Otfrid Foerster, the great neurologist and neurosurgeon from Breslau (Wrocław): his influence on early neurosurgeons and legacy to present-day neurosurgery

White matter connections within the central sulcus subserving the somato-cognitive action network

The somato-cognitive action network (SCAN) consists of three nodes interspersed within Penfield's motor effector regions. The configuration of the somato-cognitive action network nodes resembles the one of the 'plis de passage' of the central sulcus: small gyri bridging the precentral and postcentral gyri. Thus, we hypothesize that these may provide a structural substrate of the somato-cognitive action network. Using microdissections of 16 human hemispheres, we consistently identified a chain of three distinct plis de passage with increased underlying white matter in locations analogous to the somato-cognitive action network nodes. We mapped localizations of plis de passage into standard stereotactic space to seed functional MRI connectivity across 9000 resting-state functional MRI scans, which demonstrated the connectivity of these sites with the somato-cognitive action network. Intraoperative recordings during direct electrical central sulcus stimulation further identified inter-effector regions corresponding to plis de passage locations. This work provides a critical step towards an improved understanding of the somato-cognitive action network in both structural and functional terms. Furthermore, our work has the potential to guide the development of refined motor cortex stimulation techniques for treating brain disorders and operative resective techniques for complex surgery of the motor cortex.

Technical Standards in Neurosurgery in Germany around 1950

The technical state of neurosurgery in Germany around 1950 was characterized by the limitations imposed by the postwar period in a war-damaged, challenging environment. Neurosurgeons from that era had to rely on their skills, knowledge, and improvisational skills when performing complex procedures with limited resources. The development of neurosurgery was also shaped by the division of the country with the establishment of different neurosurgical schools in East and West Germany. Despite these great challenges, German neurosurgery made significant contributions to the development of the field during this time. Significant and important advances were made in hemostatic techniques, anesthesiology, and the development of new surgical instruments. Limitations in resources and technology posed enormous challenges. Craniotomy, which is presented as an example, represents the long and complex path of development of our specialty.

Ethical questions arising from Otfrid Foerster's use of the Sherrington method to map human dermatomes

Otfrid Foerster (1873-1941) is well known for his maps of human dermatomes. We have examined the history of the development of his protocols for mapping dermatomes by analyzing his lectures and publications from 1908 to 1939, focusing on his Schorstein Memorial Lecture in 1932 and his use of the isolation (Sherrington) method, in which a single dorsal root is spared in a sequence of resections (dorsal rhizotomies). Because of the absence of medical records for Foerster's patients, we also review eyewitness accounts of his operating technique, his occasional comments on patients, and the issue of consent. There appears to be no medical justification-at that time or currently-for Foerster's use of the Sherrington method to map dermatomes L1, L5, S1, and S2, and in our view, these results were obtained unethically. Hence, clinicians and researchers who use his maps should acknowledge those whom Foerster exploited in order to produce them.

[A researcher and physician who gained international fame: Otfrid Foerster (1873-1941) as Nobel Prize candidate]

This paper discusses the 17 Nobel Prize nominations for the neurologist and neurosurgeon Otfrid Foerster (1873-1941). Drawing on files from the Stockholm Nobel Prize Archive, primary and secondary literature, it addresses the following questions: what were the reasons given by nominators for Foerster's nominations? What was the relationship between him and his nominators? Why was he ultimately not awarded the Nobel Prize? Most nominators of Foerster's highlighted as the main motive his Handbuch der Neurologie, which he had edited with Oswald Bumke. According to the nominators, this book together with Foerster's neurosurgical work had an enormous impact on contemporary neurology. Furthermore, his "honorable character" was underlined in the nomination letters; however, these reasons were not sufficient for the Nobel Committee: the members classified the handbook as not being original research. Despite this, Foerster's fame is reflected in the present, for example in the Otfrid Foerster Medal, which has been awarded to researchers by the German Society of Neurosurgery since 1953.

[A researcher and physician who gained international fame: Otfrid Foerster (1873-1941) as Nobel Prize candidate]

This paper discusses the 17 Nobel Prize nominations for the neurologist and neurosurgeon Otfrid Foerster (1873-1941). Drawing on files from the Stockholm Nobel Prize Archive, primary and secondary literature, it addresses the following questions: what were the reasons given by nominators for Foerster's nominations? What was the relationship between him and his nominators? Why was he ultimately not awarded the Nobel Prize? Most nominators of Foerster's highlighted as the main motive his Handbuch der Neurologie, which he had edited with Oswald Bumke. According to the nominators, this book together with Foerster's neurosurgical work had an enormous impact on contemporary neurology. Furthermore, his "honorable character" was underlined in the nomination letters; however, these reasons were not sufficient for the Nobel Committee: the members classified the handbook as not being original research. Despite this, Foerster's fame is reflected in the present, for example in the Otfrid Foerster Medal, which has been awarded to researchers by the German Society of Neurosurgery since 1953.

[A researcher and physician who gained international fame: Otfrid Foerster (1873-1941) as Nobel Prize candidate]

This paper discusses the 17 Nobel Prize nominations for the neurologist and neurosurgeon Otfrid Foerster (1873-1941). Drawing on files from the Stockholm Nobel Prize Archive, primary and secondary literature, it addresses the following questions: what were the reasons given by nominators for Foerster's nominations? What was the relationship between him and his nominators? Why was he ultimately not awarded the Nobel Prize? Most nominators of Foerster's highlighted as the main motive his Handbuch der Neurologie, which he had edited with Oswald Bumke. According to the nominators, this book together with Foerster's neurosurgical work had an enormous impact on contemporary neurology. Furthermore, his "honorable character" was underlined in the nomination letters; however, these reasons were not sufficient for the Nobel Committee: the members classified the handbook as not being original research. Despite this, Foerster's fame is reflected in the present, for example in the Otfrid Foerster Medal, which has been awarded to researchers by the German Society of Neurosurgery since 1953.

[Otfrid Foerster (1873-1941) and his ambivalent attitude towards National Socialism]

When Adolf Hitler was appointed Chancellor of the Reich Otfrid Foerster was almost 60 years old and an internationally renowned neurologist, neurosurgeon and a pioneer of localization research. Since 1922 he held the chair of neurology in Breslau (Wroclaw) and from 1925 to 1932 he was president (later honorary president) of the first Society of German Neurologists. In 1934 "his" Neurological Research Institute in Breslau was inaugurated. Biographical studies have unanimously established that he has never been a member of the party, that he found himself promptly marginalized after 1933 within his own ranks, and that he never participated in eugenic measures or "euthanasia" activities. A re-reading and analysis of his relevant papers and publications on neurology reveal however reverences paid to the Nazi state, which are surprising in this clarity. A possible explanation for Foerster's overall ambivalent attitude, he was married to a non-Aryan woman (in Nazi jargon), is the threat posed to his relatives by Nazi racial hygiene laws. On the other hand, there are clear indications of his conservative German national patriotism encouraging and supporting a restrengthened state and the National Socialist vision of the German Reich as a "great power". Further investigations will have to show how the numerous influential factors that had a bearing on his biographical characteristics, political attitude, medical research interests and private motivation should be weighted.

Stereoelectroencephalography in epilepsy, cognitive neurophysiology, and psychiatric disease: safety, efficacy, and place in therapy

For patients with drug-resistant epilepsy, surgical intervention may be an effective treatment option if the epileptogenic zone (EZ) can be well localized. Subdural strip and grid electrode (SDE) implantations have long been used as the mainstay of intracranial seizure localization in the United States. Stereoelectroencephalography (SEEG) is an alternative approach in which depth electrodes are placed through percutaneous drill holes to stereotactically defined coordinates in the brain. Long used in certain centers in Europe, SEEG is gaining wider popularity in North America, bolstered by the advent of stereotactic robotic assistance and mounting evidence of safety, without the need for catheter-based angiography. Rates of clinically significant hemorrhage, infection, and other complications appear lower with SEEG than with SDE implants. SEEG also avoids unnecessary craniotomies when seizures are localized to unresectable eloquent cortex, found to be multifocal or nonfocal, or ultimately treated with stereotactic procedures such as laser interstitial thermal therapy (LITT), radiofrequency thermocoagulation (RF-TC), responsive neurostimulation (RNS), or deep brain stimulation (DBS). While SDE allows for excellent localization and functional mapping on the cortical surface, SEEG offers a less invasive option for sampling disparate brain areas, bilateral investigations, and deep or medial targets. SEEG has shown efficacy for seizure localization in the temporal lobe, the insula, lesional and nonlesional extra-temporal epilepsy, hypothalamic hamartomas, periventricular nodular heterotopias, and patients who have had prior craniotomies for resections or grids. SEEG offers a valuable opportunity for cognitive neurophysiology research and may have an important role in the study of dysfunctional networks in psychiatric disease and understanding the effects of neuromodulation.

For the further training of individuals in neurosurgery: a history of the William P. Van Wagenen Fellowship

The William P. Van Wagenen Fellowship, celebrating its 50th anniversary, is an annual award given by the AANS and administered by the Neurosurgery Research and Education Foundation (NREF). Named after its benefactor, Dr. William Van Wagenen, the fellowship continues his legacy of mentorship and innovation. As the premier research award for young neurosurgeons, it has provided a foundation for career development for many thought leaders in the field. The award was created in the spirit of Van Wagenen's belief in collaboration with other institutions as a means of refining neurosurgical technique, creating new research initiatives, and improving patient outcomes. Van Wagenen's commitment was informed by his early experiences in neurosurgery with his mentor Dr. Harvey Cushing, who helped to fund Van Wagenen's scientific endeavors in Europe. This journey catalyzed Van Wagenen's lifelong commitment to mentorship, which is exemplified by his instrumental role in the creation of the Harvey Cushing Society, now the AANS. Over the last 50 years, the recipients of this award have used the endowment to lay the groundwork for many scientific and technical innovations in neurosurgery. The fellowship remains an unmatched opportunity to explore new lines of investigation, foster academic and research goals, incorporate new technology and skills into American neurosurgical practice, and motivate young neurosurgeons to transform the field. The legacy of mentorship, scientific inquiry, and clinical excellence personified by Cushing and Van Wagenen is memorialized in the William P. Van Wagenen Fellowship.

Electrical stimulation of the brain and the development of cortical visual prostheses: An historical perspective

Rapid advances are occurring in neural engineering, bionics and the brain-computer interface. These milestones have been underpinned by staggering advances in micro-electronics, computing, and wireless technology in the last three decades. Several cortically-based visual prosthetic devices are currently being developed, but pioneering advances with early implants were achieved by Brindley followed by Dobelle in the 1960s and 1970s. We have reviewed these discoveries within the historical context of the medical uses of electricity including attempts to cure blindness, the discovery of the visual cortex, and opportunities for cortex stimulation experiments during neurosurgery. Further advances were made possible with improvements in electrode design, greater understanding of cortical electrophysiology and miniaturisation of electronic components. Human trials of a new generation of prototype cortical visual prostheses for the blind are imminent. This article is part of a Special Issue entitled Hold Item.

Margaret Kennard (1899-1975): not a 'principle' of brain plasticity but a founding mother of developmental neuropsychology

According to the 'Kennard Principle', there is a negative linear relation between age at brain injury and functional outcome. Other things being equal, the younger the lesioned organism, the better the outcome. But the 'Kennard Principle' is neither Kennard's nor a principle. In her work, Kennard sought to explain the factors that predicted functional outcome (age, to be sure, but also staging, laterality, location, and number of brain lesions, and outcome domain) and the neural mechanisms that altered the lesioned brain's functionality. This paper discusses Kennard's life and years at Yale (1931-1943); considers the genesis and scope of her work on early-onset brain lesions, which represents an empirical and theoretical foundation for current developmental neuropsychology; offers an historical explanation of why the 'Kennard Principle' emerged in the context of early 1970s work on brain plasticity; shows why uncritical belief in the 'Kennard Principle' continues to shape current research and practice; and reviews the continuing importance of her work.

History of neuropsychology through epilepsy eyes

In the 19th century, Hughlings Jackson relied on clinical history, seizure semiology, and the neurologic examination as methods for seizure localization to inform the first epilepsy surgeries. In the 20th century, psychological and neuropsychological tests were first employed as both diagnostic and prognostic measures. The contemporary practice of epilepsy evaluation and management includes neuropsychology as a critical component of epilepsy care and research, and epilepsy and neuropsychology have enjoyed a very special and synergistic relationship. This paper reviews how epilepsy has shaped the practice of neuropsychology as a clinical service by asking critical questions that only neuropsychologists were in a position to answer, and how clinical care of epilepsy patients has been significantly improved based on neuropsychology's unique contributions.

Osler vindicated: glioma of the leg center with Jacksonian epilepsy; removal and cure, with a 50-year follow-up. Historical vignette

On December 14, 1883, William Osler, then pathologist at the Montreal General Hospital, presented the specimen of a brain with an almond-sized glioma beneath the right motor cortex to the Montreal Medico-Chirurgical Society. The brain specimen was from a young woman who had suffered from intermittent Jacksonian seizures for 14 years and had eventually died in status epilepticus. Aware of the pioneering removal of a tumor from the cortex reported on in 1885 by Bennett and Godlee, Osler wrote of his case, "this was an instance in which operation would have been justifiable and possibly have been the means of saving life." In 1953, a young man with Jacksonian attacks that began in his foot underwent removal of a Grade I glioma from the central fissure. The operation was performed in an awake craniotomy during which cortical mapping was used to define the motor and sensory cortices. Treatment with focal radiation followed, and afterward the patient became seizure-free, stopped taking anticonvulsant medication, and has led an active life over the past 50 years. Reference is made to the experiences of Sherrington, Cushing, and Penfield with cortical stimulation in the awake patient under regional anesthesia as an effective aid to surgery for epileptogenic lesions, tumors, and vascular malformations. Their technique allows for maximal resection with minimal neurological deficits. Over the past 20 years, this approach has been adopted effectively in many neurosurgical centers.