"Haud Ignota Ioguor" of Neurosurgery in Albania
The first neurosurgical craniotomies in the modern era in Albania were reported to have taken place at the King Zog I Hospital in Tirana. They were performed over the course of six years by Walter Lehman, a general surgeon from Charité Hospital Berlin, who escaped Nazi rule in 1932.
The first center in the country dedicated uniquely to neurosurgery opened in 1964 with 20 beds. It was equipped with technology to perform the angiography, pneumoencefalography, myelography and EEG procedures. Xhelal Kurti, MD, who studied neurosurgery for three years at Hradec Králové in Czech Republic, was the first director of the clinic, while Arian Xhumari, MD, who was educated in France, succeeded him.
In a small country like Albania, the case load progressively increased with trauma, spine tumors and congenital abnormalities cases. A decade later, microsurgery began to be used to treat aneurysms. Cranial base and peripheral nerve surgeries followed.
The first neurosurgeons were neurologists that had converted to surgery. They had a good knowledge in basic science, diagnostics, neurology, neuropathology and neuroradiology; skills that were considered primordial. “Give me a three-year resident in neurology and in six months, I will give you a skilled neurosurgeon,” was the aphorism.
Another aphorism used to describe another group was, “Show me where the tumor is located, and we’ll show you the craftiness of how to remove it.” This other group was comprised of surgeons, and their dual purpose was growing their knowledge, education and experience in neurosurgery. Both hybrids, the neurologist and surgeon turned neurosurgeon and were important to the development of neurosurgery in Albania, which now experiences more than 300 neurosurgical elective interventions per year, while managing patients in diagnostics, anesthetic evaluations and neuroradiology, as well as in the ICU.
Eventually, the first clinic affiliated with the Faculty of Medicine in 1968 and neurosurgical education was integrated into the curriculum during the third year of medical school as a part of the study of neurology. After the Fall of Communism, the health system changed and improved substantially. A new curriculum for neurosurgery was then introduced as a five-year resident-based education program.
The opening of a new department of neurosurgery at the Military Hospital of Tirana was considered another milestone in Albanian neurosurgery. It was headed by Agim Kolasi, MD, who trained in China during the Mao period, while Fatos Olldashi, MD, a member of the first generation of neurosurgeons, educated in the country and the United States, succeeded him.
Neurotrauma and spine make up the main caseload in this department. They manage their cases in coordination with the department of neurosurgery at the Mother Teresa University Hospital Center based on coverage areas. In a population of about 3 million, there are 70 beds for neurosurgery between public and private hospitals, with seven consultants trained in the European Union, U.S., Japan and the United Kingdom that accompany 12 neurosurgeons practicing under European Union standards.
All of these individuals encompass the full range of neurosurgical specialties from well-established microsurgery to endovascular, endoscopic, radiosurgery, functional deep brain stimulation (DBS), peripheral nerves, epilepsy, vascular, spine and awake-craniotomy. These neurosurgeons should also be recognized for their initiative to integrate other specialists, such as radiologists, neurologists, neurophysiologists, physicists, oncologists and neuropathologists, into their neurosurgical departments. At that time, the development of the department of neurosurgery as a separate building with all the facilities, MRI, CT, DSA, LINAC radiotherapy, radiosurgery, microsurgery laboratory and a Stroke Unit wing with 16 beds, was considered parochial-minded, but in reality, its existence transformed the treatment of patients and became a reference outside the country.
For a while, the structure of the peccadillo of the “lonely god” neurosurgeon offered the best performance in relation to the size of our country. This “heroic” neurosurgeon has since passed and a teamwork model is the real basis for our work moving into the future. In Albania, the real challenges ahead of us include continuing education, algorithms for a community-based health system, the development of subspecialties, neuropathology and genetics and endovascular work as well as an academic focus and research.
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