History / Istorie

Moments from the History of Romanian Neurosurgery

Having a history, having a heraldry shows a disctinction note which romanian neurosurgery is promoting and honoring.

Knowing the history of the specialty in which a doctor wants to train provides him with a basis, through which he will penetrate the essence of the specialty. Our performances today are due to our predecessors, personalities with a certain scientific, cultural and administrative scope.

Neurosurgery, as a specialty, has developed within the generous framework of general surgery.

The support of the idea of neurosurgery was achieved when the general surgery had consumed its own pioneering (he mastered general anesthesia with ether and chloroform, asepsis and antisepsis was continuously improved, a series of surgical techniques were codified, numerous chapters of surgical pathology were deepened pathophysiologically) and he fully enjoys his first stable successes.

Neurosurgery is the result of a moment in the evolution of medical thinking in which neurology in its evolution identified a pathology of the central nervous system whose solution could only be surgical (tumors, abscesses, hematomas; spinal cord compressions, etc.).

Exceptional neurologists and surgeons, through their collaboration, gave birth to a new discipline: neurosurgery, which was done at the end of the 19th century.

The history of universal neurosurgery consecrates the first neurologist-surgeon couples: Godlee-Bennet and Gowers-Horsley, London (1857-1916), Jan Babinsky (1857-1937) – Thierry de Martel (1876-1940) – Cl.Vincent, Paris, 1930 ( 1879-1947), H. Oppensheim and F. Krause, Berlin, and W. Bechterev C L. Pussepp, St. Petersburg, whose activity is related to the beginnings of modern neurosurgery.

In Romania, this stage is illustrated by the collaboration between: C.I. Parhon (1874-1969) and Amza Jianu (1881-1962) and later Al.Moruzzi (1900-1957) as well as by the collaboration of I.T. Niculescu (1895-1957) and C.Noica with Dumitru Bagdasar (1893-1946).

In neurosurgery, there are two important moments: the pioneering era and the birth of modern neurosurgery.

The pioneering era

The true pioneer of neurosurgery is illustrated by the surgical approach to non-traumatic injuries based on a neurological examination or local changes in the skull.

These first interventions were performed by surgeons with a good anatomical education tempted by the emergence of a new field of surgical activity, not knowing the particular reactions of the brain parenchyma to surgical aggression and using an improvised instrument at first.

The pioneers of neurosurgery have faced failures inherent in any beginning that have been overcome by perseverance, enthusiasm and the awareness of near success.

However, these pioneers established a number of principles of surgical technique and outlining important chapters of neurosurgical pathology.

The pioneering period of neurosurgery (1890-1910) was overcome thanks to the activity of great personalities: V. Horsley, Charles Frazier, H. Cushing (1869-1939), V. Dandy (1870-1936) and F. Krause (1856- 1937).

In “Principatele Române”, the pioneering activity of neurosurgery is illustrated by a series of personalities: Ludovic Russ Senior (1816-1888). He establishes the first surgery service in the Principality within the St. Spiridon Hospital in Iasi.

In 1863 he graduate the course Topographic Anatomy, Surgical Surgery, Dressings and Instruments. Chapter III of this course presents: the anatomy of the skull in terms of trepanation, with topographic demonstration on corpses and brain, and in Chapter IV: brain, spinal cord, injuries and their consequences.

Gazeta de Moldavia no. 63 of 1852 records two cranial trepanations: adeca operations performed in the crest, opening the titva.

Within a surgical activity that adds up to 7979 different difficulties, 19 cranial trepanations are recorded.

Anastasievici Leonte (1853-1914)

Chief Physician of the Brancovenesc Hospital, he is the first Romanian surgeon who, through his activity, was constantly concerned with the different aspects of the pathology of the nervous system.

Through his activity, A. Leonte has all the surgical priorities in the field of neurotraumatology. (extradural hematoma, upper longitudinal sinus wound).

In 1892, Dr. Leonte’s neurosurgical activity included 28 cranial trepanations performed on 27 patients with a mortality totaling 5 cases, of which we distinguish 11 preventive trepanations without any death and 17 curative trepanations.

In 1891, two events took place that mark the beginning of the modern era of nervous system surgery in Romania. This year A. Leonte and N. Bardescu, at the Society of Surgery in Paris, presented the work Intervention chirurgicale dans les affection cerebrales which was published in „Revue di Chirurgie”, volume XI, in which he presents his experience on 22 cranial trepanated cases .

In the same year, 1891, Prof. G. Assaky presents a synthesis on the methods of establishing the craniocerebral topography and their practical implications.

1. L. Scully (1853-1912) operated on numerous spine fractures with paraplegia, vertebro-medullary malformations and craniocerebral traumas.

Toma Ionescu (1860-1926)

Personality of Romanian surgery, pioneer of modern surgery, oncology and neurosurgery.

He was one of the most skilled operators of the time. At one of the demonstrations made in W. Mayo’s clinic, in the presence of a numerous nurse (1500 people !?) he resected the cervical sympathetic chain in 6 minutes.

1. Ionescu approached the surgery of the nervous system with all the professionalism, not giving curiosity, not giving the pleasure of risk or entertainment, but knowing in depth the problems it raises.

He sensed the importance of addressing brain damage using the cranial osteoplastic volt technique, which he improved and presented in 1895 at the International Congress in Moscow.

Using this technique he approached numerous expansive intracranial processes (tumors, hydatid cysts, intracerebral hematomas) as well as in the treatment of epilepsy.

He operated on 5 intraorbital tumors using the Kronline procedure, a priority for Romanian surgery and European surgery.

The multitude of aspects of the nervous system surgery that he approached and whose results he presented to the European scientific world ensured him a well-deserved prestige.

Amza Jianu (1881-1962)

A student of Prof. Toma Ionescu approached aspects of neurosurgical pathology from the position of a true neurosurgeon.

In 1915, he published two cases of pontocerebellar tumors successfully operated using F. Krause’s technique in his clinic in Iasi. These patients were diagnosed by Prof. C.I. Parhon. These cases were taken up by H. Cushing in his statistics.

In his clinic in Bucharest where he moved in 1920, he operated on numerous cases of essential trigeminal neuralgia.

Karl Diel (1855-1930)

During the Austro-Hungarian Empire, a surgeon named Karl Diel practiced in the town of Jimbolia. At that time, his fame attracted patients from all over historic Banat, but also from abroad. It seems that at that time in the surgery department were currently solved cases that were solved only at the level of university hospitals in Vienna, Budapest or Berlin. In 1911, 999 cranial operations and 557 operations for lumbosciatica were found in the operating conditions. We can say that for the western part of the country here was the beginning of pioneering neurosurgery.

The modern romanian neurosurgery is related to the activity of prof. Al. Moruzi (1900-1957) who founded the first neurosurgery service on January 1, 1953 at the Socola Hospital in Iasi and Prof. D. Bagdasar (1893-1946) who founded the Neurosurgery Service at the Central Hospital in Bucharest on June 1 1936.

Professor Al. Moruzi, a student of the Parisian medical school, through his student, professor Nicolae Oblu created a school distinct from that of professor Bagdasar, formed at the School of Neurosurgery of the famous H. Cushing (1869-1939).

In 1972, Professor N. Oblu (1912-1995) built the first neurosurgery hospital in the country, inaugurated on October 14, and Professor C. Arseni (1912-1994) built the largest neurosurgery hospital in the country in 1974 with a capacity of 650 beds.

The tradition of the Iasi neurosurgery school was continued by professors Mihai Rusu (1926-2015), professor Nicolae Ianovici (b. 1944), professor H. Aldea (b. 1942), professor I. Poeata (b. 1955).

Under the leadership of Professor C. Arseni, a series of personalities were created who, responding to medical needs, created new surgical centers in Cluj through conf. Stefan Tristan Iacob (b. 1920-1975), in Timisoara the lecturer Vasile Miclaus (1919-1977) and against his will in Galati by Dr. Stefan Grigorovici (1920-2000).

A more special situation had the neurosurgery service from Tg. Mures, which was patronized by acad. D. Miskolczy, neuropathologist of European value, the first neurosurgical interventions being performed by Prof. Istvan Korney (1901-1988), with Venetian and Budapest education.

Contemporary Romanian neurosurgery benefiting from the technological explosion and the openness to European neurosurgery has evolved towards performance, being illustrated by the activity of prof. Al. Constantinovici (1929-2018), prof. L. Danaila (b. 1933) – the first to introduce the operating microscope in Romanian technology -, prof. A. V. Ciurea (b. 1940), I. Poeata (b. 1955 Iasi), M.R. Gorgan (b. 1954-Bucharest), St. Florian (b. 1961 Cluj) and H. Ples (b. 1954 Timisoara).

Numerous colleagues from the young generation, with internships in international education, will successfully illustrate the Romanian neurosurgery both in the country and abroad.

Professor. Dr. H. Aldea

21.01.2019

Note from SRN: To those who want to deepen the reading of Romanian neurosurgery, we recommend the book Modern and Contemporary History of Romanian Neurosurgery, by Prof. Dr. Hortensiu Aldea (Pim Publishing House, Iasi, 2017).

Momente din istoria neurochirurgiei romanesti

A avea o istorie, a avea un blazon este o nota de distinctie pe care neurochirurgia romaneasca, in ascensiunea ei, o onoreaza.

A cunoaste istoria specialitatii in care un medic doreste sa se formeze ii asigura acestuia o baza, un orizont profesional, prin care acesta va patrunde in esenta specialitatii. Performantele noastre de astazi se datoreaza predecesorilor nostri, personalitati cu o anumita anvergura stiintifica, culturala si administrativa.

Neurochirurgia ca specialitate s-a dezvoltat in cadrul generos al chirurgiei generale.

Conturarea ideii de neurochirurgie s-a realizat in momentul in care chirurgia generala isi consumase propriul pionierat (stapanea anestezia generala cu eter si cloroform, asespsia si antisespsia se perfectiona in continuu, o serie de tehnici operatorii erau codificate, numeroase capitole de patologie chirurgicala erau aprofundate fiziopatologic) si se bucura din plin de primele sale succese stabile.

Neurochirurgia este rezultatul unui moment din evolutia gandirii medicale in care neurologia in evolutia ei a identificat o patologie a sistemului nervos central a carei solutionare nu putea fi decat chirurgicala (tumori, abccese, hematoame; compresiuni medulare, etc).

Neurologi si chirurgi de exceptie, prin colaborarea lor, au dat nastere unei noi discipline: neurochirurgia, fapt ce s-a realizat la sfarsitul sec al XIX-lea.

Istoria neurochirurgiei universale consacra primele cupluri neurolog-chirurg : Godlee-Bennet si Gowers-Horsley, Londra (1857-1916), Jan Babinsky (1857-1937) – Thierry de Martel (1876-1940) – Cl.Vincent, Paris, 1930 (1879-1947), H.Oppensheim si F.Krause, Berlin, si W.Bechterev C L.Pussepp, Sankt Petersburg, de a caror activitate sunt legate inceputurile neurochirurgiei moderne.

In Romania aceasta etapa este ilustrata de colaborarea dintre : C.I.Parhon (1874-1969) si Amza Jianu (1881-1962) si ulterior Al.Moruzzi (1900-1957) precum si de colaborarea I.T.Niculescu (1895-1957) si C.Noica cu Dumitru Bagdasar (1893-1946).

In conturarea ideii de neurochirurgie se disting doua momente: epoca de pionierat si epoca de nastere a neurochirurgiei moderne.

Epoca de pionierat

Pionieratul adevarat al neurochirurgiei este ilustrat de abordul chirurgical al leziunilor netraumatice pe baza unui examen neurologic sau a unor modificari locale ale craniului.

Aceste prime interventii au fost efectuate de chirurgi cu o buna educatie anatomica tentati de aparitia unui nou domeniu de activitate chirurgicala, necunoscand reactiile particulare ale parenchimului cerebral la agresiunea operatorie si utilizand un instrumentar improvizat intr-o prima perioada.

Pionierii neurochirurgiei au infruntat insuccese inerente oricarui inceput ce au fost depasite de perseverenta, de entuziasm precum si de constiinta unui succes apropiat.

Cu toate acestea, acesti pionieri au stabilit o serie de principii de tehnica chirurgicala si la conturarea unor importante capitole de patologie neurochirurgicala.

Perioada de pionierat a neurochirurgiei (1890-1910) a fost depasita gratie activitatii unor mari personalitati : V. Horsley, Charles Frazier, H. Cushing (1869-1939), V.Dandy (1870-1936) si F. Krause (1856-1937).

In Principatele Romane activitatea de pionierat a neurochirurgiei este ilustrata de o serie de personalitati : Ludovic Russ Senior (1816-1888). El infiinteaza primul serviciu de chirurgie din Principate in cadrul Spitalului Sf. Spiridon din Iasi.

In 1863 sustine cursul Anatomie topografica, chirurgie operatorie , pansamente si instrumente. Capitolul III din acest curs prezinta: anatomia craniului in privinta trepanatiunii, cu demonstrare topografica pe cadavre si cerebru, iar in capitolul IV: cerebru, maduva spinarii, leziunile si consecintele lor.

Gazeta de Moldavia nr. 63 din 1852 consemneaza doua trepanatii craniene : adeca operatii ce se fac in crestet, deschizandu-se titva.

In cadrul unei activitati chirurgicale ce sumeaza 7979 de diferite dificultati se consemneaza efectuarea a 19 trepanatii craniene.

Anastasievici Leonte (1853-1914)

Medic Sef al Spitalului Brancovenesc, este primul chirurg roman care prin activitatea sa s-a preocupat in mod constant de diferitele aspecte ale patalogiei sistemului nervos.

Prin activitatea sa A. Leonte detine toate prioritatile chirurgicale in domeniul neurotraumatologiei. (hematom extradural, plaga a sinusului longitudinal superior).

In 1892 activitatea neurochirurgicala a dr. Leonte insuma 28 de trepanatii craniene efectuate la 27 de bolnavi cu o mortalitate ce suma 5 cazuri, din care distingem 11 trepanatii preventive fara nici un deces si 17 trepanatii curative.

In anul 1891 au avut loc doua evenimente ce marcheaza inceputul epocii moderne a chirurgiei sistemului nervos din Romania. In acest an A. Leonte si N. Bardescu, la Societatea de Chirurgie din Paris, au prezentat lucrarea Intervention chirurgicale dans les affection cerebrales ce a fost publicata in Revue di Chirurgie, tom XI, in care prezinta experienta sa pe 22 de cazuri trepanate cranian.

In acelasi an 1891 Prof. G. Assaky prezinta o sinteza asupra metodelor de stabilire a topografiei craniocerebrale si a implicatiilor lor practice.

L.L.Scully (1853-1912) a operat numeroase fracturi de coloana cu paraplegie, malformatii vertebro-medulare si traumatisme cranio-cerebrale.

Toma Ionescu (1860-1926)

Personalitate covarsitoare a chirurgiei romanesti, pionier al chirurgiei moderne, al oncologiei si neurochirurgiei.

A fost unul dintre cei mai abili operatori ai epocii. La una din demonstratiile facute in clinica lui W. Mayo, in prezenta unei numeroase asistente (1500 de persoane !?) a efectuat in 6 minute rezectia lantului simpatic cervical.

Th. Ionescu a abordat chirurgia sistemului nervos cu tot profesionalismul, nu dand curiozitate, nu dand placerea riscului sau a divertismentului, ci cunoscand in profunzime problemele pe care aceasta le ridica.

A intuit importanta abordarii leziunilor cerebrale prin tehnica voltului osteoplastic cranian, pe care a imbunatatit-o si a prezentat-o in 1895 la Congresul International de la Moscova.

Folosind aceasta tehnica a abordat numeroase procese expansive intracraniene (tumori, chisturi hidatice, hematoame intracerebrale) precum si in tratamentul epilepsiei.

A operat 5 tumori intraorbitare utilizand procedeul Kronline, prioritate pentru chirurgia romaneasca si realizare pe plan european.

Multitudinea aspectelor chirurgiei sistemului nervos pe care le-a abordat si a caror rezultate le-a prezentat lumii stiintifice europene i-a asigurat un binemeritat prestigiu.

Amza Jianu (1881-1962)

Elev al Prof. Toma Ionescu a abordat aspecte ale patologiei neurochirurgicale de pe pozitia unui autentic neurochirurg.

In anul 1915 publica doua cazuri de tumori pontocerebeloase operate cu succes utilizand tehnica lui F. Krause in clinica sa de la Iasi. Acesti pacienti au fost diagnosticati de catre Prof. C.I. Parhon.  Aceste cazuri au fost preluate de catre H. Cushing in statistica sa.

In clinica sa de la Bucuresti unde s-a transferat in anul 1920, a operat numeroase cazuri de nevralgie esentiala de trigemen.

Karl Diel (1855-1930)

In timpul Imperiului Austro-Ungar, in orasul Jimbolia a profesat un chirurg pe numele Karl Diel. In acea perioada faima sa a atras pacienti din tot Banatul istoric, dar si din afara acestuia. Se pare ca in acea perioada in sectia de chirurgie se rezolvau in mod curent cazuri care erau solutionate doar la nivelul spitalelor universitare din Viena, Budapesta sau Berlin. In anul 1911 in condicile de operatii s-au gasit 999 operatii craniene si 557 operatii pentru lombosciatica. Putem spune astfel ca pentru partea de vest a tarii aici a fost inceputul neurochirurgiei de pionierat.

Neurochirurgia moderna romaneasca este legata de activitatea prof. Al. Moruzi (1900-1957) care a infiintat primul serviciu de neurochirurgie la 1 ianuarie 1953 in cadrul spitalului Socola din Iasi si a prof. D. Bagdasar (1893-1946) care a infiintat Serviciul de Neurochirurgie in cadrul Spitalului Central din Bucuresti la 1 iunie 1936.

Profesorul Al. Moruzi, elev al scolii parisiene de medicina, prin elevul sau, profesorul Nicolae Oblu a creat o scoala distincta de cea a profesorului Bagdasar, format la Scoala de Neurochirurgie a celebrului H. Cushing (1869-1939).

In anul 1972, profesorul N. Oblu (1912-1995) a realizat primul spital de neurochirurgie din tara, inaugurat la 14 octombrie, iar profesorul C. Arseni (1912-1994) realizeaza cel mai mare spital de neurochirurgie din tara in anul 1974 cu o capacitate de 650 de paturi.

Traditia scolii de neurochirurgie iesene a fost continuata de catre profesorii Mihai Rusu (1926-2015), profesorul Nicolae Ianovici (n. 1944), profesorul H. Aldea (n. 1942), profesorul I. Poeata (n. 1955).

Sub patronajul profesor C. Arseni s-au realizat o serie de personalitati care raspunzand necesitatilor medicale au creat noi centre chirurgicale la Cluj prin conf. Stefan Tristan Iacob (n. 1920-1975), la Timisoara conferentiarul Vasile Miclaus (1919-1977) si impotriva vointei sale la Galati prin doctorul Stefan Grigorovici (1920-2000).

O situatie mai speciala a avut-o serviciul de neurochirurgie din Tg. Mures, care a fost patronat de catre acad. D. Miskolczy , neuropatolog de valoare europeana, primele interventii neurochirurgicale fiind realizate de catre prof. Istvan Korney (1901-1988), cu educatie vieneza si budapestana.

Neurochirurgia romaneasca contemporana beneficiind de explozia tehnologica si de deschiderea catre neurochirurgia europeana a evoluat spre performanta fiind ilustrata de activitatea prof. Al. Constantinovici (1929-2018), prof. L. Danaila (n.1933) – primul care a introdus microscopul operator in tehnologia romaneasca -, prof. A. V. Ciurea (n. 1940), I. Poeata (n. 1955 Iasi), M.R. Gorgan (n. 1954-Bucuresti), St. Florian (n. 1961 Cluj) si H. Ples (n. 1954 Timisoara).

Numerosi colegi din tanara generatie, cu stagii de educatie internationala vor ilustra cu succes neurochirurgia romaneasca atat in tara, cat si in strainatate.

Profesor. Dr. H. Aldea

21.01.2019

Nota din partea SRN: Celor care doresc sa aprofundeze lectura neurochirurgiei romanesti le recomandam cartea Istoria Moderna si Contemporana a Neurochirurgiei Romanesti, de prof. dr. Hortensiu Aldea (Editura Pim, Iasi, 2017).