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It is well known that the Horsley-Clarke frame (HCF) was developed and engineered by the British physicians Robert Henry Clarke and Victor Horsley in 1906 for use in animals. It is less appreciated that the HCF was also used by the Frederic Gibbs group in 1947 for studies of human epileptics. Subcortical depth electrodes were placed using the relationship between external landmarks and intracranial structures and confirmed by pneumoencephalography. Events leading to the development of the HCF and its subsequent use in humans for depth recordings, and lesion production in the treatment of epilepsy, movement disorders, and psychosurgery are discussed.

It is well known that the Horsley-Clarke frame was developed and first used by Robert Henry Clarke and the pioneer neurosurgeon Victor Horsley in 1906 for making lesions in the central nervous system of animals. The Horsley-Clarke frame was extensively used throughout the next 4 decades for excitation and lesion production in animals. Aubrey Mussen, a student of Clarke, designed a stereotactic apparatus for use in humans, but no procedures were actually performed with the instrument. It is less appreciated that a Horsley-Clarke frame was also constructed for human use and first applied for depth electroencephalography by Robert Hayne and Frederic Gibbs in 1947. The assumed relationship between external landmarks and intracranial structures provided initial target localization, and pneumoencephalography confirmed depth electrode position. In many ways, the work of Hayne and Gibbs paralleled the simultaneous efforts of Ernest A. Spiegel and Henry T. Wycis. Events leading to the development of stereotactic frames and their subsequent use in humans for the treatment of epilepsy, movement disorders, and psychosurgery are reviewed.

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The present investigation represents an extension of an inquiry into the electrical potentials of the basal ganglia and exposed cerebral cortex in Parkinsonism reported upon by one of us (R.M.) in 1941. At that time, the first recordings from the human caudate nucleus were obtained by means of an Adrian-Bronk needle inserted under direct inspection into the head of the nucleus and supported in situ by the operator's hand. The electrocaudatograms thus obtained were characterized by a faster frequency and lower amplitude than ,corresponding electrocorticograms recorded by means of concentric electrodes applied directly to various parts of the convexity of the frontal'lobe. The relative crudity of these early attempts gave rise to the misgiving that the experimental findings might have been much more dependent upon the recording techniques employed than upon the pathophysiologic phenomena presumed to be under inquiry. Further exploration of the problem by more reliable techniques therefore appeared desirable.Method Before the institution of the experimental routine in each patient, all medication was discontinued for several days. Under local infiltration anaesthesia of the scalp with 1 per cent. procaine hydrochloride, paired burr openings were made through the right and left anterior vertical regions of the skull. The position of the opening on each side was so planned as to lie directly above the head of the caudate nucleus. The dura and piarachnoid were suitably incised and the scalp was closed in two layers with black silk. At a later time, usually within two hours of trepanation, a slender plastic shaft equipped with eight ring-type " pick-up " electrodes was passed through one of the burr openings. The direction given to the needle and its distance from the surface were such as to place the electrodes in one or more of the following subcortical structures in each subject: the head of the caudate nucleus, the putamen, crus II of the globus pallidus, the subcallosal bundle, the anterior portion of the body of the corpus callosum, * From the Division of Neurosurgery and the Department of Psychiatry, The College of Medicine, State University of Iowa, Iowa City, Iowa. 111 the substantia medullaris of the corona radiata, the olfactory area, the cortex of the olfactory sulcus, the hypothalamic area, and the infracallosal portion of the cingulate gyrus (Fig. 1).The electrode shaft was of the same design as that recently employed by one of us (R.H.) collaborating withBelinson and Gibbs (Hayne and others, in the press) in.a study of the electrical activity of the thalamus in epileptic patients. The length of the shaft was 105 cm. and its diameter 2-3 mm. Eight silver rings, each 2 5 mm. wide and separated by 3 0 mm. from its neighbours, served as pick-up electrodes. These were disposed along the distal half of the non-conducting plastic shaft. Within the shaft, an insulated wire coursed from each of the eight ring-type electrodes and emerged from the hub. To the free-hanging distal end of each wire a phone-tip jack...