When you hear the term “brain surgery,” you automatically conjure up the image of the most complex procedure imaginable. There have been some great neurosurgeons since brain surgery became mainstream, but many believe that Wilder Penfield, a Canadian neurosurgeon, may have had the greatest impact of all on modern brain surgery. There are those who believe that Penfield completely changed the entire concept of brain surgery. If this is the case, in what way did Wilder Penfield change brain surgery forever?
Without questions, Wilder Penfield pioneered a completely new approach to the manner in which brain surgery was performed. One area in which he was able to make a drastic impact was in the manner that epilepsy is treated. When you study the approach adopted by Dr. Penfield, you might believe that you are reading the script for a science fiction movie. To treat epilepsy, Penfield actually removed a portion of the patient’s skull while the patient was still fully awake. Can you imagine being awake and your brain is literally exposed?
The procedure became known as the “Montreal Procedure,” and it allowed Dr. Penfield to become highly precise in locating the part of the brain that was responsible for causing the seizure. Seizures, especially those caused by epilepsy, are often the result of lesions on the brain. By removing the lesion, the epilepsy attacks would be relieved, either fully or at least significantly.
It was the work of Dr. Penfield in dealing with epilepsy that helped us better understand the architecture of the brain. It was Penfield who literally remapped the brain to give the world a better understanding of how different parts of the brain are directly related to different sensations throughout the body.
When you read the notes on the procedures that Penfield performed, it is nothing short of amazing. The first thing that stands out to me is the fact that the patients were able to remain calm during the procedure. Just the idea of having my skull opened up to expose my brain is unnerving. Then you have to also consider the fact that the person would also be having a small portion of their brain removed in order to get rid of the lesions that were causing epilepsy.
It was important that the patients remained awake. The doctor needed to be able to see how the patient responded when he engaged a certain part of the brain. This eliminated unnecessary cutting of the brain — protecting the healthy areas of the brain from being cut.
Those who are familiar with epilepsy are probably also familiar with the concept of an “aura.” An aura is a unique and highly specific sensation (thought, taste, or smell) that the person experiences right before they have a seizure. What Penfield was often able to do is find the part of the brain that produced the aura and then remove it. When that part of the brain was removed, it greatly reduced the chance of having seizures in the future.
It was not only the work that Penfield did with epilepsy patients that solidified his place in history. He was also instrumental in creating a completely new understanding of how the brain works by remapping the human brain. There are sketches that show just how he worked his way through the process. Penfield used small electrodes to stimulate parts of the brain to detect how that part of the brain impacted sensations and movement all over the body. It was this work that helps us understand what we now know about what part of the brain does what. His work was so valuable that today’s doctors can now observe certain behavior or the lack thereof and know where in the brain the problem is likely originating from.
Penfield was even able to trigger memories in his patients — memories that had been dormant for years. Some patients heard voices and some were able to relive experiences that they had long forgotten. As the worlds of psychology and neurology continue to merge, the work of Dr. Penfield is still proving quite valuable. Now we have machines that can scan the brain in the fraction of the time it would take during the Montreal Procedure; however, none of it would be possible if it were not for Dr. Penfield’s work.