Neurol Med Chir (Tokyo) 45, 433¿437, 2005 377777777777777777777777777777777777777777777777777774 9 : 9 : 9 .-# %MM;S#FO< : 9 : 9 : 9 : 9 Role of Japan in the Future of Neurosurgery in Asia : 9 : 9 Iftikhar Ali RAJA, F.R.C.S., F.C.P.S. and Ali I. RAJA, M.D., M.S.* : 9 : 9 * : 9 Former Professor of Neurosurgery, K.E. Medical College, Lahore, Pakistan; Resident in : 9 Neurosurgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, U.S.A. : 9 : 9 Key words: role of Japan, neurosurgery, Asia : 9 : 9 : 9 : 9 : 9 : 9 : 9 Preface tions and historical facts, some of Imperial University of Tokyo. : 9 which have been published Dr. Hayari Miyake (1867–1945) : 9 As a visitor to Japan over the last already. was an assistant to Dr. Julius : 9 : 9 17 years as well as other countries Scribaandissaidtohaveper- : 9 in Asia, I was convinced that with Introduction formed the first successful enbloc : 9 the increasing demand on Western removal of a meningioma from the : 9 countries for training of young Before I elaborate my view point left rolandic area in 1905. He was : 9 neurosurgeons from Asia, it was ontheroleofJapaninthefutureof later appointed as professor of : 9 : 9 Japan that could play a very useful neurosurgery in Asia, I would like surgery at the medical school in : 9 role. The numbers of training slots to mention briefly the history of Fukuoka, Kyushu, which is now : 9 and opportunities for ``hands on Japanese neurosurgery, because a medical university.6) Professor : 9 training'' in the West have virtual- this will reflect as to how the Banju Sekiguchi of Tohoku : 9 ly become non-existent for the Japanese neurosurgeons have University and Prof. Hayazo Ito : 9 : 9 developing countries. The develop- achieved their current status. This of Kyoto University were other : 9 ing and underdeveloped Asian will also act as a roadmap for the pioneer general surgeons who : 9 countries should look for training development and better practice contributed to the development of : 9 in Asia. For this Japan stands out of neurosurgery for other Asian neurosurgery in Japan.7) In 1902, : 9 as the most conspicuous possibili- countries. Neurological surgery in Dr. Hayazo Ito gave a special : 9 : 9 ty.Iwassohappy,whenProf. Japan was started by a number of lecture titled ``The brain surgery'' : 9 Kazuo Hashi, Department of general surgeons in the late 18th in the 1st general meeting of the : 9 Neurosurgery at Sapporo Medical century and became organized in Japan Medical Association and : 9 University, Sapporo, Japan, asked its modern form after World War showed results of 46 neurosurgical : 9 me if I could deliver a talk on this II. The first neurosurgical opera- operations including three for : 9 : 9 subject during a symposium being tion was performed by Dr. Susumu hydrocephalus, two for meningi- : 9 organized at the time of his Sato in 1877. The operation was tis, one for gumma, one for : 9 retirement 3 years ago. Professor trepanation and removal of a bullet trigeminal neuralgia, and 39 for : 9 Kawase, who happened to be there and bone from the left frontal lobe. epilepsy. : 9 after the presentation, asked me to The report was published in his I understand from Prof. K. Hashi : 9 : 9 give the same talk later during a book in 1880. Dr. Sato became the that the first neurosurgery : 9 meeting at Tokyo in November president of Tokyo University department in Japan was started : 9 2001. Hospital in 1885. The first perfor- at Sapporo Medical College, : 9 This presentation has been lying mance of craniectomy for simple Sapporo. Professor Teruyoshi : 9 with me since. I thought that it depressed skull fracture is credited Hashiba after receiving training : 9 : 9 mightbeworthwhilehavingitpub- to Julius Scriba (1848–1905), a for nearly 2 years under Prof. : 9 lished as it contains some sugges- German professor of surgery at the White at Massachusetts General : 9 : 588888888888888888888888888888888888888888888888888886 433 434 9 : 9 Hospital in Boston started the neurological disorders.1,6) so named in Japan. Superfine : 9 department of neurosurgery at This is because Japanese neu- fiberscopes are also developed in : 9 : 9 Sapporo in 1954 on his return. rosurgeons also specialize in Japan for endovasculoscopy, ven- : 9 TokyoandKyotoUniversitieshad various other fields related to triculoscopy, and myeloscopy.6) : 9 been practicing neurosurgery for neurosurgery like neuropathology, Japanese neurosurgery since : 9 quitesometimebutthesewere neuroradiology, radiosurgery, World War II has progressed so : 9 government institutions and hence molecular biology, neurosurgical much that one can confidently : 9 : 9 could not have independent oncology, cerebrovascular sur- express the standard of neurologi- : 9 departments till 8 and 11 years gery, and endovascular surgery, cal surgery in various university : 9 later.TheJapanesegovernment in contrast to other developed hospitals in the following words, : 9 officially approved Tokyo and countries.6) ``Here is the state of art practice of : 9 Kyoto as departments of neurosur- neurosurgery.'' : 9 : gery in 1962 and 1964, respec- Role of Japan The answer to the question of 9 4) : 9 tively. Sapporo Medical College roleofJapaninfutureofneurosur- : 9 was a prefecture school, and was The Japanese used the slogan of gery in Asia is not as simple as : 9 more or less independent from WAKON YOSAI after World War wemaythink.Thisisbecause : 9 Government control. II for pursuing their future de- neurosurgery and for that matter : 9 velopment according to the devel- neurosurgeons are affected in : 9 : 9 Some Facts About Japanese oped Western society. WAKON many ways by socio-economic, : 9 Neurosurgery means Japanese spirit and YOSAI political, cultural, and historical : 9 Western knowledge. In their factors. Asia is the planet's largest : 9 The Japan Neurosurgical Society slogan it was said ``The Japanese, continent, and includes 47 coun- : 9 for their future development tries and assorted island depen- : 9 was founded in 1948 and its first : 9 meeting was held at Niigata with should maintain their originality dencies. The constituent countries : 9 nearly 100 participants consisting of Japanese spirit but must can be divided into developed like : 9 of neurosurgeons, neurologists, acquire the advanced Western Japan and South Korea, developing : 9 and basic scientists. The Japanese knowledge.''5) Professor Keiji Sano like India and Pakistan, and : 9 wrote ``If there will be any impact underdeveloped like Mongolia and : 9 Congress of Neurological Sur- : 9 geons was established in 1981. In of Japan on the future of neurosur- Vietnam. It includes the world's : 9 2004 Japan had 7987 neurosur- gery, it will be attributed to the two most populated countries, : 9 geons, 5812 certified and 2175 in Thymos or Yamato spirit of China and India. Because of the : 9 training. In Japan there are 80 Japanese neurosurgeons and their diversity of development of neu- : 9 esteem of harmony within their rosurgery, the requirements of no : 9 medical schools, and 373 training : 9 hospitals (Class A) with 844 at- groups based on the spirit of the two countries of Asia like Vietnam : 9 tached Class C hospitals, which first clause or Article 1 of the and Pakistan are the same, hence it : 9 are approved by the Japan Neu- Seventeen Clause Constitution in would be helpful, to look at each : 9 rosurgery Board for training 604 AD, Harmony is to be country on an individual basis. : 9 (written communication with valued.''6) Professor Sano also There are some key factors, which : 9 quoted ``when new thought was need to be considered when trying : 9 Akira Teramoto, M.D., February : 9 2004). The U.S.A. has only 95 brought to Japan from abroad, the to answer this question. : 9 training centers with double the special characteristics of the in- 1. The general level of skill and : 9 population of Japan. According to digenous world-view were seldom knowledge of neurosurgeons in the : 9 the available data, Japan with a damaged, and the question of a developing nations is probably : 9 : population of 120 million has one crisis in cultural integrity and very similar to their colleagues 9 3) : 9 neurosurgeon for every 22000 peo- autonomy never arose.'' in the developed world. In some : 9 ple. It is always questioned The current millennium is the ways, it may be even better, : 9 weather Japan has more neurosur- era of computers, genetics, and because there may be certain : 9 geons than required. The Japanese robotics. Among high-tech de- problems peculiar and common : 9 velopments, priority should be in their countries and they may : 9 answer is ``NO.'' Japanese neu- : 9 rosurgeons are of the view that given to Japanese neurosurgeons have more knowledge about their : 9 Japan needs three times more neu- in the invention of the neuronavi- management. : 9 rosurgeons to treat patients with gator which was first devised and : 9 : 588888888888888888888888888888888888888888888888888886 435 9 : 9 2. The paying capacity of the research. The developed nations survey taking into consideration : 9 patients and the subsidizing power like Japan have a much greater all aspects of neurosurgery and : 9 : 9 of the government are far less in edge with public and private collect the required information : 9 the developing nations. This trans- universities. These are supported from various underdeveloped and : 9 latesintoveryfewfundsforby money from well-funded developing countries of Asia in a : 9 buying technology inside and out- government institutions as well as variety of following ways: : 9 side the operating room and hence hefty private endowments. These a) The Task Force may visit vari- : 9 : 9 reliance mostly on the skill of funds not only support the ous Asian countries and discuss : 9 doctors and nurses. This may be research equipment costs but also with their national societies the : 9 one reason why some of the attract the best scientists and areas of improvements.