PMC3582858_01
Excision of the Precentral Gyrus for Athetosis.. Sketches by British neurosurgeon Victor Horsley of the operative field and surgical pathology in a 14-year-old boy with athetosis who underwent excision of the right precentral gyrus in 1908. Far left is the operative field, showing the cut edge of bone. The central sulcus passes in front of (i.e., to the right of) G. Numbers indicate cortical locations that were electrically stimulated. Center illustration is the outline of the removed portion of the precentral gyrus, with notations indicating the motor response to electrical stimulation during surgery: e.e., elbow extension; w.e., wrist extension; w.f., wrist flexion; ul. Ad., ulnar adduction; f.f., finger flexion. Right illustration is a photograph of the excised precentral gyrus after fixation in formalin. The scale at right is in centimeters and millimeters. Figure source: Horsley, 1909.
tre-03-133-2893-1-g009.jpg
PMC3582858_01_tre-03-133-2893-1-g009.jpg
f09
Horsley by neurologist James Risien Russell (1863-1939). Horsley "advised that the arm area in this case should be delimited by excitation [i.e., mapped by electrical stimulation] and then removed." In 1908, Horsley resected "the whole depth of the [contralateral] gyrus pre-centralis" (Figure 9) with resulting "disappearance of spasmodic movements" that persisted for at least a year after surgery, but with significant sensory loss and weakness of the arm, which gradually improved to a modest degree (Figures 10 and 11).
Post-operative Photographs of the Left Arm of Horsley's Patient After Resection of the Right Precentral Gyrus.. The top photograph shows "'Voluntary' movement of the left upper limb in placing the hand on the iliac crest." The middle photograph shows "'Voluntary' flexion of elbow and abduction of shoulder. Fingers continuing to slowly flex." The bottom photograph shows "Forcible voluntary abduction and extension of limb, showing the effort causes contracture of the digits." Figure source: Horsley, 1909.
tre-03-133-2893-1-g010.jpg
PMC3582858_01_tre-03-133-2893-1-g010.jpg
f10
Horsley by neurologist James Risien Russell (1863-1939). Horsley "advised that the arm area in this case should be delimited by excitation [i.e., mapped by electrical stimulation] and then removed." In 1908, Horsley resected "the whole depth of the [contralateral] gyrus pre-centralis" (Figure 9) with resulting "disappearance of spasmodic movements" that persisted for at least a year after surgery, but with significant sensory loss and weakness of the arm, which gradually improved to a modest degree (Figures 10 and 11).
Post-operative Photographs of the Left hand of Horsley's Patient after Resection of the Right Precentral Gyrus.. The top photograph shows the extent of voluntary extension of the fingers. The bottom photograph shows the extent of voluntary flexion of the fingers. Contractures of the fourth and fifth digits are not visible. A prominent wrist drop is evident. Figure source: Horsley, 1909.
tre-03-133-2893-1-g011.jpg
PMC3582858_01_tre-03-133-2893-1-g011.jpg
f11
Horsley by neurologist James Risien Russell (1863-1939). Horsley "advised that the arm area in this case should be delimited by excitation [i.e., mapped by electrical stimulation] and then removed." In 1908, Horsley resected "the whole depth of the [contralateral] gyrus pre-centralis" (Figure 9) with resulting "disappearance of spasmodic movements" that persisted for at least a year after surgery, but with significant sensory loss and weakness of the arm, which gradually improved to a modest degree (Figures 10 and 11).
New York Neurologist Charles Loomis Dana.. Dana proposed posterior rhizotomy, later called "Dana's operation," in 1888. Courtesy of the U.S. National Library of Medicine.
tre-03-133-2893-1-g012.jpg
PMC3582858_01_tre-03-133-2893-1-g012.jpg
f12
Abbe (1851-1928), New York neurologist Charles Loomis Dana (1852-1935) (Figure 12) had proposed sectioning the posterior spinal roots in patients with intractable chronic pain. Abbe (Figure 13) soon adopted this posterior rhizotomy procedure and called it "Dana's operation," ultimately applying it to a variety of conditions.
New York Surgeon Robert Abbe.. Abbe performed the posterior rhizotomy procedure (Dana's operation) in a patient with athetosis. Photograph from Notable New Yorkers: 1896-1899 (1899) by Moses King.
tre-03-133-2893-1-g013.jpg
PMC3582858_01_tre-03-133-2893-1-g013.jpg
f13
Abbe (1851-1928), New York neurologist Charles Loomis Dana (1852-1935) (Figure 12) had proposed sectioning the posterior spinal roots in patients with intractable chronic pain. Abbe (Figure 13) soon adopted this posterior rhizotomy procedure and called it "Dana's operation," ultimately applying it to a variety of conditions.
Surgical Field During Posterior Rhizotomy.. Figure source: Abbe, 1911.
tre-03-133-2893-1-g014.jpg
PMC3582858_01_tre-03-133-2893-1-g014.jpg
f14
Abbe performed a posterior rhizotomy at C5-C8, and an anterior rhizotomy at C7-C8 to help control the pain and "incessant spasm" (Figure 14). Abbe reported that the man was "discharged [a month later] with very great improvement" and, in particular, that "the constant athetoid spasms had gone." Abbe followed him over the next 16 years until his death in 1910, and noted that although the patient "said he suffered ... the old athetoid spasms did not return." Up to the time of his death, the man "complained moderately and took his morphine."
Philadelphia Neurosurgeon Charles Harrison Frazier.. Frazier worked with neuropathologist and neurologist William Gibson Spiller on several neurosurgical procedures for athetosis, including posterior rhizotomy and nerve "transplantation" (i.e., neurotomy and nerve-to-nerve anastomosis). Etching by Erwin F. Faber. Courtesy of the U.S. National Library of Medicine.
tre-03-133-2893-1-g015.jpg
PMC3582858_01_tre-03-133-2893-1-g015.jpg
f15
Frazier (1870-1936) (Figure 15), Professor of Clinical Surgery at the University of Pennsylvania, also used posterior rhizotomy in a case of athetosis, after the persistent urging of Spiller who was then Professor of Neuropathology and Associate Professor of Neurology at the University of Pennsylvania.
PMC3582858_02