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.

El Área del Lenguaje Articulado, Perspectiva Histórica y Denominación Epónima Equívoca: Entre Dax y Broca / Articulated Language Area, Historical Perspective and Erroneous Epomy: Between Dax and Broca

El término epónimo área de Broca corresponde a una región cortical cerebral humana dedicada a la expresión del lenguaje oral y que no siempre se ubica en el giro frontal inferior del lobo frontal en el hemisferio izquierdo. Al estudiar 25 artículos del año 2022 y 25 libros de enseñanza de la neuroanatomía, neurofisiología, neurociencia o áreas asociadas del presente siglo, se estableció y cuantificó la existencia del término área de Broca encontrándose que en los libros había un 96 % de inclusión epónima sobre esta área cortical cerebral y en artículos de revista existía un 100 % del mismo epónimo, además, en ninguno de los libros y artículos se encontró un epónimo diferente. Aunque a lo largo del tiempo, en las ciencias médicas se han usado epónimos para designar estructuras anatómicas como en el caso para tratar de designar el área del cerebro que genera el lenguaje oral, este término no proporciona ninguna información descriptiva ni funcional, lo que equivale a un desatino en la lógica del pensamiento morfológico actual, además que lleva a confusión, pues hace pensar que su descubrimiento inicial fue dado por Broca, equivocando el conocimiento histórico que vincula a Marc Dax como el primero en descubrir esta zona.

SUMMARY: The eponymous Broca's area is a human cerebral cortical region that controls the expression of oral language, and which is not always located in the inferior frontal gyrus of the frontal lobe in the left hemisphere. In a study of 25 articles published in 2022, and 25 teaching books on neuroanatomy, neurophysiology, neuroscience or associated areas, it was found that the term Broca's area was established and quantified. In books there was a 96 % eponymous inclusion of this cerebral cortical area and in journal articles there was 100 % of the same eponym. Furthermore, no other eponyms were found in any of the books and articles. Although over time, eponyms have been used in medical sciences to identify anatomical structures, as in the designation of the area in the brain that controls oral language, this term does not provide any descriptive or functional information. The result is contradictory to current morphological thought and also leads to confusion, erroneously suggesting that the initial discovery was made by Broca, when in fact Marc Dax was the first to discover this area some 30 years earlier.

The 'worm' in our brain. An anatomical, historical, and philological study on the vermis cerebelli.

The cell doctrine-the theory of ventricular localization of the mental faculties-includes Galen's idea of a locking or valve mechanism between the middle and the rear ventricle. The anatomical substrate was the vermiform epiphysis, known today as the vermis cerebelli. This entity played a significant role in brain physiology even though its appearance, texture, and location changed over time. This article tells the story of the "worm's" transformation from Galen to Vesalius and beyond. Until the time of Albertus Magnus (c. 1200-1280 ce), the worm corresponded to the vermis cerebelli. From the beginning of the fourteenth century, under the influence of Mondino's Anothomia, the worm referred to the choroid plexus in the anterior ventricles; its Galenic heritage was abandoned. Contemporaneous illustrations confirm this anterograde movement. The contributions of post-Galenic natural philosophers and pre-Vesalian anatomists to this development are discussed. Today, the worm can serve as an example for different viewpoints and often deadlocked doctrines (religious, philosophic, scientific). In tracing beliefs about the worm from the Greeks to the Arabs and back to the Latin West, this article follows the history of neuroanatomy in the Middle Ages and the Renaissance.

[Franciscus Silvius (1614-1672) and his contributions to neuroanatomy and clinical medicine]. / Frantsisk Sil'vii (1614­1672) i ego vklad v neiroanatomiyu i klinicheskuyu meditsinu.

The article is dedicated to the 350th anniversary of the death of the Dutch anatomist, physiologist, yatrochemist and the greatest physician of the XVII century, Franciscus Sylvius (Franz de le Boe) (1614-1672). His contribution to the study of the structure of the nervous system is characterized, as well as the main scientific discoveries and achievements in building a rational system of medical science and practice. It is stated that eponym «aquaeductus Sylvii¼ was coined by Lorenz Heister in 1717 in his paper «De admiranda cerebelli structura¼.

Thomas Willis' legacy on the 400th anniversary of his birth.

To celebrate the 400th anniversary of the birth of Thomas Willis, his main contributions to the development of neurosciences, in particular neurology, are presented. Willis coined the term neurology and contributed significantly to the field of neuroanatomy, with the description of the arterial circle-located at the base of the brain-, which bears his name. He also described the striatum and cranial nerves. Furthermore, as a clinical neurologist, Willis participated in the description of various diseases, including myasthenia gravis and restless legs syndrome.

Na comemoração dos 400 anos de nascimento de Thomas Willis, são apresentadas as suas principais contribuições para o desenvolvimento das neurociências, em particular a neurologia. Willis cunhou o termo neurologia, contribuiu significativamente na área de neuroanatomia, com a descrição do círculo arterial localizado na base do cérebro, que tem o seu nome, além da descrição do corpo estriado, e de nervos cranianos. Da mesma forma, como neurologista clínico, Willis participou da descrição de várias doenças como a miastenia gravis e da síndrome das pernas inquietas, entre outras doenças.

Summarizing the medieval anatomy of the head and brain in a single image: Magnus Hundt (1501) and Johann Dryander (1537) as transitional pre-Vesalian anatomists.

Of the early-sixteenth century pre-Vesalian anatomists, Magnus Hundt in 1501 and Johannes Eichmann (known as Johann Dryander) in 1537 both attempted to summarize the anatomy of the head and brain in a single complex figure. Dryander clearly based his illustration on the earlier one from Hundt, but he made several improvements, based in part on Dryander's own dissections. Whereas Hundt's entire monograph was medieval in character, Dryander's monograph was a mixture of medieval and early-modern frameworks; nevertheless, the corresponding illustrations of the anatomy of the head and brain in Hundt (1501) and Dryander (Dryandrum 1537) were both essentially medieval. This article examines in detail the symbology of both illustrations within the context of the medieval framework for neuroanatomy and neurophysiology. These two woodcuts of the head and brain provide the most detailed pictorial representation of medieval cranial anatomy in a printed book prior to the work of Andreas Vesalius in 1543.

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.

A historical perspective on training students to create standardized maps of novel brain structure: Newly-uncovered resonances between past and present research-based neuroanatomy curricula.

Recent efforts to reform postsecondary STEM education in the U.S. have resulted in the creation of course-based undergraduate research experiences (CUREs), which, among other outcomes, have successfully retained freshmen in their chosen STEM majors and provided them with a greater sense of identity as scientists by enabling them to experience how research is conducted in a laboratory setting. In 2014, we launched our own laboratory-based CURE, Brain Mapping & Connectomics (BMC). Now in its seventh year, BMC trains University of Texas at El Paso (UTEP) undergraduates to identify and label neuron populations in the rat brain, analyze their cytoarchitecture, and draw their detailed chemoarchitecture onto standardized rat brain atlas maps in stereotaxic space. Significantly, some BMC students produce atlas drawings derived from their coursework or from further independent study after the course that are being presented and/or published in the scientific literature. These maps should prove useful to neuroscientists seeking to experimentally target elusive neuron populations. Here, we review the procedures taught in BMC that have empowered students to learn about the scientific process. We contextualize our efforts with those similarly carried out over a century ago to reform U.S. medical education. Notably, we have uncovered historical records that highlight interesting resonances between our curriculum and that created at the Johns Hopkins University Medical School (JHUMS) in the 1890s. Although the two programs are over a century apart and were created for students of differing career levels, many aspects between them are strikingly similar, including the unique atlas-based brain mapping methods they encouraged students to learn. A notable example of these efforts was the brain atlas maps published by Florence Sabin, a JHUMS student who later became the first woman to be elected to the U.S. National Academy of Sciences. We conclude by discussing how the revitalization of century-old methods and their dissemination to the next generation of scientists in BMC not only provides student benefit and academic development, but also acts to preserve what are increasingly becoming "lost arts" critical for advancing neuroscience - brain histology, cytoarchitectonics, and atlas-based mapping of novel brain structure.

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.

Johann Jakob Wepfer (1620-1695): A review of his contributions to neuropsychology on the quadricentennial of his birth.

The effects of brain damage on behavior have been reported by authors from the Greek, Roman, Medieval, Renaissance, and seventeenth-century medical traditions. However, few of the reported cases discussed mind-brain relationships, even fewer reported data that offered a description of cognitive functions, and none described a clear association of a functional mechanism of cognitive impairment with identifiable focal brain damage. An exception is found in the case studies by Johann Jakob Wepfer (1620-1695). After reviewing the pre-seventeenth-century background and Wepfer's milieu, we analyze his texts on neuroanatomy, apoplexy, and brain vascularization (Observationes anatomicae ex cadaveribus eorum, quos sustulit apoplexia cum exercitatione de ejus loco affecto) and his remarkable collection of 222 neurological cases (Observationes medico-practicae de affectibus capitis internis & externis), posthumously published in 1727. We focus on his reports concerning on the presence of aphasia, memory disorders, and unilateral neglect, correlated with focal brain damage, with particular emphasis on his examination of language impairments.

Pre-Brodmann pioneers of cortical cytoarchitectonics I: Theodor Meynert, Vladimir Betz and William Bevan-Lewis.

This study and the sequel paper revisit landmark discoveries that paved the way to the definition of the renowned Brodmann areas in the human cerebral cortex, in an attempt to rectify certain undeserved historical neglects. A 'first period of discoveries,' from 1867 to 1882, is represented by the work of neuropsychiatrists Theodor Meynert (1833-1892) in Vienna, Vladimir Betz (1834-1894) in Kiev and William Bevan-Lewis (1847-1929) in Wakefield. Their classical findings are placed in a modern perspective.

Revisiting the Vertebral Venous Plexus-A Comprehensive Review of the Literature.

The venous drainage of the vertebral and paravertebral regions is important for a better understanding of hematogenous disease spread. Moreover, the spine surgeon must be well acquainted with this anatomy to minimize intraoperative and postoperative complications. A comprehensive review of the vertebral venous plexus (Batson plexus) was performed with a concentration on the clinical and surgical correlations of this venous network.

El tracto cortico espinal: perspectiva histórica / The corticospinal tract: historical perspective

RESUMEN: La neuroanatomía y la neurofisiología han permitido en gran parte entender de forma más integrada las estructuras que conforman el sistema nervioso y los mecanismos asociados con la transmisión de los potenciales de acción, relacionados con la vía corticoespinal en la ejecución de movimientos voluntarios. Se realizó una revisión histórica sobre la vía corticoespinal, desde el punto de vista neuroanatómico y neurofisiológico mediante una revisión de literatura en distintas bases de datos y libros de texto dedicados a estas vías nerviosas. La información obtenida se ordenó cronológicamente, seleccionando los datos más relevantes que desde el punto de vista neuroanatómico y neurofisiológico han permitido comprender su mecanismo funcional. Actualmente se tiene un conocimiento muy depurado de los distintos elementos que componen la vía corticoespinal, lo que permitirá su aplicación en el campo de la salud y resolver múltiples problemas de la función motora.

SUMMARY: Neuroanatomy and Neurophysiology have, in large part, permitted a more thorough understanding of those structures that conform the nervous system and mechanisms associated with the transmission of action potentials associated with the corticospinal tract. This assertion is made based upon a literature review of various databases and textbooks dedicated to said nerve tracts. The information obtained was ordered chronologically, and data was selected that, from the neuroanatomical and neurophysiological viewpoints, were most relevant and have permitted the comprehension of its functional mechanism. The thorough understanding of those elements that compose the corticospinal tract will permit its application in the health field and resolve multiple motor function problems.

Cortical Brain Functions ­ The Brodmann Legacy in the 21st Century

In 1909, Korbinian Brodmann described 52 functional brain areas, 43 of them found in the human brain. More than a century later, his devoted functional map was incremented by Glasser et al in 2016, using functional nuclear magnetic resonance imaging techniques to propose the existence of 180 functional areas in each hemisphere, based on their cortical thickness, degree of myelination (cortical myelin content), neuronal interconnection, topographic organization, multitask answers, and assessment in their resting state. This opens a huge possibility, through functional neuroanatomy, to understand a little more about normal brain function and its functional impairment in the presence of a disease.

Pre-Brodmann pioneers of cortical cytoarchitectonics II: Carl Hammarberg, Alfred Walter Campbell and Grafton Elliot Smith.

The present study and the preceding paper revisit landmark discoveries that paved the way to the definition of the renowned Brodmann areas in the human cerebral cortex, in an attempt to rectify certain undeserved historical neglects. A 'second period of discoveries', from 1893 to 1908, is marked by the work of Carl Hammarberg (1865-1893) in Uppsala, Alfred Walter Campbell (1868-1937) in Liverpool and Grafton Elliot Smith (1871-1937) in Cairo. Their classical findings are placed in a modern perspective.

A detailed comparison of the cytoarchitectonic and myeloarchitectonic maps of the human neocortex produced by the Vogt-Vogt school.

The comprehensive research programme of the Vogt-Vogt (V-V) school, which was active during the period 1900-1970, included detailed cytoarchitectonic and myeloarchitectonic analyses of the human cerebral cortex, with the aim to integrate the data obtained into a map, showing a parcellation of the human cerebral cortex into fundamental structural and potentially functional units. The cytoarchitectonic V-V analyses yielded two maps of the human cerebral cortex, the famous map of Brodmann (Vergleichende Lokalisationslehre der Grosshirnrinde in ihren Prinzipien dargestellt auf Grund des Zellenbaues. Barth, Leipzig, 1909), Brodmann (in: Bruns P (ed) Neue deutsche Chirurgie, Enke, Stuttgart, 1914), and the less known, but more detailed map of Sarkisov et al. (Cytoarchitecture of the human cortex cerebri. Medgiz, Moscow, 1949). Sarkisov et al. used in their cytoarchitectonic parcellation of the cortex the same numbering scheme as Brodmann. They confirmed the presence of most of the areas delineated by the latter, but they subdivided several of these areas into two or more separate areas or subareas. Within the realm of the myeloarchitectonic V-V analyses, numerous meticulous studies of the cortex of individual cerebral lobes were carried out, but these were not united into a single map. Consequently, the envisioned integration of cytoarchitectonic and myeloarchitectonic data mentioned above was never realized. Some years ago, we (Nieuwenhuys et al. in Brain Struct Funct 220:2551-2573, 2015a, Nieuwenhuys et al. in Brain Struct Funct 220:3753-3755, 2015b) reanalyzed the V-V myeloarchitectonic data, and succeeded in constructing a complete myeloarchitectonic map of the human neocortex from these data. Because the data provided by the V-V school were derived from many different brains, a standard brain had to be introduced as a template to which all data available could be transferred. As such the MNI305 template was selected. Having made available now the cytoarchitectonic maps of Brodmann and Sarkisov et al. and the recently prepared myeloarchitectonic map, an attempt is made here to realize at last the original aim of the V-V school, viz. the preparation of a single, combined (cyto + myelo) architectonic map of the human cortex. To this end, the following three steps have been made. First, Brodmann's (BR) map, and the map of Sarkisov et al. (SA) were harmoniously transferred to the same template brain as the one used during the construction of our myeloarchitectonic map. Second, the standardized BR and our myeloarchitectonic (NI) map were compared, and the data contained within these maps were integrated into a single standardized combined BR-NI map (Fig. 11). The standardized SA and NI maps were subjected to the same procedure (Fig. 12). Finally, the standardized combined BR-NI and SA-NI maps were united into a single combined BR-SA-NI map (Fig. 13). This map renders it possible to make direct comparisons between the results of the architectonic studies of the V-V school and current parcellations of the human neocortex.

[P.E. Flechsig's contribution to a Russian-German scientific exchange in the fields of neuropathology and psychiatry]. / Vklad P.É. Fleksiga v rossiisko-nemetskoe nauchnoe sotrudnichestvo v oblasti nevrologii i psikhiatrii.

The University of Leipzig has played an important role in the Russian-German scientific exchange in the fields of psychiatry and neurology in the 19th century. An outstanding but almost forgotten protagonist of that exchange was the psychiatrist and neurologist Paul Flechsig, who enjoyed worldwide recognition for his neuroanatomical works. Famous Russian neurologists and psychiatrists as Vladimir Bekhterev, Liverij Osipovich Darkshevich, Vladimir Chizh not only learned from Flechsig's experience, but also undertook independent research, which gave them impulses for furthering their carriers in Russia.