History of the Stereotactic Societies

Abstract

The field of human stereotactic neurosurgery was born in 1947 when Spiegel and Wycis (Figure 2-1 ) published their groundbreaking manuscript in Science [1]. In this article they describe their device, which was actually a animal apparatus suspended on the patient’s head with a plaster cap. The original Horsley-Clarke animal stereotaxic (which was the original spelling) apparatus that had been used in the laboratory was aligned with the skull by means of earplugs and orbital tabs, and the target was defined by its relationship to those bony landmarks [2]. However, there was too much variability between the boney landmarks and the human brain to use this system clinically. It was only possible when intraoperative encephalographic x-rays became available in the 1940s, that it became possible to align the human apparatus with internal cerebral landmarks. Because their human system was based on encephalographic landmarks, Spiegel and Wycis termed their procedure “stereoencephalotomy.”

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The field of human stereotactic neurosurgery was born in 1947 when Spiegel and Wycis (Figure 2-1 ) published their groundbreaking manuscript in Science [1]. In this article they describe their device, which was actually a animal apparatus suspended on the patient’s head with a plaster cap. The original Horsley-Clarke animal stereotaxic (which was the original spelling) apparatus that had been used in the laboratory was aligned with the skull by means of earplugs and orbital tabs, and the target was defined by its relationship to those bony landmarks [2]. However, there was too much variability between the boney landmarks and the human brain to use this system clinically. It was only possible when intraoperative encephalographic x-rays became available in the 1940s, that it became possible to align the human apparatus with internal cerebral landmarks. Because their human system was based on encephalographic landmarks, Spiegel and Wycis termed their procedure “stereoencephalotomy.”

Figure 2-1

Spiegel and Wycis

During the next decade, neurosurgeons who were interested in learning this new technique visited Spiegel and Wycis in Philadelphia, and later at each other’s institutions. Since there were no commercially available stereotactic apparatus, they first had to design and build their own device when they returned home before they could use this new procedure. The pioneer stereotactic neurosurgeons exchanged information informally and personally. They met in small groups at irregular times, usually at each other’s institutions.

The International Society for Research in Stereoencephalotomy

Periodically, the growing number of stereotactic neurosurgeons met more formally. Many of the early meetings were hosted by Ernest A. Spiegel and Henry T. Wycis at Temple Medical School in Philadelphia. In 1961, at one of their meetings, they attempted to provide a more formal venue for the exchange of stereotactic information and experience and founded the first stereotactic society, which was called the International Society for Research in Stereoencephalotomy, a term that never really caught on. When only the American members met, the meeting was designated as the American Branch of the International Society for Research in Stereoencephalotomy, and when European members met as the European Branch. They met as groups at approximately two year intervals (reference). Consequently, when the International Society for Research in Stereoencephalotomy met in 1963 in Philadelphia at what was designated the First International Symposium on Stereoencephalotomy, the society was formally chartered (Table 2-1 ).

Table 2-1 History of the Stereotactic Societies

The Second International Symposium on Stereoencephalotomy was held in 1965, partly in Copenhagen and partly in Vienna, the latter coincident with the Meeting of the World Federation of Neurosurgical Societies (WFNS) (Table 2-2 ). The Third Symposium on Stereoencephalotomy took place in 1967 in Madrid, hosted by Sixto Obrador.

Table 2-2 Meetings of the WSSFN

The first formal independent meeting of the American Branch of the International Society for Research in Stereoencephalotomy met in Atlantic City, New Jersey, in 1968. It focused mainly on Parkinson’s disease, and was the last meeting to do so, since the field became quiescent after L-dopa was introduced in 1968 [3]. Although the meetings were relatively small, advances in pain management, epilepsy, and other movement disorders were exchanged. The core of dedicated stereotactic neurosurgeons remained interested and active in the field, which led to the Fourth International Symposium on Stereoencephalotomy in 1969 in New York, along with the meeting of the World Federation of Neurosurgical Societies (WFNS). In 1970 the Fifth International Symposium on Stereoencephalotomy was held in Freiburg, Germany, hosted by Traugott Riechert, which is also recognized as the founding and the first meeting of the ESSFN. At that time[4], both the American and European branches were considered components of the International Society.

The World Society for Stereotactic and Functional Neurosurgery

It was well into the early 1970s before activity began to increase once again, which led also to organizational changes. At the Sixth Symposium of the International Society for Research in Stereoencephalotomy in Tokyo in 1973, hosted by Hirotaro Narabayashi, the name of the international organization was changed to the World Society for Stereotactic and Functional Neurosurgery (WSSFN) (Figure 2-2 ). The American branch became the American Society for Stereotactic and Functional Neurosurgery (ASSFN), and the European branch became the European Society for Stereotactic and Functional Neurosurgery (ESSFN) (Figure 2-3 ).

Figure 2-2

Logo of both the WSSFN and the ASSFN

Figure 2-3

Logo of the ESSFN

This caused an interesting dilemma. Horsley and Clarke designated their new technique as “stereotaxic,” as did many of the neurosurgeons involved in this new field. However, some neurosurgeons, particularly in Europe, spelled the term “stereotactic” [4]. There needed to be consensus on how to spell the names of these new societies. A vote was taken, and “stereotactic” won, even though it was a mongrel term with “stereo,” meaning three dimensional, derived from Greek and “tactic,” meaning to touch, derived from Latin. The original term “stereotaxic” had been derived from two Greek words, “stereo” and “taxic,” meaning an arrangement. It was felt to reflect what stereotactic surgery did to use the term “to touch” rather than just to observe.

The first meeting of the WSSFN was actually the reorganizational meeting held in Tokyo in 1973 and hosted by Hirotoro Narabayashi. At that meeting it was decided that the WSSFN would meet each time just prior to the meeting of the World Federation of Neurological Societies (WFNS) that met every 4 years. Since the WFNS alternated the location of the meetings from one continent to another, it became customary for the WSSFN to meet somewhere near the WFNS so members might attend both meetings with a minimum of travel, but yet in a separate venue.

The WSSFN met every 4 years, with the next meeting held in 1977 in Saõ Paulo, Brazil, hosted by Raul Marino [5]. However, advances in the field occurred ever more rapidly, so each of the continental societies met during the intervening years. Each four year cycle began with the WSSFN meeting, then the ESSFN the following year, the ASSFN the next year, and the ESSFN the next year again. With that schedule, the ESSFN Meetings were held at 2 year intervals the first and third year of the cycle, whereas the WSSFN and ASSFN each met once every 4 years. Because there was more new information than could be provided to the members every 4 years, during the past 4 years the ASSFN also began to meet at 2 year intervals coincident with the years the ESSFN meets.

The atmosphere at each of the meetings has been fraternal and informal, and the gathering of international stereotacticians maintained a feeling of collegiality. A perusal of the topics at each of the meetings of the WSSFN and the ASSFN has served as a good indicator of what basic and clinical advances were made and what procedures and technology in stereotactic and functional neurosurgery were developed. The Proceedings of each of the meetings was published as complete issues of volumes of the official journal, Stereotactic and Functional Neurosurgery from 1968 through 2001.

When the Eighth Meeting of the WSSFN in Zurich in 1981 was hosted by Jean Siegfried [6], the ESSFN declared that it was a joint meeting between the ESSFN and the WSSFN, and the ESSFN was not a component society of the WSSFN, but rather an independent society.

The Ninth Meeting of the WSSFN was held in Toronto in 1985, with Ronald Tasker [7] as host. The Tenth Meeting of the WSSFN was held in Maebashi, Japan, in 1989 with Chihiro Ohye [8] as host. The Eleventh Meeting of the WSSFN was held in Ixtapa, Mexico, in 1993, with Philip L. Gildenberg [9] as the host (Figure 2-4 ).

Figure 2-4

Presidents of the WSSFN prior to 1993, when this picture was taken. Gildenberg, Nashold, Tasker, Narabayashi, Siegfried, Ohye, and Gybels

The 1997 the Twelfth Meeting of the WSSFN was held in Lyon, France, with Marc Sindou [10] as the host. It was by far the largest meeting and included many European neurologists and many local neurosurgeons. Deep brain stimulation for movement disorders was advancing rapidly, as was reflected in the program.

The Thirteenth Meeting of the WSSFN was held in Adelaide, Australia, in 2001, hosted by Brian Brophy, and became a memorable meeting for an unrelated event. It was during that meeting that the terrorist attack on the World Trade Center occurred in New York. In addition to concerns about being far from family, all flights to the United States were canceled, both stranding attendees from returning to the US and preventing US neurosurgeons from attending the meeting of the World Federation of Neurosurgical Societies in Sydney immediately following the WSSFN Meeting. Many of the WSSFN speakers found themselves filling in for neurosurgeons who were unable to travel to speak at the WFNS in Sydney.

The most recent WSSFN Meeting was held in Rome in 2005 and hosted by Mario Meglio. The 2009 meeting will be hosted by the current President, Andres Lozano, in Toronto. Additional updated information may be obtained on the WSSFN web site at www.wssfn.org.

At each international symposium from 1977 to 1985, (see Table 2-3 ) the WSSFN has presented an award to an outstanding stereotactic neurosurgeon. At the presentation of the first award, it was named the Spiegel-Wycis Award, and a gold medal was made by Prof. Manuel Velasco-Suarez to be presented to Lars Leksell (Table 2-4 ). In 1981 the award was presented to Traugott Riechert. It was felt that there were too many potential recipients for only one award to be given every 4 years, so in 1985 a gold award was presented to Jean Talairach and a silver award to Manuel Velasco Suarez. Since there was little distinction between the requirements for the gold and silver awards, two identical gold awards have been presented since 1989.

Table 2-3 Meetings of the ASSFN

Table 2-4 Past Recipients of the Spiegel-Wycis Award

In July, 2006, the WSSFN sponsored and organized for the first time an interim meeting in Shanghai, China, which was hosted by Bomin Sun from the Shanghai Jiao Tong University, Rui Jin Hospital. The meeting covered surgical treatment for movement disorders, pain, psychiatric disease, and epilepsy. Andres M. Lozano was the meeting chairman, and Drs. Benabid, Kaplit, Krauss, Schulder, Taira, Delong, Chang, Aziz, Broggi, Sun and Zhang were among those who gave the 36 plenary lectures. It was the first time that a WSSFN meeting was held on mainland Asia. The meeting coincided with a satellite symposium on functional neurosurgery in China. Overall 250 attendees from mainland China, Taiwan and Hong Kong joined WSSFN members from 15 other countries throughout the world. The event was considered a tremendous success by those who attended.

The American Society for Stereotactic and Functional Neurosurgery

The first separate meeting of the ASSFN was held in Houston in 1980 and hosted by Philip L. Gildenberg [11]. The 27 papers included basic neurophysiology, movement disorders, epilepsy and pain. The meeting attracted an international audience, which has been the hallmark of all of both the continental and the world stereotactic society meetings. It is interesting that even at that early date, 11 papers concerned the use of the newly developing use of computers in neurosurgical guidance, both for addressing functional targets and in the new field of image-guided neurosurgery.

The next independent ASSFN meeting took place in Durham, North Carolina, in 1983, with Blaine Nashold [12] as the host, as the field showed signs of increased activity and reawakening. New technology was of greatest interest, and half of the papers concerned image guidance as it impacted brain tumor management.

The 1987 meeting in Montreal, which was hosted by André Olivier, was the largest ASSFN meeting up to that time. Out of the 103 papers, 14 concerned the rapidly developing field of stereotactic radiosurgery and 41 concerned the use of computers in neurosurgery. Functional neurosurgery showed signs of significant awakening, as represented by 36 presentations.

The 1991 meeting in Pittsburgh was hostedby L. Dade Lunsford [13], and represented another milestone. The stereotactic surgery meeting was followed by a two day meeting on stereotactic radiosurgery, which attracted non-neurosurgical colleagues in radiation physics and radiotherapy, as well as those stereotactic neurosurgeons who were using the Gamma Knife, the only stereotactic radiosurgical system available at that time. It was at that satellite meeting that the International Society for Stereotactic Radiosurgery was formed. In addition, this large meeting involved such new fields as tissue transplantation. It was also at that meeting that Lauri Laitinen [14,15] first presented his observations on ventroposterior pallidotomy, which signaled the return of Parkinson’s disease surgery to the functional neurosurgery arena.

The ASSFN meeting was held in Los Angeles and hosted by Michael Apuzzo and David Roberts in 1995 [16,17]. Half of the papers were about classical functional neurosurgical topics of movement disorders, epilepsy and pain. There were eight papers about stereotactic radiosurgery and the rest about image guided surgery and brain tumor management.

The 1999 ASSFN meeting was held in Snowbird, Utah, and hosted by Peter Heilbrun and Douglas Kondziolka. Two-thirds of the 55 papers were in functional neurosurgery, with emphasis on movement disorders, epilepsy, and pain. The rest were divided among imaging and computer guidance, stereotactic radiosurgery, and brain tumors.

In 2003, the ASSFN met in New York, and was hosted by Patrick Kelly. The program demonstrated the increasing use of computers in stereotactic and image guided surgery. Prior to that meeting, the FDA had provided approval of chronic deep brain stimulation, and much of the data related to that was presented.

The meeting in 2006 was held in Boston and hosted by G. Rees Cosgrove. There was a significant shift toward interest in functional neurosurgery, involving both DBS and extending to epilepsy surgery.

The current administrative structure includes officers elected for a term of 4 years, a board of directors and five Continental Vice Presidents. During the period from 2005 – 2009 the ESSFN leadership is represented by Andres M. Lozano (Toronto, Canada) as President, Joachim K. Krauss (Hannover, Germany) as Vice-President, Takaomi Taira (Tokyo, Japan) as Secretary-Treasurer, Michael Schulder (Newark, USA) as Assistant Secretary-Treasurer, and Philip L. Gildenberg (Houston, USA) as Historian. Honorary members include Blaine Nashold, Jean Siegfried, Ronald Tasker, Chihiro Ohye and Philip L. Gildenberg.

Prior to 1975, there was no formal arrangement between the ASSFN and the American Association of Neurological Surgeons (AANS), although it was customary to have a representative of stereotactic surgery on the AANS program committee. In 1975, due to the efforts of then ASSFN President John Van Buren, the ASSFN amalgamated with the AANS and became the Section for Stereotactic and Functional Neurosurgery. This arrangement put the responsibility for the program of one and later two afternoon sessions in the hands of the ASSFN officers. In addition, members of the ASSFN automatically became members of the AANS Section of Stereotactic and Functional Neurosurgery. The ASSFN treasury, however, remained independent of the AANS, which provided the opportunity for the ASSFN to hold independent meetings every 4 years. The business meeting of the ASSFN is held at the conclusion of one of the days when the stereotactic scientific program is held. Since 2004, the annual residents’ research award, which has been named the Gildenberg Award, has been presented at one of the Stereotactic Sections programs.

In 1984, a similar administrative arrangement was made between the ASSFN and the Congress of Neurological Surgeons (CNS). The amalgamation was facilitated by the presence of the ASSFN President, George Sypert, on the CNS Board of Directors at that time.

Current details of the ASSFN can be found on the web site at www.assfn.org.

The European Society for Stereotactic and Functional Neurosurgery

The formation of the European Society for Stereotactic and Functional Neurosurgery (ESSFN) dates back as far as 1970 when the International Society for Research in Stereoencephalotomy met in Freiburg, Germany. The founding fathers at that time were Fritz Mundinger, Traugott Riechert and John Gillingham, and this meeting now is also considered as the founding meeting of the ESSFN. The society was registered as a tax-exempted society in Freiburg, Germany, in 1971. It was founded primarily in order to represent the interests of European functional neurosurgeons and also to enhance communication and exchange between European countries. At that time, the European idea was blossoming, but it took still several years until traveling from one European country to the other was as comfortable as it is nowadays. The judicial seat of the society was moved to Toulouse, France, in 2002. Initially, the ESSFN had a relatively isolated position in the general neurosurgical community. With the rapid development of new imaging techniques and computer technology, however, stereotactic concepts and methods had a profound impact on the progress of European neurosurgery, in general. The ESSFN over the decades thus served both the interests of those who were subspecialized in functional and stereotactic neurosurgery and those whose activities were embedded in general neurosurgery.

The ESSFN has stated its principal objectives in a mission which is displayed on the ESSFN web site (www.essfn.org). Also, its Constitution and By-Laws are displayed on the web site. The logo of the ESSFN became popular during the 1990s (Figure 2-3 ). The board of officers is elected for a term of 4 years by the General Assembly which comes together during the congresses. It is supported by an Executive Committee which has representatives from 20 different European countries. During the period from 2006 – 2010 the ESSFN leadership is represented by Yves Lazorthes (Toulouse, France) as President, Giovanni Broggi (Milano, Italy) as Vice-President, Joachim K. Krauss (Hannover, Germany) as Secretary, Damianos Sakas (Athens, Greece) as Second Secretary, and Bart Nuttin (Leuven, Belgium) as Treasurer. The honorary presidents are the former ESSFN presidents F. John Gillingham, Fritz Mundinger, Gian Franco Rossi, Björn Meyerson, Christoph B. Ostertag, David G. T. Thomas, and Andries Bosch.

There are five different categories of membership: active, associate, resident, honorary and benefactor. Membership has increased steadily over the years, and in early 2008 there were more than 230 members. The majority of members come from France, Germany, Italy, Spain, The Netherlands, and the UK. There are members, however, from almost all European countries with increasing numbers in particular from Eastern European countries and Russia. Overall, the society has about 30 non-European members coming mainly from South Korea, Japan, Mexico and the United States.

Since its inception in 1970, the ESSFN organized congresses at regular intervals in various locations all over Europe (Table 2-5 ). While the first meeting was still under the umbrella of the International Society for Research in Stereoencephalotomy, the subsequent congresses were proper ESSFN congresses. The 1981 congress in Zürich was considered a joint meeting of both the WSSFN and the ESSFN. While attendance was limited in the early years to those who practiced in a subspeciality frame, the scope of topics in recent years became much broader attracting also many neurosurgeons not devoted exclusively to functional neurosurgery. During the congress, awards are available for best oral presentations by young neurosurgeons and also prizes for best posters. The ESSFN also provides grants for research in stereotactic and functional neurosurgery considering both basic and clinical research. The grant recipients will report at the congresses about their results.

Table 2-5 Congresses of the ESSFN

In the years between the congresses the ESSFN administers hands-on courses which are open to ESSFN members or those who wish to apply for membership. The purpose of these courses is to provide education and training in functional and stereotactic techniques. The first course was given in 2003 (Tolochenaz, Switzerland) on movement disorders surgery, followed by courses on pain surgery (Toulouse, France) in 2005, and on radiosurgery (Marseilles, France) in 2007. The topics for future courses will be adapted to include new horizons, but also to provide in-depth teaching about common standards.

The web site has become an important medium to keep the membership posted with updated information. Application forms for membership can be downloaded from the web site. Furthermore, members are supplied with a Newsletter that is distributed about yearly detailing new developments and announcements for grants and courses.

There are many close institutional and personal links between the ESSFN and the other societies for stereotactic and functional neurosurgery, in particular to the WSSFN. Nevertheless, there is no such a formal affiliation between the ESSFN and the WSSFN as it has been established between the ASSFN and the WSSFN. The ESSFN also communicates with the national functional neurosurgery societies which have been established in almost all European countries. In addition, a subcommittee of the ESSFN cooperates with the UEMS (Union Europeene des Medecines Specialistes) to establish more uniform guidelines and standards for stereotactic and functional neurosurgery for all European countries.

Other International Stereotactic Surgical Societies

In addition to the time-honored European and American functional neurosurgery societies, there are other international societies that organize meetings to enhance regional information exchange. The Sociedad Latinoamericana de Neurocirugia Funcional y Estereotaxia (SLANFE) is active since 1998 and covers the interests of functional neurosurgeons in Latin America. The Asian Society for Stereotactic, Functional and Computer Assisted Neurosurgery (ASSFCN) convenes meetings in Asia. In addition, several countries maintain their own Society for Stereotactic and Functional Neurosurgery, in order to accommodate their junior neurosurgeons who may not speak English or have funds to travel to the international meetings, such as Japan, Korea, Argentina, and China.