MODERN NEUROSURGICAL GIANTS MODERATORS: Dr. P. S. Chandra Dr. Vivek Tandon PRESENTED BY: Gaurang Vaghani Neurosurgery “Only the man who knows exactly the art and science of the past and pppresent is competent to aid in its progress in the future” Christian Albert TheodorBillroth Neurosurgery 1.Pre1.Pre--modern:modern: before Macewan, 1879 when all 3 tenets used in practice 2.Gestational:: 18791879--19191919 transition into distinct profession 3M3.Mod ern: after Cushing, 1919 develops into distinct profession 4.Contemporary: present day operative microscope, imaging advances, GKS HARVEY WILLIAMS CUSHING April 8, 1869- October 7, 1939. Born- as Tenth child . Cleveland, Ohio. Education-Yale University and Havard UiUnivers ity Surgery Residency- Johns Hopkins,Baltimore under William Halsted Neurosurgery under Kocher, at Bern and Sherrington at Liverpool. Started private practice. Became Associate Prof. Johns Hopkins. Also served in World War I. as rank of Colonel HARVEY WILLIAMS CUSHING First American Neurosurgeon Father of Modern Neurosurgery + Ernest Amory Codman: 1st anesthetic , “Ether Chart” First to map human cerebral cortex with faradic stimulation in conscious patients March 1909, first operation for Acromegaly 1910, Small silver clip (Cushing’s clip). HARVEY WILLIAMS CUSHING y Standardization of Surgical techniques- ◦ Compressing scalp for hemostasis, ◦ Waxing the bone edges, ◦ Hemostatic clips, ◦ Electrocautery, motor driven suction y Classified brain tumors with Percival Bailey y Experiment with cocaine nerve blocks, x coined ‘ Regional anaesthesia’ y Medical Historian: Biographer of Sir William Osler (Pulitzer, 1926) y Died on 77ctoctober ber1939,1939 –myo cardial infarction y Interestingly -Autopsy found colloid cyst in3rd ventricle Walter Edwards Dandy y April 6, 1886- April 19, 1946. y Sedalia , Missouri y Medicine- Johns hopkins university y William Cushing and William Halsted-teachers y + Kenneth Blackfan, established modern concept of circulation of CSF and hydrocephalus. y Developed choroid plexectomy, third ventriculostomy and catheterisation of aqueduct of sylvius y Ventriculography in 1918.(Nominated for Noble prize in 1933) y “The Greatest single contribution ever made to brain surgery.”-Samuel J Crowe Walter Edwards Dandy Expose & resects Pineal tumor 1917, Remove 1st Acoustic neuroma completely Pioneer in Surgery of AVM and int racrani al aneurysm neck clipping Rx -Meniere’s disease by sectioning CN VIII First to intracranially section CN IX - Glossopharyngeal neuralgia. Section sensory root of CN V - tic douloureux Fedor Krause y 1856- 1937,German y Studied – Music. !! Later Medicine- Berlin y Worked with Neurologist Oppenheim. y Father of German surgical neurology y Extens ive ly used radiograp hy for diagnosi s y With Hartley-‘Modified’ Preganglionic resection of CN V-trigeminal neuralgia( Hartley- Krause operation) y Transfrontal craniotomy- pituitary tumors y With Foerster-Epppyilepsy surg gyery in German y y Acoustic neuromas- ◦ sitting position, intradural posterior fossa craniectomy y Suprasellar subtentorial approach to pineal gland & posterior third ventricle Charles Elsberg y 1871-1948.Born-NewYork y SddStudied-At Col um bia University y Neurology Institute Ney York. y Pioneer in spine surgery y Emphasized on careful neurological examination and spinal manometric studies to localize blocks y Describes Spinal cord tumors and surgical thitechniques y First to decompress Intramedullary Glioma and Excise Cauda Equina Ependymoma EGAZ MONIZ y 1874-1955 y PtPortuguese neurollitogist, LibLisbon: y 1990s20s-Cereb r al an gi ograp hy & encephalography (Nominated for Nobel prize, 1928) y Founder of Neuroradiology y 1935- Prefrontal leucotomy for schizophrenia (Nobel prize, 1949) y Coined term – “Psychosurgery” Otfrid Foerster y 1873- 1941 y Foerster’s operation: dividing posterior roots did not cause spasticity in hemiplegic y Defined dermatomal borders y Anterolateral cordotomyyp: for pains y Successful removal of intramedullary tumor y Surgery for post traumatic epilepsy y + Altenburger: 1st EEG of brain tumor y Hyperventilation to evoke seizure y Coined psychomotor epilepsy Wilder Graves Penfield y 1891-19761976, SkSpokane, WhWashington y “Greatest living Canadian” y Princeton University.-Excellent Student and Football player y First world war –worked as Dresser and wounded y Convalesce at home of Sir William Osler- y Under Great influence –graduated from John Hopkins University. y 1928, Joined Mc Gill University , Montreal. y Pioneer of Epilepsy Surgery y Centre-encephalic theory of generalized epilepsy y + Herbert Jasper: x Montreal procedure - destroying originating nerve cells x Electrocorticography(1941) Wilder Graves Penfield y ‘Penfield dissector’ y “Montreal neurological institute” y Outlined Motor and Sensory HlHomonculus using stiltitimulation stditudies y Established role of Cortical Excision in treatment of medical refractory epilepsy, specially in Temporal Lobe Epilepsy. y Also wrote Novel “No other God” Falconer : - En bloc temporal lo bectomy wit h excision of uncus, hippocampus and amygdala. Rasmussen:- - modified technique to reduce morbidity and mortality and improve outcome of epilepsy surgery. - also describe intramedullary tumors of sppgine and surgical considerations A Earl Walker y 1907- 1995 y Born: Winnipeg, Canada y University of Chicago1937-47 y Johns Hopkins Hospital,1947-onwards y SiStereotactic or filfunctional neurosurgery y Post traumatic epilepsy y Anatomic studies on thalamic systems y Dandyyy Walker syndrome y Walker-Warburg Syndrome William H Sweet y 1910-2001,Born- Kerriston, Washington y Harvard Medical School y Neurosurgi ca l Tra in ing under Dr. Perci val Ba iley. y Massachusetts General Hospital y + Gordon Brownell- PET y Boron Neutron Capture therapy for brain tumors y Pituitary stalk section – ◦ dia be tic retinopa thy y Percutaneous thermal rhizotomy ◦ Trigeminal neuralgia y hypothermia during neurosurgical operations y First carotid bifurcation reconstruction y Died due to complication of Parkinson’ s disease Lars Leksell (1907(1907--1986)1986) y Swedish, y Stereotactic frame -1949, y With Larson—principles of Radiosurgery, y Gamma knife- 1968. y Leksell rongg,eurs, y Recanalisation of cerebral aqueduct in atresia Irving S Cooper y 1922-1985, Born-Atlantic City ,New jersey y MD. From George Washington Uni. y Ph.D from Uni . Minnesot a. Fell ow at Mayo Clinic y 1952- JJgoined New York Medical College y Pioneer in functional neurosurgery y Parkinson Disease - ligate d anterior chhidoroidal artery to control tremor and rigidity - chemopallidectomy and cryothalamectomy y electrical stimulation cerebellum/ thalamus(DBS) - to treat spasticity Mahmut Gazi Yasargil y Born in July ,1925 y Lice village, Turkey y Education at Anakara. y Medical Edu-Jena, Germany then Basel. y Prof. Hugo Krayenbuhl-Teacher y University of Zurich y Training of Microvascular Anatomy at University of Vermont, Burlington. y Greatest 20th century neurosurgeon y Founder of Microneurosurgery Mahmut Gazi Yasargil y 1967: first cerebral vascular bypass(EC/IC) under Microscope y Invented ◦ floating microscope, ◦ self retaining adjustable retractor, ◦ microsurgical instruments, ◦ ergonomic aneurysm clips and appliers y With Rand-First Oppperated Spinal cord AV angioma y Extensive study of subarachnoid cisterns- y 330 Research Papers and 6 volume of “Microneurosurgery” Charles G Drakes y 1920-1998 y Born-Windsor, Ontario y Medicine Graduate-Uni. Of WesternOntario y 1952-Faculty at University. y Posterior circulation aneurysm surgery y Giant aneurysm y Occlusion of bilateral vertebral artery, bilbasilar or middle cerebblral artery. y Pioneered work on Vasospasm with Allcock and Aitk en. Albert Rhoton Jr y Born , Kentucky y Studied at Washington University y Residency-under Dr Henry Schwartz y Professor, 1972.University of Florida y Fatherly figure for microscopic neurosurgery y Brain anatomy - microsurgical perspective Herbert Olivercrona y 1891-1980 y Founder and Father of Swedish Neurosurgery y Serafimer Hospital,Stockholm y Students-Leksell and Lundberg y First successflful surgery for intracranial AVM. y FilFacial Nerve preservation in Acous tic tumors y First used power suction Jules Hardy y Born, 1932, Sorel y Prof. at Notre-Dame Hospital and University of Montreal y Trans sphenoidal pituitary surgery with Peroperative Fluoroscopy , Microscope and Microinstrumentation. y First to recoggpynize small intrapituitary lesions “Micoradenomas” Ossama Al-Al-MeftMefty y Skull base surgery, meningioma, y brain tumors , cerebro vascular surgery Tikeshi Kawase (Tokyo): y skull base surgery y kawase approach for petroclival meningiomas. ROBERT F SPETZLER y Born,1944 , Germany y Director , Barrow Neurological Institute, Arizooana y Atlas of Microneurosurgery y Vascular surgery y Skull base surgery y Spetzler –martin grading for AVM Neuroendoscopy y 1910- L’ Espinasse- 1st NSx endoscope ◦ Fulguration of choroid plexus y 1918- Walter Dandy- ◦ Endoscopic choroid plexectomy y 1923- Mixter- 1st ETV using urethroscope NEURORADIOLOGY y 1918, Walter Dandy: Pneumoventriculography & Pneumoenceppgpyhalography y 1921,Jean Sicard : Myelography y Arthur Schuller: Father of modern Neuro- radiology y 1947, George Moore: Radionuclide imaging y 1972-CT scan : x BitihBritish engineer GdfGodfrey Houns fildfield & Allan Cormack ,jointly awarded the Nobel Prize in 1979. y 1970- 1974 –MRI x Block & Purcell-Nobel prize winning work in 1940’s y 2003 – x Nobel Prize to Paul C Lauterbur and Peter Mansfield