. These studies depend on aspects of face, content, and construct validity. 11 In the context of hands-on surgical simulators, face validity refers to the anatomical realism of the simulator invention, whereas content validity refers to its perceived effectiveness as a training tool, and construct validity to a simulator’s ability to delineate a spectrum of proficiency on a novice-to-expert gradient. 11 , 12 Face and content validity can be the documented feedback of only a few experts in the field, sometimes only two or three, depending on their scarcity in a
Grace M. Thiong’o, Thomas Looi, James T. Rutka, Abhaya V. Kulkarni, and James M. Drake
Dominik Gross and Gereon Schäfer
T o T he E ditor : Thank you for publishing our paper, “Egas Moniz (1874–1955) and the ‘invention’ of modern psychosurgery: a historical and ethical reanalysis under special consideration of Portuguese original sources” ( Neurosurg Focus 30(2): E8, 2011). After publication we found 2 near-identical errors in our paper. The second sentence of the Abstract originally stated: “He performed the first prefrontal leukotomy in 1935—about 75 years ago—with the help of neurosurgeon John F. Fulton (1899–1960),” and the sixth sentence of the Introduction
Dominik Gross and Gereon Schäfer
The Portuguese neurologist Egas Moniz (1874–1955) is often regarded as the founder of psychosurgery. He performed the first prefrontal leukotomy in 1935—about 75 years ago—with the help of neurosurgeon Almeida Lima (1903–1985). In contrast to the psychosurgical interventions performed by the Swiss psychiatrist Gottlieb Burckhardt (1836–1907), Moniz's interventions on the white brain substance caught great attention worldwide. As a matter of fact, it was this repercussion that led to the award of the Nobel Prize for Medicine in 1949, an award that is still highly controversial today.
The goal of the present article is to reconstruct the historical background of the first leukotomies, the tangible expert debate since 1935 on the indication and legitimacy of these interventions, and their contemporary and recent (ethical) evaluation. Special focus will be set on the original Portuguese literature, which has been given too little attention thus far in the English-language literature.
Ryan Brewster, Wenya Linda Bi, Timothy R. Smith, William B. Gormley, Ian F. Dunn, and Edward R. Laws Jr.
the shield is preferably curved or arcuate, as shown in Figs 1 and 4, while the lower edge (6b) is substantially straight. In the form of the invention shown in Figs. 1 , 2 and 3 , the shield receiving pocket is provided with an opening in the fabric body of the cap, preferably near the lower edge, which opening is closed by means of a suitable slide fastener (7). Functionally, the lightweight protective guards were engineered to disperse the mechanical energy from the blow throughout the entire head instead of being absorbed in a localized area. One major
Scott L. Zuckerman, Daniel J. France, Cain Green, Susie Leming-Lee, Shilo Anders, and J Mocco
our ongoing quality projects. Although the surgical debriefing literature has yet to definitively link debriefing with reduced rates of morbidity and mortality, it has shown decreased error rates and improvements in team communication. The neurosurgical literature on this topic, however, is even more limited. We report our own experience and challenges with a debriefing module, from invention to pilot implementation. Debriefing has potential to serve a valuable role in the culture of safe surgery. We hope our colleagues can learn from our experience and improve
The 2011 AANS Presidential Address
James T. Rutka
Society will be one of the organizations our grandchildren will wish to thank.” 10 F ig . 7. Current edifice of the Royal Society, whose mandate is to support the best in science and the best scientists worldwide. ©royalsociety.org. Discovery of Target Destinations Through Navigation The second topic on which I will speak is discovery through navigation. The discovery of places unknown, whether by sea or land, required the invention of the compass, which is generally attributed to the Chinese more than 2000 years ago. The compass arrived in Europe in the
Vincent C. Traynelis
Symptomatic degenerative spinal disease is a serious medical condition that affects many individuals. Modern neuroimaging modalities, the development of new medications, and advances in operative and nonoperative treatments have all contributed to improved outcomes. Unfortunately, there remain a significant number of patients in whom primary therapy either fails or new or recurrent symptoms develop over time. The last decade has witnessed the invention of devices designed to reconstruct the spinal motion segment. These devices can be divided into those that primarily function to replace a nucleus pulposus and those that completely replace the disc complex. In this article the author reviews the background leading to the development of the current group of disc replacements. The design and preliminary clinical results obtained using major lumbar and cervical devices are also reviewed.
Mark C. Preul, Joseph Stratford, Gilles Bertrand, and William Feindel
✓ Neurosurgeons are well known for being productive researchers and innovators. Few, however, have possessed the prolific ingenuity of William Cone. In 1934, he and Wilder Penfield were cofounders of the Montreal Neurological Institute where, until 1959, he filled the twin roles of neurosurgeon-in-chief and neuropathologist.
Because he did not find writing easy, many of his technical inventions and refinements remained unpublished. His numerous innovations included the extensive use of twist-drill technique for biopsy, drainage for subdural hematoma and cerebral abscess, and ventriculography. In the mid-1940's, he developed power tools driven by nitrogen that led to the modern, universally used air-driven tool systems. He had a special interest in the treatment of spinal dysfunction, for which he invented the Cone-Barton skull-traction tongs along with the Cone spinal operating table. He also devised operative procedures for vertebral fracture-dislocation and craniospinal anomalies. For the maintenance of muscle tone in the paralyzed bladder, he constructed a tidal drainage system. He introduced and popularized ventriculoperitoneal shunting techniques and carried out some of the earliest experimental trials to treat brain infections with sulphonamide and antibiotic drugs. He designed his own set of surgical suction devices, bone rongeurs, and a personal suction “air-conditioning” system for each surgeon. He had a keen early interest in intracranial tumors, and also demonstrated on monkeys how subdural mass lesions caused pupillary dilation and mesial temporal lobe damage due to cerebral compression. His work for the military during World War II on effects of altitude on brain pressure remained classified for many years. The first clipping and excision of an intracranial aneurysm is attributed to Cone.
Although Penfield was known as “the Chief,” Cone was referred to as “the Boss.” His fervent dedication to provide total care to his patients was expressed in round-the-clock vigils; he did not separate “nursing” from “surgical” care. Ultimately, Cone's driving passion for perfection led in part to his tragic death. His accomplishments, inventions, and his example as teacher and physician have become part of neurosurgery's collective legacy.
Sunil Manjila, Gagandeep Singh, Ayham M. Alkhachroum, and Ciro Ramos-Estebanez
Edward Muybridge was an Anglo-American photographer, well known for his pioneering contributions in photography and his invention of the “zoopraxiscope,” a forerunner of motion pictures. However, this 19th-century genius, with two original patents in photographic technology, made outstanding contributions in art and neurology alike, the latter being seldom acknowledged. A head injury that he sustained changed his behavior and artistic expression. The shift of his interests from animal motion photography to human locomotion and gait remains a pivotal milestone in our understanding of patterns in biomechanics and clinical neurology, while his own behavioral patterns, owing to an injury to the orbitofrontal cortex, remain a mystery even for cognitive neurologists. The behavioral changes he exhibited and the legal conundrum that followed, including a murder of which he was acquitted, all depict the complexities of his personality and impact of frontal lobe injuries. This article highlights the life journey of Muybridge, drawing parallels with Phineas Gage, whose penetrating head injury has been studied widely. The wide sojourn of Muybridge also illustrates the strong connections that he maintained with Stanford and Pennsylvania universities, which were later considered pinnacles of higher education on the two coasts of the United States.
T o T he E ditor : In the July 2009 issue of the Journal of Neurosurgery , I published an article on the history of detachable coils (Guglielmi G: History of the genesis of detachable coils. A review. J Neurosurg 111: 1–8, July, 2009). 1 In this article I described all the steps that eventually led to the invention of detachable coils in 1989. While looking at the article after publication, I had the sense that something was missing. I then realized that the description of an invention should not only consider the scientific aspect, it should also