Nerves and Nerve Injuries

Vol 1: History, Embryology, Anatomy, Imaging, and Diagnostics

R. Shane Tubbs, Elias B. Rizk, Mohammadali M. Shoja, Marios Loukas, Nicholas Barbaro, Robert J. Spinner, R. Shane Tubbs, Elias Rizk, Mohammadali M. Shoja, Marios Loukas, Nicholas Barbaro, Robert J. Spinner

• Publisher: Academic Press
• Year: 2015
• ISBN:
  9780124104471
• Topic: Psychology
• Subtopic: Neuropsychology
• Index: Psychology

Nerves and Nerve Injuries is the first comprehensive work devoted to the nerves of the body. An indispensable work for anyone studying the nerves or treating patients with nerve injuries, these books will become the 'go to' resource in the field. The nerves are treated in a systematic manner, discussing details such as their anatomy (both macro- and microscopic), physiology, examination (physical and imaging), pathology, and clinical and surgical interventions. The authors contributing their expertise are international experts on the subject. The books cover topics from detailed nerve anatomy and embryology to cutting-edge knowledge related to treatment, disease and mathematical modeling of the nerves.

Nerves and Nerve Injuries Volume 1 focuses on the history of nerves, embryology, anatomy, imaging, and diagnostics. This volume provides a greatly detailed overview of the anatomy of the peripheral and cranial nerves as well as comprehensive details of imaging modalities and diagnostic tests.

• Detailed anatomy of the peripheral and cranial nerves including their history and ultrastructure
• Comprehensive details of the imaging modalities and diagnostic tests used for viewing and investigating the nerves
• Authored by leaders in the field around the globe – the broadest, most expert coverage available

Part I

History, Histology and Development of the Peripheral Nerves

Chapter 1

History of the Peripheral and Cranial Nerves

James Tait Goodrich^1,*; Michel Kliot^{2 1} Division of Pediatric Neurosurgery, Children’s Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York, USA.
² Peripheral Nerve Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
^* Corresponding author: [email protected]

Abstract

This chapter reviews developments in the practice of treating injuries and tumors of the peripheral and cranial nerves. Starting with the Edwin Smith Papyrus, we explore the treatment of nerve damage from antiquity to the mid-twentieth century. Up until the post-Renaissance era, distinguishing a nerve from a tendon or ligament was not easily done, and the concept of repairing an injured or severed nerve only came into fashion in the latter half of the nineteenth century. Although attempts were made to remove tumors and perform surgical repairs of the nerves, the outcomes were often not favorable, and in many cases, the surgeries left patients with even more painful outcomes. In this chapter we discuss the surgical concepts surrounding various historical nervous system repairs, highlighting the techniques that succeeded and failed. We also introduce key personalities in the field and their contributions, including a number of historical illustrations, many of which may be new to students of this subject.

Keywords

History of peripheral nerve injuries

History of peripheral nerve surgery

Causalgia

Peripheral nerve tumors

History of surgery

No surgical treatment of peripheral nerves can be intelligently undertaken without an eye on their anatomical and physiological connections with the central nervous system. Nerves cannot be considered as independent peripheral structures, as are muscles and tendons, but rather as peripheral parts of the central nervous system, in close association and intimate relation with the latter. The surgical treatment of peripheral nerves is closely allied to the surgery of the brain and spinal cord and forms the third division of the surgery of the nervous system.

Stookey (1922)

The earliest known written record of injuries and tumors of the peripheral nerves is the Edwin Smith Papyrus, which was written about 1700 BC. Among the case studies presented in the Papyrus, one stands out as a likely case of a neurofibromas on the chest (Case 45). The writer describes “round masses on the chest” (Sanchez & Meltzer, 2012). The described masses were multiple in number, hard to the touch, sometimes appeared elsewhere on the body, and did not produce secretions or pain. The masses were clearly differentiated from any type of infection, and when discussing the treatment of the masses, the writer comments, “It is nothing/there is no treatment/remedy.” This last comment is similar to the treatment recommendations many surgeons offered over the next 3500 plus years.

After the time of the Edwin Smith Papyrus, surgery and other forms of medicine became more formalized with the writings from the Alexandrian schools of medicine, which developed in Asia Minor. The early anatomical writings of the Alexandrian schools (300 BC-AD 300) show that physicians and surgeons often anatomically confused nerves and tendons. In the treatment of nerve injuries such as avulsion and laceration, the suturing of the severed ends was commonly discouraged due to the more unbearable pain that often occurred after the surgical repair.

A pioneer in the Alexandrian schools of medicine was an anatomist (some consider him to be the Father of Scientific Anatomy) and physiologist by the name of Herophilus of Chalcedon (335-280 BC) (Marx, 1838; Von Staden, 1989). Herophilus had access to condemned criminals for anatomical studies. So, he was one of the first to provide anatomical differentiation between nerves and tendons, and he attributed the concept of sensation to nerves. Rufus of Ephesus (fl AD 50) further uncovered the differences between nerves and tendons and their underlying anatomical characteristics (Rufus of Ephesus, 1554, 1567). Rufus did most of his anatomical studies on apes and other lower animals. He was the first to describe the decussation of the optic nerves. In his early medical writings, Rufus detailed a clearer anatomical distinction between nerves and tendons but still often confused the two. The anatomical distinction of nerves arising from the brain first appeared in his writings. The concept of a nerve having both motor and sensory capabilities also first appeared in some detail in Rufus’s writings on the anatomy of the body (Rufus of Ephesus, 1554, 1567).

A distinguished surgeon and anatomist of the second century AD was an individual by the name of Galen of Pergamon (AD 121-201). Galen entered the study of medicine at the age of 17 and eagerly studied anatomy. An early anatomical subject of Galen’s was a robber who had been killed by the locals and then “cleaned” of the soft tissues by birds. Following his medical studies, Galen rapidly gained prominence as a physician. He had the good fortune to live under two of the greatest Roman emperors, Antonius Pius (AD 136-161) and Marcus Aurelius (AD 161-180). As physician to the gladiators of Pergamon and Rome, Galen had access to a plethora of human material, particularly subjects requiring attention for traumatic injuries. This extensive surgical experience, together with his scientific studies, enabled Galen to make a wide range of contributions to surgery and in particular issues dealing with peripheral nerves (Galen of Pergamon, 1576-1577). Galen concluded that repairing a severed nerve might lead a patient to develop epilepsy, leading him to discourage nerve repair unless it was absolutely necessary. Yet, Galen was one of the first to purposefully experimental transect a nerve to see the result. In oxen and pigs, he sectioned the recurrent laryngeal nerve and recognized that hoarseness was a consequence (Figures 1.1 and 1.2).

Figure 1.1 Title page from Galen’s collected works. At the bottom of the page is a scene of Galen doing a dissection on a pig for a recurrent laryngeal nerve transection, which he describes as causing hoarseness in the animal.

Figure 1.2 Enlarged dissection image showing Galen positioning the pig, surrounded by students and other famous figures in medicine and surgery. In this scene Galen is getting ready to section the recurrent laryngeal nerve. He reports that the voice is not totally destroyed when one nerve is cut, only weakened. If you cut both branches of the recurrent laryngeal nerve, the voice is totally lost.

In discussing the nerve dissection, Galen describes the following:

An if you do that, then you well see that when the injury has affected only one of the nerves, that is, one of the two great nerves or the recurrent nerves, the animal now retains one half of its voice. But if the injury has affected both nerves then the animal becomes completely voiceless, except that there remains a certain rattling sound which is produced when it gasps.

Chapter XIV.7, Galen of Pergamon (1962)

Nor was this all. Galen provided the first recorded attempt at identifying and numbering the cranial nerves, demonstrating 11 of the 12 nerves. Unfortunately, by combining several, he arrived at a total of only seven. Galen discarded Hippocrates's notion that the brain is only a gland, and he claimed it was responsible for voluntary action, sensation, and the information carried through the spinal cord and out the nerves—a considerable conceptual advance for the time (Figure 1.3).

Figure 1.3 A collection of surgical instruments from the Roman period, including a series of scalpels, forceps, and various probes and dissectors. The coins in the center are Alexander the Great tetradrachms dating from the fourth century BC. From the author’s personal collection.

The Byzantine era (AD 324-1453) began in AD 324 with the seat of the Roman Empire moving to Constantinople under the governance of Constantine the Great (AD 272-337). The Byzantine era was a complex period for surgeons who were continuing to better define human anatomy using cadaveric dissections and trauma that occurred fro...