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Charles J. Prestigiacomo and T. Forcht Dagi

Neurosurgery is of great interest to historians of medicine and technology because it is relatively young, because it developed in an era of journals and publications, because lines and traditions of training and mentorship are relatively clear, and because the technologies that enabled the evolution of the profession and acted as inflection points in the emergence of certain surgical approaches and procedures are at once well documented and remarkably unambiguous. To the extent that is the case for neurosurgery as a whole, it is even more so for surgery of

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Gaurav Gupta and Charles J. Prestigiacomo


Writers of neurosurgical history have traditionally maintained that the initial use of cranial bone wax for hemostasis in humans was developed and promoted by Sir Victor Horsley, the father of British neurosurgery. A thorough literature review, however, suggests that the use of bone wax for cranial bone hemostasis had its roots more than 50 years before Dr. Horsley's description in 1892. In this study the authors review the sources addressing this issue and establish due credit to the surgeons using bone wax for cranial bone hemostasis before Horsley.


Primary and secondary general surgery and neurosurgery literature from 1850 to the present was comprehensively reviewed. The key words used in the literature searchers were “bone wax,” “sealing wax,” “cranial surgery,” “Victor Horsley,” “hemostasis,” and “bone hemostasis.”


Although Dr. Horsley's description in 1892 clearly delineates the necessary formula for creating a soft, malleable, nonbrittle wax that would easily promote hemostasis, the literature suggests that sealing wax was commonly used as early as 1850 for hemostasis in cranial bones. Even though there is documentation that Magendie (1783–1855) used wax to occlude venous sinuses in animals, detailed documentation of the constituents are not available. Evidence reveals that surgeons like Henri Ferdinand Dolbeau (1840–1877), professor of external pathology and the surgical clinic (1868–1872) at the Paris hospitals, used bone wax in 1864 for the extirpation of a frontal osteoma/exostoses of the frontal sinus.


The use of bone wax in cranial surgery was described by Henri Ferdinand Dolbeau, 50 years prior to Sir Victor Horsley's report in 1892. Nonetheless, it was Horsley who advocated and popularized its use in neurological surgery as an additional tool in the hemostatic and surgical armamentarium.

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Charles J. Prestigiacomo and Mark C. Preul

advanced fields in medicine, brain or head surgery and its associated technologies, mainly in the form of instruments, existed in prehistoric ages. Today, neurological surgery enjoys a position at the forefront of both science and technology. Arguably neurosurgery relies on technology and its development more than other surgical specialties. Kinsmen to the neurosurgeon are bioengineers, radiation physicists, neuroscientists, nuclear MR scientists, electrophysicists, optical scientists, anatomists, anthropologists, illustrators, and more. Perhaps because the brain is not

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Charles J. Prestigiacomo and Mark Krieger

colleagues continue to study and learn about these factors, ranging from hydrocephalus, to the craniosynostoses, to benign positional molding. Mehta et al. provide an excellent survey of the history of the diagnosis and treatment of craniosynostosis. The article authored by Maher et al. presents to us Cushing's limited but some may say seminal work in deformity surgery of the skull. Manjila et al. provide an excellent historical perspective and modern therapy for Kleeblattschadel deformity, giving the reader a surgical strategy for treatment of this rare disorder. The

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Chirag D. Gandhi, Lana D. Christiano, Jean Anderson Eloy, Charles J. Prestigiacomo and Kalmon D. Post

advances facilitating TSS. The Beginning: Evolution of the Approach to the Pituitary The movements that have influenced the past 50 years in pituitary surgery were set in motion almost a century earlier by the 1886 report of Pierre Marie 45 introducing the term “acromegaly.” In this landmark paper, he introduced 2 new patients and reviewed 5 previously published reports of patients with similar findings. This initiated a time of renewed interest in pituitary function and led to the development of intense debate between advocates of transsphenoidal and

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Rachid Assina, Sebastian Rubino, Christina E. Sarris, Chirag D. Gandhi and Charles J. Prestigiacomo

surgery from the era of Hippocrates until the 18th century focused mostly on head trauma, with much respect to the dura and the brain parenchyma, and the only retraction that was needed was of the extraaxial soft tissue. In his book on skull fractures, Jacopo Berengario da Carpi (AD 1460–1530) illustrated an elevator (retractor) used to perform trepanation in the 16th century ( Fig. 2 ). 2 , 36 Notably, many surgical instruments of the 16th and 17th centuries were decorative, large, and clumsy. 4 During the later half of the 19th century, there was a significant

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Christopher Doe, Pinakin R. Jethwa, Chirag D. Gandhi and Charles J. Prestigiacomo

continued in the early 1980s when some physicians believed that conservative medical management was warranted until severe stenosis or symptoms appeared 60 versus others who advocated more aggressive prophylactic surgery. 72 Current American Heart Association and American Stroke Guidelines indicate that endarterectomy and aggressive management of risk factors is the best course of treatment for ACAS in patients with ≥ 60% stenosis if surgery is not otherwise contraindicated due to comorbidities and other risk factors. 27 Polling in the US indicates that about 47% of

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Lana D. Christiano, Gaurav Gupta, Charles J. Prestigiacomo and Chirag D. Gandhi

retraction required to obtain proximal control. The perforating vessels may be difficult to visualize and separate from the parent vessel during proximal clip placement. Lastly, the rich vascular supply coursing through the surface of the aneurysm, similar to a vasa vasorum, can cause significant blood loss during the surgery. Each individual case must be considered carefully, taking into account the location, presenting symptoms, aneurysm morphology, and distal vasculature. Surgical interventions described in the literature include carotid artery ligation, 1 , 31

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Ryan Holland, David Kopel, Peter W. Carmel and Charles J. Prestigiacomo

attendants and nurses. They also experienced reductions in sudden emotional outbursts. However, his final case resulted in death on the 6th postoperative day. Autopsy suggested subdural hematoma as the cause of death. FIG. 2. Gottlieb Burckhardt. From Verhandlungen der Schweizerischen Naturforschenden Gesellschaft, 1907. Public domain. Reaction from the psychological and surgical communities was largely critical. Burckhardt’s surgeries were seen as needlessly dangerous with unimpressive results. 21 He ceased performing these operations following the publication of his

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Larry V. Carson, James T. Goodrich and Charles J. Prestigiacomo

It has defined who we are since the days of prehistory. It is the most “basic” of procedures, and yet without it and without doing it well, many suffer. The craniotomy has been the defining procedure for neurosurgeons, though it is not the most common procedure we do. The evolution of the craniotomy parallels the development of technology, the growth of our collective imagination, and our desire to provide maximum benefit with minimum risk and the smallest footprint. This issue brings to focus three major historical aspects of neurological surgery: the