Epilepsy surgery at the MNI:. From Archibald to the creation of the Shirley and Mark Rayport fellowship in surgery of epilepsy

The thread of history of epilepsy surgery has been followed on numerous occasions (Feindel et al., 2009). Our purpose is to recall some aspects of the role played by the Montreal Neurological Institute (MNI) with emphasis on the period covering the last 30 years. The discovery of the primary motor area in the dog by Fritsch and Hitzig (1870), its confirmation in primate and its extrapolation to the human by Ferrier (1876) led Horsley (1886) to apply these discoveries to treat lateralized convulsions by central resections. By the time Fedor Krause published his extensive somatotopical map of the motor cortex (Krause, 1911), the precentral gyrus had long been recognized as the primary motor center (Sebileau, 1898). Cushing (1909) demonstrated in awake patients that the primary sensory area was located within the postcentral gyrus. Archibald (1908) working at McGill published a book on neurosurgery in 1908, which emphasized the status of cerebral localization. Recognized as Canada’s first neurosurgeon, he was the key person in eventually bringing Penfield to Montreal. In 1928 the center of epilepsy surgery was in Breslau, Germany, in the clinic of Otfried Foerster. Foerster himself had studied neurology with Jules Dejerine in Paris and Carl Wernicke in Germany, two neurologists–neuroanatomists interested in cerebral localization and speech mechanisms. He also kept a working relationship with the anatomists Oskar and Cecile Vogt, themselves very involved in cortical mapping. During World War I, Foerster became a surgeon and treated peripheral nerves and spinal cord injuries and eventually posttraumatic epilepsy. Surgery for epilepsy was carried out under local anesthesia and all operative findings were plotted over a modified Vogt map of cortical regions (Foerster, 1936a,b). Foerster was the first with Altenburger to perform direct electrograms from the surface of the exposed brain (Foerster & Altenburger, 1935). Prior to coming to Montreal in 1928, Penfield spent 6 months with Foerster in Breslau and carried out histologic studies on the posttraumatic scars resected at surgery, which led to publications on posttraumatic epilepsy (Foerster & Penfield, 1930; Penfield, 1930). Penfield brought Foerster’s concepts and techniques to Montreal and in his turn developed a systematic and global approach to the surgical treatment of epilepsy, strongly reinforced with the founding of the MNI in 1934. The arrival of Herbert Jasper in 1937 led to a most successful integration of basic and clinical approach in the study of epilepsy, which had a major worldwide impact. Among the numerous early MNI contributions a few can be mentioned: that of Penfield and Boldrey (1937) on sensorimotor representation illustrated with the famous homunculus, that of Penfield and Flanigin (1950) on the surgical therapy of temporal lobe seizures, and the seminal book by Penfield and Jasper (1954): Epilepsy and the Functional Anatomy of the Human Brain. Numerous fellows and surgeons came to the MNI and later went on to establish surgical epilepsy programs abroad among others. Ed Broldrey went to the University of San Francisco; T.C. Erickson to University of Wisconsin; Guy Odom and Blaine Nashold to Duke University; Jack Handberry to Stanford University; Arthur Ward to University of Washington; Kesley Welsh to Colorado and Harvard Universities; Maitland Baldwin and John Van Buren to National Institutes of Health (NIH); Mark Rayport to Albert Einstein and Ohio Medical College; Lamar Robert to University of Florida; and Herman Flanigin to Universities of Arkansas and Georgia. Theodore Rasmussen succeeded Penfield as the epilepsy surgeon and was largely responsible for maintaining the MNI at the forefront during the 25-year period spanning from the early 1960s to the mid-1980s. His surgical techniques were impeccable and his sense of organization astonishing. As recalled by Feindel (2003) in his 25 years (1955–1980) of active surgery at the MNI, Rasmussen Address correspondence to Andr Olivier, MD, PhD, Montreal Neurological Institute and Hospital, 3801 University street, Montreal, Quebec, Canada, H3A 2B4. E-mail: Andre.olivier@mcgill.ca