Читать книгу Current Concepts in Movement Disorder Management - Группа авторов - Страница 13

Work done previously in Russia in the late 19th century by Zernov suggested that external skull guiding devices could be used to target intracranial targets. Unfortunately, these prototype devices were based on the concept of brain function determined by phrenology. A method to reach deep brain targets reliably was first created by Sir Victor Horsley and his colleague Robert Clarke, which was eventually reported in their landmark 1908 article [10]. Horsley requested Clarke to develop an intracranial guiding device that would facilitate placement of electrodes in the cerebellum of animals. They then studied the effects on animal movement after electrolytic lesions. This stereotactic guiding device is generally credited with being the first device based on neuroanatomic structures. Despite the manufacturing of several models of the Horsely-Clarke device, Horsley never used it in humans. Visitors to London, including Ernest Sachs used the Horsley-Clark device for animal experiments in the 1920s. Another disciple of Clarke’s, Aubrey Mussen, proposed the use of this device in humans. Mussen travelled back and forth between McGill University in Montreal and London, and eventually in 1918 arranged the construction of a rectilinear device for which he proposed a brain atlas and galvanic heating of brain tumors through a 5 mm burr hole [11]. His family found the prototype device wrapped in newspapers dated 60 years earlier, and it does not appear that any patient was actually treated using this device. The device itself was subsequently placed in the archives of the Montreal Neurological Institute. However, it seems that credit for the first true human stereotactic procedure should go to Captain Newberry Ferguson who reported in the 1918 British Surgical Journal that he had used a guiding device to extract a bullet fragment from the brain of a World War I soldier [12]. The bullet could be localized using X-rays and removed with the assistance of long pituitary forceps mounted on a carrier arc. The introduction and progression of stereotactic techniques as well as selected pioneers are shown in Table 1.

The team of Ernst Spiegel, a neurologist who had escaped from German-occupied Austria, and Philadelphia neurosurgeon Henry Wycis, was the first to report the use of a stereotactic guiding device for movement disorders, in this case patients with Huntington’s disease [13]. During the late 1940s, many surgeons both from the United States and from abroad studied at Temple University. One of the early students in Philadelphia was Lars Leksell, a pioneering Swedish neurosurgeon who had closely collaborated with Ragnar Granit in the description of the gamma motor system of the brain [14]. Granit subsequently was awarded the Nobel Prize in medicine or physiology.

Leksell grew up in a turbulent time for neurosurgery since both anesthetic techniques as well as surgical instrumentation remained relatively primitive in the 1930s. Studying under the Scandinavian neurosurgical pioneer, Herbert Olivercrona, Leksell became convinced that less invasive procedures were needed to reach deep brain targets. After his return to Stockholm, he published his first paper on the center-of-arc principle for stereotactic guiding devices in 1949 [15]. His first prototype device is shown in Figure 1. Leksell continued his efforts related both to movement disorders and to refractory psychiatric disorders. Working as a Professor in Lund and eventually at the Karolinska Institute in Stockholm, he gradually moved from a pallidal to a thalamic lesion as the preferred target for movement disorders.

Table 1. Highlighted history of movement disorder surgery

Time frame	Era	Pioneers
Before 1990	Brain function	Zernov [31]
1910s-1920	Frame stereotaxy Bullet extraction	Horsley and Clarke, 1908 [10] Fergusson, 1918 [12]
1920s	Animal stereotactic surgery	Sachs [12] Mussen [11]
1930s	Pre-stereotactic	Bucy-Cortical [5] Putnam-Cordotomy [32] Walker [6] Guiot-Peduncolotomy [33] Meyer-Caudate [7]
1940s	Early stereotactic brain surgery	Spiegel and Wycis, 1947 [13] Leksell, 1949; Pallidotomy [15]
1950s-1960	Spread of stereotaxy	Cooper [8] Hassler [34] Guiot [33] Narabayashi [17] Bertrand [35] Gillingham [36] Mundinger [37] Riechert [38] Tailarach
1970s	Decline of stereotaxy	Seigfried [39]
1980s	Transplant	Backlund [40] Madrazo [20] Bakay [41]
1990s	Imaging and mapping	Tasker [42] Kelly [43] Lunsford [44] Ohye [45] Laitinen [46]
2000s	Deep brain stimulations	Benabid [35] Lozano [47]
2010	Frameless stereotaxy	Starr-Intraoperative MRI [48] HIFU [30]
1970–Present	Radiosurgery	Leksell [15] Lunsford [49] Regis [50] Ohye [28] Young [51]
A brief timeline of the development of surgical procedures for movement disorders, emphasizing selected pioneers in the evolution of movement disorder surgery.

Fig. 1. The arc centered principle of the first Leksell Stereotactic frame, published first in 1949. The frame evolved as imaging tools progressed from skull X-rays and encephalograhy to computed tomography and magnetic resonance imaging (Photo courtesy of Dr. Dan Leksell).