Neurological Functional Surgery in Mexico: From Pre-Columbian Cranial Surgery to Functional Neurosurgery in the 21st Century Jesu ´ s Q. Beltra ´n 1 and Jose ´ D. Carrillo-Ruiz 2,3 INTRODUCTION The brain is the most complex organ in the body. The function of the brain is amazing and is currently the subject of intense research. 1,2 Acquiring knowledge of its structure, function, and alterations has not been easy, and the most impor- tant steps have occurred in the past 150 years. However, this interest in the brain and its underlying functions and alter- ations has been long-standing and not restricted to any specific region. Ancient cultures and modern civilizations have shown significant interest in the brain, its behavior and cognitive functions, and its lesions and treatment. 3,4 The Amer- ican continent represents a particular and interesting case because it was an un- discovered world with unique cultures with a different cosmovision, knowledge, and cultural practices. More recently, in the previous century, the renewed inter- est in the brain and its disorders have resulted in the origin and development of modern functional neurosurgery (FN) in Mexico. Pre-Columbian Cultures: Cranial Surgery and Neurological Disorders No explicit evidence has been found of any specific texts on anatomy or neuro- anatomy during the pre-Columbian era; however, pre-Hispanic civilizations did have anatomic knowledge of the skull and spine. This can be inferred from their cultural practices and figures and from some records such as the Florentine Codex. 5,6 Olmec was the first major civi- lization in Mesoamerican chronology that emerged in the pre-Classic period (formative; 2000 BC to 200 AD) close to the shores of the Gulf of Mexico. They shared several similar characteristics with Mesoamerican cultures, including a cal- endar system, a Mesoamerican ballgame, and astronomically oriented architecture. 7 Their characteristic colossal heads are monumental stone representations of human heads sculpted from basalt boulders. These huge sculptures represent complex portraits of previous rulers: human heads with unique natural characteristics. These structures reveal a good knowledge of the head anatomy. It has been described that in addition to detailed representation, the facial anatomical characteristics of almost all of these colossal heads are outstanding. For instance, the harmonic proportions between the constituent parts were adjusted to the golden ratio. 8 However, the presence of this ratio in the Olmec sculptures does not imply knowledge of the Pythagorean principle but, rather, implies the consistency of human perception in different cultures regarding proportion and beauty. Olmec culture vanished around 400 BC but had a significant influence in the development of other cultures. One of these was the Zapotec civilization, which flourished in the central valleys of the current state of Oaxaca. They referred to themselves as Ben’zaa, which means “the people of the clouds” in the Zapotec language. Monte Alban (founded w500 BC) was the main Zapotec city and one of the first major cities in Mesoamerica. Specimens with trephined skulls with bone regeneration that suggest long-term survival of the individuals subjected to this procedure have been found in Monte Alban. 9 Although archaeological evidence of these types of trephinations has not been very common in Mesoamerican sites compared with other archaeological sites, such as the pre-Incan cultures, ev- idence has been found of several tech- niques performed to perforate skulls. Cutting and sawing were the main trephination techniques for ancient Peruvians. In addition, they used From the predominance of the pre-Columbian cultures to the present, an interest has existed in Mexico in brain structure and function, in both normal and pathological conditions. This interest has resulted in both medical and surgical attempts to treat some neurological conditions. Eighty years ago, with the in- fluence of American and European neurosurgeons, modern Mexican neurosur- gery emerged. Since then, it has progressively grown and diversified into several high specialties. At present, functional neurosurgery in Mexico consti- tutes, similar to that in other countries, a recognized surgical subspecialty that provides valuable information to treat brain dysfunctions such as movement disorders, pain, epilepsy, and other conditions. In the present report, we have briefly described the main historical aspects of the emergence and development of functional neurosurgery in Mexico. Key words - Functional neurosurgery - History - Mexico Abbreviations and Acronyms FN: Functional neurosurgery GHM: General Hospital of Mexico NINN: National Institute of Neurology and Neurosurgery PD: Parkinson’s disease SXXI-NMC: Siglo XXI National Medical Center From the 1 Department of Neurosurgery and 2 Stereotactic and Functional Neurosurgery and Radiosurgery Unit, General Hospital of Mexico, Mexico City; and 3 Pyschophysiology and Neuroscience Coordination, Anahuac University, North Campus, Mexico To whom correspondence should be addressed: José D. Carrillo-Ruiz, M.D., Ph.D. [E-mail: josecarrilloruiz@yahoo.com] Citation: World Neurosurg. (2019) 122:549-558. https://doi.org/10.1016/j.wneu.2018.11.165 Journal homepage: www.WORLDNEUROSURGERY.org Available online: www.sciencedirect.com 1878-8750/$ - see front matter ª 2018 Elsevier Inc. All rights reserved. WORLD NEUROSURGERY 122: 549-558, FEBRUARY 2019 www.WORLDNEUROSURGERY.org 549 Literature Review