One hundred years of neuroradiology in Acta Radiologica: a Swedish perspective.

This year, Acta Radiologica marks its 100th anniversary. In this article, the authors present some of the highlights from the close collaboration between Swedish neuroradiology and Acta Radiologica over the last 100 years.

Explorando el oscuro continente: imagen médica y cerebro / Exploring the dark continent: medical image and brain

Introducción. Hasta finales del siglo XIX, el sistema nervioso central es prácticamente inaccesible a la observación directa. El descubrimiento en 1895 de los rayos X y su posterior aplicación médica constituyen un cambio de paradigma que revoluciona por completo la manera en que se practica la neurología. La posibilidad de visualizar el interior del encéfalo tiene un impacto mayúsculo en la práctica clínica y enriquece el diagnóstico y el tratamiento de patologías cerebrales de una forma hasta entonces inimaginable. Desarrollo. El propósito de este trabajo es describir el nacimiento y el desarrollo de la imagen médica cerebral: partimos del descubrimiento de los rayos X y del inicio de la radiografía hasta llegar a la aparición en la década de los setenta de la tomografía computarizada y la resonancia magnética, técnicas que cambiarían el mundo del diagnóstico por imagen. En este breve recorrido por la historia de la neurorradiología también se incluye el origen de la angiografía y otras técnicas actualmente en desuso, pero que en su momento constituyeron una auténtica revolución; tal es el caso de la ventriculografía o la neumoencefalografía. Conclusiones. Los procedimientos y técnicas descritos en este artículo han permitido visualizar el interior del cerebro, facilitando el diagnóstico y el tratamiento de múltiples procesos neurológicos (AU)

Introduction. Until the late 19th century, direct observation of the central nervous system was practically impossible. The discovery of X-rays in 1895 and their subsequent application in the field of medicine brought about a shift of paradigm that completely revolutionised the way in which neurology was practised. The possibility of viewing the inside of the brain had a pronounced impact on clinical practice, and enriched the diagnosis and treatment of brain pathologies in a manner that was unimaginable up until then. Development. The aim of this study is to describe the birth and development of medical imaging of the brain, from the discovery of X-rays and the early days of radiography to the appearance of computerised tomography and magnetic resonance in the 60s, both of which are techniques that were to change the world of diagnostic imaging forever. This brief overview of the history of radiology also includes the origins of angiography and other techniques that are no longer in use, but which were ground-breaking innovations in their time, such as ventriculography or pneumoencephalography. Conclusions. The procedures and techniques described in this article made it possible to view the inside of the brain, thereby facilitating the diagnosis and treatment of a number of neurological processes (AU)

The Pioneering and Unknown Stereotactic Approach of Roeder and Orthner from Göttingen. Part I. Surgical Technique for Tailoring Individualized Stereotactic Lesions.

During the 1950s through the 1970s, Hans Orthner and Fritz Roeder, two German neurologists from Göttingen, developed a sophisticated technique to perform functional stereotactic surgery with outstanding accuracy. They introduced direct air ventriculography performed in the same surgical session as the ablative stereotactic procedure. For individualized surgical targeting, Orthner prepared a stereotactic atlas (>60 brains) with an ingenious brain-slicing device, the Göttinger macrotome. Brains were grouped based on similarity of six different head and ventricle measurements. A brain cluster representing the best match for a patient was selected for stereotactic targeting. Stereotactic lesions were tailored in an individual manner and shaped by stringing together multiple small coagulations following intraoperative test stimulation. This was achieved from a single probe trajectory by using well-engineered string electrodes with calibrated curving and involved laborious calculations. Only high-frequency thermocoagulation was regarded as appropriate for lesioning. With this meticulous technique, the most advanced stereotactic procedures were performed, including bilateral pallidotomy that ultimately could be restricted to the ansa lenticularis and ventromedial hypothalamotomy, the most delicate stereotactic operation performed to date. Outside Göttingen, this technique has only been used by Prof. Dieter Müller in Hamburg, Germany. This elaborate stereotactic approach is widely unknown and deserves to be discussed in a historical context.

The Cushing-Dandy conflict­the Dandy family perception of the discord.

The rivalry between Harvey Cushing and Walter Dandy has long fascinated neurosurgeons. Once a mentor to Dandy, Cushing saw his pupil's cunning prowess in the laboratory and unique surgical skill rival his own, and he took years to embrace some of Dandy's innovations, the most well-known of which was the technique of ventriculography. In this report, Dandy's great grandson draws on his family archives and personal letters of Dandy to lineate the evolution of the Dandy-Cushing relationship.

Neuroradiology investigations before scanning.

Coaxial tomography (CT) and magnetic resonance imaging (MRI) scans are so much part of neurological investigation these days and provide such detailed information that even thorough neurological clinical examination may be neglected. The investigations in common use forty years ago were pneumoencephalography, ventriculography in babies with hydrocephalus, and carotid angiography with the injection of X-ray contrast to outline the arteries.

Walter Edward Dandy (1886-1946).

Dandy was a leading light in the initiation and development of neurosurgery, not only in his native America but also throughout the world. This paper attempts briefly to outline his main achievements. After a turbulent relationship with Cushing he emerged as a brilliant, if vain, surgeon and investigator, based mainly at Johns Hopkins. He initiated air ventriculography and effected original studies on cerebrospinal fluid formation and circulation. The Dandy-Walker syndrome, surgery for aneurysms and cerebellopontine angle tumours were but a few areas where he made his mark and left a lasting legacy of neurosurgical endeavour.