In 1946, Karnosh (a neuropsychiatrist at the Cleveland
Clinic), Gardner, and Stowell62reported the effects of tem-
porary cerebral sympathectomy accomplished by bilateral
stellate ganglion blocks on organic brain diseases and psy-
choses.60,61 This discovery occurred incidentally in January
1946 when a 38-year-old woman received bilateral stellate
blocks for cerebral embolus accompanied by hemiplegia
and Dejerine–Roussy syndrome. This led to the implemen-
tation of this procedure in a series of patients with cere-
bral vascular disease, brain atrophy, and Parkinson disease.
Most patients were enthusiastic about the improvement that
they claimed the procedure produced, although motion pic-
ture analysis revealed no improvement in motor function
and it was believed that this apparently impressive improve-
ment in mood was caused by the sympatholytic effects.
Karnosh and Gardner decided to try bilateral stellate gan-
glion procaine blocks in a small group of patients suffering
from depression and anxiety and in patients with known
schizophrenia. In three patients with depression, the tempo-
rary sympathetic block resulted in an improvement of af-
fect, a relative euphoria, transient relief from suicidal idea-
tion, and psychomotor retardation.
W. James Gardner: pioneer neurosurgeon and inventor
NARENDRANATHOO, M.D., PH.D., MARCR. MAYBERG, M.D., ANDGENEH. BARNETT, M.D.
Brain Tumor Institute and Department of Neurosurgery, Cleveland Clinic Foundation,
Cleveland, Ohio
J Neurosurg 100:965–973, 2004