The brainstem and its neurosurgical history

Area of Science:

• Neurosurgery
• Neuroanatomy
• History of Medicine

Background:

• The brainstem presents highly complex intracranial anatomy, making surgery challenging.
• Its deep-seated location historically delayed anatomical understanding and surgical development.
• Understanding brainstem surgery requires knowledge of neuroanatomy, neuropathology, and neuroscience evolution.

Purpose of the Study:

• To review the historical understanding of neuroanatomy and brainstem surgery.
• To trace the evolution of surgical techniques from antiquity to the present.
• To examine the development of safe entry zones in brainstem surgery.

Main Methods:

• Historical review of anatomical and surgical literature.
• Chronological division of brainstem discovery and surgical approach into four periods.
• Analysis of evolving surgical techniques from early attempts to modern practices.

Main Results:

• Brainstem anatomy understanding progressed through macroscopic, microscopic, and neurophysiological stages.
• Surgical approaches evolved from basic interventions to sophisticated techniques like posterior fossa surgery.
• The concept of 'safe entry zones' represents a significant advancement in brainstem surgical strategy.

Conclusions:

• The history of brainstem surgery is intrinsically linked to advancements in neuroanatomy and neuroscience.
• Surgical techniques have continuously evolved, improving safety and efficacy in treating brainstem pathologies.
• A comprehensive historical perspective is crucial for understanding contemporary brainstem neurosurgery.