- College of Medical Sciences, Unifacisa University Center, Campina Grande, Paraíba,
- Neuroscience Post-Graduate Program, Federal University of Pernambuco, Recife, Pernambuco,
- Department of Neurology, Psychology and Psychiatry, State University of São Paulo, São Paulo,
- College of Medical Sciences, Federal University of Paraíba, João Pessoa, Paraíba,
- Department of Neurosurgery, São Paulo State University, São Paulo.
Luiz Severo Bem Junior, Neuroscience Post-Graduate Program, Federal University of Pernambuco, Recife, Pernambuco, Brazil.
DOI:10.25259/SNI_200_2021Copyright: © 2021 Surgical Neurology International This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
How to cite this article: Luiz Severo Bem Junior1,2, Nilson Batista Lemos1, Luís Felipe Gonçalves de Lima1, Artêmio José Araruna Dias1, Otávio da Cunha Ferreira Neto1, Carlos Cezar Sousa de Lira3, Andrey Maia Silva Diniz4, Nicollas Nunes Rabelo5, Luciana Karla Viana Barroso1, Marcelo Moraes Valença2, Hildo Rocha Cirne de Azevedo Filho2. The anatomy of the brain – learned over the centuries. 28-Jun-2021;12:319
How to cite this URL: Luiz Severo Bem Junior1,2, Nilson Batista Lemos1, Luís Felipe Gonçalves de Lima1, Artêmio José Araruna Dias1, Otávio da Cunha Ferreira Neto1, Carlos Cezar Sousa de Lira3, Andrey Maia Silva Diniz4, Nicollas Nunes Rabelo5, Luciana Karla Viana Barroso1, Marcelo Moraes Valença2, Hildo Rocha Cirne de Azevedo Filho2. The anatomy of the brain – learned over the centuries. 28-Jun-2021;12:319. Available from: https://surgicalneurologyint.com/?post_type=surgicalint_articles&p=10916
This article reports the evolution and consolidation of the knowledge of neuroanatomy through the analysis of its history. Thus, we propose to describe in a historical review to summarize the main theories and concepts that emerged throughout brain anatomy history and understand how the socio-historical context can reflect on the nature of scientific knowledge. Therefore, among the diverse scientists, anatomists, doctors, and philosophers who were part of this history, there was a strong influence of the studies of Claudius Galen (AD 129–210), Leonardo da Vinci (1452– 1519), Andreas Vesalius (1514–1564), Franciscus Sylvius (1614–1672), Luigi Rolando (1773–1831), Pierre Paul Broca (1824–1880), Carl Wernicke (1848–1905), Korbinian Brodmann (1868–1918), Wilder Penfield (1891–1976), Mahmut Gazi Yasargil (1925), and Albert Loren Rhoton Jr. (1932–2016) on the fundamentals of neuroanatomy.
Keywords: Anatomy, Brain, History of medicine, Neuroanatomy, Neurosurgery
At present, it is known that the brain has an anatomical and functional distribution due to the complexity of the organization of the cells. This division due to the cortex organization of highly compacted neurons that cover outermost part and make up the gray matter. In addition, according to recent studies, the cerebral cortex is divided into seven lobes: frontal, central, parietal, occipital, insular, temporal, and limbic.[
However, before we understand the current brain anatomical division, it is important to know the nature of scientific knowledge and how it was recorded in a socio-historical context. In antiquity, the search for knowledge of the brain anatomy was marked by several protagonists who, over the centuries, produced proposals to justify the clinical findings of the period and define the functioning of the organ. The purpose of this article is to report, through temporal progress, who are the main characters who guided the path to obtain knowledge of neuroanatomy and what are their theories [
The construction of these hypotheses, initially, was based on the observation of nature and suffered a lot of influence from the religion and beliefs of each civilization. This behavior in the elaboration of knowledge about the brain was first found in Egyptian medical papyri. In addition, through its famous mummification technique and its records, several scholars came to recognize the mastery of part of human anatomy by this ancient society.
In the 17th century BC, the Egyptians, through the treatment of individuals affected by head injuries, started to correlate the pattern of fractures of the skull bones with brain injuries.[
The brain’s intriguing machinery is something that fascinates many scholars worldwide. Its role in the control of the central and peripheral nervous system, despite having achieved great advances, begins to be discussed still in Classical Antiquity, since the Greeks gave greater importance to this organ, unlike the Egyptians. In ancient Greece, Alcmaeon of Croton (sixth-fifth century BC) recognizes the brain as a central organ responsible for higher activities such as intelligence, memory, and thought.[
The ventricles, in the center of the brain itself, are filled with cerebrospinal fluid, a fluid produced, in large part, by ependymal cells present in its walls, whose primary function is to provide mechanical protection to nervous tissue. Today, we know that the lateral ventricles contribute with a greater cerebrospinal fluid volume, which passes to the III ventricle through the interventricular foramina and from this to the IV ventricle through the midbrain aqueduct. Claudius Galen, through his extensive studies of the anatomy of the brain, formulated the hypothesis that the ventricles were the place of the intellect and the cornerstone of the human physiological system.[
During his dissections, Galen observed that exposure of the brain does not result in loss of sensation or movement.[
About 2 centuries after Galen’s death, Western culture came to live in the Dark Ages. During this period, the practice of dissecting human corpses was prohibited, leaving only access to the vestiges of the cultural collection of the Greeks and Arabs. The church, through its institutional and moral power, consolidated the influence of medieval patristic and scholastic philosophy on understanding the functioning of the brain and rekindled the search for the location of the soul.
MODERN AGE: LEONARDO DA VINCI AND ANDREAS VESALIUS – THE RENAISSANCE AND THE ARTISTIC REPRESENTATION OF THE BRAIN
In 1493, Leonardo da Vinci (1452–1519), trying to interpret the “Senso Comune,” was surprised to notice that a toad’s spinal cord injury was capable of causing instant death in the animal.[
The great increase in the quality of painting and the artistic description of the brain reflects how robust his understanding was in the 16th century. The relentless search to characterize this organ has led artists, philosophers, and scientists to dedicate a large part of their works to illustrative representation and to the written account of its anatomy. Among the most influential books published in this period, we can highlight the De Humani Corporis Fabrica by Vesalius. The rich detail of his images made by using the woodcut technique and the use of the best artists in their elaboration demonstrates how far the brain illustrations have evolved. Andreas Vesalius (1514–1564), challenging the ventricle-centered model, decides to portray the anatomy of the brain only by observing its physical form since historical knowledge about anatomy had been affected by theological thinking.[
The gyri and sulci of the brain are fascinating structures. Upon knowing that its formation results from the progressive increase of cortical tissue in a limited bone cavity show how important the development of these structures is for the elevation of the human encephalization coefficient, which holds the apex of the evolution of the nervous system and which presents about 86 billion neurons in the brain.[
Franciscus Sylvius, after gaining prominence in the teaching of anatomy in Dutch universities, came to exercise the position of rector of the University of Leiden and to be recognized as responsible for the elaboration of the iatrochemical theory of the body.[
In 1860, contradicting the idea that the arrangement of the cerebral cortex had no defined orientation, Luigi Rolando (1773–1831) detects, for the 1st time, the existence of a pattern in the convolutions of the brain.[
With the advances in neurophysiology and its efforts to try to understand the brain’s network of connections, several hypotheses and questions about its arrangement, function, and area of action arose in the 19th century. Many of these doubts are still frequent today, such as the classic dichotomy between the areas associated with language discovered by Broca and Wernick. This persistent questioning originates for the understanding of the complex connections among themselves, through the arched fascicle, and among other areas of the brain. To understand part of the elaboration of this current knowledge and what were the paths taken by the study of the functional division of the cortex, it is necessary to go back to how it all came about. The belief that the cerebral cortex was composed of functional units responsible for different psychic activities contributed to the rise of Franz Joseph Gall’s phrenology (1758–1828).[
In 1874, the German physician, Carl Wernicke (1848–1905), described, for the 1st time, the existence of the sensory center of speech.[
Although Carl Wernicke’s developed in the 19th century his publications, it is worth noting how similar his theories are to the contemporary view of neuroanatomy, such as the organization of the white medullary center in projection and association fibers. Following the analysis of the history of the study of neuroanatomy, we find the founder of anatomical mapping of the brain, Korbinian Brodmann (1868–1918). Born in the small city of Hohenfels in Germany, Brodmann went a long way until the publication, in 1909, of his first studies on the cytoarchitecture of the cortex.[
In the first half of the twentieth century, by observing the electrical stimulation of the brain, Wilder Penfield (1891– 1976) managed to represent the somatosensory area of different parts of the body in the central lobe cortex.[
To emphasize the importance of neuroanatomy for neurosurgical practice and the on-demand to overcome its macroscopic barrier might highlight how valuable the creation of the microscope was in the history of medicine.[
The importance of this article is based on the study of the main characters that guided the path toward consolidating the knowledge of neuroanatomy and what were their respective contributions. Through the study of the origin of scientific knowledge about the brain, it is possible to conclude that much of the knowledge of neuroanatomy in Classical Antiquity until the Modern Age had little progress. Moreover, it is from the second half of the 19th century that the understanding of the cortex is a view at a microscopic level and achieves a greater resemblance to the current view of neuroanatomy, reflecting the considerable significance of the publications of its main protagonists and its influence on the interpretation of cortex topography. From these advances in macroscopic anatomy and the use of the microscope, the use of microsurgery in brain structures and the development of new accesses and more sophisticated techniques begin. As a result of all this work, there has been a significant evolution in the way that neurosurgeons perform microsurgery. It is clear, from this historical study, how important it is to know about the origin of scientific knowledge and how it was generated and its socio-historical context to understand the origins of the anatomical and functional layout of the brain.
Patient’s consent not required as patients identity is not disclosed or compromised.
There are no conflicts of interest.
1. Araújo JLV, Lovato RM, Guirado VMP, Veiga JCE. The legacy of yasargil: The father of modern neurosurgery. J Neurosurg. 2010. 112: 1175
2. Bakkum BW. A historical lesson from Franciscus Sylvius and Jacobus Sylvius. J Chiropr Humanit. 2011. 18: 94-8
3. Caputi F, Spaziante R, de Divitiis E, Nashold BS. Luigi Rolando and his pioneering efforts to relate structure to function in the nervous system. J Neurosurg. 1995. 83: 933-7
4. da Gomes MM, Moscovici M, Engelhardt E. Andreas Vesalius as a renaissance innovative neuroanatomist: His 5th centenary of birth. Arq Neuropsiquiatr. 2015. 73: 155-8
5. Debernardi A, Sala E, D’Aliberti G, Talamonti G, Franchini AF, Collice M. Alcmaeon of croton. Neurosurgery. 2010. 66: 247-52
6. Del Maestro RF. Leonardo da Vinci: The search for the soul. J Neurosurg. 1998. 89: 874-87
7. Dronkers NF, Plaisant O, Iba-Zizen MT, Cabanis EA. Paul Broca’s historic cases: High resolution MR imaging of the brains of Leborgne and Lelong. Brain. 2007. 130: 1432-41
8. Figueiredo EG, Tavares WM, Rhoton AL, de Oliveira E. Nuances and technique of the pretemporal transcavernous approach to treat low-lying basilar artery aneurysms. Neurosurg Rev. 2010. 33: 129-35
9. Friedrich P, Anderson C, Schmitz J, Schlüter C, Lor S, Stacho M. Fundamental or forgotten? Is Pierre Paul Broca still relevant in modern neuroscience?. Laterality. 2019. 24: 125-38
10. Gage NY, Hickok G. Multiregional cell assemblies, temporal binding and the representation of conceptual knowledge in cortex: A modern theory by a “classical” neurologist, carl wernicke. Cortex. 2005. 41: 823-32
11. Herculano-Houzel S. The human brain in numbers: A linearly scaled-up primate brain. Front Hum Neurosci. 2009. 3: 1-11
12. Kamp M, Tahsim-Oglou Y, Steiger HJ, Hänggi D. Traumatic brain injuries in the ancient Egypt: Insights from the Edwin Smith Papyrus. Cent Eur Neurosurg. 2012. 73: 230-7
13. Lanczik M, Keil G. Carl Wernicke’s localization theory and its significance for the development of scientific psychiatry. Hist Psychiatry. 1991. 2: 171-80
14. Loukas M, Pennell C, Groat C, Tubbs RS, Cohen-Gadol AA, Korbinian Brodmann. (1868-1918) and his contributions to mapping the cerebral cortex. Neurosurgery. 2011. 68: 6-11
15. Markatos K, Chytas D, Tsakotos G, Karamanou M, Piagkou M, Mazarakis A. Andreas Vesalius of Brussels (1514-1564): his contribution to the field of functional neuroanatomy and the criticism to his predecessors. Acta Chir Belg. 2020. 120: 437-41
16. Matsushima T, Matsushima K, Kobayashi S, Lister JR, Morcos JJ. The microneurosurgical anatomy legacy of Albert L. Rhoton Jr. MD: An analysis of transition and evolution over 50 years. J Neurosurg. 2018. 129: 1331-41
17. Morishita T, Miki K, Inoue T. Penfield homunculus and recent advances in brain mapping. World Neurosurg. 2020. 134: 515-7
18. Nanda A, Khan IS, Apuzzo ML. Renaissance neurosurgery: Italy’s iconic contributions. World Neurosurg. 2016. 87: 647-55
19. Opp G. Historical roots of the field of learning disabilities. J Learn Disabil. 1994. 27: 10-9
20. Pearce JM. Broca’s aphasiacs. Eur Neurol. 2009. 61: 183-9
21. Pevsner J. Leonardo da Vinci’s studies of the brain. Lancet. 2019. 393: 1465-72
22. Ribas GC. The cerebral sulci and gyri. Neurosurg Focus. 2010. 28: E2
23. Rocca J. Galen and the ventricular system. J Hist Neurosci. 1997. 6: 227-39
24. Rose FC. Cerebral localization in antiquity. J Hist Neurosci. 2009. 18: 239-47
25. Sammet K, Luigi Rolando. (1773-1831). J Neurol. 2007. 254: 404-5
26. Snyder PJ, Whitaker HA. Neurologic heuristics and artistic whimsy: The cerebral cartography of wilder penfield. J Hist Neurosci. 2013. 22: 277-91
27. Strotzer M. One century of brain mapping using Brodmann areas. Clin Neuroradiol. 2009. 19: 179-86
28. Tubbs RS, Linganna S, Loukas M, Franciscus Sylvius. (1614-1672): A historical review. Child’s Nerv Syst. 2006. 23: 1-2
29. Van Gijn J, Franciscus Sylvius. (1614-1672). J Neurol. 2001. 248: 915-6
30. Vargas A, López M, Lillo C, Vargas MJ. El papiro de Edwin Smith y su trascendencia médica y odontológica. Rev Med Chil. 2012. 140: 1357-62
31. Viale GL, Pau A, Sehrbundt E, Turtas S. The subchoroidal approach to the third ventricle: Surgical anatomy according to Galen. Neurosurgery. 2001. 49: 986-91
32. Walker AE.editors. A History of Neurological Surgery. New York: Hafner; 1967. p.
33. Wills A. Herophilus, Erasistratus, and the birth of neuroscience. Lancet. 1999. 354: 1719-20
34. Yagmurlu K, Safavi-Abbasi S, Belykh E, Kalani MY, Nakaji P, Rhoton AL. Quantitative anatomical analysis and clinical experience with mini-pterional and mini-orbitozygomatic approaches for intracranial aneurysm surgery. J Neurosurg. 2017. 127: 646-59
35. Yasargil MG. A legacy of microneurosurgery: Memoirs, lessons, and axioms. Neurosurgery. 1999. 45: 1025-92
36. Zilles K, Amunts K. Centenary of Brodmann’s map conception and fate. Nat Rev Neurosci. 2010. 11: 139-45
37. Zilles K. Brodmann: A pioneer of human brain mapping his impact on concepts of cortical organization. Brain. 2018. 141: 3262-78