ROOTS OF NEUROANATOMY, NEUROLOGY, AND NEUROSURGERY AS FOUND IN THE BIBLE AND TALMUD

Gods and monsters: Greek mythology and Christian references in the neurosurgical lexicon

Background:

Myths and religion are belief systems centered around supernatural entities that attempt to explain the observed world and are of high importance to certain communities. The former is a collection of stories that belong to a cultural tradition and the latter are organized faiths that determine codes of ethics, rituals and philosophy. Deities or monstrous creatures in particular act as archetypes instructing an individual’s conduct. References to them in Greek mythology and Christianity are frequently manifested in the modern neurosurgical vernacular.

Methods:

A review of the medical literature was performed using the PubMed and MEDLINE bibliographic databases. Publications from 1875 to 2021 related to neurosurgery or neuroanatomy with the medical subject headings (MeSH) terms mythology, religion, Christianity and Catholicism were reviewed. References pertaining to supernatural beings were classified to either a deity or a monstrosity according to their conventional cultural context.

Results:

Twelve narratives associated with neurosurgery were identified, nine relating to Greek mythology and three associated with the Christian-Catholic faith. Eight accounts concerned deities and the remaining with monstrous creatures.

Conclusion:

This article explores the etymology of commonly utilized terms in daily neurosurgical practice in the context of mythology and religion. They reveal the ingenuity and creativity of early pioneers who strived to understand the brain.

Temporal lobe epilepsy and cavernous malformations: surgical strategies and long-term outcomes

OBJECTIVE

Cerebral cavernous malformations (CCM) of the temporal lobe often present with seizures. Surgical resection of these lesions can offer durable seizure control. There is, however, no universally accepted methodology for assessing and surgically treating these patients. We propose an algorithm to maximize positive surgical outcomes (seizure control) while minimizing post-surgical neurological deficit.

METHODS

A retrospective review of 34 patients who underwent epilepsy surgery for radiographically proven temporal lobe CCM was conducted. Patients underwent a relatively standard work-up for seizure localization. In patients with mesial temporal lobe epilepsy (MTLE), a complete resection of the epileptogenic zone was performed including amygdalo-hippocampectomy in addition to a lesionectomy if not contraindicated by pre-operative work-up. Patients with neocortical epilepsy underwent intraoperative electrocorticography (ECoG)-guided lesionectomy.

RESULTS

Seizure-free rate for mesial and neocortical (anterior, lateral, and basal) location was 90 vs. 83 %, respectively. Complete resection of the lesion, irrespective of location, was statistically significant for seizure control (p = 0.018). There was no difference in seizure control based on disease duration or location (p > 0.05). Patients with mesial temporal CCM who presented with MTLE were presumed to also have mesial temporal sclerosis (MTS), or dual pathology. These patients underwent routine resection of the mesial structures. Interestingly, patients who had MTLE and basal (neocortical) lesions who underwent a mesial resection for suspected MTS were found not to have dual pathology.

CONCLUSIONS

Patients with temporal lobe CCM should be offered resection for durable seizure control, prevention of secondary epileptogenic foci, and elimination of hemorrhage risk. The preoperative work-up should follow a team approach. Surgical intervention should include complete lesionectomy in all cases. Intra or extra-operative ECoG for neocortical lesions may be beneficial. Management of mesial temporal CCMs (archicortex) should consider resection of a well-defined epileptogenic zone (including mesial structures) due to high probability of pathologically proven MTS. The use of this treatment algorithm is useful for the education and treatment of these patients.

The first case of drug-dependent memory: the biblical Lot in Talmudic and Midrashic exegesis

The literature on alcohol and alcoholism has long noted how the effects of alcohol are reported in early sources, including religious texts such as the Bible and Talmud. In that vein, we suggest that the Bible, as elucidated according to long-established rabbinic interpretation, contains the earliest recorded case of drug-dependent memory, in the account of Lot's alcohol-facilitated incestuous relationships with his daughters (Genesis 19:29-38). We posit that the Talmudic, Midrashic, and traditional rabbinic commentaries that support our reading of the Lot narrative convey keen understanding of the effects of alcohol on recall. These Jewish sources, written centuries ago, demonstrate insight into the nature of alcohol-influenced cognitive function, which was thought to have been unknown prior to contemporary times.

Newer insights to the neurological diseases among biblical characters of old testament

Many people over the years have studied the Bible from a medical point of view offering diagnoses for the symptoms and signs that appear to have afflicted numerous individuals in the Bible. We review the biblical characters in the Old Testament and offer newer insights to their neurological diseases. We first look at the battle between Goliath and David. Interestingly, Goliath probably suffered from acromegaly. We propose autism as a diagnosis for Samson which would precede the first known case of autism by centuries. Isaac was a diabetic, and he probably had autonomic neuropathy. Few verses from the books of I Samuel, Psalms, and Ezekiel reveal symptoms suggestive of stroke. Jacob suffered from sciatica, and the child of the Shunnamite woman in II Kings had a subarachnoid hemorrhage. These instances among others found in the Old Testament of the Bible offer newer insights on the history of current neurological diseases.

Failure of temporal lobe resection for epilepsy in patients with mesial temporal sclerosis: results and treatment options

OBJECT

The purpose of this study was to identify the causes of failed temporal lobe resection in patients with mesial temporal sclerosis (MTS) and the role of repeat surgery for seizure control.

METHODS

This is a retrospective study of 105 patients who underwent temporal lobe resection for MTS with unilateral electroencephalographic findings. The mean follow-up duration was 36 months (range 24-84 months). Surgeries were all performed by the senior author (F.L.V.).

RESULTS

Following initial surgical intervention, 97 patients (92%) improved to Engel Class I or II (Group A), and 8 (8%) did not have significant improvement (Engel Class III or IV; Group B). These 8 patients were restudied using video-electroencephalography (EEG) and MR imaging. All major surgical failures occurred within 1 year after initial intervention. Reevaluation demonstrated 3 patients (37.5%) with contralateral temporal EEG findings. Five patients (62.5%) had evidence of ipsilateral recurrent discharges. Four patients underwent extended neocortical resection along the previous resection cavity. Their outcomes ranged from Engel Class I to Class III. Only 1 patient (12.5%) who failed to improve after initial surgery was found to have incomplete resection of mesial structures. This last patient underwent reoperation to complete the resection and improved to Engel Class I.

CONCLUSIONS

Failure of temporal lobe resection for MTS is multifactorial. The cause of failure lies in the pathological substrate of the epileptogenic area. Complete seizure control cannot be predicted solely by conventional preoperative workup. Initial surgical failures from temporal lobe resection often benefit from reevaluation, because reoperation may be beneficial in selected patients. Based on this work, the authors have proposed a management and treatment algorithm for these patients.