The Birth of Stereotactic Surgery: A Personal Retrospective Philip L. Gildenberg, MD ’59, PhD ’70
The field of human stereotactic surgery was born at Temple University School of Medicine, and I had the great fortune working with its parents, Professors Ernst A. Spiegel, MD, and Henry T. Wycis, MD ’37. As a freshman medical student looking for a summer research project in 1956, I wandered into Dr. Spiegel’s laboratory—and ended up working with Drs. Spiegel and Wycis for the next 13 years. Dr. Spiegel accepted a post as professor and head of experimental neurology at Temple in 1933 at the invitation of Dean William Parkinson. He had graduated from the University of Vienna in 1918 and had been on target for a sterling academic
Philip L. Gildenberg
career in Austria until the Nazis took hold. The same year that Dr. Spiegel came to Temple, Henry Wycis entered Temple Medical School, later graduating first in his class. He completed his neurosurgery residency with Dr. Spiegel and accepted a faculty position. Both he and Dr. Spiegel remained at Temple, maintaining a remarkably productive collaboration.
FROM PRINCIPLE TO PRACTICAL
FPO FPO Henry T. Wycis was huge, gregarious, and boisterous. He loved horse racing and gambling and socialized with the politically prominent in Philadelphia. Dr.Wycis was a brilliant student but was not sufficiently challenged by his medical school studies. He spent so much time working in Dr. Spiegel’s laboratory, among other things, that he had the distinction of missing more classes than any other student. Nevertheless, he graduated first in his class, with a record that stood for many years thereafter.
Ernst A. Spiegel was small and slight, and spoke with a thick German accent. He was quiet, serious, and introspective, but he had a sly, subtle sense of humor. He was the consummate academician and spoke seven languages. Dr. Spiegel’s laboratory reflected his personality: every inch was packed with specimens, equipment, and piles of electroencephalographic paper. In all the time I spent there, I do not recall ever seeing anything thrown away.
The birth of human stereotactic surgery took place in 1947, nine years before my fortuitous encounter with Drs. Spiegel and Wycis, with the publication of a brief article in the journal Science by Spiegel, Wycis, Marks, and Lee. The article described an apparatus used to make lesions in the dorsomedial nucleus of the thalamus. The apparatus was a modification of one devised by Horsley and Clarke 40 years earlier for animal experimentation. The procedure enabled by the apparatus proved the principle of stereotactic surgery and opened the door to the practical surgical management of movement disorders as well as pain, epilepsy, and psychiatric illness. Although Drs. Spiegel and Wycis’s original apparatus was quickly abandoned (as were Models II, III, and IV), Model V, introduced in 1956, was used throughout the remainder of the esteemed doctors’ careers. This apparatus was attached with four screws countersunk into the cranium. Removable posts were secured to the screws and emerged through the scalp. The four adjustable legs of the apparatus were attached to the posts so the apparatus could be removed and repositioned accurately. This was important in the early years when it was necessary to use pneumoencephalography for radiographic visualization. A patient was brought to the operating room, and the screws continued on next page
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