Surgery of the Skull Base by 3 Pioneering 19th-Century Italian Surgeons—A Surgical Subspecialty That Has Been Around for a Long Time

Abstract

eviewing the history of a subject and in particular reviewing surgical history often provides new enlightenR ment on how advanced in thinking were our surgical forefathers. When looking back at 19th-century surgical techniques, and in particular looking at the first half of the 19th century, it was clearly quite challenging to have been a surgical patient about to undergo a “speedy” and extremely painful surgery. Surgical anesthesia and “painless” surgery only came about in the mid-1840s and then notwidely adopted until the late 1850s.When reviewing the careers of the 3 surgeons, T. Vanzetti, D. Giordano, and F. Durante, only the last 2 had surgical anesthesia, that is, “painless surgery” available, Vanzetti did not. For a surgeon to even begin to think of doing extensive skull base surgery, this individual would need to be able to provide the patient with a “painless state” and this state would need to be maintained throughout the surgery. For the surgeon of the 21st century, these concepts of painless surgery are not even an issue but in the 19th century this was not the case. Themedications used, for example, ether and chloroform, were often hard to control, leading to death during the surgery from overdosing in a number of cases. This perspective is extremely important to keep in mind, simply becausesurgeonswereundertaking somevery complex surgeries and in particular also developing complex surgical approaches to the skull base.