Tuesday, April 16
7:00 am - 9:00 am
210 Seeing Inside: Early Experiences with Diagnostic and Therapeutic X-ray in Neurosurgery
Moderator(s): T Forcht Dagi, MD, DMedSc, DHCEd, FAANS
Panelist(s): Charles J. Prestigiacomo, MD, FAANS; Mark C. Preul, MD; Michael Schulder, MD, FAANS; Chris A. Sloffer, MD, MBA, FAANS
Early on, neurology was a very exacting intellectual discipline because it depended on an intimate understanding of neuroanatomy, as it existed in the 19 th century, to localize lesions. In particular, the variable relationships between neuroanatomy and neurophysiology were not fully understood and more credit was given to the art of cerebral localization by physical examination than it deserved. That made neurosurgery particularly challenging, and probably discouraging in equal measure. Within two months of the published description of 1895 by Roentgen, both Harvey Cushing and Fedor Krause seized upon X-ray apparatus for routine diagnostic use in neurosurgery. A cascade of diagnostic, surgical and ultimately therapeutic applications of X-rays followed. These advancements included Dandy's introduction of ventriculography in 1918, the Potter-Bucky X-ray Grid in 1920, and Moniz's 1926 Introduction, Parallel to Elvidge's later in the 1920s, of cerebral angiography. By 1900, malignancy was one of the five established indications for X-ray treatment, though the failure to provide a cure began to inhibit its use by 1905. In 1924, Coutard a French radiologist described a radium cure in a case of laryngeal cancer. In time, he also described fractionated therapy. By 1929, wide ranging discussion of "Deep Roentgenization" for invasive brain tumors took place at the first symposium of the Society for Neurological Surgeons in 1929. Neurosurgery could not have progressed without diagnostic radiology and the introduction of contrast to outline first the ventricular structures and later the vascular system and spinal cord. Progress on the therapeutic side took longer. This breakfast seminar will explore the influence of diagnostic and therapeutic radiology on neurosurgery over the first 60 years of the profession, and touch on what was required for new technologies, such as computed tomography, magnetic resonance imaging and stereotactic radiotherapy to become adopted.
- Identify the beginnings of routine application of X-ray energy for diagnosis in neurosurgery, especially as related to Harvey Cushing and Fedor Krause.
- Discuss the application of X-rays as they relate to the first applications and then routine therapeutic use for malignant brain tumors, as well more recent technology therapeutics for brain tumors such as focused irradiation techniques.
- Discuss the application of X-rays that began the explosion of the subspecialty of vascular neurosurgery.
- Recognize the impact of the innovation of computerized tomography scanning upon neurosurgical diagnosis.