Vesalius Award: More than a Mere Tubercle: Contributions of Laurent Princeteau to Neurosurgery and Anatomy

Introduction: His name is attached to a small, but important tubercle, however, the contributions of Laurent Princeteau (1858-1932) to neurosurgery have largely gone unrecognized, perhaps because he was educated and practiced outside Paris. After his 1884 thesis describing an iliac artery anomaly, and obtaining the distinguished teaching agrégé degree, he started at the Universite de Bordeaux and Hôpital Saint-André. Working with Arnozan, Cannieu, Abel Bouchard, Villar, Pitres and Poirier, Princeteau became surgical clinic chief, anatomy institute head, dental school anatomy professor, and among many recognitions was awarded (1904) the Golden Palms Officier de l'Instruction Publique, and (WWI 1917) Legion of Honor Knight’s Cross. Pioneering experimental surgical anatomical study techniques, his contributions on the trigeminal nerve and trigeminal neuralgia (an early popular subject of neurosurgery) stand out. Identifying a bony prominence near the petrous apex (retro-gasserian tubercle) to help locate the Gasserian ganglion, his description was rapidly adopted by the European “neurosurgical” community, entering the classic French anatomy textbooks (while remaining almost unknown to the rest of the world) with Thierry de Martel, prominent early 20th century French neurosurgeon, naming the anatomy for Princeteau. In his student Edouard-Charles Sambuc’s 1898 thesis, Princeteau provided the first analysis, clear classification, indications, and critical appraisal of procedures for attacking the Gasserian ganglion which for decades would define trigeminal neuralgia surgery. Princeteau innovated malleable brain retractors, conceptualized gravity-assisted brain retraction, and provided a detailed description of the foramen lacerum fibrous membrane surrounding the carotid artery lacerum segment (that we believe deserves the eponym “membrane of Princeteau”). A general surgeon and anatomist like others who became the first generation of “neurosurgeons” and being in Bordeaux perhaps are reasons for unfamiliarity with his important legacy. Princeteau fundamentally contributed to experimental surgical and neurosurgical anatomic research, teaching, instrumentation and surgical methodology – especially for concepts and treatment of trigeminal neuralgia.

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