The Origins of Human Functional Stereotaxis: A Reappraisal

Abstract

In order to shed light on the first application of human functional stereotactic neurosurgery, whether it was in the realm of movement disorders, as has been claimed repeatedly, or in the realm of psychiatry, a review of the original scholarly literature was conducted. Tracking and scrutinising original publications by Spiegel and Wycis, the pioneers of human stereotactic neurosurgery, it was found that its origin and the very incentive for its development and first clinical use were to avoid the side effects of frontal leucotomy. The first applications of functional stereotactic neurosurgery were in performing dorsomedial thalamotomies in psychiatric patients; it was only later that the stereotactic technique was applied in patients with chronic pain, movement disorders and epilepsy. Spiegel and Wycis’ first functional stereotactic operations were for obsessive-compulsive disorder, schizophrenia, and other psychiatric conditions.

Robot-assisted stereoelectroencephalography exploration of the limbic thalamus in human focal epilepsy: implantation technique and complications in the first 24 patients

“…Stereotactic procedures targeting the thalamus date back to the mid-20th century when Spiegel and Wycis reported on thalamotomy for several psychiatric indications, 33 and these authors were also the first to record sei- zure activity from this location. 38 Since then, numerous thalamic stereotactic procedures have been performed for a wide variety of indications.…”

“…The broadest midline nuclear segment was anterior and ventral to the massa intermedia, where the reuniens and central median nuclei are located. 33 The massa intermedia could be visualized in 5 of the 8 MED thalamic groups of patients. When not distinct, the anteroposterior midpoint at the level of the anterior commissure-posterior commissure plane was chosen.…”

Against the Current: Wilder Penfield, the Frontal Lobes and Psychosurgery

“…As Spiegel later recalled, "In the winter of 1947, I watched a prefrontal lobotomy performed and I was appalled by the resulting extensive brain damage and by the severe personality changes." 32 This experience led Spiegel and Wycis to devise a stereotactic method of targeting the medial nucleus of the thalamus for use "in psychosurgery : : : in order to reduce the emotional reactivity by a procedure much less drastic than frontal lobotomy." 33 This led to the development of stereotactic surgery as we know it today.…”

Implantation technique, safety and complications of robot-assisted stereoelectroencephalography exploration of the limbic thalamus in human focal epilepsy

“…For the medial group of thalamic nuclei, neurosurgeons targeted the ventral midline thalamus near the massa intermedia (MI), providing recordings from the central-medial or mediodorsal nuclei. The broadest midline nuclear segment was anterior and ventral to the MI, where the reuniens and central median nuclei are located 33 . The MI could be visualized in five of the eight medial thalamic groups of patients.…”

“…Discussion Stereotactic procedures targeting the thalamus date back to the mid-20 th century when Spiegel and Wycis reported on thalamotomy for several psychiatric indications 33 and they were also the first to record seizure activity from this location 38 . Since then, numerous thalamic stereotactic procedures have been performed for a wide variety of indications.…”