PRESIDENTIAL ADDRESS J Neurosurg 127:1203–1212, 2017 THE 2017 AANS PRESIDENTIAL ADDRESS A world of innovation Frederick A. Boop, MD Department of Neurosurgery, University of Tennessee Health Science Center; and Semmes-Murphey Neurologic & Spine Institute, Memphis, Tennessee The 2016 scientific meeting of the American Association of Neurological Surgeons (AANS) focused on the theme “A World of Innovation.” In his presidential address, 2016 AANS President Frederick Boop compared the historical develop- ment of the specialty of neurological surgery with that of the development of global communications. In the early years, general surgeons training in the United States would spend post-residency time abroad learning from surgical masters in Europe and other places. Since Harvey Cushing’s day, neurosurgeons from around the world continue to travel abroad, with many now coming to America for training at centers of excellence. Current clinical practice is defined by multi-national, multi-center clinical trials, and the AANS subsidiary NeuroPoint Alli- ance has positioned itself to serve as an international center for the oversight of such trials. The Neurosurgery Research & Education Foundation and the Journal of Neurosurgery Publishing Group have made it possible for a neurosurgeon anywhere with Internet access to learn relevant surgical anatomy, learn new neurosurgical procedures, and watch mas- ters in the field perform operations via high-definition surgical videos at no cost via learning platforms such as the Rho- ton Collection, the Neurosurgical Atlas, and Neurosurgical Focus video supplements. At the same time, patients are now traveling abroad to seek medical specialty care. Although the globalization of health care poses certain threats, it also presents neurosurgeons with a world of opportunities. https://thejns.org/doi/abs/10.3171/2017.7.JNS171329 KEY WORDS neurosurgery; presidential address; AANS T has been a tremendous honor for me to serve as your cess, the AANS performs a membership needs assessment 84th president of the American Association of Neuro- to make certain that we continue to meet your expectations logical Surgeons (AANS). Even though this is the 85th and that your priorities haven’t changed over time. This AnniversaryI of our Society, Dr. Frank Ingraham served year Alex Valadka, Chairman of our Strategic Planning as president of the organization 2 years in a row during Committee, undertook a new membership needs survey. World War II, which makes this the 84th Presidency. With over 1000 responses, once again and by a large ma- This past year the AANS membership surpassed jority, your two most important requests were education 11,000 people. To have been bestowed your confidence in and advocacy (AANS Strategic Initiative 2017). It is upon my leadership abilities will always remain the greatest mo- those subjects that I would like to speak today. ment of my professional career. Education, like many things in our time, is evolving at My father, who could not be here today, has always an accelerating pace. History has shown us that the best maintained that “life is like a roll of toilet paper—the clos- way to prepare for the future is to understand the lessons er you get to the end, the faster is goes.” That being said, from our past. So to put things into perspective, it might be this year passed so quickly that my roll must be growing worthwhile to examine from whence we have come. short. Let me take you back to the mid-1800s, to another era Every few years, as part of our strategic planning pro- of rapid change (Fig. 1). ABBREVIATIONS AANS = American Association of Neurological Surgeons; ACGME = Accreditation Council of Graduate Medical Education; CNS = Congress of Neuro- logical Surgeons; NREF = Neurosurgery Research & Education Foundation. SUBMITTED June 5, 2017. ACCEPTED July 6, 2017. INCLUDE WHEN CITING DOI: 10.3171/2017.7.JNS171329. ©AANS, 2017 J Neurosurg Volume 127 • December 2017 1203 Unauthenticated | Downloaded 09/23/21 12:40 PM UTC F. A. Boop FIG. 1. “Golden Boy” statue, owned by AT&T, represents the develop- ment of global cable communications. This scene from 1966 with New York Harbor and the Statue of Liberty in the background signifies the role of American industry in our World of Innovation. Courtesy of AT&T Archives and History Center. Figure is available in color online only. The Past Cyrus West Field, who some have called “the greatest 5 FIG. 2. Cyrus West Field, the force behind the development of the first American of whom you’ve never heard” (Fig. 2), was born trans-Atlantic communications cable, has been called “the most famous in New York City in 1819 and, despite a sickly youth, be- American of whom you have never heard.” Photograph, circa 1920, by gan his first job working in a dry goods store at the age of Napoleon Sarony (1821–1896). Image in the public domain. 15. By age 18 he had started his own paper company. This proved successful and he soon made his fortune selling paper products. By all accounts, he was a tireless worker sor of Surgery at the University of Glasgow, first published who rarely took a day off. 6 articles in The Lancet describing his preliminary results Mr. Field had retired at an early age over health con- in the use of 5% carbolic acid (which we now term phenol) cerns when one day he was approached by an English en- to prepare skin and surgical instruments as a means of gineer, Frederick Gisborne, who was looking for investors preventing surgical infection. This discovery led, by the in a project running the first telegraph cable across the time of his death in 1912, to his being called “The Father Atlantic Ocean, linking North America to Europe. of Modern Surgery.” After consulting with Samuel Morse, inventor of the His student and fellow Scotsman, William Macewen, telegraph, on the feasibility of sending electrical impulses became an assistant surgeon at the Glasgow Royal Infir- those great distances, Field soon became obsessed with mary in 1875. In 1879, having become familiar with the the project and began fundraising among his wealthy col- brain mapping techniques of John Hughlings Jackson and leagues. David Ferrier, Macewen was able to localize and success- It took several attempts, including a pause for the fully remove a left frontal lobe meningioma in one patient American Civil War, and, ultimately, financial backing and a subdural hematoma in another. Harvey Cushing from both the British and American governments to com- later commented, “To Macewen belongs the distinction of plete this task. having been the chief pioneer in cranio-cerebral surgery” The final cable was 2500 miles long, took 8 months to (Fig. 3). make at 14 miles per day, and had a weight of 9000 tons In London, Victor Alexander Haden Horsley joined the and a cost of $250 million. That is the equivalent of $3.6 faculty at Queen’s Square where, in 1886, he performed billion in today’s money. his first brain surgery, resecting a seizure focus in a young On June 13, 1866, Field’s dreams were realized and the adult. In August of 1890, at the International Medical trans-Atlantic telegraph became a reality. Consider that it Congress in Berlin, Horsley reported a series of 44 brain cost $10.00—or the equivalent of $285.00 per word—to operations with only 10 deaths. At a time when blood re- send text! But in that era the telegraph had become, in the placement was nonexistent, Horsley is also credited with words of Western Union’s president, William Orton, “the inventing bone wax to stop bone bleeding. nervous system of commerce.”10 Meanwhile, on the continent, neurosurgery was also It was the next year, 1867, that Joseph Lister, a Profes- moving rapidly. The Parisian surgeon Thierry de Martel 1204 J Neurosurg Volume 127 • December 2017 Unauthenticated | Downloaded 09/23/21 12:40 PM UTC AANS Presidential Address FIG. 3. A: William Macewen, of whom Harvey Cushing commented, “To Macewen belongs the distinction of having been the chief pioneer in cranio-cerebral surgery.” Courtesy of the University of Glasgow Archives & Special Collections, GB248 DC198. B: Fedor Krause, who is Germany’s Father of Neurosurgery. Image in the public domain. C: Sir Victor Alexander Haden Horsley, Britain’s first neurosurgeon. Image in the public domain. D: Thierry de Martel, the first neurosurgeon in France. Image in the pub- lic domain, circa 1920. E: Harvey Cushing, America’s Father of Neurosurgery. Courtesy of the Cushing/Whitney Medical Library, Medical Historical Library of Yale University. F: William Van Wagenen, the first president of the Harvey Cushing Society, later renamed the American Association of Neurological Surgeons (AANS). Image in the public domain. had heard of the work of Horsley, visited him regularly, rate, and temperature were recorded by the nurses. As was learned from him, and returned to Paris where, working the fashion for American medical graduates of the time, with neurologists Babinski and Clovis, he began to per- he then traveled to Europe where he studied under more form similar neurosurgery in 1907. than a dozen of the most renowned surgeons and scientists He is known for introducing the sitting position for of the day. posterior fossa surgery, for which he developed a special Upon his return to New York City in 1880, Halsted chair. He was also the first surgeon to begin filming his spent the next 6 years in a busy general surgery practice. operations.3 He is said to have performed one of the first cholecystec- In 1892 in Germany, Fedor Krause developed an extra- tomies in America—on his mother, upon her kitchen table dural approach to the gasserian ganglion and successfully at 2:00 in the morning.