James L. Poppen and surgery of the "seat of the soul": A contemporary perspective

Dr. James Leonard Poppen (1903-1978) was one of the most renowned American neurosurgeons of the 20th century. The now eponymous Poppen approach to the pineal region is still used routinely in current neurosurgical practice. He was also one of the first to describe and practice the prefrontal lobotomy and appears to be one of the surgeons in the case of Eva Peron in 1952. Poppen was born in a Dutch family on February 28, 1903, in the town of Drenthe, Michigan. Poppen described the occipital transtentorial approach to the pineal region, this operative technique to access a deep-seated area was novel and effective, and now bears his name. His other well-known contribution includes the description of a tacking suture to prevent the formation of postoperative extradural hematomas (Poppen's stitch). Besides these, he described many novel procedures including bilateral lumbar sympathectomy, cervical rhizotomy for torticollis, and thoracolumbar sympathectomy and splanchnicectomy through small incisions. He was the first to advocate wrapping of an aneurysm neck with muscle or plastic rather than sacrificing the parent artery in difficult-to-clip aneurysms. His famous atlas on neurosurgical techniques was published in 1960. He retired from this post in 1970; however, he continued his practice of neurosurgery until his death. This historical vignette aims to highlight the work of James L. Poppen and the evolution of the surgery of the "Seat of the Soul." His work has had a lasting influence on neurosurgeons and neuroscientists over the years.