interesting cases of royal family members who underwent surgery for head injuries that were quite severe. The surgeons involved, Ambroise Paré, Andreas Vesalius, and Berengario da Carpi, were among the most prominent surgeons in Europe. Despite very challenging political situations, all were willing to undertake a complex surgical intervention on the member of a prominent royal family. The individuals involved, both royal and medical, plus the neurosurgical injuries are discussed.

[The origins of the French neurosurgery]. / Aux origines de la neurochirurgie française.

Modern French neurosurgery starts at the beginning of the XXth century under the motivation of Joseph Babinski. He submitted his patients to Thierry de Martel who had learned this new specialized area of medicine with H. Cushing in the États-Unis and V. Horsey in Great Britain. His first successfully treated case of an intracranial tumor was published in 1909. But the true founding father was Clovis Vincent, initially a neurologist and collaborator of de Martel, who became the first chairman in 1933 of the neurosurgical department at the Pitié hospital of Paris and the first professor of neurosurgery in 1938. After the Second World War, many departments were created outside of Paris. Neurosurgery was definitively recognized as a specialized area in medicine in 1948. Currently, more than 400 neurosurgeons work in France. Because I had the very great privilege to be present at the birth of this society in 1970 and to still be in contact with some of the second and third generation of French neurosurgeons who led it to its high international recognition, the Chairman of the French Neurosurgical Society asked me to write this short historical vignette.

Remarks upon the term stereotaxy: a linguistic and historical note.

The correct explanation of the term 'stereotaxy' is linguistically not self-evident because the Greek term stereon means not spatial but 'hard' or 'solid'. The aim of our study was to clarify the term stereotaxy historically and linguistically. We carried out our study by reviewing the neurosurgical and ancient Greek literature. The term stereotaxy is composed of two ancient Greek words: stereon and taxis. Stereon was used in particular as a technical term for geometrical solids in Greek mathematics. This term can be traced back to Platon and Euclid in the 4th and 3rd century BC, respectively. Only in this sense of the word does stereon in stereotaxy actually mean 'spatial' or '3-dimensional'. Taxis is derived from the verb tattein(τάττειν) with the meaning 'to position'. The terms 'stereotaxis' and 'stereotaxic apparatus' were introduced by Clarke and Horsley in 1908 to denote a method for the precise positioning of electrodes into the deep cerebellar nuclei of apes. The target in space was defined by 3 distances in relation to 3 orthogonal planes. Although this concept corresponded exactly to x-, y- and z-coordinates in a cartesian coordinate system, Clarke never used the concept of coordinates. The intuitive explanation of the term stereotaxy as spatial positioning is correct, but linguistically more complex than would be expected.

Scythian trepanations in the Gorny Altai in Hippocratic times: modern expert appraisal of ancient surgical technologies.

OBJECTIVE: To report the analysis of 3 cases of ancient trepanation discovered in the craniological collection (153 skulls) of the Pazyryk nomadic culture (500-300 bc) from the Gorny Altai, Russia, and to evaluate the technique, instrumentation, and materials used for cranial surgery as well as the motivation for the trepanations in Scythian times. METHODS: A multidisciplinary approach was chosen to study the trepanned skulls. Visual inspection and examination under magnification, multislice computed tomography, high-field magnetic resonance imaging, and coupled plasma mass spectrometry and synchrotron radiation-induced x-ray fluorescence analysis of the bone samples from the site of trephination were used. RESULTS: In the Pazyryk culture, trepanation was very likely used to perform the intracranial procedures that were not yet indicated by Hippocrates. No signs of bone infection were detected. Higher copper abundance found at the site of trepanation showed that a bronze knife was the most likely tool used by Scythian surgeons. CONCLUSIONS: Our data suggest that the Scythian population of the Altai Mountains had sufficient medical knowledge to perform sophisticated and successful manipulations on the human skulls. Scraping technique with bronze tools was quite effective for prevention of wound infection and resulted in a high survival rate after surgery. In the era of methicillin-resistant Staphylococcus aureus, it may be useful to consider some ancient surgical technologies.

From Pergamon to Army Base Hospital No. 5: the history and significance of the galea aponeurotica in the evolution of neurosurgery.

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.

75 years of neurosurgery at the University of Minnesota.

Neurosurgery began as a distinct discipline at the University of Minnesota in 1937 with the appointment of William Peyton as head of the division. Under the leadership of Peyton, Lyle French, and Shelley Chou, the Department rose to national prominence. Substantial contributions included the introduction of dexamethasone to the practice of neurosurgery by Galicich and French, early procedures for the transthoracic correction of spinal deformity, important contributions to the understanding of brain death, the early laboratory work that led to the development of nimodopine, one of the first intraoperative magnetic resonance imaging facilities in the United States (1996), and the training of many academic neurosurgeons and department chairmen. The challenges of managed care and more recent changes in the health care system have been met, and the Department is a thriving clinical, educational, and research center for 21st-century neurosurgery.

Medieval times' influencing figure Rhaze's approach to head injuries in Liber Almansoris.

OBJECTIVE: To present the chapter "On wound of the head and fracture of the head bone" of Kitab al-Mansuri / Liber Almansoris, which was one of the early works of Rhazes. METHODS: Both Arabic (Süleymaniye Manuscript Library, Ayasofya collection, Nr. 3751 and Millet Library, Feyzullah Efendi collection, Nr. 1327) and the Latin (Basileae, 1544) texts of Kitab al-Mansuri / Liber Almansoris were studied, and the 26th section of the 7th chapter, entitled "Fi al-shajja kasr al-'azm al-ra's / De plagis capitis et fractura cranei / On wound of the head and fracture of the head bone" was translated into English and English text created. RESULTS: Rhazes underlined removing bone fragments in depressed and separated fractures of cranium along with protection of the dura, but he did not describe any surgical technique in this chapter. CONCLUSIONS: Galen's contemplation for the care of the dura with its integrity and as well his proposal to remove the bone fragments for preventing the dura from injury were the golden standards at the time that Rhazes also followed in the treatment of skull fractures.