The Value of Neurosurgery and Its Role in Innovation
Consistent with the theme of this issue of AANS Neurosurgeon, I can think of no greater value to medicine and society than the role neurosurgeons have played in innovation. During the career of Egas Moniz (1874-1955), there was no formal neurosurgical training in Portugal. Neurosurgery was performed by general surgeons and Dr. Moniz clearly pushed the boundaries as a practicing neurologist by performing surgery. His hands had become deformed by gout by the time of his discovery of cerebral angiography in 1927 so he sent an associate, Dr. Almeida Lima, to learn neurosurgery from Dr. Hugh Cairns. Drs. Moniz and Lima had collaborated on frontal leucotomies and Dr. Moniz ultimately became the first Portuguese citizen to receive the Nobel Prize in 1949 for his pioneering work with prefrontal leucotomy. In addition to his pioneering innovations in medicine, he also served multiple roles in the Portuguese government, both legislative and diplomatic.
Significant Neurosurgical Innovators
Clearly, one of the most spectacular innovators in the history of medicine is Harvey Cushing. It is hard to envision modern neurosurgery without his contributions. He first employed the Bovie electrosurgical generator in 1926 and described Cushing’s disease in 1912. He introduced blood pressure measurement in surgery in North America and developed numerous surgical instruments including the Cushing forceps. The use of a pneumatic scalp tourniquet together with injectable adrenaline and hemostats allowed craniotomies to be performed virtually bloodless. Dr. Cushing received the Pulitzer Prize in 1926 for his description of the life of Sir William Osler.
Dr. Louise Eisenhardt was trained as a neuropathologist but had amazing roles within the field of neurological surgery. She was a founding member of the Harvey Cushing Society and was its first secretary treasurer and first female president. She was also the first Cushing Orator and the first editor of the Journal of Neurosurgery. Her brain tumor registry was a landmark innovation that preserved the work of Dr. Cushing.
Important Contributions to the Specialty
Professor Alim-Louis Benabid, who will be the Richard Schneider lecturer during the 2016 AANS Annual Scientific Meeting, won the 2014 Lasker-DeBakey Clinical Medical Research Award for his landmark work with deep brain stimulation in collaboration with Dr. Mahlon DeLong. In 1987, while he was performing a procedure to create a lesion for a patient with an essential tremor, he had an idea and tried something different. He delivered an electrical pulse just below 100 Hz, and amazingly, the tremor stopped. This signature experiment and observation transformed the management of patients with refractory movement disorders.
Two lesser known brothers also made an extremely important contribution to our specialty. Aidan and Rupert Raney worked in southern California and came up with a unique idea leading to the development of our modern Raney clips. A simple innovation allowed safe and bloodless craniotomies to be performed.
Spectacular innovations came from the work of Dr. Walter Dandy. His early observations describing the blood supply and innervation of the pituitary gland as well as his original description of the circulation of cerebral spinal fluid were transformative. In 1918, he invented air ventriculography and pneumoencephalography and was later nominated for a Nobel Prize. In 1922, he described brain endoscopy for the treatment of hydrocephalus and set up the first neurological intensive care unit in 1923. He described sectioning of the trigeminal nerve for those suffering from trigeminal neuralgia. In 1938, he gave birth to the new field of cerebrovascular neurosurgery by clip ligation of a posterior communicating artery aneurysm.
These are only a few of the incredibly innovative contributions by neurosurgeons. The severity of the diseases we treat put practicing neurosurgeons in very difficult situations on a day-to-day basis. Many times, we encounter problems that we have not previously experienced and for which there is no reference source to bring to bear. Neurosurgeons solve these dilemmas because they have to. Our successors will continue to provide great value to our patients and to society by their strength of character and willingness to be creative to retrieve patients from risk of disastrous outcomes.
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