Statistics from Altmetric.com
The existence of neurosurgery as a scientific discipline, owes its emergence in large to surgeons themselves as well as to neurologists and psychiatrists who utilised the morphological approach. Among the lead contributors to nascent neurosurgery was the neuro-psychiatrist Gabriel Anton, who strongly influenced the development of this discipline during the first two decades of the 20th century. One of his most renowned scientific achievements was the Anton-von Bramannsche Balkenstich method of treating hydrocephalus. In collaboration with fellow surgeons Gustav von Bramann and Victor Schmieden, he proposed new clinical procedures for the treatment of hydrocephalus: the Balkenstich method and the suboccipital puncture.
The establishment of neurosurgery as an independent discipline within the broad field of medicine required a fundamental knowledge of the structure and function of the nervous system. The beginning of modern neurosurgery is strongly associated with names such as Victor Horsley (1857–1916) in England, and Harvey Cushing (1869–1939) and Percival Bailey (1892–1973) in the USA.
The pioneering German surgeon Ernst von Bergmann (1836–1907) insisted on the necessity of establishing a scientific base for neurosurgery. Above all other aspects of neuroanatomical knowledge, clinical practice required expertise in neurological diagnostic methodology. This necessity gave birth to an era of interdependent cooperation between surgeons and neurologists. An excellent example of this fruitful alliance can be found in the beginning of the 20th century at the University of Halle, where many advancements in the field of neurosurgery were coupled with the names of surgeons such as Fedor Krause (1857–1937) and Gustav von Bramann (1854–1913), as well as Gabriel Anton.
Gabriel Anton – life and scientific works1
Gabriel Anton was born on August 28, 1858 in Saaz (Bohemia). On completion of his medical education in Prague, he worked as an assistant to Arnold Pick. In 1887 he resigned his position in order to join Theodor Meynert (1833–1892) in Vienna. Meynert was a very important representative of neuroanatomy and neuropathology at this time.
In 1905 Anton received a full professorship in psychiatry at the University of Halle in Germany. He held the chair of psychiatry at the department of psychiatry until his Emeritus in 1926. Gabriel Anton passed away on January 3, 1933.
Anton’s initial inspiration for his scientific activities derived from the ideas of Arnold Pick (1851–1924) and Hans Chiari (1851–1916). His early scientific work dealt with anatomical examinations of brain structure and developmental disorders of the brain. In 1895 he described the neurological and psychological symptoms that result from high cerebral pressure. In certain cases he insisted on the importance of early operative procedures with trepanation for the release of cerebral pressure.2 His main focus of interest laid on problems arising from hydrocephalus and cerebral oedema. These workings formed the basis for his later theories that in turn impacted the field of neurosurgery.
Anton’s influence on brain surgery
Anton, in collaboration with the surgeon Gustav von Bramann, developed the Balkenstich method (callosal puncture)—an operational procedure that applies a form of ventricle drainage to reduce cerebral pressure.3 Anton proposed a puncture of the ventricle made through a direct path from the corpus callosum (ventriculopuncture) to allow drainage into the subarachnoid space without implant. Unlike previous methods that required repeated draining procedures, Anton’s drainage procedure took place only once. Thus, the Balkenstich method provided an understanding of cerebrospinal fluid (CSF) drainage and avoided the negative side effects accompanying the necessity to continually drain fluids from the brain. The Balkenstich method was primarily recommended to be applied to release pressure in case of hydrocephalus. In the following years the Balkenstich method was introduced in clinics around the world.
In 1917, a new cooperation with Bramann’s heir, Victor Schmieden (1874–1945), produced a second major surgical technique for releasing pressure on the brain, known as the suboccipital puncture.4 This procedure was the puncture of the membrane atlantooccipitalis resulting in a continuous drainage of CSF to the neck musculature.
In 1938 Arne Torkildsen (1899–1968) published his works on ventriculocisternostomy. This “Torkildsen shunt” proved to be very successful in the treatment of hydrocephalus and produced repeated, more permanent successes. The Balkenstich method was finally superseded by Torkildsen’s technique.