Commentary: La Pitié-Salpêtrière Hospital in Paris: the Historic Cradle of Neurosurgery

Commentary: La Pitié-Salpêtrière Hospital in Paris: the Historic Cradle of Neurosurgery The Pitié-Salpêtrière University Hospital results from the unification of La Pitié Hospital, founded in 1612, and La Salpêtrière Hospital, founded in 1656. Located in the southeast part of Paris (France), the hospital occupies an area of 33 hectares (Figures 1 and 2). FIGURE 1. View largeDownload slide Aerial view displaying La Pitié-Salpêtrière University Hospital (2017). Image used with permission from the Service de Neurochirurgie, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris. All rights reserved. FIGURE 1. View largeDownload slide Aerial view displaying La Pitié-Salpêtrière University Hospital (2017). Image used with permission from the Service de Neurochirurgie, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris. All rights reserved. FIGURE 2. View largeDownload slide Current view of the historical entrance of La Salpêtrière Hospital (2017). The Saint-Louis chapel appears in the background. Image used with permission from the Service de Neurochirurgie, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris. All rights reserved. FIGURE 2. View largeDownload slide Current view of the historical entrance of La Salpêtrière Hospital (2017). The Saint-Louis chapel appears in the background. Image used with permission from the Service de Neurochirurgie, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris. All rights reserved. HISTORY OF LA PITIÉ-SALPÊTRIÈRE HOSPITAL The construction of La Pitié-Salpêtrière Hospital is strongly linked with French history. In 1612, Marie de Médicis, Queen of France, founded La Pitié Hospital, intended for enclosing the poor people of the city. For 2 centuries, La Pitié was more of a detention center than a place of care. The 19th century was marked by the progressive medicalization of La Pitié hospice. The early 20th century brought a dramatic transformation that revolutionized the structure of La Pitié, through the complete reconstruction of all buildings to form a hospital complex (Figure 3). FIGURE 3. View largeDownload slide La Pitié Hospital at the beginning of the 20th century. Image used with permission from the Service de Neurochirurgie, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris. All rights reserved. FIGURE 3. View largeDownload slide La Pitié Hospital at the beginning of the 20th century. Image used with permission from the Service de Neurochirurgie, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris. All rights reserved. Additionally, in 1656, Mazarin, the Prime Minister of Louis XIV, turned an old arsenal into a hospice to take care of mendicants. Therefore, La Salpêtrière Hospital owes its name to the fact that it was originally a saltpeter and gunpowder store in the 16th century.1 Louis XIV’s architect Le Vau designed the plans for the Saint-Louis chapel (Figures 1 and 2), which was completed by Bruant, the architect of the Paris National Residence of the Invalids. During the 17th and 18th centuries, 8000 indigent women were housed at La Salpêtrière, which was the largest hospice in Europe (Figure 4).2,3 Prostitutes, disabled people, and epileptics were progressively included in this population. This inspired stories and legends reported by French and international literatures. Thus, the courtesan Manon Lescaut was deported from La Salpêtrière to Louisiana, in the masterwork eponymous novel written by Abbé Prévost (1753), which was set to music by Jules Massenet and Giacomo Puccini in 2 famous operas. In the 19th century, psychiatry was the most important specialty until the arrival of Jean-Martin Charcot in 1862. Charcot (Figure 5), one of the pioneers of neurology,4 applied the anatomoclinical method and described several neurological diseases, including amyotrophic lateral sclerosis and multiple sclerosis.5-7 He also studied hysteria from the 1870s onwards.8 Charcot's lectures on hysteria at La Salpêtrière Hospital were attended not only by many famous physicians such as Sigmund Freud, but also politicians, painters, architects, and intellectuals.5 Finally, Charcot was the first professor of neurology at La Salpêtrière Hospital in 1882. The hospital then became known as a reference center in neurology. Between 1850 and today, many famous neurologists from La Salpêtrière Hospital played a major role in developing and shaping the entire field of normal and pathological neurology.7 In addition to developing influential concepts, these pioneering neurologists made important contributions to major scientific issues. The neurological tradition of the Salpêtrière school persists today. In the 20th century, all medical and surgical specialties were established in La Salpêtrière Hospital, which became a general hospital modeled after La Pitié Hospital. During World War II, while the German army requisitioned La Pitié Hospital, La Salpêtrière Hospital was a major place of French Resistance. FIGURE 4. View largeDownload slide La Salpêtrière Hospital at the beginning of the 18th century. Drawing by C. Reiss, courtesy of Musée de l’Assistance publique – Hôpitaux de Paris. All rights reserved. FIGURE 4. View largeDownload slide La Salpêtrière Hospital at the beginning of the 18th century. Drawing by C. Reiss, courtesy of Musée de l’Assistance publique – Hôpitaux de Paris. All rights reserved. FIGURE 5. View largeDownload slide Emblematic figures of the development of neurosurgery at La Pitié-Salpêtrière Hospital. A, Jean-Martin Charcot (1825-1893). B, Pierre Marie (1853-1940). C, Antony Chipault (1866-1920). D, Joseph Babinski (1857-1932). E, Clovis Vincent (1879-1947). F, Thierry de Martel (1876-1940). G, Marcel David (1898-1986). H, Daniel Petit-Dutaillis (1889-1968). I, Bernard Pertuiset (1920-2000). J, Denis Fohanno. K, Georges Guillain (1876-1961). L, Jean-Marie Guillaume (1903-1959). M, Jacques Philippon. N, Rémy Van Effenterre. O, Philippe Cornu. P, Alexandre Carpentier. Image used with permission from the Service de Neurochirurgie, Hôpital de la Pitiè-Salpêtrière, Assistance Publique-Hôpitaux de Paris. All rights reserved. FIGURE 5. View largeDownload slide Emblematic figures of the development of neurosurgery at La Pitié-Salpêtrière Hospital. A, Jean-Martin Charcot (1825-1893). B, Pierre Marie (1853-1940). C, Antony Chipault (1866-1920). D, Joseph Babinski (1857-1932). E, Clovis Vincent (1879-1947). F, Thierry de Martel (1876-1940). G, Marcel David (1898-1986). H, Daniel Petit-Dutaillis (1889-1968). I, Bernard Pertuiset (1920-2000). J, Denis Fohanno. K, Georges Guillain (1876-1961). L, Jean-Marie Guillaume (1903-1959). M, Jacques Philippon. N, Rémy Van Effenterre. O, Philippe Cornu. P, Alexandre Carpentier. Image used with permission from the Service de Neurochirurgie, Hôpital de la Pitiè-Salpêtrière, Assistance Publique-Hôpitaux de Paris. All rights reserved. The Saint-Louis chapel and some of the buildings of La Pitié and La Salpêtrière have been classified as historic monuments since 1927. Luckily, the hospital has been spared from bombings and destruction during both World Wars. The Pitié-Salpêtrière University Hospital, administratively unified in 1964, has approximately 2000 beds within its 77 clinical and medicotechnical departments, covering all fields of medicine and surgery for adult patients. With 170 000 hospitalizations and 600 000 outpatients per year, the hospital is one of the largest clinical centers in Europe. HISTORY OF THE DEPARTMENT OF NEUROSURGERY At the end of the 19th century, neurosurgery was not considered as a recognized specialty and remained limited to isolated cases. Working with renowned neurologists such as Pierre Marie (Figure 5), Antony Chipault (Figure 5), a general surgeon, rapidly became interested in the surgery of the nervous system. He began to operate on tumors of the spine and performed his first operation for a brain tumor in 1892. In 1894, he described the anatomical relationship between spinal roots and spinal processes known as “Chipault laws” and, a year later, he published an extensive book describing the various approaches used for brain lesions.9,10 Neurosurgery truly began at the time of Joseph Babinski (Figure 5), when he took over the direction of a medical department at La Pitié Hospital in 1895. Despite the relocation of La Pitié Hospital to the grounds of La Salpêtrière Hospital in 1911, the 2 hospitals remained administratively distinct for more than 50 yr, which explains why each one developed its own neurosurgical department. Babinski promptly anticipated the development of neurosurgery and encouraged 2 of his former residents, Clovis Vincent (Figure 5) and Thierry de Martel (Figure 5), to do the same. In 1910, de Martel, already a brilliant general surgeon, entered the new field of neurosurgery. He started to perform neurosurgical procedures within the general surgery department. Seeking to improve his surgical technique, he went to London at Queen's Square Hospital every week to attend Victor Horsley's operative sessions, returning to Paris the next day to perform his own operations. Some other famous neurologists, such as Pierre Marie, began to refer patients to de Martel.11 De Martel made several valuable innovations: he recommended the sitting position in neurosurgery and the use of local anesthesia. He also designed several surgical tools that remain currently in use. Vincent suggested collaboration with de Martel who had been his colleague during residency in 1904. Vincent was the neurologist in charge of examining patients and referring the neurosurgical cases.12 The collaboration between de Martel and Vincent worked perfectly for years. Therefore, Babinski and de Martel encouraged Vincent to become more deeply involved in neurosurgical techniques by going to Peter Bent Brigham Hospital in Boston to meet Harvey Cushing. Vincent had been particularly impressed during his trip to the USA, where neurosurgery had become a distinct field. He decided to make the same thing happen in France.13 Having participated in de Martel's operations for several years, Vincent then began to make surgical decisions and operate by himself. A quarrel between Vincent and de Martel led them to a definitive breakup in 1929, at which time de Martel left the hospital and pursued an intensive neurosurgical activity at the American Hospital of Paris. On 19 June 1940, while the German army entered Paris, de Martel committed suicide after recalling his commitment to freedom and homeland to the American ambassador. For his part, Vincent continued a fulfilling life, completely devoted to neurosurgery. The creation of the first department of neurosurgery at La Pitié Hospital, which was the first in France, took place in 1933 (Figure 6). Vincent became the first professor of neurosurgery in France and he founded the first school of neurosurgery in 1938.14 As he was visiting him in Paris, Cushing paid homage to Vincent's work.15 The enormous contribution of Vincent to the field of neurosurgery, particularly concerning temporal lobe surgery and brain abscesses surgical management, made him internationally famous. Vincent is definitely considered as the founder of French neurosurgery while Babinski was most certainly the pathfinder. FIGURE 6. View largeDownload slide Operating room for neurosurgical activities at La Pitié Hospital at the beginning of the 20th century. Image used with permission from the Service de Neurochirurgie, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris. All rights reserved. FIGURE 6. View largeDownload slide Operating room for neurosurgical activities at La Pitié Hospital at the beginning of the 20th century. Image used with permission from the Service de Neurochirurgie, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris. All rights reserved. During World War II, Vincent continued to exercise leadership at La Pitié Hospital and publicly resisted the occupying Germans. He died in 1947 after having trained many neurosurgeons. Three of his pupils later founded new neurosurgical departments in Paris: Jacques Le Beau founded the department at Lariboisière Hospital in 1951 before being chairman at La Salpêtrière Hospital from 1960; Gérard Guiot, well known for the development of the transsphenoidal surgery,16 founded the department at Foch Hospital in 1950; and Raymond Houdart, who had become an international reference on spinal cord surgery,17,18 led the department at Lariboisière Hospital from 1960 onwards. Vincent's reputation also lived on through the work of his pupils. After Vincent's death, the original department at La Pitié Hospital continued under the successive chairmanships of Daniel Petit-Dutaillis (1947-1960, Figure 5);19 Marcel David (1960-1970, Figure 5),20 who previously pointed the way to the creation of functional neurosurgery at Sainte-Anne Hospital and founded the French-speaking Neurosurgery Society; Bernard Pertuiset (1970-1990, Figure 5),21 world renowned for his works on brain arteriovenous malformations,22-24 and Denis Fohanno (1990-2000, Figure 5). Meanwhile, a distinct neurosurgical activity was being developed at La Salpêtrière Hospital. In the 1920s, Daniel Petit-Dutaillis began to perform neurological surgery in a general surgery department, in partnership with Georges Guillain (Figure 5), Professor of neurology, who notably described the Guillain-Barré syndrome. In 1928, Petit-Dutaillis described the first case of lumbar disc herniation as a cause of radiculopathy, thus paving the way for a new field of neurosurgery. Jean-Marie Guillaume (Figure 5), a neurologist who rapidly became interested in neurosurgery, enabled the true development of neurosurgery at La Salpêtrière Hospital by forming his own surgical team during World War II. The department of neurosurgery was created in 1949 and Guillaume became its chairman in 1952. The scientific contribution of Guillaume was considerable and covered all fields of neurosurgery. In 1947, he published Neurosurgical Diagnosis, which remains a reference book in literature. Among many valuable scientific articles, he reported the first measurement of intracranial pressure in man in 1951.25 He died suddenly in 1959, at the age of 56. Jacques Le Beau, a former assistant of Vincent, became chairman in 1959. He retired in 1978, having completed the department with the adjunction of neuroradiology and a neuropathological laboratory. Jacques Philippon (Figure 5) was the last chairman (1978-2000) of La Salpêtrière's department before the unification of both departments of La Pitié and La Salpêtrière (Figure 7). FIGURE 7. View largeDownload slide Listing of all chairmen serving the department of neurosurgery at La Pitié-Salpêtrière Hospital and their respective dates of service. Image used with permission from the Service de Neurochirurgie, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris. All rights reserved. FIGURE 7. View largeDownload slide Listing of all chairmen serving the department of neurosurgery at La Pitié-Salpêtrière Hospital and their respective dates of service. Image used with permission from the Service de Neurochirurgie, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris. All rights reserved. Finally, all neurosurgical activities of La Pitié-Salpêtrière Hospital have been centralized in a modern building since 1996 (Figure 8). This building, grouping together the departments of neurosurgery, ear nose throat (ENT), ophthalmology, neuroradiology, the neuro-intensive care unit (ICU) and the stroke center, has been named “Babinski” to pay tribute to the memory of the founder of French neurosurgery. Rémy van Effenterre (2000-2008, Figure 5) and Philippe Cornu (2008-2017, Figure 5) were successively in charge of this new neurosurgical department. In 2017, Alexandre Carpentier (Figure 5) was appointed chairman. From its creation, the department also participated to the formation and blossoming of some famous French neurosurgeons such as Jean Talairach (1911-2007), the pioneer of stereotactic surgery;26 Jacques Rougerie (1921-1984), who founded French pediatric neurosurgery in the 1950s;27 Alim-Louis Benabid, who described the deep brain stimulation to treat Parkinson's disease (1987);28 Bernard George, who is recognized for his work on the vertebral artery surgical anatomy (2002);29 or Hugues Duffau, who developed awake surgery and brain mapping for low-grade diffuse glioma (2005).30,31 FIGURE 8. View largeDownload slide The “Babinski building” groups together the departments of neurosurgery, ENT, ophthalmology, neuroradiology, the neuro-intensive care unit (ICU) and the stroke center. Image used with permission from the Service de Neurochirurgie, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris. All rights reserved. FIGURE 8. View largeDownload slide The “Babinski building” groups together the departments of neurosurgery, ENT, ophthalmology, neuroradiology, the neuro-intensive care unit (ICU) and the stroke center. Image used with permission from the Service de Neurochirurgie, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris. All rights reserved. CURRENT ACTIVITIES Today, the department of neurosurgery has a staff of 17 neurosurgeons (Dr Anne-Laure Boch, Dr Carine Karachi, Dr Soledad Navarro, Dr Aymeric Amelot, Dr Arthur André, Dr François Arthuis, Dr Pierre-Yves Borius, Dr Laurent Capelle, Prof Alexandre Carpentier, Dr Stéphane Clemenceau, Prof Philippe Cornu, Prof Michel Kalamarides, Dr Bertrand Mathon, Dr Aurélien Nouet, Dr Matthieu Peyre, Dr Jean-Pierre Sichez, and Dr Charles-Ambroise Valéry). There are also 10 residents and 10 student trainees. The department has a patient capacity of 100 neurosurgical beds and 25 ICU beds, 6 operating rooms and a Gamma Knife (Elekta AB, Stockholm, Sweden) unit. Approximately 3500 surgical procedures and 1000 Gamma Knife radiosurgical procedures are performed in the department each year, in all fields of neurosurgery with the exception of pediatric cases (Table). Approximately 15 000 patients were treated in a year in the outpatient clinics. Neurosurgical emergencies are managed on a 24-h/7-d basis. With a high-level technical platform, the department is organized to respond to the most complex emergencies occurring in the Paris region.32 TABLE. Surgical Activities of the Neurosurgical Department. Specialty Number of cases/year Intracranial tumor Brain and cerebellar tumor 500 (awake: 55) Brain biopsy 200 Meningioma 300 Cerebellopontine angle tumor 150 Pituitary tumor 80 Total 1230 Gamma Knife radiosurgery 1000 Functional neurosurgery Epilepsy 100 Movement disorders (deep brain stimulation) 75 Pain 75 Generator replacement 160 Total 410 Cerebrovascular diseases Aneurysm 60 Cavernoma 20 Arterioveinous malformation 10 Arterioveinous fistula 10 Total 100 Brain trauma 420 Hydrocephalus 350 Spinal diseases Lumbar spine 400 Cervical spine 250 Spinal tumor 60 Total 710 Infectious diseases 90 Peripheral nerve 40 Other 150 Total 4500 Specialty Number of cases/year Intracranial tumor Brain and cerebellar tumor 500 (awake: 55) Brain biopsy 200 Meningioma 300 Cerebellopontine angle tumor 150 Pituitary tumor 80 Total 1230 Gamma Knife radiosurgery 1000 Functional neurosurgery Epilepsy 100 Movement disorders (deep brain stimulation) 75 Pain 75 Generator replacement 160 Total 410 Cerebrovascular diseases Aneurysm 60 Cavernoma 20 Arterioveinous malformation 10 Arterioveinous fistula 10 Total 100 Brain trauma 420 Hydrocephalus 350 Spinal diseases Lumbar spine 400 Cervical spine 250 Spinal tumor 60 Total 710 Infectious diseases 90 Peripheral nerve 40 Other 150 Total 4500 View Large TABLE. Surgical Activities of the Neurosurgical Department. Specialty Number of cases/year Intracranial tumor Brain and cerebellar tumor 500 (awake: 55) Brain biopsy 200 Meningioma 300 Cerebellopontine angle tumor 150 Pituitary tumor 80 Total 1230 Gamma Knife radiosurgery 1000 Functional neurosurgery Epilepsy 100 Movement disorders (deep brain stimulation) 75 Pain 75 Generator replacement 160 Total 410 Cerebrovascular diseases Aneurysm 60 Cavernoma 20 Arterioveinous malformation 10 Arterioveinous fistula 10 Total 100 Brain trauma 420 Hydrocephalus 350 Spinal diseases Lumbar spine 400 Cervical spine 250 Spinal tumor 60 Total 710 Infectious diseases 90 Peripheral nerve 40 Other 150 Total 4500 Specialty Number of cases/year Intracranial tumor Brain and cerebellar tumor 500 (awake: 55) Brain biopsy 200 Meningioma 300 Cerebellopontine angle tumor 150 Pituitary tumor 80 Total 1230 Gamma Knife radiosurgery 1000 Functional neurosurgery Epilepsy 100 Movement disorders (deep brain stimulation) 75 Pain 75 Generator replacement 160 Total 410 Cerebrovascular diseases Aneurysm 60 Cavernoma 20 Arterioveinous malformation 10 Arterioveinous fistula 10 Total 100 Brain trauma 420 Hydrocephalus 350 Spinal diseases Lumbar spine 400 Cervical spine 250 Spinal tumor 60 Total 710 Infectious diseases 90 Peripheral nerve 40 Other 150 Total 4500 View Large The department has also continued to engage in basic and applied research activities (Figure 9), and maintains close working relationships with the Brain and Spine Institute (Figure 10), which is an international brain and spinal cord research center, located on the grounds of the Hospital, whose innovative concept and structure allows the development of projects in all fields of neurological and neurosurgical sciences. Clinical and research activities are proceeding in tight collaboration with the departments of neurology (epileptology, movement disorders, neuro-oncology, and vascular neurology units), interventional neuroradiology, neuro-ICU, ENT, ophthalmology, and endocrinology. FIGURE 9. View largeDownload slide Annual number of articles published by the department of neurosurgery of La Pitié-Salpêtrière Hospital in international journals (2000-2017). Image used with permission from the Service de Neurochirurgie, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris. All rights reserved. FIGURE 9. View largeDownload slide Annual number of articles published by the department of neurosurgery of La Pitié-Salpêtrière Hospital in international journals (2000-2017). Image used with permission from the Service de Neurochirurgie, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris. All rights reserved. FIGURE 10. View largeDownload slide The Brain and Spine Institute, located on the grounds of La Pitié-Salpêtrière Hospital, is an international brain and spinal cord research center. Image used with permission from the Service de Neurochirurgie, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris. All rights reserved. FIGURE 10. View largeDownload slide The Brain and Spine Institute, located on the grounds of La Pitié-Salpêtrière Hospital, is an international brain and spinal cord research center. Image used with permission from the Service de Neurochirurgie, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris. All rights reserved. During the last decades, basic and clinical research on brain tumors has been widely developed within La Pitié-Salpêtrière in collaboration with the neuro-oncological department and adjacent research units. First-in-man laser interstitial thermal therapy and first-in-man blood-brain barrier disruption by pulsed ultrasound were assessed in clinical trials as treatment of brain metastasis and/or recurrent glioblastomas.33-36 Early description of brain plasticity induced by cerebral pathologies.31,37,38 Currently other clinical trials using immunotherapy, viral vectors, or gene therapy for the treatment of recurrent gliomas are underway. Interest in the biology and genetics of meningiomas started in the 1980s39,40 and has never declined since that time.41-44 The department hosts the French Reference Center for neurofibromatosis type 2 allowing large studies on associated tumors like vestibular schwannomas.45 In the field of Parkinson's disease and movement disorder surgery, the department supported many studies and clinical trials from the origins of the technique to the present. Magnetic resonance stereotactic guidance was therefore developed to increase precision of electrode implantations.46,47 Different targets, procedures, and predictive factors for deep brain stimulation were investigated and evaluated for Parkinson's disease,48-55 dystonia,56,57 Tourette's syndrome,58-60 severe obsessive-compulsive disorder61 and Huntington's disease.62 Basic research on functional anatomy of basal ganglia using animal models is still a priority.63,64 In the field of epilepsy surgery, presurgical evaluation and intracranial electrode implantation for video-electroencephalography recordings have been the subjects of many studies over the past 30 yr.65-68 The surgical team also described an approach for mesial temporal structures’ selective resection69 and identified predictive factors of outcomes of surgery for mesial temporal lobe epilepsy.70-73 The department collaborates closely on research of epilepsy from human tissues.74-76 The department also cooperates with most national and international multicentric studies concerning head injury77,78 and subarachnoid hemorrhage79 patients. There is also an interest in long-term outcome prediction in severe brain trauma by using quantitative diffusion tensor imaging.80-82 CONCLUSION To date, the PubMed database reports dozens of articles supporting the role of La Pitié-Salpêtrière Hospital in the development of neurology and neurosurgery. This historical overview of the development of neurosurgery at La Pitié-Salpêtrière Hospital affirms the positive importance of such strong links between neurology, neuroradiology, anesthesiology, radiotherapy, and neurosurgery. The future major achievements in the field of neuroscience should emerge from this fundamental partnership. Disclosure The authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article. REFERENCES 1. Hurwitz LJ . L’Hopital de la Salpetriere, Paris . Br Med J . 1962 ; 1 ( 5286 ): 1196 - 1197 . Google Scholar CrossRef Search ADS PubMed 2. Philippon J . 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The medical response to multisite terrorist attacks in Paris . Lancet North Am Ed . 2015 ; 386 ( 10012 ): 2535 - 2538 . Google Scholar CrossRef Search ADS 33. Carpentier A , Canney M , Vignot A et al. Clinical trial of blood-brain barrier disruption by pulsed ultrasound . Sci Transl Med . 2016 ; 8 ( 343 ): 343re2 - 343re2 . Google Scholar CrossRef Search ADS PubMed 34. Carpentier A , Chauvet D , Reina V et al. MR-guided laser-induced thermal therapy (LITT) for recurrent glioblastomas . Lasers Surg Med . 2012 ; 44 ( 5 ): 361 - 368 . Google Scholar CrossRef Search ADS PubMed 35. Carpentier A , McNichols RJ , Stafford RJ et al. Laser thermal therapy: real-time MRI-guided and computer-controlled procedures for metastatic brain tumors . Lasers Surg Med . 2011 ; 43 ( 10 ): 943 - 950 . Google Scholar CrossRef Search ADS PubMed 36. Carpentier A , McNichols RJ , Stafford RJ et al. Real-time magnetic resonance-guided laser thermal therapy for focal metastatic brain tumors . 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Role of the pedunculopontine nucleus in controlling gait and sleep in normal and parkinsonian monkeys . J Neural Transm (Vienna) . 2018 ; 125 ( 3 ): 471 - 483 . Google Scholar CrossRef Search ADS PubMed 64. Sebille SB , Belaid H , Philippe AC et al. Anatomical evidence for functional diversity in the mesencephalic locomotor region of primates . Neuroimage . 2017 ; 147 : 66 - 78 . Google Scholar CrossRef Search ADS PubMed 65. Mathon B , Clemenceau S , Hasboun D et al. Safety profile of intracranial electrode implantation for video-EEG recordings in drug-resistant focal epilepsy . J Neurol . 2015 ; 262 ( 12 ): 2699 - 2712 . Google Scholar CrossRef Search ADS PubMed 66. Dupont S , Van de Moortele PF , Samson S et al. Episodic memory in left temporal lobe epilepsy: a functional MRI study . Brain . 2000 ; 123 ( 8 ): 1722 - 1732 . Google Scholar CrossRef Search ADS PubMed 67. Lehericy S , Cohen L , Bazin B et al. 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Complications after surgery for mesial temporal lobe epilepsy associated with hippocampal sclerosis . World Neurosurg . 2017 ; 102 : 639 - 650 . e2 . Google Scholar CrossRef Search ADS PubMed 72. Dupont S , Semah F , Clemenceau S , Adam C , Baulac M , Samson Y . Accurate prediction of postoperative outcome in mesial temporal lobe epilepsy . Arch Neurol . 2000 ; 57 ( 9 ): 1331 - 1336 . Google Scholar CrossRef Search ADS PubMed 73. Dupont S , Tanguy ML , Clemenceau S , Adam C , Hazemann P , Baulac M . Long-term prognosis and psychosocial outcomes after surgery for MTLE . Epilepsia . 2006 ; 47 ( 12 ): 2115 - 2124 . Google Scholar CrossRef Search ADS PubMed 74. Huberfeld G , Blauwblomme T , Miles R . Hippocampus and epilepsy: Findings from human tissues . Rev Neurol (Paris) . 2015 ; 171 ( 3 ): 236 - 251 . Google Scholar CrossRef Search ADS PubMed 75. Huberfeld G , Menendez de la Prida L , Pallud J et al. 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Google Scholar CrossRef Search ADS PubMed Copyright © 2018 by the Congress of Neurological Surgeons This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/about_us/legal/notices) http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Neurosurgery Oxford University Press

Commentary: La Pitié-Salpêtrière Hospital in Paris: the Historic Cradle of Neurosurgery

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Copyright © 2018 by the Congress of Neurological Surgeons
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0148-396X
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Abstract

The Pitié-Salpêtrière University Hospital results from the unification of La Pitié Hospital, founded in 1612, and La Salpêtrière Hospital, founded in 1656. Located in the southeast part of Paris (France), the hospital occupies an area of 33 hectares (Figures 1 and 2). FIGURE 1. View largeDownload slide Aerial view displaying La Pitié-Salpêtrière University Hospital (2017). Image used with permission from the Service de Neurochirurgie, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris. All rights reserved. FIGURE 1. View largeDownload slide Aerial view displaying La Pitié-Salpêtrière University Hospital (2017). Image used with permission from the Service de Neurochirurgie, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris. All rights reserved. FIGURE 2. View largeDownload slide Current view of the historical entrance of La Salpêtrière Hospital (2017). The Saint-Louis chapel appears in the background. Image used with permission from the Service de Neurochirurgie, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris. All rights reserved. FIGURE 2. View largeDownload slide Current view of the historical entrance of La Salpêtrière Hospital (2017). The Saint-Louis chapel appears in the background. Image used with permission from the Service de Neurochirurgie, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris. All rights reserved. HISTORY OF LA PITIÉ-SALPÊTRIÈRE HOSPITAL The construction of La Pitié-Salpêtrière Hospital is strongly linked with French history. In 1612, Marie de Médicis, Queen of France, founded La Pitié Hospital, intended for enclosing the poor people of the city. For 2 centuries, La Pitié was more of a detention center than a place of care. The 19th century was marked by the progressive medicalization of La Pitié hospice. The early 20th century brought a dramatic transformation that revolutionized the structure of La Pitié, through the complete reconstruction of all buildings to form a hospital complex (Figure 3). FIGURE 3. View largeDownload slide La Pitié Hospital at the beginning of the 20th century. Image used with permission from the Service de Neurochirurgie, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris. All rights reserved. FIGURE 3. View largeDownload slide La Pitié Hospital at the beginning of the 20th century. Image used with permission from the Service de Neurochirurgie, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris. All rights reserved. Additionally, in 1656, Mazarin, the Prime Minister of Louis XIV, turned an old arsenal into a hospice to take care of mendicants. Therefore, La Salpêtrière Hospital owes its name to the fact that it was originally a saltpeter and gunpowder store in the 16th century.1 Louis XIV’s architect Le Vau designed the plans for the Saint-Louis chapel (Figures 1 and 2), which was completed by Bruant, the architect of the Paris National Residence of the Invalids. During the 17th and 18th centuries, 8000 indigent women were housed at La Salpêtrière, which was the largest hospice in Europe (Figure 4).2,3 Prostitutes, disabled people, and epileptics were progressively included in this population. This inspired stories and legends reported by French and international literatures. Thus, the courtesan Manon Lescaut was deported from La Salpêtrière to Louisiana, in the masterwork eponymous novel written by Abbé Prévost (1753), which was set to music by Jules Massenet and Giacomo Puccini in 2 famous operas. In the 19th century, psychiatry was the most important specialty until the arrival of Jean-Martin Charcot in 1862. Charcot (Figure 5), one of the pioneers of neurology,4 applied the anatomoclinical method and described several neurological diseases, including amyotrophic lateral sclerosis and multiple sclerosis.5-7 He also studied hysteria from the 1870s onwards.8 Charcot's lectures on hysteria at La Salpêtrière Hospital were attended not only by many famous physicians such as Sigmund Freud, but also politicians, painters, architects, and intellectuals.5 Finally, Charcot was the first professor of neurology at La Salpêtrière Hospital in 1882. The hospital then became known as a reference center in neurology. Between 1850 and today, many famous neurologists from La Salpêtrière Hospital played a major role in developing and shaping the entire field of normal and pathological neurology.7 In addition to developing influential concepts, these pioneering neurologists made important contributions to major scientific issues. The neurological tradition of the Salpêtrière school persists today. In the 20th century, all medical and surgical specialties were established in La Salpêtrière Hospital, which became a general hospital modeled after La Pitié Hospital. During World War II, while the German army requisitioned La Pitié Hospital, La Salpêtrière Hospital was a major place of French Resistance. FIGURE 4. View largeDownload slide La Salpêtrière Hospital at the beginning of the 18th century. Drawing by C. Reiss, courtesy of Musée de l’Assistance publique – Hôpitaux de Paris. All rights reserved. FIGURE 4. View largeDownload slide La Salpêtrière Hospital at the beginning of the 18th century. Drawing by C. Reiss, courtesy of Musée de l’Assistance publique – Hôpitaux de Paris. All rights reserved. FIGURE 5. View largeDownload slide Emblematic figures of the development of neurosurgery at La Pitié-Salpêtrière Hospital. A, Jean-Martin Charcot (1825-1893). B, Pierre Marie (1853-1940). C, Antony Chipault (1866-1920). D, Joseph Babinski (1857-1932). E, Clovis Vincent (1879-1947). F, Thierry de Martel (1876-1940). G, Marcel David (1898-1986). H, Daniel Petit-Dutaillis (1889-1968). I, Bernard Pertuiset (1920-2000). J, Denis Fohanno. K, Georges Guillain (1876-1961). L, Jean-Marie Guillaume (1903-1959). M, Jacques Philippon. N, Rémy Van Effenterre. O, Philippe Cornu. P, Alexandre Carpentier. Image used with permission from the Service de Neurochirurgie, Hôpital de la Pitiè-Salpêtrière, Assistance Publique-Hôpitaux de Paris. All rights reserved. FIGURE 5. View largeDownload slide Emblematic figures of the development of neurosurgery at La Pitié-Salpêtrière Hospital. A, Jean-Martin Charcot (1825-1893). B, Pierre Marie (1853-1940). C, Antony Chipault (1866-1920). D, Joseph Babinski (1857-1932). E, Clovis Vincent (1879-1947). F, Thierry de Martel (1876-1940). G, Marcel David (1898-1986). H, Daniel Petit-Dutaillis (1889-1968). I, Bernard Pertuiset (1920-2000). J, Denis Fohanno. K, Georges Guillain (1876-1961). L, Jean-Marie Guillaume (1903-1959). M, Jacques Philippon. N, Rémy Van Effenterre. O, Philippe Cornu. P, Alexandre Carpentier. Image used with permission from the Service de Neurochirurgie, Hôpital de la Pitiè-Salpêtrière, Assistance Publique-Hôpitaux de Paris. All rights reserved. The Saint-Louis chapel and some of the buildings of La Pitié and La Salpêtrière have been classified as historic monuments since 1927. Luckily, the hospital has been spared from bombings and destruction during both World Wars. The Pitié-Salpêtrière University Hospital, administratively unified in 1964, has approximately 2000 beds within its 77 clinical and medicotechnical departments, covering all fields of medicine and surgery for adult patients. With 170 000 hospitalizations and 600 000 outpatients per year, the hospital is one of the largest clinical centers in Europe. HISTORY OF THE DEPARTMENT OF NEUROSURGERY At the end of the 19th century, neurosurgery was not considered as a recognized specialty and remained limited to isolated cases. Working with renowned neurologists such as Pierre Marie (Figure 5), Antony Chipault (Figure 5), a general surgeon, rapidly became interested in the surgery of the nervous system. He began to operate on tumors of the spine and performed his first operation for a brain tumor in 1892. In 1894, he described the anatomical relationship between spinal roots and spinal processes known as “Chipault laws” and, a year later, he published an extensive book describing the various approaches used for brain lesions.9,10 Neurosurgery truly began at the time of Joseph Babinski (Figure 5), when he took over the direction of a medical department at La Pitié Hospital in 1895. Despite the relocation of La Pitié Hospital to the grounds of La Salpêtrière Hospital in 1911, the 2 hospitals remained administratively distinct for more than 50 yr, which explains why each one developed its own neurosurgical department. Babinski promptly anticipated the development of neurosurgery and encouraged 2 of his former residents, Clovis Vincent (Figure 5) and Thierry de Martel (Figure 5), to do the same. In 1910, de Martel, already a brilliant general surgeon, entered the new field of neurosurgery. He started to perform neurosurgical procedures within the general surgery department. Seeking to improve his surgical technique, he went to London at Queen's Square Hospital every week to attend Victor Horsley's operative sessions, returning to Paris the next day to perform his own operations. Some other famous neurologists, such as Pierre Marie, began to refer patients to de Martel.11 De Martel made several valuable innovations: he recommended the sitting position in neurosurgery and the use of local anesthesia. He also designed several surgical tools that remain currently in use. Vincent suggested collaboration with de Martel who had been his colleague during residency in 1904. Vincent was the neurologist in charge of examining patients and referring the neurosurgical cases.12 The collaboration between de Martel and Vincent worked perfectly for years. Therefore, Babinski and de Martel encouraged Vincent to become more deeply involved in neurosurgical techniques by going to Peter Bent Brigham Hospital in Boston to meet Harvey Cushing. Vincent had been particularly impressed during his trip to the USA, where neurosurgery had become a distinct field. He decided to make the same thing happen in France.13 Having participated in de Martel's operations for several years, Vincent then began to make surgical decisions and operate by himself. A quarrel between Vincent and de Martel led them to a definitive breakup in 1929, at which time de Martel left the hospital and pursued an intensive neurosurgical activity at the American Hospital of Paris. On 19 June 1940, while the German army entered Paris, de Martel committed suicide after recalling his commitment to freedom and homeland to the American ambassador. For his part, Vincent continued a fulfilling life, completely devoted to neurosurgery. The creation of the first department of neurosurgery at La Pitié Hospital, which was the first in France, took place in 1933 (Figure 6). Vincent became the first professor of neurosurgery in France and he founded the first school of neurosurgery in 1938.14 As he was visiting him in Paris, Cushing paid homage to Vincent's work.15 The enormous contribution of Vincent to the field of neurosurgery, particularly concerning temporal lobe surgery and brain abscesses surgical management, made him internationally famous. Vincent is definitely considered as the founder of French neurosurgery while Babinski was most certainly the pathfinder. FIGURE 6. View largeDownload slide Operating room for neurosurgical activities at La Pitié Hospital at the beginning of the 20th century. Image used with permission from the Service de Neurochirurgie, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris. All rights reserved. FIGURE 6. View largeDownload slide Operating room for neurosurgical activities at La Pitié Hospital at the beginning of the 20th century. Image used with permission from the Service de Neurochirurgie, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris. All rights reserved. During World War II, Vincent continued to exercise leadership at La Pitié Hospital and publicly resisted the occupying Germans. He died in 1947 after having trained many neurosurgeons. Three of his pupils later founded new neurosurgical departments in Paris: Jacques Le Beau founded the department at Lariboisière Hospital in 1951 before being chairman at La Salpêtrière Hospital from 1960; Gérard Guiot, well known for the development of the transsphenoidal surgery,16 founded the department at Foch Hospital in 1950; and Raymond Houdart, who had become an international reference on spinal cord surgery,17,18 led the department at Lariboisière Hospital from 1960 onwards. Vincent's reputation also lived on through the work of his pupils. After Vincent's death, the original department at La Pitié Hospital continued under the successive chairmanships of Daniel Petit-Dutaillis (1947-1960, Figure 5);19 Marcel David (1960-1970, Figure 5),20 who previously pointed the way to the creation of functional neurosurgery at Sainte-Anne Hospital and founded the French-speaking Neurosurgery Society; Bernard Pertuiset (1970-1990, Figure 5),21 world renowned for his works on brain arteriovenous malformations,22-24 and Denis Fohanno (1990-2000, Figure 5). Meanwhile, a distinct neurosurgical activity was being developed at La Salpêtrière Hospital. In the 1920s, Daniel Petit-Dutaillis began to perform neurological surgery in a general surgery department, in partnership with Georges Guillain (Figure 5), Professor of neurology, who notably described the Guillain-Barré syndrome. In 1928, Petit-Dutaillis described the first case of lumbar disc herniation as a cause of radiculopathy, thus paving the way for a new field of neurosurgery. Jean-Marie Guillaume (Figure 5), a neurologist who rapidly became interested in neurosurgery, enabled the true development of neurosurgery at La Salpêtrière Hospital by forming his own surgical team during World War II. The department of neurosurgery was created in 1949 and Guillaume became its chairman in 1952. The scientific contribution of Guillaume was considerable and covered all fields of neurosurgery. In 1947, he published Neurosurgical Diagnosis, which remains a reference book in literature. Among many valuable scientific articles, he reported the first measurement of intracranial pressure in man in 1951.25 He died suddenly in 1959, at the age of 56. Jacques Le Beau, a former assistant of Vincent, became chairman in 1959. He retired in 1978, having completed the department with the adjunction of neuroradiology and a neuropathological laboratory. Jacques Philippon (Figure 5) was the last chairman (1978-2000) of La Salpêtrière's department before the unification of both departments of La Pitié and La Salpêtrière (Figure 7). FIGURE 7. View largeDownload slide Listing of all chairmen serving the department of neurosurgery at La Pitié-Salpêtrière Hospital and their respective dates of service. Image used with permission from the Service de Neurochirurgie, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris. All rights reserved. FIGURE 7. View largeDownload slide Listing of all chairmen serving the department of neurosurgery at La Pitié-Salpêtrière Hospital and their respective dates of service. Image used with permission from the Service de Neurochirurgie, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris. All rights reserved. Finally, all neurosurgical activities of La Pitié-Salpêtrière Hospital have been centralized in a modern building since 1996 (Figure 8). This building, grouping together the departments of neurosurgery, ear nose throat (ENT), ophthalmology, neuroradiology, the neuro-intensive care unit (ICU) and the stroke center, has been named “Babinski” to pay tribute to the memory of the founder of French neurosurgery. Rémy van Effenterre (2000-2008, Figure 5) and Philippe Cornu (2008-2017, Figure 5) were successively in charge of this new neurosurgical department. In 2017, Alexandre Carpentier (Figure 5) was appointed chairman. From its creation, the department also participated to the formation and blossoming of some famous French neurosurgeons such as Jean Talairach (1911-2007), the pioneer of stereotactic surgery;26 Jacques Rougerie (1921-1984), who founded French pediatric neurosurgery in the 1950s;27 Alim-Louis Benabid, who described the deep brain stimulation to treat Parkinson's disease (1987);28 Bernard George, who is recognized for his work on the vertebral artery surgical anatomy (2002);29 or Hugues Duffau, who developed awake surgery and brain mapping for low-grade diffuse glioma (2005).30,31 FIGURE 8. View largeDownload slide The “Babinski building” groups together the departments of neurosurgery, ENT, ophthalmology, neuroradiology, the neuro-intensive care unit (ICU) and the stroke center. Image used with permission from the Service de Neurochirurgie, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris. All rights reserved. FIGURE 8. View largeDownload slide The “Babinski building” groups together the departments of neurosurgery, ENT, ophthalmology, neuroradiology, the neuro-intensive care unit (ICU) and the stroke center. Image used with permission from the Service de Neurochirurgie, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris. All rights reserved. CURRENT ACTIVITIES Today, the department of neurosurgery has a staff of 17 neurosurgeons (Dr Anne-Laure Boch, Dr Carine Karachi, Dr Soledad Navarro, Dr Aymeric Amelot, Dr Arthur André, Dr François Arthuis, Dr Pierre-Yves Borius, Dr Laurent Capelle, Prof Alexandre Carpentier, Dr Stéphane Clemenceau, Prof Philippe Cornu, Prof Michel Kalamarides, Dr Bertrand Mathon, Dr Aurélien Nouet, Dr Matthieu Peyre, Dr Jean-Pierre Sichez, and Dr Charles-Ambroise Valéry). There are also 10 residents and 10 student trainees. The department has a patient capacity of 100 neurosurgical beds and 25 ICU beds, 6 operating rooms and a Gamma Knife (Elekta AB, Stockholm, Sweden) unit. Approximately 3500 surgical procedures and 1000 Gamma Knife radiosurgical procedures are performed in the department each year, in all fields of neurosurgery with the exception of pediatric cases (Table). Approximately 15 000 patients were treated in a year in the outpatient clinics. Neurosurgical emergencies are managed on a 24-h/7-d basis. With a high-level technical platform, the department is organized to respond to the most complex emergencies occurring in the Paris region.32 TABLE. Surgical Activities of the Neurosurgical Department. Specialty Number of cases/year Intracranial tumor Brain and cerebellar tumor 500 (awake: 55) Brain biopsy 200 Meningioma 300 Cerebellopontine angle tumor 150 Pituitary tumor 80 Total 1230 Gamma Knife radiosurgery 1000 Functional neurosurgery Epilepsy 100 Movement disorders (deep brain stimulation) 75 Pain 75 Generator replacement 160 Total 410 Cerebrovascular diseases Aneurysm 60 Cavernoma 20 Arterioveinous malformation 10 Arterioveinous fistula 10 Total 100 Brain trauma 420 Hydrocephalus 350 Spinal diseases Lumbar spine 400 Cervical spine 250 Spinal tumor 60 Total 710 Infectious diseases 90 Peripheral nerve 40 Other 150 Total 4500 Specialty Number of cases/year Intracranial tumor Brain and cerebellar tumor 500 (awake: 55) Brain biopsy 200 Meningioma 300 Cerebellopontine angle tumor 150 Pituitary tumor 80 Total 1230 Gamma Knife radiosurgery 1000 Functional neurosurgery Epilepsy 100 Movement disorders (deep brain stimulation) 75 Pain 75 Generator replacement 160 Total 410 Cerebrovascular diseases Aneurysm 60 Cavernoma 20 Arterioveinous malformation 10 Arterioveinous fistula 10 Total 100 Brain trauma 420 Hydrocephalus 350 Spinal diseases Lumbar spine 400 Cervical spine 250 Spinal tumor 60 Total 710 Infectious diseases 90 Peripheral nerve 40 Other 150 Total 4500 View Large TABLE. Surgical Activities of the Neurosurgical Department. Specialty Number of cases/year Intracranial tumor Brain and cerebellar tumor 500 (awake: 55) Brain biopsy 200 Meningioma 300 Cerebellopontine angle tumor 150 Pituitary tumor 80 Total 1230 Gamma Knife radiosurgery 1000 Functional neurosurgery Epilepsy 100 Movement disorders (deep brain stimulation) 75 Pain 75 Generator replacement 160 Total 410 Cerebrovascular diseases Aneurysm 60 Cavernoma 20 Arterioveinous malformation 10 Arterioveinous fistula 10 Total 100 Brain trauma 420 Hydrocephalus 350 Spinal diseases Lumbar spine 400 Cervical spine 250 Spinal tumor 60 Total 710 Infectious diseases 90 Peripheral nerve 40 Other 150 Total 4500 Specialty Number of cases/year Intracranial tumor Brain and cerebellar tumor 500 (awake: 55) Brain biopsy 200 Meningioma 300 Cerebellopontine angle tumor 150 Pituitary tumor 80 Total 1230 Gamma Knife radiosurgery 1000 Functional neurosurgery Epilepsy 100 Movement disorders (deep brain stimulation) 75 Pain 75 Generator replacement 160 Total 410 Cerebrovascular diseases Aneurysm 60 Cavernoma 20 Arterioveinous malformation 10 Arterioveinous fistula 10 Total 100 Brain trauma 420 Hydrocephalus 350 Spinal diseases Lumbar spine 400 Cervical spine 250 Spinal tumor 60 Total 710 Infectious diseases 90 Peripheral nerve 40 Other 150 Total 4500 View Large The department has also continued to engage in basic and applied research activities (Figure 9), and maintains close working relationships with the Brain and Spine Institute (Figure 10), which is an international brain and spinal cord research center, located on the grounds of the Hospital, whose innovative concept and structure allows the development of projects in all fields of neurological and neurosurgical sciences. Clinical and research activities are proceeding in tight collaboration with the departments of neurology (epileptology, movement disorders, neuro-oncology, and vascular neurology units), interventional neuroradiology, neuro-ICU, ENT, ophthalmology, and endocrinology. FIGURE 9. View largeDownload slide Annual number of articles published by the department of neurosurgery of La Pitié-Salpêtrière Hospital in international journals (2000-2017). Image used with permission from the Service de Neurochirurgie, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris. All rights reserved. FIGURE 9. View largeDownload slide Annual number of articles published by the department of neurosurgery of La Pitié-Salpêtrière Hospital in international journals (2000-2017). Image used with permission from the Service de Neurochirurgie, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris. All rights reserved. FIGURE 10. View largeDownload slide The Brain and Spine Institute, located on the grounds of La Pitié-Salpêtrière Hospital, is an international brain and spinal cord research center. Image used with permission from the Service de Neurochirurgie, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris. All rights reserved. FIGURE 10. View largeDownload slide The Brain and Spine Institute, located on the grounds of La Pitié-Salpêtrière Hospital, is an international brain and spinal cord research center. Image used with permission from the Service de Neurochirurgie, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris. All rights reserved. During the last decades, basic and clinical research on brain tumors has been widely developed within La Pitié-Salpêtrière in collaboration with the neuro-oncological department and adjacent research units. First-in-man laser interstitial thermal therapy and first-in-man blood-brain barrier disruption by pulsed ultrasound were assessed in clinical trials as treatment of brain metastasis and/or recurrent glioblastomas.33-36 Early description of brain plasticity induced by cerebral pathologies.31,37,38 Currently other clinical trials using immunotherapy, viral vectors, or gene therapy for the treatment of recurrent gliomas are underway. Interest in the biology and genetics of meningiomas started in the 1980s39,40 and has never declined since that time.41-44 The department hosts the French Reference Center for neurofibromatosis type 2 allowing large studies on associated tumors like vestibular schwannomas.45 In the field of Parkinson's disease and movement disorder surgery, the department supported many studies and clinical trials from the origins of the technique to the present. Magnetic resonance stereotactic guidance was therefore developed to increase precision of electrode implantations.46,47 Different targets, procedures, and predictive factors for deep brain stimulation were investigated and evaluated for Parkinson's disease,48-55 dystonia,56,57 Tourette's syndrome,58-60 severe obsessive-compulsive disorder61 and Huntington's disease.62 Basic research on functional anatomy of basal ganglia using animal models is still a priority.63,64 In the field of epilepsy surgery, presurgical evaluation and intracranial electrode implantation for video-electroencephalography recordings have been the subjects of many studies over the past 30 yr.65-68 The surgical team also described an approach for mesial temporal structures’ selective resection69 and identified predictive factors of outcomes of surgery for mesial temporal lobe epilepsy.70-73 The department collaborates closely on research of epilepsy from human tissues.74-76 The department also cooperates with most national and international multicentric studies concerning head injury77,78 and subarachnoid hemorrhage79 patients. There is also an interest in long-term outcome prediction in severe brain trauma by using quantitative diffusion tensor imaging.80-82 CONCLUSION To date, the PubMed database reports dozens of articles supporting the role of La Pitié-Salpêtrière Hospital in the development of neurology and neurosurgery. This historical overview of the development of neurosurgery at La Pitié-Salpêtrière Hospital affirms the positive importance of such strong links between neurology, neuroradiology, anesthesiology, radiotherapy, and neurosurgery. The future major achievements in the field of neuroscience should emerge from this fundamental partnership. Disclosure The authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article. REFERENCES 1. Hurwitz LJ . L’Hopital de la Salpetriere, Paris . Br Med J . 1962 ; 1 ( 5286 ): 1196 - 1197 . Google Scholar CrossRef Search ADS PubMed 2. Philippon J . 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Google Scholar CrossRef Search ADS PubMed Copyright © 2018 by the Congress of Neurological Surgeons This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/about_us/legal/notices)

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NeurosurgeryOxford University Press

Published: Apr 11, 2018

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