Fedor Krause’s inspiring biography shows the value of translational thinking: one of the fathers of modern neurosurgery, this gifted child was recognized for his musical talent; he was able to study medicine thanks to financial support in recognition for his study performances. He wrote his doctor thesis on pneumology, and contributed to general surgery, neuroanaesthesiology, and neurosurgery application of novel technologies in neurosurgery and ethics. More in detail, in the neurosurgical field, he performed the first lumbar discectomy, set up intraoperative nerve monitoring, and pioneered trigeminal and acusticus nerve surgery, epilepsy surgery, and cortical mapping. His passion and engagement for surgery allowed him to make small centers turn into great centers recognized as renowned academic environments.
This article is devoted to the life, scientific, and surgical achievements as well as to the legacy of Fedor Krause (Fig. 1).
Father of the German neurosurgery [2,3,4,5,6] and pioneer of electrostimulation, he was born on March 10, 1857, in Friedland in Niederschlesien (Lower Silesia, today Mieroszów). He was orphaned by his father, a modest judicial clerk from the district of Waldenburg and Glatz, when he was young. When he was 9 years old, his mother decided to move the family to Berlin, where he led a humble life. This did not prevent Fedor from studying at Glatz (now Kłodzko, a town in Silesia—approximately 50 miles from Wrodaw), and at the “Sophien Gymnasium” in Berlin, where he became known for his talent, studying piano and winning many awards. He then studied music at the Conservatory of Music in Berlin, and later, in 1875, thanks to a generous financial support and the suggestion of von Volkmann, he could switch to medicine, studying at Friedrich-Wilhelms University in Berlin (named Humboldt University since 1949), and earning his doctorate. On July 1, 1879, he successfully defended his dissertation entitled “Pneumatometrische Untersuchungen nach einer neuen Methode” (“Pneumatometric analyses according to a new method”). After, Krause undertook clinical training at Stettin for 3 months, and from July 1880 worked for 2 years as an ophthalmologist in the prestigious ophthalmology clinic “Berlin Eye Clinic” directed by Professor Julius Hirschberg (1843–1925). In this early period, Krause also worked with many famous scientists, such as the bacteriologists Robert Koch (1843–1910) and Karl Friedländer (1847–1887), the pathologist Karl Weigert (1845–1904), and the surgeon Bernhard von Langenbeck (1810–1887). In his later works, Fedor Krause explored various fields of medicine. With Robert Koch at the “Imperial Board of Health,” he studied the systemic manifestations of tuberculosis, and especially of bone tuberculosis. The treatise “Die Tuberkulose der Knochen und der Gelenke. Nach eigenen in der Volkmann’schen gesammelten Erfahrungen und Tierversuchen. Leipzig, Vogel 1891” (“The tuberculosis of the Bones and Joints, according to the personal experiences with Volkmann and animal trials”) was published in 1891 and was based on the personal experience gained at the Volkmann’s clinic in Halle. In 1883, he became a medical assistant to Richard von Volkmann (1830–1889) at the surgical university clinic at Halle, where he learned the principles of antisepsis. Krause remained in Halle until March 1890. Later, he practiced as a pathologist at the Senckenberg Institute in Frankfurt am Main (1890–1892). He was then called as a surgeon-in chief at the city hospital at Hamburg-Altona (1892–1900), where the best equipment was introduced, such as a Roentgen-tube in 1896, which had been invented just the year before, and both the staff as well as the beds and operating rooms were potentiated so that surgical procedures per year increased from 415 in 1892 to 1239 in 1899, when he was called as surgeon-in chief at the surgical department at Augusta Hospital in Berlin. This hospital was named after Augusta, who died in 1890, and, as the Queen of Prussia, had inaugurated the Augusta hospital in 1869. In 1901, Krause became an associate professor at the University of Berlin. In 1914, Krause was awarded with an honorary full professorship by the Berlin Friedrich-Wilhelms University. During World War I, he served as a surgical consultant and following the end of the war, he traveled to Latin America, where he taught and introduced neurosurgical practices in several countries. Krause was succeeded by Heymann in 1921, but remained (surgically) active as “Senior Head” until the end of 1930. He was still treated with great respect by all staff members, and also several foreign visitors came to assist to his operations, which he could describe in several languages. In 1930, some years after his wife’s death in 1924, he stopped his surgical activity and settled in Rome where he not only devoted himself to music and fine arts but also completed some of his volumes on brain surgery. Krause died of pneumonia in Bad Gastein on 22nd September 1937 at the age of 80 years old and was buried in the Kaiser Wilhelm Memorial Cemetery in Berlin—Charlottenburg .
Contributions in the field of neurosurgery
Functional and stereotactic neurosurgery
Krause was one of the pioneers in the field of functional neurosurgery, being a strong advocate of electrostimulation (Fig. 2). He was one of the first to use direct electrical stimulation (DES) in humans prior to Otfried Foerster (1873–1941), after Gustav Fritsch (1838–1927) and Eduard Hitzig (1838–1907) in dogs, Charles Sherrington (1857–1952), Harvey Williams Cushing (1869–1939), Oskar Grünbaum (1870–1959) and Cécile Vogt (1875–1962), and Moritz Schiff (1823–1896) in animal models, Robert Bartholow (1831–1904) and Victor Horsley (1857–1916) in 1890 in humans. In 1912, in a series of 142 surgical patients, Krause was able to finely map motor and sensorial functions .
Intraoperative nerve monitoring
On July 14, 1898, Krause described the use of intra-operative nerve monitoring and in particular of monopolar facial nerve stimulation during a cochlear nerve section for intractable tinnitus and reported his findings, as follows: “…The divided acusticus was now placed backward, so that it came in contact with the cerebellum. Unipolar faradic irritation of the remaining nerve trunk with the weakest possible current of the induction apparatus resulted in contractions of the right facial region, especially of the orbicularis oculi, as well as of the branches supplying the nose and the mouth. The irritation of the displaced acusticus (using also the very weakest possible current) caused the right shoulder to be elevated twice in succession. The accessorius situated below had undoubtedly been reached by the current, because it was, together with the stump of the acusticus, bathed in liquor that had trickled down…” [7, 9]. In 1898, he performed the first vestibulocochlear nerve section to treat a patient with severe tinnitus .
Krause was one of the pioneers of epilepsy surgery together with Foerster, performing over 400 surgical operations. Krause collaborated in Berlin with the German neurologist Hermann Oppenheim (1858–1919) and was inspired by the prior physiological work of the neuropsychiatrist Eduard Hitzig. He published in 1909 the article “Die operative Behandlung der Epilepsie” (“The surgical treatment of seizures”) in a Berlin medical journal. In his later books (see below), he proposed that the surgical resection of the ictal onset zone was the most important intervention in order to achieve a successful outcome. He operated before the advent of electroencephalogram and relied on cortical stimulation [11, 12].
Krause was a pioneer in the sub-specialty of spinal surgery as well. He performed the first discectomy and laminectomy in a patient who had been suffering from severe sciatic pain for several years and who had developed an acute cauda equina syndrome. He was actually the first surgeon to remove a herniated lumbar disc in 1908, even though he confused the herniated disc with a tumor, naming it “enchondroma.” Together with Oppenheim, he reported this clinical case in 1909 in an article entitled “Über Einklemmung bzw. Strangulation der cauda equinae” (“About the entrapment or strangulation of the cauda equina”) [13,14,15].
He refined the surgical approach for many brain and spinal cord tumors. In 1904, he performed the first supra-orbital, sub-frontal approach for the resection of a large skull base meningioma, affecting the tuberculum sellae. He advocated a trans-frontal craniotomy in case of pituitary tumors and for vestibular schwannomas an intradural posterior fossa craniectomy, with the patient in sitting position. The development of the surgical approach to the cerebellopontine angle was probably his most important achievement (Fig. 3a). In 1909, he performed his first resection of a tumor of the pituitary gland, via a trans-frontal approach, being skeptical of the trans-nasal approach developed by Hermann Schloffer of Innsbruck, of the supra-nasal technique by the Viennese Anton von Eiselberg, and of the endo-nasal approach suggested by the rhinologist Oskar Hirsch. He advocated a suprasellar sub-tentorial approach to the pineal gland and posterior third ventricle. He was also the first neurosurgeon to surgically approach the fourth ventricle (Fig. 3b), as written by the otologist Güttich in his obituary: “Krause was the first person looking into the fourth ventricle of a living human being”. In 1908, Krause published the first volume of a text on neurosurgery, “Chirurgie des Gehirns und Rückenmarks nach eigenen Erfahrungen” (“Surgery of the Brain and Spinal Cord according to his own experience”), and translated into English in 1909 and in which different neurosurgical techniques, including the trans-frontal approach to the chiasm, were described. The second volume followed in 1911. This was the first published multivolume text totally devoted to neurosurgery [17,18,19]. In 1912, together with his senior assistant Emil Heymann, he started a six-volume textbook “Chirurgische Operationen” (“Surgical procedures”), of which only the first two volumes appeared in 1912 and 1914. The project was interrupted by the Great War.
Trigeminal neuralgia surgery
The eponymous Hartley-Krause operation (a pre-ganglionic resection of the fifth cranial nerve) is named after Krause and after the surgeon Frank Hartley (1857–1913), who proposed it in 1892 independently [20, 21]. This procedure involves an extra-dural sub-temporal excision of the Gasserian ganglion and its roots to relieve trigeminal neuralgia (Fig. 3c). This procedure implies creating a small Ω-shaped incision just above the zygoma and turning down a tissue flap composed of the skin, muscle, and bone to expose the ganglion. The nerves were divided at the foramen ovale and the foramen rotundum and excised to a point back beyond the gasserian ganglion. Despite the proximity of the gasserian ganglion to the internal carotid artery, Krause, in 70 cases of Gasserian ganglionectomy, never injured the carotid artery. The first operation was performed on January 31, 1893, on an 86-year-old patient and is described in a 260-page monography entitled “Die Neuralgie des trigeminus nebst der Anatomie und Physiologie des Nerven” (“The nevralgia of the trigeminus nerve and the anatomy and physiology of the nerve”). The Hartley-Krause approach was refined and popularized by Spiller and Frazier in 1901. The major contribution of Spiller and Frazier was the implementation of Tiffany’s idea of subtotal resection by sparing the upper portion of the ganglion and the first branch of the trigeminal nerve to decrease the risk of corneal anesthesia.
He was a pioneer in the sub-specialty of vascular neurosurgery, being the first neurosurgeon who operated on a brain angioma (Fig. 3d). The patient was a 46-year-old man who presented with Jacksonian seizures. Krause reported the surgical procedure in all details starting from a very strong bleeding after dura incision originating from a pial thick vessel that was directed into the dura. He well described the thick and tortuous (arterialized) veins of the pia filled with light red blood, many directed to the sinus longitudinalis surrounded by newly formed vessels, and smaller 2-mm-thick tortuous veins with no interposed brain parenchyma. He surrounded those abnormal vessels and their (arterial) feeders and performed several ligations until blood was stagnating within the vessels between the sutures. Krause describes those ligated veins looking like “Würste” (sausages). During the ligations, Krause described his attention in avoiding to ligate the arteria fossae Sylvii (the middle cerebral artery). He avoided to cut off the ligated vessels since the patient had already lost high amounts of blood and left “vioform” sponges for some days in the surgical cavity that were then gently retracted after some days and finally removed. The patient had an uneventful outcome. Krause’s diagnosis was that of an Angioma venosum racemosum .
Krause advised against the risk of cerebral edema caused by ether and chloroform. Despite the fact that, while working with professor von Volkman, Krause used this combination of morphine and chloroform, he was convinced that this formula was detrimental for neurosurgical interventions. This motivated Krause to pursue his research in the field of neuro-anesthesiology .
Krause also pioneered the specialty of neurotraumatology. In 1900, Krause was able to remove a revolver bullet from the clinoid process, carrying out a frontal osteoplastic craniotomy .
Within a few months of Wilhelm Conrad Röntgen’s discovery of x-rays in 1895, Fedor Krause acquired an x-ray apparatus and began to extensively use it in his daily interactions with patients and for diagnosis. He was the first neurosurgeon to use x-rays methodically and systematically for diagnosis. In the chapter “Radiographie” (“Radiography”) of his masterpiece “Chirurgie des Gehirns und Rückenmarks” (“Surgery of the Brain and of the spinal cord”), Krause described cases showing radiographs and described diagnosis, surgery, and outcome with illustrations by Max Landsberg .
His view on neurosurgical syllabus
Although Krause excelled in and promoted neurosurgery, he believed that surgeons should excel at general surgery. He wrote: “Since I hold to the point of view that specialization in surgery should be avoided, if one desires not to become one-sided, I take particular satisfaction in being able to devote my career to a hospital in which … general surgery in the truest sense of the term has been practiced”. He became acquainted with the recognition of neurosurgery as independent specialty when he was dying. He told Wilhelm Tönnis (1898–1978) “Nur vorwärts auf dem eingeschlagenen Wege. Er führt zum Ziel” (“Move forward on the chosen path. It will lead to the goal”) .
Contributions to other surgical fields
Krause also pioneered other surgical specialties: namely, general surgery, plastic surgery (free transplantation of full-thickness skin flaps for covering skin defects, the so-called Krause grafts), orthopedics (bone and joint tuberculosis, application of walking casts), urology (total cystectomy, bilateral ureterosigmoidostomy, re-implantation of the ureter into the bladder), endocrine surgery (adrenotomy, transplantation of endocrinous tissue), ear, nose, and throat (ENT) surgery (sympathectomy, carotid artery ligation), digestive surgery (gastric resection), and thoracic surgery (partial resection of a lobe of lung), among others. 
His view on neuroethics and neurotechnologies
Krause can be credited as one of the first, if not the first, to have developed a bioethical reflection on the relationship between neurosurgery and technology, thus pioneering the modern specialty of neuroethics, defined by William Safire as “the examination of what is right and wrong, good and bad about the treatment of, perfection of, or unwelcome invasion of and worrisome manipulation of the human brain”. Krause was inclined to adopt technology that he believed could be helpful in surgery .
Fedor Krause gave birth to an important German school of neurosurgery. Among his disciples, we have to remember Emil Heymann (1878–1936), Karl Max Behrend (1895–1963), and Georg Merrem (1908–1971), among others. In his honor, the Medal of the German Society and the Memorial Lecture at Leipzig have been established.
Krause is also an example of a Physician and Scientist with international engagement: he visited Latin America, in particular Brazil (1920 and 1922) and Mexico (winter 1922–1923) where he could contribute to neurosurgical developments [26,27,28]. These overseas visits by Krause occurred in the context of Deutschtum or Germanism (in the Austro-German idealistic context characterized by liberalism and the 1848 revolutions) describing efforts of the Weimar government after the First World War to recover Germany’s prewar economic, scientific, and industrial prominence. In his official talks, Krause appealed the need for “joint effort and mutual trust” among people and countries for progress and remarked that “science has no boundaries.” His visits were diplomatic (he met the Brazilian President Epitàcio Pessoa, the Brazilian Minister of Justice Joachim Ferreira Chaves and the German envoy Georg Alfred Plum), scientific (he performed several innovative neurosurgical procedures and lectures), and also personal (one of his Brazilian trainees had contributed to arrange his trip to Brazil) and on his second visit to Brazil, he also presented a donation sent by German chemical-pharmaceutical companies to the medical school. Of note, as mentioned above, Krause also mastered several languages to be able to encounter persons from other nations, for example, he learned Portuguese for his second visit to Brazil in 1922 .
A particularly well-written and interesting tribute to Fedor Krause can be found in the book “Neurosurgery in Germany. History. 50 years of German Society of Neurosurgery” , which inspired this manuscript.
The present study is an overview of Professor Krause’s life and his main achievements, which, despite the time, remain of great interest and actuality. Krause has been a pioneer in several fields of neurosurgery and his precise, objective, and meticulous descriptions and considerations of diseases and procedures are still valid and exciting to read for neurosurgeons even 100 years later. His numerous contributions and surgical achievements are certainly the result of a holistic view of the patient and of a multidisciplinary preparation that he had integrated in order to optimize patient care. This does not mean that he did not deepen and focus on specific aspects, but it underlines the importance of a huge, both medical and non-medical, culture for successfully practicing as a doctor.
Moreover, besides knowledge and technical skills, the ethical values of this surgeon and his capacity to leave a strong legacy are elements that contribute to make his efforts lasting over time.
Krause F (1941) Die spezielle Chirurgie der Gehirnkrankheiten, Bd. III Reihe Neue Deutsche Chirurgie, Band 50. F. Enke-Verlag, Stuttgart
Alexander E Jr, Alexander E III (1981) German influences on the work of Harvey Cushing, the pioneer of neurosurgery in America. Neurosurgery 9(5):501–505
Buchfelder M (2005) From trephination to tailored resection: neurosurgery in Germany before World War II. Neurosurgery 56(3):605–613
Bushe KA (1991) How it all came about". On the beginnings of current neurosurgery in Germany up to the beginning of the "Zentralblatt für Neurochirurgie. Zentralbl Neurochir 52(1):7–16
Costea CF, Turliuc DM, Sava A, Dumitrescu GF, Cucu AI, Patrașcanu E, Trandafir D, Turliuc Ș (2016) Fedor Krause (1857-1937): the father of German neurosurgery. Rom Neurosurg 30(2):241–247
Greenblatt SH, Dagi TF, Epstein MH (eds) (1997) History of neurosurgery. The American Association of Neurological Surgeons, Park Ridge
Horwitz NH (1996) Fedor Krause (1857-1937). Neurosurgery 38(4):844–848
Krause F (1911) Die Chirurgie des Gehirns und Rückenmarks nach eigenen Erfahrungen (Band 2), Urban und Schwarzenberg, Berlin und Wien (Source: Archiv für Geschichte der Deutschen Neurochirurgie, Würzburg)
Vilensky JA, Gilman S (2002) Horsley was the first to use electrical stimulation of the human cerebral cortex intraoperatively. Surg Neurol 58(6):425–426
Jackler RK, Whinney D (2001) A century of eighth nerve surgery. Otol Neurotol 22(3):401–416
Feindel W, Leblanc R, de Almeida AN (2009) Epilepsy surgery: historical highlights 1909-2009. Epilepsia 50(Suppl 3):131–151
Schijns OE, Hoogland G, Kubben PL, Koehler PJ (2015) The start and development of epilepsy surgery in Europe: a historical review. Neurosurg Rev 38(3):447–461
Castro ID, Santos DP, Christoph Dde H, Landeiro JA (2005) The history of spinal surgery for disc disease: an illustrated timeline. Arq Neuropsiquiatr 63(3A):701–706
Collmann H, Vitzthum HE (2008) Historical perspective on neurosurgery in Germany after World War II. Neurosurgery 63(5):989–999 discussion 999-1000
Gruber P, Sciatica BT (2015) From stretch rack to microdiscectomy. Unfallchirurg. 118(Suppl 1):53–65
Krause F (1908) Die Chirurgie des Gehirns und Rückenmarks nach eigenen Erfahrungen (Band 1), Urban und Schwarzenberg, Berlin und Wien (Source: Archiv für Geschichte der Deutschen Neurochirurgie, Würzburg)
Jefferson G (1961) Fedor Krause and neurological surgery (Fedor-Krause-Gedächtnisvorlesung - Fedor Krause und die neurologische Chirurgie). Acta Neurochir 9(5):661–664
Kuhlendahl H (1973) Beginnings of neurosurgery in Germany: Fedor Krause. With comments on the understanding of medical history. Z Neurol 204(3):159–163
Reisch R, Perneczky A, Filippi R (2003) Surgical technique of the supraorbital key-hole craniotomy. Surg Neurol 59(3):223–227
Rosegay H (1992) Historical vignette: the Krause operations. J Neurosurg 76(6):1032–1036
Thomas JL (1938) Operation upon the Gasserian ganglion by the Hartley-Krause method for facial neuralgia: three years after. Br Med J 1(1938):487–488
Lanier WL (2012) The history of neuroanesthesiology: the people, pursuits, and practices. J Neurosurg Anesthesiol 24(4):281–299
Elhadi AM, Kalb S, Martirosyan NL, Agrawal A, Preul MC (2012) Fedor Krause: the first systematic use of X-rays in neurosurgery. Neurosurg Focus 33(2):E4
Collmann H, Halves E, Arnold H (2002) Neurosurgery in Germany from 1880 to 1932. In Neurosurgery in Germany. History. 50 years of German Society of Neurosurgery. Hansisches Verlagskontor, Lübeck, pp 39-52
Menon J, Riskin DJ (2015) Technological innovation and ethical response in neurosurgery. Virtual Mentor 17(1):62–68
Figueiredo EG, Almeida da Silva S, Jacobsen Teixeira M, Belykh E, Carotenuto A, Moreira LB, Spetzler RF, Dagi TF, Preul MC (2019) Travels to the tropics: Deutschtum and Fedor Krause’s visits to Brazil. J Neurosurg 5:1–8
Shucart WA (1975) Fedor Krause, 1856-1937. Surg Neurol 3(3):115–117
Tertsch D (1989) The 100th anniversary of neurosurgery in Halle. Zentralbl Neurochir 50(1):1–8
The authors wish to thank Prof. Hartmut Collmann, Würzburg, for helpful and important comments and for the images.
The present study is a historical review and thus neither ethics approval nor informed consent were required.
Conflict of interest
The authors declare that they have no conflict of interest.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Bacigaluppi, S., Bragazzi, N.L. & Martini, M. Fedor Krause (1857–1937): the father of neurosurgery. Neurosurg Rev 43, 1443–1449 (2020). https://doi.org/10.1007/s10143-019-01186-1
- Fedor Krause
- History of neurosurgery
- Epilepsy surgery
- Cortical stimulation
- Trigeminal nerve surgery
- Cranial nerve decompression
- Lumbar disc surgery
- Vestibular schwannoma