neurosurgery(redirected from Microneurosurgery)
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the clinical discipline that studies neurological diseases that are primarily treated by surgical methods. Neurosurgery has its basis in neurology and deals with many conditions, including neuronopathic tumors, neurotraumas, and neurangiosis; with the sequelae and complications of infectious inflammatory processes and congenital anomalies of the central nervous system; with corrective surgery for epilepsy and intractable pain; and with conditions that call for stereotaxic surgery.
Neurosurgery became an independent discipline early in the 20th century, after extensive research and many attempts to perform operations on the brain and spinal cord. The first neurosurgical operation, trepanation of the skull, was performed as early as the Stone Age, but it was not until the end of the 19th century that the use of antisepsis, asepsis, and anesthesia made systematic neurosurgical intervention possible. Instrumental in these developments were the British surgeons W. Macewen and V. Horsley; the first to perform such operations in Russia was N. I. Pirogov. In 1898, V. M. Bekhterev organized the department of neurosurgery at the clinic for nervous and mental diseases of the Military Medical Academy. In 1912 his student L. M. Pussep organized a specialized clinic for neurosurgery in St. Petersburg; the founding of this institution paved the way for the successful surgical treatment of tumors and other disturbances in the brain.
The American neurosurgeons H. H. Cushing and W. Dandy and the founder of French neurosurgery, N. T. de Martel, made the greatest contributions to neurosurgical research and practice outside Russia. The leading neurosurgeons outside the USSR today are W. G. Penfield (Canada), A. Walker (United States), N. Dott (Great Britain), M. David (France), E. Busch (Denmark), H. Olivecrona (Sweden), and A. Asenjo (Chile).
The rapid development of neurosurgery in the USSR is due to the establishment of specialized research institutes. In 1926 the Institute of Surgical Neuropathology—the world’s first such institution—was organized in Leningrad on the initiative of S. P. Fedorov and A. G. Molotkov. In 1929, N. N. Burdenko and V. V. Kramer opened a neurology clinic in Moscow as an extension of the roentgenologic institute; the new clinic was reorganized in 1934 into the Institute of Neurosurgery, which in 1944 became part of the Academy of Medical Sciences of the USSR. The combined method of research and treatment was first used at the institute and has been the decisive influence in the development of the Soviet school of neurosurgery.
In 1938 the Institute of Neurosurgery was formed in Leningrad as a result of the merger of the Institute of Surgical Neuropathology and the neurosurgery clinic that had been directed by A. L. Polenov. The single Soviet neurosurgical school that was formed by the creation of the Moscow and Leningrad institutes made a major contribution to the theory and practice of neurosurgery.
Soviet neurosurgery finally evolved into an independent scientific and practical clinical discipline in the 1930’s. This made it possible to coordinate successful efforts at providing skilled neurosurgical care for the hundreds of thousands of wounded during the Great Patriotic War (1941—45). In those years, all the practical work and research of neurosurgeons were devoted to open and closed craniocerebral traumas and to injuries of the vertebral column, spinal cord, and peripheral nervous system. In 1950 the USSR’s third neurosurgical institute was established in Kiev on the initiative of A. I. Arutiunov.
The newly established network of specialized neurosurgical facilities has greatly improved the treatment of brain tumors and of congenital anomalies and inflammatory diseases in the central nervous system. Owing to the facilities provided by the new institutions, two new branches of neurosurgery have arisen: surgery of the cerebral and spinal blood vessels (neurangiology) and stereotaxis. The neurosurgical operating room has become a physiology laboratory where general and specific patterns of functional connections are studied in the cortex, in the subcortical structures, and in the brainstem; other aspects of neurophysiology are also studied, for example, the central regulation of visceral functions. The physiology and pathology of circulation and energy metabolism in the brain and spinal cord constitute a new area of interest that is especially promising.
An important factor in the growth of neurosurgery has been the introduction of refined operative techniques and diagnostic methods. Important advances in these two areas include new techniques of gaining access to certain regions of the brain, electrosurgery, drugs and procedures to lower intracranial pressure), and X-ray contrast methods (the most important of which are angiography and its modifications—directed, selective, and total catheterization). Also of great importance to neurosurgery has been the introduction of modern methods of anesthesia and resuscitation, which have made it possible to monitor vital functions both during and after neurosurgical interventions. Intravascular surgery and microsurgery are also new techniques that should prove to be most useful.
Advances in all fields of neurosurgery have helped broaden the scope of radical surgery and considerably reduce postoperative mortality. Further progress in physics, electronics, cybernetics, radiology, and other natural sciences will make it possible to treat successfully glial tumors, severe craniocerebral injuries, and epilepsy. The achievements of neurosurgery in the study of the most complex functions of the central nervous system benefit such allied disciplines as neuropathology, psychiatry, neurophysiology, and psychology.
The World Federation of Neurosurgical Societies, which has been meeting every four years since 1957 (the 1973 conference was held in Tokyo), coordinates the activities of neurosurgeous around the world. The All-Union Neurosurgical Society was established in the USSR in 1947. Articles on neurosurgery are published in Voprosy neirokhirurgii (Problems in Neurosurgery), which has been issued since 1937. In other countries, journals are published in Chicago, Stuttgart, and Paris, and a journal of neuropathology, neurosurgery, and psychology appears in London. Advances in neurosurgery are also covered in the general medical periodicals.
REFERENCESBurdenko, N. N. Sobr. soch.. vol. 4. Moscow, 1950. Pages 26–41.
Arutiunov, A. I. “50 let sovetskoi neirokhirurgii.” Voprosy neirokhirurgii. 1967, fasc. 5.
Mnogotomnoe rukovodstvo po khirurgii, vol. 3, books 1–2; vol. 4. Moscow, 1963–68.
Irger, I. M. Neirokhirurgiia. Moscow, 1971.
A. I. ARUTIUNOV