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[Galen " On the anatomy of nerves": Translation from the Greek text and discussion].

Galen's treatise "On the Anatomy of Nerves" was translated literally from the Greek text (Kuhn's edition, vol. 2, pp. 831-856) into Japanese, utilizing the knowledge of anatomy. The previous Latin and English translations, as well as the descriptions of the nervous system in the other Galenic texts such as "Anatomical Procedures" and "On the Usefulness of the Parts of the Body," were utilized as references for the present translation, but it became evident from the present study that the previous translations contained an abundance of immature and erroneous understandings of the Galenic text. The present study has made it clear that the third cranial nerve referred to by Galen contains the most branches of the trigeminal nerve, and that the fourth cranial nerve represents the sympathetic trunk and the palatine nerves. The Galenic texts which were translated into Latin mainly in the 16th century before development of anatomical knowledge contain misunderstandings peculiar to the age. Thus the modern translations inherit some misunderstandings found in those Latin translations. Descriptions in the Galenic "On the Anatomy of Nerves" appear vague at first sight, but the described structures can be identified in most cases without doubt on the basic of anatomical knowledge. Furthermore we can estimate how Galen developed the preceding understanding of the nervous system made by Marinus on the basis of his own observations.

Anatomy↗

The role of dural anomalies in vein of Galen aneurysms: report of six cases and review of the literature.

It is proposed that the vein of Galen aneurysm represents a venous ectasia secondary to an increased flow (usually caused by a deep-seated arteriovenous shunt draining either directly into the vein of Galen aneurysm or into a tributary of the vein of Galen) associated with obstruction of a dural sinus distal to the aneurysm. The closer the venous obstruction is to the vein of Galen, the better the chances are of developing obstructive (noncommunicating) hydrocephalus and the more likely it is that the venous drainage from the rest of the brain will be unaffected. The farther the venous obstruction is from the vein of Galen aneurysm, the better the chances are of developing a communicating type of hydrocephalus. The development of cardiac failure is related to the magnitude of the arteriovenous shunt. Brain damage, seizures, and hemorrhage may be related to the retrograde venous engorgement, causing impaired drainage of the healthy brain. Careful attention should be paid to the venous drainage characteristics of the lesion because the types of dural venous obstructions and anomalies vary from case to case. The term "vein of Galen aneurysm" should be abandoned in favor of the term "vein of Galen ectasia."

Adult↗

Vein of Galen aneurysm: anatomical study of an adult autopsy case.

We present a case of vein of Galen aneurysmal malformation in an adult, the rupture of which caused a fatal hemorrhage. Macroscopic examination, together with plastination of specimen with S10, and microscopic examination showed connection of the aneurysm with the right thalamoperforating artery and, bilaterally, with the posterior choroidal and mesencephalic arteries. Histology also showed thinning of the aneurysmal wall, due to marked reduction of the muscular media at the point of rupture, and its connection with an arteriovenous malformation of the left thalamus. A review of the anatomy of the Galenic system shows that the medullary veins curve at an acute angle to form the paired internal cerebral veins, with a sudden change in flow and that, from late fetal life, the vein of Galen curves around the splenium to enter the straight sinus at an angle opposing its flow. Based on anatomical study and a review of the literature, we suggest that aneurysmatic dilatation of the vein of Galen may result from a combination of pathological and predisposing anatomical factors. The anatomical characteristics of the origin of the internal cerebral veins and of the entry of the vein of Galen into the straight sinus make particularly susceptible to the hemodynamic effects of arteriovenous shunts the vein of Galen itself, which is situated in the cisterna ambiens, an anatomical space that does not impede its enlargement.

Adult↗

Galen on obesity: etiology, effects, and treatment.

Only a few studies have been conducted to determine the historical background of obesity, and even fewer have focused on specific writers who have made great contributions on the subject. Galen was among the first to establish scientific methods to describe and treat morbid obesity, and a presentation of his ideas is important because of the influence he has exerted even up to modern times. The methodology of the current research was based on detailed study of Galen's treatises, which concern the nature of obesity, the etiology, the consequences, and the treatment, often in comparison to the writings of other writers from the Hippocratic period up to recent years. Galen stated that obesity results from the surplus of "bad humors" in the body and specifically from a surplus of blood. He specifically described patients' conditions, both physiologic and practical; he presented side effects; and he introduced methods of treatment that are used even today. Galen also described an illness he called polisarkia, which today we call morbid obesity. According to Galen's views, we can identify morbid obesity under the description of polisarkia. Galenic physiology and pathology have been proved wrong and have been set aside. Nevertheless, he proposed some treatments for obesity such as diet, exercise, and medications that are still valuable and are nearly the same as what is advocated today.

Greece, Ancient↗

Surgical treatment of the thrombosed vein of galen aneurysm.

OBJECTIVE AND IMPORTANCE: Vein of Galen aneurysm is a rare congenital anomaly of cerebral circulation and occurs mainly in newborns and children. The spontaneously thrombosed vein of Galen aneurysm is especially rare and an uncommonly reported event. CLINICAL PRESENTATION: Two patients with a spontaneously thrombosed vein of Galen aneurysm were operated on at our institute. CT and MRI demonstrated space-occupying lesions of the pineal region and two other masses in the posterior fossa in the second case. The first described case should be referred to as the true type of aneurysm. The vascular malformation, revealed in the second case should be referred to as the false type. In this case the vein of Galen was enlarged to a gigantic size due to the blood drainage from the arteriovenous malformation supplying it from the inferior posterior cerebellar artery. TECHNIQUE: Thrombosed aneurysmal sacs were resected totally by subtentorial supracerebellar and median suboccipital approaches. CONCLUSION: The authors report two cases of successful surgical resection of a thrombosed vein of Galen aneurysm in children. Diagnostic features are considered and the informative value of magnetic resonance imaging is stressed. The principles of choosing the right approach and dissection techniques of thrombosed aneurysms of the vein of Galen are described.

Cerebral Veins↗

Claudius Galen: from a 20th century genitourinary perspective.

PURPOSE: We review the life and contributions of Claudius Galen from a 20th century perspective and examine his genitourinary observations. MATERIALS AND METHODS: All obtainable English translations of Galen's works were explored in addition to relevant commentaries. RESULTS: Galen's remarkable observations and novel concepts expanded medical knowledge in general and contributed to fundamental genitourinary principles in particular. Galen was one of the first to describe correctly the function of kidneys and explain micturition. Among his many neologisms he coined the term ureter, and he was probably the first to recognize the value of a competent ureterovesical valve. Galen advocated catheterization for urinary obstruction. He was a teacher, practitioner and philosopher, and wrote voluminously. CONCLUSIONS: Galen's influence on medical theory, terminology and practice remained unquestioned in Europe and the Middle East throughout the Middle Ages and Renaissance.

Animals↗

Blood velocity in the fetal vein of Galen and the outcome of high-risk pregnancy.

BACKGROUND: Pulsation in the flow velocity waveform in the umbilical vein is related to perinatal mortality but the flow velocity waveform in the fetal vein of Galen is normally even and without fluctuation. OBJECTIVES: To establish whether blood flow velocity pulsations in the vein of Galen in high-risk pregnancies are related to outcome. STUDY DESIGN: The vein of Galen was located by colour Doppler ultrasound in 102 pregnancies complicated by severe pregnancy-induced hypertension. The blood velocity waveform was recorded by pulsed Doppler within 2 days of delivery and the presence pulsations related to pregnancy outcome, including emergency operative intervention and neonatal distress. Umbilical artery and vein and uterine artery blood flow velocity waveform were also recorded at the same time. The clinicians managing the women were unaware of the venous flow results. RESULTS: Pulsation were present in the vein of Galen in 68 cases and in the umbilical vein in 21. Both were significantly related to adverse outcome. Pulsations in the vein of Galen were seen in all seven perinatal deaths. CONCLUSIONS: Since umbilical venous pulsation are a late sign of fetal compromise, and pulsations in the vein of Galen seem to appear earlier, thus being an intermediate sign of fetal compromise that might be of great value for fetal surveillance.

Asphyxia↗

Serial ultrasonographic evaluation of neonatal vein of Galen malformations to assess the efficacy of interventional neuroradiological procedures.

Two-dimensional echocardiography complemented with color-flow imaging and pulsed Doppler ultrasound was used to evaluate one fetus and five neonates with a vein of Galen malformation who had severe high-output congestive heart failure and cranial bruits at birth. Intracranial blood flow through the vein of Galen malformations, cardiac status, and direction of aortic blood flow were assessed before and after staged interventional neuroradiological treatment with transarterial and transvenous embolization procedures. Color-flow imaging in each infant displayed the major vascular anatomy including feeding vessels and the patterns of filling of the vein of Galen malformations. Pulsed Doppler ultrasound performed on the descending aorta above the diaphragm showed the degree of diastolic flow reversal indicative of runoff into the vein of Galen malformations. A reduction in blood flow through the vein of Galen malformation was seen on color-flow imaging in four patients treated successfully by embolic procedures. The ratio of diastolic retrograde flow velocity in the descending aorta to systolic antegrade velocity decreased from 0.51 +/- 0.15 (mean +/- standard deviation) to 0.15 +/- 0.20 (P less than 0.05). Color-flow imaging and pulsed Doppler ultrasonography provided anatomical and pathophysiological information regarding cardiac hemodynamics and intracranial blood flow; with the patient's clinical status, these methods provided a reliable, noninvasive means to evaluate the effectiveness of therapy and the need for further treatment in neonates with vein of Galen malformations.

Cerebral Veins↗

Galen: a pioneer of spine research.

Galen of Pergamum AD (2nd century), the most eminent Greek physician after Hippocrates, marked the history of medicine for more than 14 centuries. His doctrines, expressed in his voluminous work, combined the medical heritage of the Hippocratic, the Alexandrian, and some of the most important medical schools of antiquity. The strong influence of the Hippocratic tradition can characteristically be traced in orthopaedics and particularly in Galen's presentation of the spine. Based on his observations, derived from dissection and vivisection of animals, Galen established a pioneer model for the study of human spine. His research ended in an accurate description of the vertebral column and the spinal cord. He also described the course and the distribution of the nerves emerging from the spine. In addition, he dealt with the diseases affecting these structures focusing on spinal tuberculosis and the injuries of the spine and the spinal marrow. Galen was the first physician to demonstrate the neurological implications following transection of the spinal cord at several levels. The predominant feature in Galen's reference to spine is its teleological perspective; the great physician tended to attribute the prodigious structure of the spine to nature's providence. Despite the inevitable anatomical errors, Galen's inspired experiments remained the only thorough approach of spinal anatomy and pathology until the recent centuries, when the evolution of sophisticated technical aids opened new pathways to spine research.

Greece, Ancient↗

Three-dimensional computed tomography angiography of the galenic system for the occipital transtentorial approach.

The venous variations of the galenic system were evaluated using three-dimensional computed tomography angiography (3D-CTA) to assess the influence on the occipital transtentorial approach in 150 patients who underwent 3D-CTA as a routine screening examination for cerebrovascular diseases. The variations of the vein of Galen with its tributaries, the tentorial sinus, and the veins around the tentorium were evaluated in multiple intensity projections and stereoscopic images. The angle between the vein of Galen and the straight sinus was 67.1 +/- 31.9 degrees (mean +/- SD). Observation of the pineal body from the direction of the approach tended to extend to the quadrigeminal bodies in acute angle cases, and to the third ventricle in obtuse angle cases. Bilateral internal cerebral veins (ICVs) joined in the anterior portion were associated with a long vein of Galen, or in the posterior portion with a short vein of Galen. The distance between the bilateral ICVs was 4.66 +/- 2.28 mm (mean +/- SD), and the shape of the space could be classified as spindle, parallel, hairpin, and round types. The basal vein could be classified into well-developed, hypoplastic, hardly recognized, and mimicking two basal veins because the tributary did not join but ran parallel to the basal vein. The drainage pathways lead to the anterior or posterior portion of the vein of Galen, the ICV, the tentorial sinus, and the superior petrosal sinus. The various types of the tentorial sinus and primitive tentorial sinus which might be sacrificed during section of the tentorium were confirmed. The inferior cerebral vein draining to the tentorial sinus could be seen. 3D-CTA could also demonstrate the presence, the course, and the drainage points of the internal occipital vein, the precentral cerebellar vein, the posterior pericallosal vein, and so on. 3D-CTA is useful to evaluate the variations of the venous system and the relationship with the tumor, and for preoperative simulation and intraoperative navigation of the occipital transtentorial approach.

Cerebral Angiography↗

[In memory of Galen--on the 1800th anniversary of his death].

In the year 1999 or 2000 it is the 1800th anniversary of Galen's death. He was one of the leading thinkers in medicine and one of the best known physicians of all times. He was not only a gifted practitioner but also a first class anatomist, physiologist, pathologist, and pharmacologist of the ancient times. His work is present in all these parts of medicine. This article gives Galen's biography and contributions to the above mentioned medical disciplines and practice. During fourteen centuries Galen's works were undisputable textbooks for students of medicine and most valuable manuals for practitioners besides the works of Hippocrates. Galen founded a new medico-philosophical school, based on that of Hippocrates, but comprising all medical knowledge of that time as well as his remarkable medical experience. While Hippocrates formulated the basis of the clinical medicine and the members of the Alexandria school made the most important discoveries in anatomy and physiology, Galen compiled all the knowledge of his predecessors, added a philosophical basis and created a unified system for centuries believed to be a definitive one where nothing should be added. Besides Hippocrates, Galen was the most outstanding physician of the ancient times and one of the greatest of all times. He established the fundamentals of the medical science which are still significant.

Greece, Ancient↗

[Vesalius and De humani corporis fabrica: Galen's errors and the change of anatomy in the sixteenth century].

In medieval universities, human dissections were in general unusual, and public dissections were moreover strictly standardized. At public anatomical lessons three persons were needed to perform an autopsy. The Lector (a lecturer) read and commented on an authoritative text, which usually was Mondino dei Liuzzi's Anatomy. The Ostensor pointed out to the sector, normally a surgeon or a barber, the part of the body to be dissected. The procedure followed the text, the truth of which was not, questioned, and what was seen in a dissected body only confirmed what was stated in the text. In his De Humani corporis fabrica Vesalius criticized both the medieval method of dissection and the dependence of anatomy on authoritative texts. Vesalius wanted to unite the roles of lector, ostensor and sector. In Vesalius's view, a lecturer on anatomy must be able to dissect a cadaver himself and trust his own eyes more than authoritative text. Relying on his own eyes Vesalius gradually began to doubt the truth of various anatomical statements found in Galen's anatomical treatises. Galen (ca. 130-200) was the greatest medical authority during the Renaissance, and he was regarded as almost infallible. In Galen's person culminated the idealism of Renaissance humanism, according to which medical truth rested solely on ancient, especially Greek, heritage. The primary task of the medical humanist was to return to the ideas of the ancients. Vesalius's attitude toward this idealism was somewhat ambiguous. On one hand he found antique evidence for the view that anatomy should be based on one's own experience achieved by dissection of human cadavers. On the other hand he was forced to question the infallibility of Galen. Vesalius solved the discrepancy between the proof of his own eyes and the humanistic ideal by pointing out that anatomy had occupied a much higher level before Galen, in ancient Alexandria, and that Galen in his anatomical works had relied too much on animal dissection....

Anatomy↗

Vein of Galen malformation: correlation of clinical presentation, arteriography, and MR imaging.

To test the value of currently proposed angiographic categorizations of vein of Galen malformations and a hypothesis regarding the causes of vein of Galen malformations and of accompanying hydrocephalus, as well as to assess the relative utility of MR imaging and CT in clinical evaluation, we reviewed the clinical and radiologic records of 34 patients with vein of Galen malformations. Patients were divided into two groups on the basis of the angiographic demonstration of either an arteriovenous malformation nidus or a direct arteriovenous fistula to the wall of the vein of Galen or one of its tributaries. Patients with such a nidus (n = 17) could be distinguished from those with arteriovenous fistulas alone (n = 17) on the basis of age at presentation (p less than .01) and presenting symptoms. Venous constraints, thought to be etiologically important, were identified in 31 of 34 patients. The presence or absence of hydrocephalus was explainable by mass effect in only 24 of 32 patients. In seven of 32 cases, no obvious mass effect was seen in the presence of hydrocephalus, but arteriographic evidence of venous hypertension was present in all patients with hydrocephalus. MR provided improved depiction of both arterial and venous anatomy as compared with CT. Parenchymal abnormalities were uncommon. No patients had subarachnoid hemorrhages. We conclude that MR is superior to CT in the clinical evaluation of vein of Galen malformations, that the angiographic finding of a nidus separates patients with vein of Galen malformations into clinical and therapeutically relevant groups, and that simple mass effect on the aqueduct is not an adequate explanation for all cases of hydrocephalus in patients with this disease.

Cerebral Angiography↗

Transfemoral venous embolization of vein of Galen malformations.

Three infants with vein of Galen malformations, all presenting with congestive heart failure, underwent a total of five embolization procedures that employed a percutaneous transfemoral venous approach to catheterize the vein of Galen. In one instance, direct retrograde catheterization of feeding arterial pedicles to the vein of Galen and embolization of the fistulous connections was achieved via this route. The indications for transfemoral venous treatment included persistent symptoms despite transarterial and transtorcular embolization in one patient, an unsuccessful transarterial embolization attempt (complicated by catheter fracture) in another, and the inadvisability of transarterial embolization because of an excessive number of feeding arteries in a third. Complete obliteration of the malformation was achieved in one patient and significant flow reduction in the other two. Vein of Galen perforation with the catheter tip complicated one procedure. All three patients were stable after clinical follow-ups (9-12 months). The transvenous route to the vein of Galen can be undertaken from a transfemoral approach, obviating surgical exposure of the torcular Herophili. In addition, we introduce the concept of direct retrograde catheterization of the feeding arteries to the vein of Galen malformation by a transfemoral venous approach, a procedure that has not been reported previously.

Cerebral Veins↗

Venous pressure measurements in vein of Galen aneurysms.

Venous pressures were measured within the vein of Galen aneurysm/straight sinus complex in 15 patients with Galenic arteriovenous fistulae and vein of Galen aneurysms. Pressures exceeded normal (less than 5 cm of H2O) in each instance, ranging between 9 and 55 cm of H2O. Measured values exceeding 20 cm of H2O were associated with an increased occurrence of brain calcification. Mean venous pressures were relatively higher in the patients with thalamic arteriovenous malformations, and relatively lower in patients with true vein of Galen fistulae and choroidal type malformations. A pressure gradient across the straight sinus was measured in one patient and suspected in three others when disproportionate dilatation of the vein of Galen occurred in the presence of a small or normal-sized straight sinus. No clear relationship existed between levels of venous pressure elevation and degree of ventriculomegaly. Refractory heart failure occurred only in neonates with choroidal type fistulae and no apparent venous outflow obstruction. It is likely that the degree of venous pressure elevation reflects the hemodynamic significance of arteriovenous shunt, provided it is interpreted in context with the current clinical status and the angioarchitecture of the Galenic fistula. Such data may assist in the timing of embolotherapy. Patients with lower venous pressure are not likely to develop brain calcification or seizures, and therefore can tolerate transtorcular embolotherapy staged at wider intervals.

Blood Volume↗

Spontaneously healed vein of Galen aneurysms. Clinical radiological features.

Vein of Galen aneurysms demonstrate a high tendency to thrombose, as extensive thrombophlebitis of the dural sinuses and deep venous system occurs frequently. This may be explained by the frequent detection of venous anomalies and retention of embryonic venous patterns such as the median prosencephalic vein. Twenty-one cases were reviewed (19 from the literature, 2 of our own cases): no typical syndrome for thrombosed aneurysm of the vein of Galen could be found; therefore, a preliminary diagnosis of clotted vein of Galen aneurysm was made in only half the cases. In all the remaining ones, pineal or III ventricle masses were suspected. Nevertheless, crescentic rimlike calcifications in the region of the vein of Galen can be found in 50% of cases. Only in half of the cases did angiography demonstrate the malformation filled by contrast medium, while in the remaining cases not only the aneurysm but also the deep Galenic venous system failed to opacify. Computed tomography and magnetic resonance scans demonstrated masses with high density/intensity values, with varying degrees of calcification. Knowledge of this pathological entity is important in order to avoid unnecessary surgical procedures.

Adolescent↗

Radical surgery of a giant Galen's vein aneurysm using total circulatory arrest: case report.

BACKGROUND: Arteriovenous malformations of Galen's vein are a rare type of vascular anomaly. The complex anatomy of these lesions creates an extremely difficult management dilemma. We report successful surgical treatment of a 7-year-old patient with a Galen's vein aneurysm. METHODS AND RESULTS: A 7-year-old patient with slowly progressing gait disturbance, emotional instability, and strange behaviour is presented. A computed tomography scan revealed a high-density mass in the pineal region and cerebral angiography showed an aneurysm of Galen's vein. We decided to perform surgical excision of the aneurysm. The operation was performed under hypothermic circulatory arrest with barbiturate cerebral protection. The patient had no signs of postoperative ischemic deficits, hemorrhage, or neurologic deterioration. CONCLUSIONS: Various techniques have been described for the obliteration of Galen's vein aneurysms, including direct surgical approach, staged operation, and transarterial, transvenous or transtorcular embolization. We present this patient to illustrate the use of hypothermic circulatory arrest and barbiturate cerebral protection for successful surgical excision of this complex vascular lesion. The combination of these techniques allowed us, in this case, to operate with reasonable safety on otherwise, difficult to treat aneurysm of Galen's vein.

Cerebral Veins↗

The fatal embrace: Galen and the history of ancient medicine.

The influence of Galen on the subsequent interpretation of the history of ancient medicine has been substantial. This paper explores the consequences of adopting a non-Galenic perspective in two different areas of research. It argues that Galen's own career, and his own views of the ideal physician, cannot be taken as typical of most ancient medical practitioners; and that the theory of the four humors, blood, bile, black bile, and phlegm, did not become a universal standard until after Galen. That theory was merely one of several variations on the theme of body fluids, and entered Greek medicine relatively late. Hippocratic contemporaries of Galen accepted it alongside other theories from the Corpus, e.g. Diseases I, that modern scholars have viewed as incompatible.

History of Medicine↗