Vitaly Aleksandrovich Khilko, professor: two Anniversaries - the 75th Birthday and 45 Years of Neurosurgical Activity

 

Khilko Vitaly Aleksandrovich is the professor of the Faculty of Neurosurgery and Honorary Doctor of the Medicomilitary Academy, head of the Saint Petersburg Neurosurgical Center, winner of the USSR State Prize, retired major-general of Medical Service. He was 75 on July 15, 2005.

V.A. Khilko, the academician of the Russian Academy of Medical Science, is one of the leading neurosurgeons of Russia and a distinguished scientist, known in many countries of the world. He has been engaged in research in urgent problems of modern neurooncology, neurotraumatology and vascular neurosurgery for about 45 years. V.A. Khilko’s scientific interests are not limited to practical neurosurgery only, but embrace such adjacent areas of medicine as pathophysiology, immunology, pathomorphology of the nervous system. This all-round knowledge and application of research methods, which are not typical of neurosurgery, allow him to elucidate a problem under study more completely and often from an unexpected side.

V.A. Khilko finished school with a silver medal in 1948 and entered the Medicomilitary Academy by his family tradition, as his father had graduated from it in 1932. Being a student, V.A. Khilko was greatly interested in surgery and research, which he carried out at the Faculty of the Field Surgery under the guidance of Prof. S.I. Banaitis and Prof. A.N. Berkutov. After graduation from the Medicomilitary Academy in 1954 he served as a medical officer in the Group of Soviet Troops in the German Democratic Republic. There V.A. Khilko continued to master surgery and was a participant of many operations, performed in a medical company. Besides, he attended advanced training courses in surgery, organized in the Central Hospital of the above Group.

In 1958 V.A. Khilko sent an application to the Medicomilitary Academy. In January of 1959 he became a doctor in charge of its Faculty of Neurosurgery. Later V.A. Khilko filled posts of a senior doctor in charge, junior lecturer, lecturer and deputy chief of the Faculty. He headed the Faculty of Neurosurgery of the Medicomilitary Academy in 1982-1992 and at the same time was the Chief Neurosurgeon of the USSR Ministry of Defense. V.A. Khilko acquired the rank of a major-general in 1985. He retired in 1993. Today V.A. Khilko is still the professor of the Faculty of Neurosurgery and heads the Saint Petersburg Science and Practice Neurosurgical Center.

V.A. Khilko is a disciple of Prof. B.A. Samotokin, who was an outstanding neurosurgeon, Hero of Socialist Labor, major-general of Medical Service and the head the Faculty of Neurosurgery for more than 25 years. V.A. Khilko was the first to introduce puncture and then catheterizing cerebral angiography in Leningrad; it happened at the time, when he was only a doctor in charge of the Faculty of Neurosurgery. He defended his theses for a Candidate’s and Doctor’s degrees in 1964 and 1970 respectively. They were entitled On Aneurysms of Cerebral Vessels and Intra- and Extracranial Aneurysms. V.A. Khilko became a professor in 1975.

One of the main trends of his research activity is diagnosis and surgical treatment of different neurovascular pathology. An experience of more than 45 years, devoted to studying this problem, is reflected in 130 scientific works. Among them one can mention two monographs. Aneurysms and Artery-Sinus Anastomoses, written together with B.A. Samotokin (1973), received the Burdenko Prize and Intravascular Neurosurgery, written in co-authorship with Yu.N. Zubkov (1982), was translated in Korea (1982) and Japan (1989). Using data of angiographic examinations, V.A. Khilko described blood supply of cerebral arteriovenous malformations and anastomoses and its types. He took an active part in development of indications and contraindications for direct and intravascular interventions in aneurysms and arteriovenous anastomoses and promoted their specification to a considerable extent. V.A. Khilko improved technique of intracranial operations in aneurysms and was one of the first to introduce microsurgical methods in interventions on cerebral vessels.

Khilko’s contribution to development of methods of endovascular surgery, used in different microvascular pathology, is of particular importance. He was the first in the country to use an improved method of muscular embolization of carotid-cavernous anastomoses. V.A. Khilko carried out an experimental study and introduced a method of embolization with polystyrene emboli into clinical practice. He was the first to embolize carotid-cavernous and artery-sinus anastomoses via the system of the external carotid artery, using this method. V.A. Khilko substantiated a method of combined embolization of carotid-cavernous anastomoses with polystyrene and muscular emboli. He developed indications for embolization of arteriovenous malformations, depending on their structure and conditions of blood supply. Besides, V.A. Khilko was an originator of a method of embolization via the vertebrobasilar system, using the so-called “controllable” ferrite-cobalt emboli, which were introduced in a magnetic field.

V.A. Khilko improved technique of introducing F.A. Serbinenko’s balloon-catheter and developed a method of artificial thrombosing of intracranial aneurysms by retarding blood flow in a specific segment of a vessel, anticoagulant administration and suppressing fibrinolytic activity of blood with epsilon-aminocaproic acid. He participated in development of a method of thrombosing aneurysms with stereotaxic electrolysis.

V.A. Khilko and his co-workers were rewarded with the USSR State Prize for development of methods of surgical treatment of cerebral aneurysms and their introduction into clinical practice.

In 1994 V.A. Khilko organized the Saint Petersburg Science and Practice Center, where he began to study problems of diagnosis and surgery of chronic vascular insufficiency in occlusion and stenosis of carotid arteries. The results of this research were discussed in the Clinical Department of the Russian Academy of Medical Science (1996). It was decided to organize an academic group, headed by V.A. Khilko. Then the Presidium of the above Academy passed a resolution (1998) on carrying out a cooperative study, devoted to an ischemic disease of the brain.

One more sphere of V.A. Khilko’s interests is oncology. He wrote more than 100 reports on this problem. V.A. Khilko improved and introduced a microsurgical approach to a chiasm-cellar region into practical neurosurgery (a subfrontal access via a burr hole). He guided development of a new classification of tumors of a chiasm-sellar region, pituitary adenomas with taking into account neoplasm morphology and topography and existing hormonal disorders. The monograph Tumors of the Pituitary Gland and Chiasm-Sellar Region was written by him in co-authorship with B.A. Samotokin.

V.A. Khilko carried out profound research and introduced a transpyramidal approach to neoplasms, located in an area of the apex of the temporal bone pyramid, i.e. neurinomas of the acoustic nerve, meningiomas of the pyramid apex region. He improved surgical approaches to tumors of the IIIrd ventricle. In particular, it concerns a subtentorial access with dissection of the cerebellum tentorium.

V.A. Khilko is one of the pioneers of developing and introducing microsurgical methods of interventions on the central and peripheral nervous system. He improved many types of operations on the brain and spinal cord. It allowed to widen the borders of indications for surgical treatment of patients with cerebral tumors, which had been considered to be inoperable before.

A considerable number of Khilko’s scientific works is devoted to functional neurosurgery. He is one of the creators of a new way of vision restoration, lying in introduction of electrodes with subsequent direct stimulation of optic nerves. It is done after removal of tumors of a chiasm-sellar region, causing compression of optic nerves and chiasm or after neurolysis of optic nerves in optochiasmal arachnoiditis. Use of such multimodality treatment allows to increase the efficacy of vision restoration in this category of patients. Besides, introduction of electrodes into optic nerves makes it possible to carry out often unique electrophysiologic examinations, to reveal peculiarities of bioelectric activity and blood flow in an optic nerve under pathologic conditions and in the process of restoration of its function, as well as to estimate a character of compensatory shifts, taking place during a rehabilitation period.

Major-General of Medical Service V.A. Khilko is one of the leading field neurosurgeons. He guided an activity, aimed at improvement of surgical treatment of cases with craniocerebral trauma and the wounded with gunshot wounds and blast injuries of the skull and brain, spine and spinal cord, peripheral nerves. Methods for determining viability of the nervous tissue and ensuring full-value debridement of a wound canal (vital staining with an acid dye, tissue fluorescence) were proposed to increase efficacy of debridement of craniocerebral wounds as a whole. The results of this research were used during the war in Afghanistan.

Prof. V.A. Khilko, his followers and Prof. Yu.E. Moskalenko have been studying cerebral blood flow under pathologic conditions and in severe craniocerebal trauma for more than 30 years. It has resulted in revealing peculiarities of local cerebral blood flow in different perifocal areas and fluctuations of cerebrovascular reactivity indices. Potentialities of correction of impaired cerebral blood flow and optimization of reactivity indices are being studied now. It ensures improvement of multimodality treatment of neurosurgical patients.

One cannot but mention V.A. Khilko’s contribution to introduction of clinical immunology into neurosurgery. He continues to guide research in immunologic aspects of trauma and brain diseases. One of the merits of this research is undoubtedly a systemic approach to studying mechanisms of non-specific resistance of the body and processes within a cerebral wound in focal injuries, which lead to acceleration of its healing.

It is important to mention that 24 theses for a Candidate’s degree were written under his guidance. Besides, V.A. Khilko gave his expert advice in preparation of 12 theses for a Doctor’s degree. He is an author of 380 publications, including 7 monographs, 12 manuals and 10 inventions.

V.A. Khiko is a member of the Board of the Association of Russian and Saint Petersburg Neurosurgeons, the editorial board of such magazines as Voprosy Neirokhirurgii and I.I. Grekov Vestnik Khirurgii. Besides, he is the Honorary Doctor of the Kirov Medicomilitary Academy.

V.A. Khilko was an active participant of many congresses and symposia, held in different countries of the world (USA, Denmark, Bulgaria, France, Poland, India, Spain).

His clinical, research and pedagogical activity is highly appreciated. V.A. Khilko was decorated with the third-degree order For Service to Motherland in the Armed Forces, the medal For Services to National Public Health and other medals.

Academician V.A. Khilko is a prominent researcher, interested in many fields of medicine, and a highly qualified neurosurgeon, who has contributed much to development of native neurosurgery. He continues to carry out research in many areas of up-to-date neurosurgery, performs successful operations in cases with the most complicated pathology of various segments of the nervous system, takes an active part in training young researchers and neurosurgeons, renders practical assistance to representatives of the Public Health system.