Japanese neurosurgeons and microsurgical anatomy: a historical review

Evolution of microneurosurgical anatomy with special reference to the history of anatomy, surgical anatomy, and microsurgery: historical overview

This article reviews the evolution of microneurosurgical anatomy (MNA) with special reference to the development of anatomy, surgical anatomy, and microsurgery. Anatomy can be said to have started in the ancient Greek era with the work of Hippocrates, Galen, and others as part of the pursuit of natural science. In the sixteenth century, Vesalius made a great contribution in reviving Galenian knowledge while adding new knowledge of human anatomy. Also in the sixteenth century, Ambroise Paré can be said to have started modern surgery. As surgery developed, more detailed anatomical knowledge became necessary for treating complicated diseases. Many noted surgeons at the time were also anatomists eager to spread anatomical knowledge in order to enhance surgical practice. Thus, surgery and anatomy developed together, with advances in each benefiting the other. The concept of surgical anatomy evolved in the eighteenth century and became especially popular in the nineteenth century. In the twentieth century, microsurgery was introduced in various surgical fields, starting with Carl O. Nylen in otology. It flourished and became popularized in the second half of the century, especially in the field of neurosurgery, following Jacobson and Suarez's success in microvascular anastomosis in animals and subsequent clinical application as developed by M.G. Yasargil and others. Knowledge of surgical anatomy as seen under the operating microscope became important for surgeons to perform microneurosurgical procedures accurately and safely, which led to the fuller development of MNA as conducted by many neurosurgeons, among whom A.L. Rhoton, Jr. might be mentioned as representative.

Albert L. Rhoton Jr., MD: His Philosophy and Education of Neurosurgeons

Dr. Rhoton’s key philosophies included “Keep working hard.”, “Make surgery more accurate, gentle and safe”, “We want perfect anatomical dissections, because we want perfect surgical operations”, “Competence without compassion is worthless. Compassion without competence is meaningless”, “Neurosurgeons share a great professional gift; our lives have yielded an opportunity to help mankind in a unique and exciting way” and “There is no finish line for this effort”. His words reveal his passion for microneurosurgery and infinite love for humankind. Although his reknown rested on his reputation as a researcher, Dr. Rhoton was also a devoted educator. The principal aim behind the enormous amount of work he performed was that of educating neurosurgeons worldwide, so that they could be better surgeons. His work included: (1) numerous dissection courses, (2) numerous lectures and publications including about 160 original papers (3) the textbook “RHOTON” and Rhoton Collection (4) the education of 119 research fellows. The projects directed in his lab, produced the international dissemination of neuroanatomical knowledge. The ultimate goal of his microsurgical research was to improve the care of patients with neurosurgical diseases around the world. The technical contributions and humble character of Dr. Rhoton should be remembered as we care for patients.

Operative simulation of anterior clinoidectomy using a rapid prototyping model molded by a three-dimensional printer

BACKGROUND

As the anatomical three-dimensional (3D) positional relationship around the anterior clinoid process (ACP) is complex, experience of many surgeries is necessary to understand anterior clinoidectomy (AC). We prepared a 3D synthetic image from computed tomographic angiography (CTA) and magnetic resonance imaging (MRI) data and a rapid prototyping (RP) model from the imaging data using a 3D printer. The objective of this study was to evaluate anatomical reproduction of the 3D synthetic image and intraosseous region after AC in the RP model. In addition, the usefulness of the RP model for operative simulation was investigated.

METHODS

The subjects were 51 patients who were examined by CTA and MRI before surgery. The size of the ACP, thickness and length of the optic nerve and artery, and intraosseous length after AC were measured in the 3D synthetic image and RP model, and reproducibility in the RP model was evaluated. In addition, 10 neurosurgeons performed AC in the completed RP models to investigate their usefulness for operative simulation.

RESULTS

The RP model reproduced the region in the vicinity of the ACP in the 3D synthetic image, including the intraosseous region, at a high accuracy. In addition, drilling of the RP model was a useful operative simulation method of AC.

CONCLUSIONS

The RP model of the vicinity of ACP, prepared using a 3D printer, showed favorable anatomical reproducibility, including reproduction of the intraosseous region. In addition, it was concluded that this RP model is useful as a surgical education tool for drilling.