Gangliformis Intumescentia and Beyond: Antonio Scarpa and His Core Contribution to Neuroanatomy, Neurosurgery, and Otoneurosurgery.

Nearly 250 years ago, Antonio Scarpa became a professor of anatomy and surgery only 2 years after he graduated from the University of Padua. The young lecturer soon became one of the most renowned anatomists in Italy and a director of the Faculty of Medicine at the University of Pavia. He worked in the fields of general surgery and ophthalmology. Several anatomic structures have been named after him, mainly Scarpa fascia and Scarpa triangle. His interest in neuroanatomy was ardent, despite being occasionally neglected. Scarpa's contributions to the fields of neurosciences have been significant. He was the first to describe the round window and the secondary tympanic membrane, and he eventually focused on the auditory and olfactory organs. Notably, the vestibular ganglion is now known as Scarpa ganglion. Scarpa's magnum opus was the book Tabulae Neurologicae, in which he described the path of several cranial nerves including the vagus nerve and innervation of the heart. Since his death in 1832, Scarpa's head has been preserved at the University History Museum of the University of Pavia. In this historical vignette, we aim to describe Antonio Scarpa's troubled life and brilliant career, focusing on his core contributions to neuroanatomy, neurosurgery, and otoneurosurgery.

Georg von Békésy and Bruce Mer: Early Pioneers of Endoscopic Ear Surgery.

The binocular operative microscope has been the workhorse of otologic and neurotologic surgeons since the 1950s. Since its advent, however, surgeons recognized that the operative microscope could not "look around corners" and its line-of-sight technology required soft tissue and bony dissection to enable light to reach the surgical plane. Endoscopic technology has evolved to address many of the limitations of operative microscopy. While the endoscope is often viewed as a recent development in otologic surgery, in the following historical article, we highlight the contributions of two mid-20th century pioneers of endoscopic ear surgery: Georg von Békésy and Bruce Mer. In the 1940s, Dr von Békésy envisioned an endoscope for determining stapes mobility. Dr Mer, with a team of engineers, created an otoendoscope to perform some of the first endoscopic ear procedures in the 1960s. Lessons gleaned from von Békésy and Mer's research include the need for counterculture thinking and the challenges of pioneering ideas beyond technical capacity.

A Biographical Journey Through the History of Ear Reconstruction.

This historical literature review of ear reconstruction differs from much of the published literature in that it focuses on the biographies of the innovators and evangelists of ear reconstruction rather than specific techniques. A biographical account of ear reconstruction demonstrates the importance of surgeons as artists, scientists, technicians, politicians, and most importantly carers of this special and fascinating group of patients who benefit from this technically challenging form of reconstruction.

Dorothy Wolff: A Pioneer in Otopathology.

Dorothy Wolff, PhD, was an inspirational anatomist, pathologist, auditory physiologist, and surgical innovator. Though little known, she worked throughout the mid-20th century in the midst of a revolution in otologic surgery, influencing well-known otologists such as Julius Lempert, MD, Phillip E. Meltzer, MD, and Richard Bellucci, MD. Wolff's seminal work included pathologic studies of the operated human ear, which provided the anatomic basis for effective modern techniques of surgical hearing rehabilitation. Wolff also developed and refined multiple animal models of otologic pathologies that are still in use today. As an independent, innovative, and ambitious scientist, Dorothy Wolff succeeded in pioneering surgical otopathology to the benefit of us all.

Lucae's Springy Pressure Probe to Mobilize the Ossicular Chain: Rise and Fall of an Ingenious Instrument.

OBJECTIVES/HYPOTHESES: In 1884, Johann Constantin August Lucae (1835-1911), a German otologist from Berlin, introduced a new "method to mechanically treat chronic troubles of the mobility of the hearing organ transmission apparatus." It consisted in the use of a springy pressure probe to directly mobilize the handle of the malleus. The aim of this study is to trace the invention, clinical use, technological modifications, and ultimate extinction of this instrument. METHOD: Review of Lucae's publications, comments by his colleagues, and trade catalogues published between 1880 and 1940. RESULTS: Lucae presented at least six different models of his springy pressure probe during his career. Some of his colleagues modified it. The success rate was much disputed, and the instrument died with Lucae. CONCLUSION: Lucae's spring pressure probe is another example of the ingenuity of man to try to find a solution when confronted with an unclear and unresolved otological problem.

The History and Evolution of Surgery on the Vestibular Labyrinth.

The history of surgery on the vestibular labyrinth is rich but sparsely documented in the literature. The story begins over a century ago with the labyrinthectomy in an era that consisted exclusively of ablative surgery for infection or vertigo. Improved understanding of vestibular physiology and pathology produced an era of selective ablation and hearing preservation that includes semicircular canal occlusion for benign paroxysmal positional vertigo. An era of restoration began with a discovery of superior semicircular canal dehiscence and its repair. The final era of vestibular replacement is upon us as the possibility of successful prosthetic vestibular implantation becomes reality.

Birth and Evolution of Chiselling and Drilling Techniques for Removing Ear Canal Exostoses.

The main surgical techniques used to remove ear canal exostoses are drilling and/or, chiselling. The aim of this study was to identify the origins and subsequent evolution of, the surgical removal of ear canal exostoses in the 19th century. A critical review and, compilation of primary and secondary historical sources was conducted. Two techniques for removal of exostoses were developed in the latter part of the 19th century and have largely remained unchanged. This demonstrates the importance of that era in the history of ear surgery.

A brief history of mastoidectomy

AIM: To describe to the new generation of otologists the origins of mastoidectomy as well as the difficulties our predecessors encountered and the solutions they devised to improve otologic surgery. METHODS: Retrospective literature review-based study. RESULTS: Before the mid-19th century, mastoidectomy was performed only sporadically and in most cases as a desperate attempt to save the lives of people suffering from complications of infectious otitis. The drainage of acute abscesses became a common procedure at the beginning of the 20th century, within the pre-antibiotic era. The first documented surgical incision to drain an infected ear was described by the French physician Ambroise Paré in the 16th century. The credit for performing the first mastoidectomy for the removal of purulent secretions went to Jean-Louis Petit. Mastoidectomies were normally performed to treat infections. However, mastoidectomies were also carried out for other purposes, particularly for the treatment of deafness and tinnitus, during various periods. Sir Charles Ballance credited Johannes Riolanus with recommending mastoidectomy for the treatment of tinnitus. William Wilde began the era of modern mastoidectomy with his introduction of the eponymous retroauricular incision. CONCLUSION: Mastoidectomy has evolved significantly throughout its history. Improvements in mastoidectomy have relied on the introduction of more elaborate surgical procedures, especially the advances in surgical equipment during the last century. Mastoidectomy continues to be a life-saving surgical procedure.

The War of Jenkins' Ear.

OBJECTIVE: In 1731, Spanish sailors boarded the British brig Rebecca off the coast of Cuba and sliced off the left ear of its captain, Robert Jenkins. This traumatic auriculectomy was used as a pretext by the British to declare war on Spain in 1739, a conflict that is now known as the War of Jenkins' Ear. Here, we examine the techniques available for auricular repair at the time of Jenkins' injury and relate them to the historical events surrounding the incident. METHODS: Review of relevant original published manuscripts and monographs. RESULTS: Surgeons in the mid-18th century did not have experience with repair of traumatic total auriculectomies. Some contemporary surgeons favored auricular prostheses over surgical treatment. METHODS for the reconstruction of partial defects were available, and most authors advocated a local post-auricular flap instead of a free tissue transfer. Techniques for repair of defects of the auricle lagged behind those for repair of the nose. CONCLUSION: Limitations in care of traumatic auricular defects may have intensified the significance of Jenkins' injury and helped lead to the War of Jenkins' Ear, but conflict between Britain and Spain was probably unavoidable because of their conflicting commercial interests in the Caribbean.

The history of middle cranial fossa approach to the cerebellopontine angle.

OBJECTIVES: To investigate the historical origins of the current middle fossa (MF) approach to the cerebellopontine angle (CPA). METHODS: A review of more than 30 original articles from the 1880 s to the early 1960s that document the evolution of the MF approach. Historically important journal articles and book chapters in various languages were supplemented by interviews with surgeons instrumental in the adaptation of this method to modern microsurgical neurotology. RESULTS: The inspiration for the current MF approach could be traced back to the late 19th century extradural subtemporal surgeries for the trigeminal neuralgia performed by Krause and Hartley and the contemporary surgeries performed by Ernst von Bergmenn for treatment of otogenic temporal bone infections. The first case of MF approach to CPA for vestibular nerve section was reported by RH Parry in 1904. In the mid-20th century, otologists found numerous applications for this approach, which gained popularity at the hands of William House. Although his initial MF operations aimed to decompress the internal auditory canal for cochlear otosclerosis, House soon realized the versatility of this approach and performed his first MF acoustic neuroma surgery in 1961. CONCLUSION: The current MF approach has its roots in operations for trigeminal neuralgia and otologic surgeries for palliation of temporal bone infections performed in the late 19th century. The earliest reported MF approach to the CPA dates back to 1904 and its application to microsurgical exposure of the internal auditory canal to the late 1950s.