The origin, course and terminations of corticospinal fibers in various mammals.

Publisher Summary This chapter discusses the origin, course, and terminations of corticospinal fibers in various mammals. Studies spanning a period of more than 20 centuries ultimately culminated in the discovery of the pyramidal decussation in the middle of the 19th century. During this period of confusion, Gudden suggested from experimental studies in the dog that the medullary pyramids arose within the cerebral cortex and distributed to the spinal cord. After lesions of the sigmoid gyms in puppies, sparing the striatum, Gudden noted a complete atrophy of the ipsilateral pyramid, the course of which could be followed into the contralateral lateral spinal funiculus. At that time, the importance of this basic experiment by Gudden was not recognized. The conceptual framework of the neuron theory was not yet developed sufficiently to correlate the lesion of one part of the nervous system with the degeneration of another. In their primitive form, the corticospinal terminations in the dorsal horn may subserve mainly a cortical modulation of the incoming sensory information at the spinal level.

[1]  W. Verhaart,et al.  The cerebral peduncle and the pyramid. , 1961, Acta anatomica.

[2]  J. Petras SOME EFFERENT CONNECTIONS OF THE MOTOR AND SOMATOSENSORY CORTEX OF SIMIAN PRIMATES AND FELID, CANID AND PROCYONID CARNIVORES , 1969 .

[3]  J. Jane,et al.  The origin, course and termination of corticospinal fibers in the slow loris, Nycticebus coucang (boddaert) , 1966, The Journal of comparative neurology.

[4]  J. K. Harting,et al.  Neocortical projections to the pons and medulla of the nine‐banded armadillo (Dasypus novemcinctus) , 1970, The Journal of comparative neurology.

[5]  M. Uno,et al.  Recurrent Facilitation in Cat Pyramidal Tract Cells , 1967 .

[6]  E. Murray,et al.  Organization of corticospinal neurons in the monkey , 1981, The Journal of comparative neurology.

[7]  P. Glees THE TIME FACTOR IN CENTRAL NERVE FIBRE DEGENERATION , 1948 .

[8]  F. Walberg,et al.  Demonstration of a somatotopically arranged cortico‐rubral projection in the cat. An experimental study with silver methods , 1963, The Journal of comparative neurology.

[9]  M. Wiesendanger,et al.  Effects of electrical stimulation of somatosensory and motor areas of the cerebral cortex on neurones of the pontine nuclei in squirrel monkeys , 1977, Neuroscience.

[10]  F. P. Wirth,et al.  Monosynaptic corticospinal-motoneuron path in the raccoon. , 1974, Brain Research.

[11]  G. Häggqvist FASERANALYTISCHE STUDIEN ÜBER DIE PYRAMIDENBAHN 1 , 1937 .

[12]  A. Brodal,et al.  Sites of termination of corticospinal fibers in the cat. An experimental study with silver impregnation methods , 1963, The Journal of comparative neurology.

[13]  Verhaart Wj,et al.  Aspects of the comparative anatomy of the mammalian brain stem. , 1957 .

[14]  M. Descheˆnes,et al.  Morphological characterization of slow and fast pyramidal tract cells in the cat , 1979, Brain Research.

[15]  H. Kuypers,et al.  An anatomical analysis of cortico-bulbar connexions to the pons and lower brain stem in the cat. , 1958, Journal of anatomy.

[16]  A. M. Lassek,et al.  THE HUMAN PYRAMIDAL TRACT: A FIBER AND NUMERICAL ANALYSIS , 1939 .

[17]  N. Strominger A comparison of the pyramidal tracts in two species of edentate. , 1969, Brain Research.

[18]  R. Dom,et al.  The rubro‐spinal tract of the opossum (Didelphis virginiana) , 1970, The Journal of comparative neurology.

[19]  A. M. Smith,et al.  Somatotopic organization of the corticospinal tract in cat motor cortex. , 1974, Brain research.

[20]  H. Kuypers Central cortical projections to motor and somato-sensory cell groups. An experimental study in the rhesus monkey. , 1960, Brain : a journal of neurology.

[21]  C. Bagley CORTICAL MOTOR MECHANISM OF THE SHEEP BRAIN , 1922 .

[22]  J. Hore,et al.  The role of the pyramidal tract in the production of cortically evoked movements in the brush-tailed possum(Trichosurus vulpecula). , 1971, Brain Research.

[23]  R. Aurenty,et al.  Dual organization of motor corticospinal tract in the cat , 1977, Neuroscience Letters.

[24]  J. Hore,et al.  The motor cortex of the brush-tailed possum (Trichosurus vulpecula): motor representation, motor function and the pyramidal tract. , 1970, Brain research.

[25]  H. Kuypers,et al.  Precentral projections to different parts of the spinal intermediate zone in therhesus monkey. , 1970, Brain research.

[26]  J. Kelly,et al.  Physiological identification of inhibitory interneurones in the feline pericruciate cortex. , 1974, Neuropharmacology.

[27]  M. E. Anderson,et al.  Cerebellar and cerebral inputs to physiologically identified efferent cell groups in the red nucleus of the cat. , 1971, Brain research.

[28]  G. Martin,et al.  A further evaluation of the origin, the course and the termination of the opossum corticospinal tract. , 1968, Journal of the neurological sciences.

[29]  H. A. Matzke,et al.  A degeneration study of the course and extent of the pyramidal tract of the opossum , 1965, The Journal of comparative neurology.

[30]  H. Kuypers,et al.  A search for corticospinal collaterals to thalamus and mesencephalon by means of multiple retrograde fluorescent tracers in cat and rat , 1981, Brain Research.

[31]  C. Bernhard,et al.  Cortical representation and functional significance of the corticomotoneuronal system. , 1954, A.M.A. archives of neurology and psychiatry.

[32]  Stanley Barnes,et al.  DEGENERATIONS IN HEMIPLEGIA: WITH SPECIAL REFERENCE TO A VENTRO-LATERAL PYRAMIDAL TRACT, THE ACCESSORY FILLET AND PICK'S BUNDLE , 1901 .

[33]  A. Bishop Chapter 12 – Use of the Hand in Lower Primates , 1964 .

[34]  N. Tsukahara,et al.  Cerebro-cerebellar connections mediated by fast and slow conducting pyramidal tract fibres of the cat. , 1969, Brain research.

[35]  G. Mihailoff,et al.  The basilar pontine gray of the opossum: A correlated light and electron microscopic analysis , 1975, The Journal of comparative neurology.

[36]  A. Rustioni,et al.  Cortical cells projecting to the dorsal column nuclei of cats. An anatomical study with the horseradish peroxidase technique , 1976, The Journal of comparative neurology.

[37]  A. Towe Chapter 3 – Motor Cortex and the Pyramidal System , 1973 .

[38]  C. Tyner Anatomic specificity in the feline corticospinal system. , 1974, Brain Research.

[39]  K. Barron,et al.  CYTOLOGIC OBSERVATIONS ON AXOTOMIZED FELINE BETZ CELLS: II. QUANTITATIVE ULTRASTRUCTURAL FINDINGS , 1979, Journal of Neuropathology and Experimental Neurology.

[40]  J. Kelly,et al.  Simultaneous recordings from pericruciate pyramidal tract and non-pyramidal tract neurons; response to stimulation of inhibitory pathways. , 1974, Brain research.

[41]  J. Hanaway,et al.  Synaptic fine structure and the termination of corticospinal fibers in the lateral basal region of the cat spinal cord , 1979, The Journal of comparative neurology.

[42]  M. Mabuchi,et al.  The cortico-rubral projection in the cat. , 1966, Brain research.

[43]  K. Endo,et al.  The distribution and pattern of axon branching of pyramidal tract cells. , 1973, Brain research.

[44]  W. Verhaart The non‐crossing of the pyramidal tract in procavia capensis (storr) and other instances of absence of the pyramidal crossing , 1967 .

[45]  J. Tigges,et al.  Efferents of area 4 in a South American monkey (Saimiri) I. Terminations in the spinal cord , 1979, Brain Research.

[46]  Y. Shinoda,et al.  The intraspinal branching patterns of fast and slow pyramidal tract neurons in the cat. , 1978, Journal of Physiology.

[47]  F. Walberg,et al.  Pyramidal tract fibres from temporal and occipital lobes; an experimental study in the cat. , 1953, Brain : a journal of neurology.

[48]  H. Kuypers Pericentral cortical projections to motor and sensory nuclei. , 1958, Science.

[49]  C. Sherrington,et al.  Observations on the physiology of the cerebral cortex of some of the higher apes. (Preliminary communication.) , 1902, Proceedings of the Royal Society of London.

[50]  M. Hepp-Reymond,et al.  Effects of peripheral, rubral, and fastigial stimulation on neurons of the lateral reticular nucleus of the cat. , 1970, Experimental neurology.

[51]  R. Miller,et al.  Identification of cortical cells projecting to the dorsal column nuclei of the cat. , 1969, Quarterly journal of experimental physiology and cognate medical sciences.

[52]  P. Bucy Is there a pyramidal tract. , 1957, Brain : a journal of neurology.

[53]  J. K. Harting,et al.  The motor cortex and corticospinal tract of the armadillo (Dasypus novemcinctus). , 1971, Journal of the neurological sciences.

[54]  H. Ku¨nzle Thalamic projections from the precentral motor cortex inMacaca fascicularis , 1976, Brain Research.

[55]  J. Desmedt,et al.  New Developments in Electromyography and Clinical Neurophysiology , 1973 .

[56]  G. Somjen Integration in the nervous system , 1981 .

[57]  S. S. Tower PYRAMIDAL LESION IN THE MONKEY , 1940 .

[58]  Lessek Am The pyramidal tract; basic considerations of corticospinal neurons. , 1948 .

[59]  P. Schröder Die vordere Zentralwindung bei Läsionen der Pyramidenbahn und bei amyotrophischer Lateralsklerose. , 1914 .

[60]  G. Martin,et al.  Corticobulbar projections of the marsupial phalanger (Trichosurus vulpecula). I. Projections to the pons and medulla oblongata , 1971, The Journal of comparative neurology.

[61]  F. Goldby An experimental investigation of the motor cortex and pyramidal tract of Echidna aculeata. , 1939, Journal of anatomy.

[62]  E. Rinvik,et al.  SOME COMMENTS ON THE PYRAMIDAL TRACT, WITH SPECIAL REFERENCE TO ITS INDIVIDUAL VARIATIONS IN MAN , 1963 .

[63]  M. Hepp-Reymond,et al.  Cortical influence on single neurons of the lateral reticular nucleus of the cat. , 1970, Experimental neurology.

[64]  C. Noback,et al.  Cortical projections to the lower brain stem and spinal cord in the tree shrew (Tupaia glis) , 1967, The Journal of comparative neurology.

[65]  G. Bishop,et al.  A horseradish peroxidase study of the cortico-olivary projection in the cat , 1976, Brain Research.

[66]  M Wiesendanger,et al.  Organization of corticofugal neurones in somatosensory area II of the cat , 1974, The Journal of physiology.

[67]  C. Watt,et al.  Evidence suggesting that both the corticopontine and cerebellopontine systems are each composed of two separate neuronal populations: An electron microscopic and horseradish peroxidase study in the rat , 1981, The Journal of comparative neurology.

[68]  M. Deschenes Dual origin of fibers projecting from motor cortex to Sl in cat , 1977, Brain Research.

[69]  F. Walshe THE GIANT CELLS OF BETZ, THE MOTOR CORTEX AND THE PYRAMIDAL TRACT: A CRITICAL REVIEW , 1942 .

[70]  A. Waller XX. Experiments on the section of the glossopharyngeal and hypoglossal nerves of the frog, and observations of the alterations produced thereby in the structure of their primitive fibres , 1850, Philosophical Transactions of the Royal Society of London.

[71]  B. Rexed The cytoarchitectonic organization of the spinal cord in the cat , 1952, The Journal of comparative neurology.

[72]  S. Miller,et al.  Projection and convergence patterns in climbing fibre paths to cerebellar anterior lobe activated from cerebral cortex and spinal cord. , 1969, Brain research.

[73]  A. M. Lassek The pyramidal tract of the monkeys. A betz cell and pyramidal tract enumeration , 1941 .

[74]  M. Hepp-Reymond,et al.  [Retrograde degeneration of the pyramidal cells in the motor cortex of apes (Macaca fascicularis)]. , 1975, Acta anatomica.

[75]  J. Bresnahan,et al.  Corticobulbar fibres in the North American opossum (Didelphis marsupialis virginiana) with notes on the Tasmanian brust-tailed possum (Trichosurus vulpecula) and other marsupials. , 1975, Journal of anatomy.

[76]  E. G. Jones,et al.  Differential distribution of corticospinal projections from individual cytoarchitectonic fields in the monkey , 1977, Brain Research.

[77]  H. Kuypers The Anatomical Organization of the Descending Pathways and their Contributions to Motor Control Especially in Primates , 1973 .

[78]  L. T. Brown Projections and termination of the corticospinal tract in rodents , 1971, Experimental brain research.

[79]  V. Brooks,et al.  Some quantitative aspects of pyramidal collateral inhibition. , 1969, Journal of neurophysiology.

[80]  A. Brodal Cerebrocerebellar pathways. Anatomical data and some functional implications. , 1972, Acta neurologica Scandinavica. Supplementum.

[81]  W. Verhaart Pyramidal tract in the cord of the elephant , 1963, The Journal of comparative neurology.

[82]  R. Lehman,et al.  Corticospinal fibers in the raccoon. , 1966, Brain research.

[83]  E. Rinvik The corticothalamic projection from the pericruciate and coronal gyri in the cat. An experimental study with silver-impregnation methods. , 1968, Brain research.

[84]  J. Petras Corticosopinal fibers in New World and Old World simians. , 1968, Brain research.

[85]  A. Sadun Differential distribution of cortical terminations in the cat red nucleus , 1975, Brain Research.

[86]  N. Tsukahara,et al.  Collateral pyramidal influences on the corticorubrospinal system. , 1968, Journal of neurophysiology.

[87]  W. Chambers,et al.  Cortico‐spinal tract of the cat. An attempt to correlate the pattern of degeneration with deficits in reflex activity following neocortical lesions , 1957, The Journal of comparative neurology.

[88]  Dr. W.J. C. Verhaart,et al.  THE UNCROSSED PYRAMIDAL TRACT , 1952, Acta psychiatrica et neurologica Scandinavica.

[89]  H. Kuypers,et al.  Cells of origin of cortical projections to dorsal column nuclei, spinal cord and bulbar medial reticular formation in the rhesus monkey , 1976, Neuroscience Letters.

[90]  W. Chambers,et al.  An Experimental study of the cortico‐spinal system in the monkey (Macaca mulatta). The spinal pathways and preterminal distribution of degenerating fibers following discrete lesions of the pre‐ and postcentral gyri and bulbar pyramid , 1964, The Journal of comparative neurology.

[91]  P. Flindt-Egebak An autoradiographical study of the projections from the feline sensorimotor cortex to the brain stem. , 1979, Journal fur Hirnforschung.

[92]  Kisou Kubota,et al.  Morphological differences between fast and slow pyramidal tract neurons in the monkey motor cortex as revealed by intracellular injection of horseradish peroxidase by pressure , 1981, Neuroscience Letters.

[93]  K. Niimi,et al.  AN EXPERIMENTAL STUDY OF THE COURSE AND TERMINATION OF THE PROJECTION FIBERS FROM CORTICAL AREAS 4 AND 6 IN THE CAT , 1963, Seishin shinkeigaku zasshi = Psychiatria et neurologia Japonica.

[94]  T. Powell,et al.  The projection of the somatic sensory cortex upon the thalamus in te cat. , 1968, Brain research.

[95]  F. Valverde Reticular formation of the albino rat's brain stem cytoarchitecture and corticofugal connections , 1962, The Journal of comparative neurology.

[96]  R. Swank The relationship between the circumolivary pyramidal fascicles and the pontobulbar body in man , 1934 .

[97]  A. M. Lassek,et al.  A comparative fiber and numerical analysis of the pyramidal tract , 1940 .

[98]  M. van Crevel,et al.  THE RATE OF SECONDARY DEGENERATION IN THE CENTRAL NERVOUS SYSTEM. II. THE OPTIC NERVE OF THE CAT. , 1963, Journal of anatomy.

[99]  J. Buettner‐Janusch Evolutionary and genetic biology of primates , 1963 .

[100]  A. M. Lassek THE PYRAMIDAL TRACT: THE EFFECT OF PRE- AND POSTCENTRAL CORTICAL LESIONS ON THE FIBER COMPONENTS OF THE PYRAMIDS IN MONKEY , 1942 .

[101]  F. Walberg Corticofugal fibres to the nuclei of the dorsal columns; an experimental study in the cat. , 1957, Brain : a journal of neurology.

[102]  D. Buxton,et al.  Motor function and the corticospinal tracts in the dog and raccoon , 1967, The Journal of comparative neurology.

[103]  J. Luhan Long survival after unilateral stab wound of medulla with unusual pyramidal tract distribution. , 1959, Archives of neurology.

[104]  J. Yokota,et al.  Divergent projection of individual corticospinal axons to motoneurons of multiple muscles in the monkey , 1981, Neuroscience Letters.

[105]  M. Descheˆnes,et al.  A comparative study of ventrolateral and recurrent excitatory postsynaptic potentials in large pyramidal tract cells in the cat , 1979, Brain Research.

[106]  Corticofugal Projections to the Subthalamic Nucleus, the Red Nucleus and the Adjacent Areas in the Monkey , 1967 .

[107]  M. van Crevel,et al.  THE RATE OF SECONDARY DEGENERATION IN THE CENTRAL NERVOUS SYSTEM. I. THE PYRAMIDAL TRACT OF THE CAT. , 1963, Journal of anatomy.

[108]  M. Wiesendanger,et al.  An anatomical investigation of the corticopontine projection in the primate (Saimiri sciureus). The projection from motor and somatosensory areas , 1977, Neuroscience.

[109]  G. Allen,et al.  Cerebrocerebellar communication systems. , 1974, Physiological reviews.

[110]  H. Kuypers Some projections from the peri‐central cortex to the pons and lower brain stem in monkey and chimpanzee , 1958, The Journal of comparative neurology.

[111]  F. Plum Handbook of Physiology. , 1960 .

[112]  P. Angaut Bases anatomo-fonctionnelles des interrelations cérébello-cérébrales. , 1973 .

[113]  F. Goldby,et al.  A SURVEY OF THE PYRAMIDAL SYSTEM IN THE COYPU RAT, MYOCASTOR COYPUS. , 1963, Journal of anatomy.

[114]  D. G. Lawrence,et al.  Cortical projections to the red nucleus and the brain stem in the Rhesus monkey. , 1967, Brain research.

[115]  G. Martin,et al.  The corticospinal tract of the marsupial phalanger (Trichosurus vulpecula) , 1970, The Journal of comparative neurology.

[116]  J. Yokota,et al.  Spinal axon collaterals of corticospinal neurons identified by intracellular injection of horseradish peroxidase , 1979, Brain Research.

[117]  H. Kuypers,et al.  THE DESCENDING PATHWAYS TO THE SPINAL CORD, THEIR ANATOMY AND FUNCTION. , 1964, Progress in brain research.

[118]  A. Towe Rleative numbers of pyramidal tract neurons in mammals of different sizes. , 1973, Brain, Behavior and Evolution.

[119]  S. Wise,et al.  Cells of origin and terminal distribution of descending projections of the rat somatic sensory cortex , 1977, The Journal of comparative neurology.

[120]  M. A. Biedenbach,et al.  Origin of the pyramidal tract determined with horseradish peroxidase , 1980, Brain Research.

[121]  A. M. Lassek THE PYRAMIDAL TRACT: A STUDY OF RETROGRADE DEGENERATION IN THE MONKEY , 1942 .

[122]  P. D. Cheney,et al.  Corticomotoneuronal connections of precentral cells detected by post-spike averages of EMG activity in behaving monkeys , 1976, Brain Research.

[123]  J. Kelly,et al.  Identification of possible inhibitory neurons in the pericruciate cortex of the cat. , 1974, Brain research.

[124]  C. Noback,et al.  Phylogenetic and Ontogenetic Aspects of the Lemniscal Systems and the Pyramidal System , 1966 .

[125]  W. Demyer,et al.  The quantitative corticoid origin of pyramidal axons of Macaca rhesus. With some remarks on the slow rate of axolysis. , 1961, Neurology.

[126]  H. Künzle,et al.  Pyramidal connections to the lateral reticular nucleus in the cat: a degeneration study. , 1974, Acta Anatomica.

[127]  R. Lemon,et al.  Cells of origin of the frontal projections to magnocellular and parvocellular red nucleus and superior colliculus in cynomolgus monkey. An HRP study , 1979, Neuroscience Letters.

[128]  R. Lende A COMPARATIVE APPROACH TO THE NEOCORTEX: LOCALIZATION IN MONOTREMES, MARSUPIALS AND INSECTIVORES * , 1969 .

[129]  W. Verhaart The pyramidal tract of tupaia, compared to that in other primates , 1966, The Journal of comparative neurology.

[130]  J. Szentágothai PROPRIOSPINAL PATHWAYS AND THEIR SYNAPSES. , 1964, Progress in brain research.

[131]  H. Kuypers,et al.  Pericruciate cortical neurons projecting to brain stem reticular formation, dorsal column nuclei and spinal cord in the cat , 1975, Neuroscience Letters.

[132]  C. Noback,et al.  Corticospinal projections from the pre- and postcentral gyri in the squirrel monkey (Saimiri sciureus). , 1970, Brain research.

[133]  E. A. Pask,et al.  Monographs of the Physiological Society , 1956 .

[134]  W. Verhaart,et al.  Cortical projections to brain stem and spinal cord in the goat by way of the pyramidal tract and the bundle of Bagley , 1967 .

[135]  Janet Marie Donatelle Growth of the corticospinal tract and the development of placing reactions in the postnatal rat , 1977, The Journal of comparative neurology.

[136]  C. Noback,et al.  The primate brain , 1970 .

[137]  G. Martin,et al.  Corticobulbar projections of the marsupial phalanger (Trichosurus vulpecula) . II. Projections to the mesencephalon , 1972, The Journal of comparative neurology.

[138]  K. Barron,et al.  CYTOLOGIC OBSERVATIONS ON AXOTOMIZED FELINE BETZ CELLS: 1. QUALITATIVE ELECTRON MICROSCOPIC FINDINGS , 1979, Journal of Neuropathology and Experimental Neurology.

[139]  D. Humphrey,et al.  Properties of pyramidal tract neuron system within a functionally defined subregion of primate motor cortex. , 1978, Journal of neurophysiology.

[140]  C. Campbell,et al.  Pyramidal Tract: A Comparison of Two Prosimian Primates , 1965, Science.

[141]  M. van Crevel,et al.  THE 'EXACT' ORIGIN OF THE PYRAMIDAL TRACT. A QUANTITATIVE STUDY IN THE CAT. , 1963, Journal of anatomy.

[142]  P. M. Levin,et al.  The exact origin of the cortico‐spinal tract in the monkey , 1938 .

[143]  G. Martin,et al.  A light and electron microscopic study of corticorubral projections in the opossum, Didelphis marsupialis virginiana. , 1972, Brain research.

[144]  S P Wise,et al.  Size, laminar and columnar distribution of efferent cells in the sensory‐motor cortex of monkeys , 1977, The Journal of comparative neurology.

[145]  G. Holmes,et al.  On the Exact Origin of the Pyramidal Tracts in Man and other Mammals. , 1909, Proceedings of the Royal Society of Medicine.

[146]  H. Kuypers,et al.  The location of cells of origin of the fibers in the ventral and the lateral funiculus of the cat's lumbo-sacral cord. , 1974, Brain research.

[147]  T. Peele Cytoarchitecture of individual parietal areas in the monkey (Macaca mulatta) and the distribution of the efferent fibers , 1942 .

[148]  A. M. Lassek,et al.  THE HUMAN PYRAMIDAL TRACT: II. A NUMERICAL INVESTIGATION OF THE BETZ CELLS OF THE MOTOR AREA , 1941 .

[149]  W. Chambers,et al.  An experimental study of the anatomical organization of the cortico‐bulbar system in the albino rat , 1964, The Journal of comparative neurology.

[150]  D. Humphrey,et al.  Cells of origin of corticorubral projections from the arm area of primate motor cortex and their synaptic actions in the red nucleus , 1976, Brain Research.

[151]  A. Rustioni,et al.  Differential projections of cortical sensorimotor areas upon the dorsal column nuclei of cats , 1979, The Journal of comparative neurology.

[152]  J. D. Coulter,et al.  Organization of corticospinal neurons in the cat , 1978, Brain Research.

[153]  B. Rexed,et al.  A cytoarchitectonic atlas of the spinal coed in the cat , 1954, The Journal of comparative neurology.

[154]  P C Bucy,et al.  The contribution of the precentral gyrus to the pyramidal tract of man. , 1967, Journal of neurosurgery.