Art and Neurosurgery: The Importance of Medical Illustration.

Art in neurosurgery has been a critical part of the discipline for centuries. Numerous cultures, such as ancient India, China, and Egypt, and more contemporary scientists, such as Leonardo da Vinci, Max Brödel, and Norman Dott, have significantly contributed to medical illustration. Today, advancements in three-dimensional technology have allowed for the creation of detailed neuroanatomy models for surgical planning and education. Medical illustrations are also used for research and outcome documentation as they help visualize anatomy and surgical procedures. Its use in education, surgical planning, and navigation remains integral to the advancement of neurosurgery. This review demonstrates the invaluable contribution of art in neurosurgery and how it has enabled continuous progress in the field.

A cigar in the left hand, a paintbrush in the right: Illustration and the anatomical sciences.

The anatomical sciences heavily rely on art and illustration to convey form, depth, and relationship within living structures. Today, biomedical illustrators carry forward traditions from 16th century artists through the likes of 20th century champions such as Frank Netter to help educators and researchers convey their messages to their listening, and more importantly, viewing audiences. Biomedical illustration programs are a valuable resource for academics to package their research as published figures, including graphical abstracts, in scientific journals. Here, we describe an innovative art-science collaboration among The Anatomical Record, the Department of Anatomy and Cell Biology at Rush University, and the Master's Program in Biomedical Visualization at University of Illinois at Chicago, whose students were invited to create and submit scientific illustrations for consideration as cover art for the journal.

Progress in neurosurgery: Contributions of women neurosurgeons in Asia and Australasia.

At the end of the first 100 years of neurosurgery as a specialty, it is appropriate to look back and then imagine the future. As neurosurgery celebrates its first century, the increasing role of women neurosurgeons is a major theme. This article documents the early women pioneers in neurosurgery in Asia and Australasia. The contributions of these trailblazers to the origins, academics, and professional organizations of neurosurgery are highlighted. The first woman neurosurgeon of the region, Dr. T.S. Kanaka of India, completed her training in 1968, not long after the trailblazers in Europe and North America. She heralded the vibrant communities of neurosurgical women that have developed in the vast and diverse nations of the region, and the many formal and informal groups of women in neurosurgery that have introduced and promoted talented women in the profession. Contributions of women neurosurgeons to academic medicine and society as a whole are briefly highlighted, as are their challenges in this male-dominated specialty. The region is home to many deeply conservative societies; in fact, some nations in the region have not yet trained their first woman neurosurgeon. The fortitude of these individuals to achieve at the highest levels of neurosurgery indicates great potential for future growth of women in the profession, but also demonstrates the need for initiatives and advocacy to reach the full potential of gender equity.

From Ancient Texts to Digital Imagery: A Brief History on the Evolution of Anatomic Illustrations.

In a time when social isolation heavily relies on the use of digital representation, photography, and e-books, it is easy to take for granted the impact imagery has on our society and the pedagogical purposes of illustration, particularly in the teaching of surgery. Illustrations after all are the basis of all anatomical atlases and are quintessential tools that allow for an expedient and thorough understanding of concepts underlying the fabric of the human body. Yet, surgery has not always been taught with an atlas. Illustrations, much like surgery, have seen an incredible transformative process spanning across the ages to achieve their status in modern medicine. Through this brief review, we will not only glean an understanding of the evolution of anatomical illustrations but also the social context in which surgery has also evolved throughout history.

Origen y evolución histórica del término «prefrontal» / Topographical origins of the term 'prefrontal'

INTRODUCCIÓN: Actualmente, existe un amplio consenso sobre los confines de lo que denominamos corteza prefrontal, pero no siempre ha sido así. El propósito de esta revisión histórica es ahondar en los orígenes topográficos del término «prefrontal» y analizar su evolución conceptual. DESARROLLO: El artículo se estructura en función de los principales criterios que se han sucedido cronológicamente para definir los límites de la corteza prefrontal: morfológico, citoarquitectónico y hodológico. Durante la segunda mitad del siglo XIX, los criterios son esencialmente de índole morfológico. En esta época se sitúa David Ferrier, responsable de la popularización del término «prefrontal». En los primeros años del siglo XX dominan los criterios basados en la organización arquitectónica de la corteza cerebral (o citoarquitectura), y su principal representante es Korbinian Brodmann. A finales de la década de 1940, Jerzy E. Rose y Clinton N. Woolsey consideran que el estudio de las conexiones cerebrales (hodología) es la vía para definir los confines de la corteza prefrontal y proponen que esta región frontal es la principal área de proyección del núcleo dorsomedial del tálamo. CONCLUSIONES: Históricamente, la región cerebral denominada «prefrontal» ha tenido unos límites borrosos y cambiantes, producto de los criterios empleados en distintas épocas. Correspondencia Diagnóstico y tratamiento del trombo móvil carotídeo. A propósito de un caso

INTRODUCTION. Today, there is a broad consensus on the boundaries of what we call the prefrontal cortex, but this has not always been the case. The purpose of this historical review is to examine in greater depth the topographical origins of the term «prefrontal» and analyse its conceptual evolution. DEVELOPMENT. The article is structured according to the main criteria that have been proposed successively over time in order to define the limits of the prefrontal cortex, namely, morphological, cytoarchitectural and hodological. During the second half of the 19th century, the criteria were essentially of a morphological nature. David Ferrier popularised the term «prefrontal» in this period. In the early years of the 20th century, criteria based on the architectural organisation of the cerebral cortex (or cytoarchitecture) predominated, and their main representative was Korbinian Brodmann. At the end of the 1940s, Jerzy E. Rose and Clinton N. Woolsey considered that the study of brain connections (hodology) was the way to define the boundaries of the prefrontal cortex and proposed that this frontal region was the main area of projection of the dorsomedial nucleus of the thalamus. CONCLUSIONS. Historically, the limits of the so-called «prefrontal» region of the brain has been blurred and changing, as a result of the different criteria used at different times

Face transplantation and the anatomy of facelessness

Heather Laine Talley locates the still-experimental technique of face transplantation within a contemporary 'disfigurement imaginary' that equates facial difference with social death. This paper extends Talley's account by considering the ideological and affective components of 'facelessness' as a shared cultural idea. The first part of the paper argues that 'facelessness' has a history that links the stigma of facial war injuries in early twentieth century Europe to current assumptions about the horror of disfigurement. The second part of the paper uses Georges Franju's Les Yeux sans Visage (Eyes Without a Face, 1959) to examine the aesthetics of horror and the uses of cinematic disgust. The paper concludes with a discussion of the 'framing' or management of disgust in the contexts of transplant medicine and anatomical illustration. Face transplantation, it is argued, presents a particular challenge to the 'spare parts' model that has dominated the biomedical approach to organ transfer

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[The "Plague Doctor's Mask" in the German Museum for the History of Medicine, Ingolstadt]. / Die Pestarztmaske im Deutschen Medizinhistorischen Museum Ingolstadt.

This paper is part of Forum COVID-19: Perspectives in the Humanities and Social Sciences. The figure of the plague doctor with the beak mask has become the symbol of the plague par excellence. It's little wonder that the plague mask in the collection of the German Museum of the History of Medicine in Ingolstadt (Bavaria) is one of the museum's most popular objects and motifs. This forum paper investigates the figure of the plague doctor on several levels: first, it analyses contemporary textual and image sources in regard to protective clothing used in times of plague and the respective role of the beak-like part of the mask. Then it takes a close look at the Ingolstadt specimen. By examining the mask's materiality and fabrication, questions of its authenticity and practicability are raised. Finally, the Ingolstadt mask is compared with the specimen at the German Historical Museum in Berlin.The conclusion: the beak mask is not mentioned before the mid-seventeenth century, and then only in Italy and Southern France. There is no proof at all of its use during plague outbreaks in Middle Europe. And the specimens in Ingolstadt and Berlin? Both masks present details which suggest that they were not used as protective clothing at all. We do not know, however, if they were produced as replicas for historic reasons or as fakes for the modern art market.

The modern vision of the vascular anatomy of the liver by Leonardo da Vinci.

Leonardo da Vinci's analysis and artistic representation of the hepatic vascular anatomy, performed more than 500 years ago, has not yet been fully recognized nor appreciated. Leonardo modified the anatomic concepts of Galen, up until then in vogue, and described for the first time the intrahepatic distribution of the proper hepatic artery, the portal vein, and the hepatic veins. The depiction of these structures is surprising for its clarity and perspective and reproduces the anatomic situation almost exactly. The segmentary division of the liver which several centuries later became the basis of modern resection hepatic surgery was extremely clear in Leonardo's mind.

Medical Illustration in the Era of Cardiac Surgery.

This article reviews the collaboration between clinician and illustrator throughout the ages while highlighting the era of cardiac surgery. Historical notes are based on Professor Sanjib Kumar Ghosh's extensive review, literature searches, and the archives of the Johns Hopkins University Department of Art as related to Medicine in Baltimore. Personal communications were explored with medical illustrators and medical practitioners, many of whom are colleagues and trainees, to further chronicle the history of medical illustration and education in the era of cardiac surgery. Medical illustrators use their talents and expressive ideas to demonstrate procedures and give them life. These methods are (1) hovering technique; (2) hidden anatomy, ghosted views, or transparency; (3) centrally focused perspective; (4) action techniques to give life to the procedure; (5) use of insets to highlight one part of the drawing; (6) human proportionality using hands or known objects to show size; and (7) step-by-step educational process to depict the stages of a procedure. Vivid examples showing these techniques are demonstrated. The result of this observational analysis underscores the importance of the collaboration between clinician and illustrator to accurately describe intricate pathoanatomy, three-dimensional interrelated anatomic detail, and complex operations. While there are few data to measure the impact of the atlas on medical education, it is an undeniable assertion that anatomical and surgical illustrations have helped to educate and train the modern-day surgeon, cardiologist, and related health-care professionals.

Photograph as Skin, Skin as Wax: Indexicality and the Visualisation of Syphilis in Fin-de-Siècle France The William Bynum Prize Essay.

In early twentieth-century France, syphilis and its controversial status as a hereditary disease reigned as a chief concern for physicians and public health officials. As syphilis primarily presented visually on the surface of the skin, its study fell within the realms of both dermatologists and venereologists, who relied heavily on visual evidence in their detection, diagnosis, and treatment of the disease. Thus, in educational textbooks, atlases, and medical models, accurately reproducing the visible signposts of syphilis - the colour, texture, and patterns of primary chancres or secondary rashes - was of preeminent importance. Photography, with its potential claims to mechanical objectivity, would seem to provide the logical tool for such representations. Yet photography's relationship to syphilographie warrants further unpacking. Despite the rise of a desire for mechanical objectivity charted in the late nineteenth century, artist-produced, three-dimensional, wax-cast moulages coexisted with photographs as significant educational tools for dermatologists; at times, these models were further mediated through photographic reproduction in texts. Additionally, the rise of phototherapy complicated this relationship by fostering the clinical equation of the light-sensitive photographic plate with the patient's skin, which became the photographic record of disease and successful treatment. This paper explores these complexities to delineate a more nuanced understanding of objectivity vis-à-vis photography and syphilis. Rather than a desire to produce an unbiased image, fin-de-siècle dermatologists marshalled the photographic to exploit the verbal and visual rhetoric of objectivity, authority, and persuasion inextricably linked to culturally constructed understandings of the photograph. This rhetoric was often couched in the Peircean concept of indexicality, which physicians formulated through the language of witness, testimony, and direct connection.

The phrenological illustrations of George Cruickshank (1792-1878): A satire on phrenology or human nature?

For a brief period in1826, George Cruickshank (1798-1878), already an established artist in political satire and book illustration, turned to phrenology. He produced one initial print (Bumpology), followed by a collection of six plates of 33 engravings, linked by an explanatory preface, under the title, Phrenological Illustrations or an Artist's View of the Craniological System of Doctors Gall and Spurzheim. It was published during what is regarded as "the phrenological craze" in Britain. The illustrations were also produced at the height of Cruickshank's staggering creative productivity. In 1873, as phrenology was making its exit from scientific credibility into history, Cruickshank's phrenological illustrations were reissued by popular demand. Yet in contrast to his other works, these illustrations have received little attention in modern scholarship. The ways and the extent to which his caricatures constitute a contribution to the history of phrenology deserve to be studied. Here they are analyzed together with his descriptions in the prefaces to both the 1826 and 1873 editions. They reveal a surprising knowledge of phrenology in relation to Spurzheim and Gall. Furthermore, their uniquely innovative features will be identified in the context of other contemporary caricatures, and the fundamental significance of Cruickshank's achievement and its impact will be evaluated.

Pernkopf's atlas: Should unethically obtained life-saving data be discarded?

Dr Pernkopf's Topographische anatomie des menschen (Topographical anatomy of man), in four volumes, was originally published in German. It had taken the author and his colleagues over twenty years to produce it, the first volume being published in 1937. It was translated into English in 1964. The atlas was received with uniform acclaim in Europe and America and praised for its accuracy and the quality of its illustrations. A recent study compared its utility with that of Dr Frank Netter's Atlas of human anatomy, first published in 1989, with its 7th edition out in 2018. "The respondents (nerve surgeons) found Pernkopf 's atlas having both greater anatomical detail (range 79%-91%) and greater utility for surgery (range 66%- 82%) when compared with Netter's (P < .001) in all plate comparisons." (1) Internationally renowned and respected neurosurgeon, Dr M Gazi Yasargil - not given to handing out praise lightly - said in 2004 of this atlas, "Pernkopf's work, in particular … Vol. 4 (800 pages, 218 figures) is of fantastic quality and is appreciated worldwide." (2) Surgeons continue to use Dr. Pernkopf's atlas to plan their operations (3). A recent example is its use in the treatment of a 13-year-old Israeli schoolboy (4). This essay discusses whether it is rational to refuse to use data and publications that are accurate and likely to help in treating patients. Since such information can save lives, should we spurn it because it was based on information obtained unethically?

Adrianus Spigelius' (1578 - 1625) Ocular Anatomy.

The aim was to study Adriaan van den Spiegel's ideas on ocular anatomy. He is better known by his Latinized name as Adrianus Spigelius (1578 - 1625). He was a Flemish physician and anatomist who lived and worked in Padua, where in 1605 he was elected to be Professor of Anatomy and Surgery. Chapter IX of book ten of Spigelius' work on human anatomy, entitled De humani corporis fabrica libri X tabulis aere icisis exornati (1627) was devoted to an anatomical description of the eye. Corresponding to contemporary ideas of the production of knowledge Spigelius endeavoured to enhance Andreas Vesalius' (1514-1564) anatomy, he did not repeat his predecessor's theories of ocular anatomy. He conceptualised that the eye has six muscles, five tunics and three humors, while he gave a brief description of ocular physiology combining anatomy and the functional role of the anatomic ocular parts. CONCLUSION: He managed to correct Vesalius' errors and to present ocular anatomy with original notes, which so far, have been ignored and are highlighted now.

Dejerine-Roussy syndrome: Historical cases.

On June 7, 1906, Jules Dejerine (1849-1917) and Gustave Roussy (1874-1948) presented to the Société de Neurologie de Paris the first description of the thalamic syndrome with serial-section microscopic images. They also provided the first account of central poststroke pain (CPSP). They suggested that pain is one of the primary symptoms of the syndrome, although one of their own patients ("Hud") did not have pain. Several contemporary studies have highlighted the involvement of the anterior part of the pulvinar (PuA) in patients with CPSP of thalamic origin. Two historical observations (cases Jos and Hud) are reviewed here using the Morel nuclei staining atlas (2007). Dejerine and Roussy proposed the "irritative theory" to explain CPSP of thalamic origin and, in line with the most recent literature, they invoked the involvement of the PuA. When matching images for the Jos and Hud cases with the Morel atlas, it appears that the lesions involved what Dejerine then termed the noyau externe; that is, the ventral posterolateral nucleus and the PuA. In the Jos case, the lesion extended medially to what Dejerine termed the noyau médian de Luys; that is, the central medial-parafascicular nuclei, whereas in the Hud case the lesion extended more inferiorly. From the finding in the Hud case, one can hypothesize that impairment of the PuA alone does not assure pain. The work of Dejerine and Roussy, based on clinico-anatomical correlations, remains relevant to this day.

An ancestor of the stereotactic atlases: the Tabulae Anatomicae of Bartolomeo Eustachio.

The authors report the history of the Tabulae Anatomicae of Bartolomeo Eustachio (ca. 1510-1574). In the tables, the anatomical illustrations were drawn inside a numerical frame, with pairs of numbers on the y- and x-axes to identify single anatomical details in the reference table. The measures and the references could be calculated using the graduated margins divided by 5 units for each the x-axis and y-axis. The Tabulae Anatomicae can be considered a precursor to modern anatomical reference systems that are the basis of studies on cerebral localization mainly used for stereotactic procedures.