Gaidar B.V., Parfyonov V.E., Rudenko V.N.
The history of the Chair of Neurosurgery of the Medicomilitary Academy, being an educational, research and medical center of military neurosurgery, reflects the process of development of military medicine in the Russian, Soviet and post-Soviet Army and Navy.
Combat operation in the region of the Khasan lake and Khalkhin-Gol river (1939), as well as battles fought during the Soviet-Finnish war (1939-1945), revealed imperfection of military medicine. It lied in the absence of a system of expert care, rendered to casualties with head and spine wounds. The necessity of creation of this system became quite evident during the first year of the Great Patriotic war (1941-1945). Thus, a new and harmonious doctrine of echelonized treatment of the wounded was worked out and introduced. Lack of personnel and research in the field of military neurosurgery demanded carrying out organizational work for provision of war- and peace-time neurosurgical care. The first steps in solution of this problem were taken by the leading scientists of the Medicomilitary Academy.
In 1948 a neurosurgical 30-bedded department was organized in the Clinic of Faculty Surgery on the initiative of Member of the USSR Academy of Medical Science, Professor, Lieutenant-General V.N. Shamov. It was headed by Senior Lecturer B.A. Samotokin. A two-year course, aimed at training neurosurgeons for military hospitals, was organized.
In 1949 there appeared the fourth and fifth volumes of " The Great Patriotic War and Experience of the Soviet Medicine", edited by V.N. Shamov, who was awarded the Stalin Prize for them later. These books generalized the experience of expert neurosurgical care, rendered during the war. Besides, they contained recommendations on organization and treatment, which were the basis of routine daily work of military neurosurgeons for many years.
The first release neurosurgeons for military with Samotokin B.A. (At the centre),
from left to right: Grechaniy K.V., Beruchashvili L.Z., Grebnyuk V.I.
Professor V.S. Galkin, who headed the Chair of Pathophysiology of the Naval Medical Academy and had been a neurosurgeon-in-chief of the Navy during WWII, decided to start a course of lectures on neurosurgery in 1945. An operating room and 25-bedded department for neurosurgical patients were organized in the Clinic of Nervous Diseases of the same Academy. Thus, V.N. Shamov and V.S. Galkin pioneered the way for future creation of the Chair of Neurosurgery of the Medicomilitary Academy.
Galkin V.S. with employees of the Chair of Pathophysiology with an attached course on neurosurgery
Amalgamation of the Medicomilitary and Naval Medical Academies (1956) prepared the ground for organization of an independent chair of neurosurgery with a 65-bedded clinic.
There was merging of the scientific school of Academician V.N. Shamov, which accumulated great practical experience, and that of Professor V.S. Galkin, characterized by profound theoretical and pathophysiologic research. It turned out to be rather prospective for further development of military neurosurgery. Thus, 1956 can be regarded as birth of the Chair and Clinic of Neurosurgery of the Medicomilitary Academy. It was the first and only chair in medical educational establishments of such a level.
Both the Chair and Clinic occupied the first floor of the Printsevsky building of the former Obukhovskaya hospital. Today there is a therapeutical clinic of the Medicomilitary Academy. It is named after Prof. N.S. Molchanov and used as a base for advanced training of doctors.
Professor, Colonel of Medical Service V.S. Galkin was the first head of the Chair of Neurosurgery. Unfortunately, Galkin held this post during one year only, as he died of hemorrhagic stroke on July31, 1957. Candidate of Medical Science, Assistant Professor, Colonel of Medical Service B.A. Samotokin was appointed the Chair's head in 1957. He was its leader during 25 years.
Tremendous efforts of the Chair and Clinic employees made it possible to turn rooms, which were absolutely unfit for surgery, into a specialized clinic with a modern (at least for that time) operating room and good wards. And this happened only ten years after the devastative war! Many lecturers, doctors and nurses of the Chair and Clinic participated in the war or suffered the siege of Leningrad. They were experienced and full of enthusiasm. The post of the Clinic assistant chief was held by V.I Grebenyuk (he became the Chair deputy head in 1960), A.F. Panichev (1960-1961) (fig. 7), R.I. Zhitnyuk (1961-1965). P.M. Panchenko was appointed a lecturer (1956-1962) and then a senior lecturer of the Chair (1962-1965).
Among senior doctors in charge one can mention V.A. Shustin (1956-1960), A.B. Gorbatsevich (1956-1960), A.F. Panichev (1956-1960); all of them became lecturers later on.
M.V. Tsyvkin, a famous roentgenologist, was in charge of an X-ray room since 1957. He became an assistant professor in 1962 and organized a course of neuroroentgenology for future neurosurgeons. His predecessor was L.P. Galkin, who worked in the Clinic during a year. Neurosurgeons were represented by G.G. Davydova and G.S. Kosenkova. A clinical laboratory was headed by K.G. Malysheva. As for a pathohistological laboratory, its chiefs were V.L. Kiselevsky, T.T. Ivanova and then A.L. Shandurina.
Complicated operations on the brain and spinal cord, lasting several hours, demanded trained instrument nurses. Neurosurgical operations differed from general surgical interventions due to some peculiarities. Thus, instrument nurses had to acquire additional knowledge and skills. A great contribution to the process of their training was made by E.P. Kuznetsova, a senior scrub nurse, who had worked in the Karelsky Front evacuation hospital during the war. This restrained, benevolent and rather exacting woman kept an operating room ready for work at any time of the day and trained many highly skilled instrument nurses.
E.F. Kopp, who was a head nurse of the Clinic, did much for improvement of personnel activity and professional skills.
From the very moment of its organization the Chair paid great attention to training military neurosurgeons for various hospitals. It was done at the Faculty of Advanced Medical Training. Before the above-mentioned amalgamation training was carried out separately, i.e. a course of lectures on neurosurgery in the Medicomilitary Academy was delivered by B.A. Samotokin and in the Naval Medical Academy by Profesor V.S. Galkin.
By 1956 there were 20 neurosurgeons, who had completed 1.5- and 2-year training courses. Unfortunately, due to absence of established neurosurgical posts in military hospitals, almost a half of them had to work as surgeons and organizers. It resulted in giving up neurosurgery with a passage of time, though need of this type of care was extremely great. Some specialists started their career of a neurosurgeon in different military districts and the Navy (V.I. Grebenyuk, V.A. Shustin, L.Z. Beruchashvili, P.M. Panchenko, A.F. Panichev, K.V. Grechany, A.N. Solomin, K.N. Kalitkin, A.R. Balabanov, A.V. Petrov, M.S. Ostrogin, etc.). Due to further expansion of pedagogical, research and medical activity in the Academy, some of them were assigned to new positions, corresponding to their professional level, and started to work at the Chair of Neurosurgery.
The educational process was characterized by four main directions:
Methods, programmes and terms of training underwent certain changes. At first duration of the independent course in neurosurgery and some adjacent disciplines, delivered at the Faculty of Advanced Medical Training, was equal to two years. Its graduates became well qualified neurosurgeons, who could be heads and senior attending doctors of neurosurgical departments. Many of them combined their activity in district military hospitals with business trips to garrison hospitals, where they worked as surgeons and at the same time rendered expert care to neurosurgical patients. There were free-lance neurosurgical departments in some district hospitals; later many of their leaders headed neurosurgical service of various military districts (A.N. Koskov, L.Z. Beruchashvili, K.V. Grechany, K.N. Kalitkin, V.A. Markelov, F.G. Pogorelov, I.L. Shkurda, A.N. Solomin, A.P. Balabanov, etc.).
A three-year course of clinical studies was organized in 1959. Future academician V.A. Khilko and M.M. Tanaskov were the first to attend it. They coped with the programme of training quite well and made a great contribution into development of the Chair and Clinic. V.A. Khilko became one of the greatest neurosurgeons of our country and the scientist, who acquired world fame. He was at the head of the Chair of Neurosurgery for many years. Then this course was attended by V.N. Rudenko (1962). One can mention V.T. Pustovoitenko (1961) and Yu.N. Podkolzin (1964) among advanced students of the Chair.
Rapid development of neurosurgery in the country and transformation of the Chair into the leading neurosurgical center of the Armed Forces demanded mastering all the variety of modern therapeutic and diagnostic methods. Many patients with complex pathology of the nervous system were admitted to the Clinic. Among them there were a lot of victims of the war with sequelae of craniocerebral gunshot wounds, complicated by arachnoiditis, hydrocephalus. epilepsy, cerebral cysts and delayed abscesses. It conditioned the necessity of working out such new diagnostic and therapeutic modalities, as electroencephalography and electrocorticography, pneumoencephalography and carotid angiography.
The first operations with application of cerebral angiography were peformed in Leningrad in 1959. It was done with the help of a device, designed by specialists of the Chair and attached to an X-ray apparatus (B.A. Samotokin, V.A. Khilko, M.V. Tsyvkin). Dissection of dural-encephalic cicatrices, plasty of defects of the dura and skull were made. Organic glass, methyl methacrylates and fast-hardening plastic (at first stiracryl and then protacryl) were used for cranioplasty. Application of fast-hardening plastic made it possible to close big cranial defects, localized both in the fornix and parabasal areas (M.M. Tanaskov). Rational bifrontal approaches to frontoorbital areas of the skull were worked out (B.A. Samotokin, G.G. Davydova, M.M. Tanaskov).
The analysis of thousands of case reports of casualties with craniocerebral wounds was carried out. Then war-disabled persons with epilepsy were invited to the Clinic. After careful and complex examination surgical interventions were made. They helped to eliminate severe sequelae of craniocerebral wounds in many patients (G.G. Davydova).
One more important trend of activity was development of urgent problems of neurooncology. As for radical removal of tumors, it was possible only in case of meningovascular neoplasms; operations on deep tumors and basal meningiomas were limited to partial resection or brain decompression. Removal of nodular and cystic tumors, localized in the third and lateral ventricles and posterior fossa, pituitary adenomas and basal meningiomas became reality only in 1960 with the advent of microsurgery. Radical removal of meningiomas of the saddle tubercle and Blumenbach's clivus was performed in some cases. Improvement of diagnostic methods and surgical technique, vital staining of tumors (V.P. Savenkov, A.N. Shandurina) and good anesthesiologic service (V.F. Lukachina, K.N. Vladimirova) were of extreme importance for increasing a number of operations on the areas, considered to be inaccessible earlier.
Successful activity in the field of neurooncology was impossible without optimum anesthesiologic support, which was paid great attention to since the moment of the Chair's organization. Local anesthesia, as well as anesthesia of reflexogenic zones, were subject to gradual improvement. Endotracheal narcosis was introduced in the Academy much earlier, than in other medical establishments of the country (V.N. Shamov, I.I. Golikov, A.B. Gorbatsevich). The effect of different myorelaxants and ganglionblockers, induced hypotension, artificial hypothermia (there was even a special bath with cold water and ice in a preoperating room) and various mixtures for anesthesia was studied (B.M. Vasilyev, A.B. Gorbatsevich, V.A. Shustin). The native preparation of lyophilized urea (urogluk) was tested and used widely for reduction of brain volume during approach to deep-lying formations and control of brain edema in a postoperative period (V.N. Rudenko). It allowed to perform different interventions, to make them less traumatic and more radical and to decrease postoperative mortality.
At the very beginning the Clinic had no permanent anesthesiologists and narcosis was induced by neurosurgeons. In 1957 B.M. Vasilyev began to work as an anesthesiologist on a voluntary basis. Being an invalid with an amputated thigh, he was at the head of anesthesiologic service of the Clinic during many years. In 1962 K.N. Vladimirova became an anesthesiologist on the staff. Anesthesiologic apparatus improved, but still artificial pulmonary ventilation was carried out either with the aid of DP-1 and DP-2 devices or a breathing bag, controlled by hand. Development of anesthesiology was of great importance from the point of view of improvement of surgical treatment of cerebrovascular pathology. It was a new trend in neurosurgery of that time and the Clinic was a pioneer in its studying.
In 1959 B.A. Samotokin and V.A. Khilko started research in diagnosis and surgical treatment of various cerebral aneurysms and carotid-cavernous anastomoses. B.A. Samotokin ligated a neck of ICA aneurysm in the same year. In 1960 V.A. Khilko was the first to perform operation according to Brooks, i.e. embolization of carotid-cavernous anastomosis with a muscular embolus.
Stereotaxis was studied carefully since 1959. It allowed to achieve a positive effect in such persistent diseases, as parkinsonism, choreoathetosis, dystonia musculorum deformans and other types of extrapyramidal hyperkinesis (N.P. Bulgakov).
Study of compressive forms of lumbar osteochondrosis was carried out simultaneously (V.A. Shustin). Indications for an operation and sparing surgical approaches were worked out. Diagnosis of this pathology was greatly dependent on a pneumomyelographic examination (M.V. Tsyvkin), which permitted to determine a level of compression of a dural sac, the spinal cord and its roots in hernias of intervertebral disks and tumors of the spinal cord and its tunics.
Active clinical work served the basis for research. The Chair's employees made reports at All-Union conferences, meetings of the Leningrad Neurosurgical Society and published their articles in different scientific magazines.
In 1959 there appeared the book "Surgery of Injuries of the Nervous System", edited by V.N. Shamov, which became a manual for neurosurgeons of the country. Its largest sections were written by B.A. Samotokin, V.I. Grebenyuk, A.B. Gorbatsevich. The latter defended his thesis for a degree of Candidate of Medical Science in 1960. It was entitled "Treatment of Persistent Palsies of Facial Muscles by Suturing Facial and Phrenic Nerves".
The results of the Chair's activity in one of the practical fields were summarized in "Discogenic Lumbar Radiculitis", being a thesis for a degree of Doctor of Medical Science , written by V.A. Shustin in 1964. Later it became the basis for a monograph, devoted to the same topic. The clinic won immense prestige of long standing in Leningrad due to precise diagnosis and successful treatment of discogenic lumbar radiculitis.
The Chair's research work was aimed at the most urgent problems of modern neurosurgery. Thus, a new trend of that time was studying cerebrovascular pathology. B.A. Samotokin, who headed the Chair, and his disciple V.A. Khilko started profound study of this fundamental problem. Introduction of cerebral angiography into practice, further improvement of surgical technique and anesthesiologic support gave a chance to make operations in some cerebral lesions, which earlier had been treated by therapeutic methods. Khilko's thesis for a degree of Candidate of Medical Science "On Aneurysms of Cerebral Vessels" (1964) was devoted to description of their clinical picture, diagnosis and surgery. The observation was carried out on 82 patients with carotid-cavernous anastomoses, arteriovenous malformations saccular aneurysms. It resulted in profound analysis of clinical symptoms, determination of indications and contraindications for an operation, development of new methods of surgical interventions and recommendations on anesthesiologic support, prevention and treatment of complications. Thus, the Chair of Neurosurgery became one of the leading centers of angiosurgery in the country.
The Central Medicomilitary Department (CMMD) introduced the institution of free-lance Chief Specialists of the USSR Ministry of Defence. The head of the Chair was appointed a Chief Neurosurgeon. Since that time the Chair began to play a peculiar role in rendering assistance to military hospitals and medical officers. There were up to 30 annual business trips to different military districts and the Navy, during which the employees of the Chair acted as consultants, operated the most serious cases, read lectures on important neurosurgical problems and carried out organizational work for improving expert neurosurgical care in troops. Directive N 161/3/14538, issued by the CMMD in July 1962, contained an order to create permanent neurosurgical units in all military districts and the Navy. It promoted improvement of care, rendered to neurosurgical patients, and development of neurosurgical service in troops. B.A. Samotokin, who turned out to be a talented organizer, made an extremely valuable personal contribution into this process.
During this period of time (1956-1964) the staff of the Chair was formed, educational programmes were developed, main trends of research were determined. Besides there appeared a new scientific school and neurosurgical service of the Armed Forces.
The next period lasted from the second half of 1964 up to 1970.
Neurosurgery began to play a more and more important part among other medical specialties. Need of specialized neurosurgical care in the Armed Forces grew to a great extent. Thus, leaders of the Academy decided to expand the existing neurosurgical base. The Clinic got a building in Pirogovskaya Naberezhnaya, which had belonged to the Clinic of Field Surgery some time ago and demanded major repairs.
In 1964 the Clinic was deployed in a part of a building, occupied by the Clinic of Faculty Surgery. It was a temporary "haven" with wards for 40 patients, operating and dressing rooms and a limited number of treatment-and-diagnosis rooms.
In spite of strained conditions and rooms, which were almost inconvenient for rendering specialized care and performing operations, the staff of the Clinic continued its therapeutic and educational activity.
Taking into account a small bed capacity and necessity to ensure a full-value educational process, a new neurosurgical department was organized in the Dzerzhinsky Dorozhnaya hospital with active participation of specialists of the Clinic of Neurosurgery and under their leadership. It was headed by V.A. Shustin, the Chair lecturer.
His active asistants were G.G. Davydova, a neurosurgeon, and N.P. Bulgakov, a senior doctor in charge. Later its head was A.I. Panyushkin, who represented the Chair's scientific school.
This period was characterized by active and profound research. One of its main goals was severe craniocerebral trauma. The results of investigations were summarized in the manual "Severe Craniocerebral Trauma", edited by B.A. Samotokin (1964). Its second edition appeared in 1971. Three theses for a degree of Candidate of Medical Science were defended successfully. They were "Emergency Surgery in Severe Closed Craniocerebral Trauma" by V.T. Pustovoitenko (1964), "Traumatic Epilepsy of a Remote Period of Combat Craniocerebral Wounds" by G.G. Davydova (1965) and "Use of Fast-Acting Platics for Plasty of Cranial Defects" by M.M. Tanaskov (1969). The results of stereotaxic operations were described in the thesis for a degree of Candidate of Medical Science, written by N.P. Bulgakov and entitled " On Surgical Treatment of Parkinsonism and Some Other Types of Hyperkinesis" (1965).
Yu.N. Podkolzin, the Chair's advanced student, carried out considerable clinical-and-experimental work, which elucidated a problem of CNS lesions, caused by modern antibiotics and applied either directly on a wound or administered into the liquor system. He studied more than 20 antibacterial drugs. Prescription of optimum doses in different types of administration allowed to minimize negative effects of concentrated antibacterial therapy in neurosurgical patients. Preventive and therapeutic doses of antibiotics and a scheme of their use under field conditions were given. The results of investigation were presented in the thesis, written by Yu.N. Podkolzin for a degree of Candidate of Medical Science (1967). It was entitled "Use of Some New Antibiotics in Neurosurgery" and was a step forward in control of infectious complications, developing after craniocerebral traumas and operations on the nervous system.
Good roentgenologic service was one of the main links in the activity of the Chair and Clinic. It was headed by M.V. Tsyvkin, who had been a chief of an X--ray room (1957) at the very beginning, then an assistant lecturer and an assistant professor (1962). His profound research in the field of pathology of the spine and spinal cord, carried out with the help of various contrast substances (in particular, myelography), allowed to improve diagnosis and surgical treatment of lumbar osteochondrosis and other pathologic states. In 1969 M.V. Tsyvkin defended the thesis for a degree of Doctor of Medical Science, entitled "Roentgenologic Evaluation of the Spine and Subarachnoid Spaces and Its Place in Diagnosis of Diseases of the Spinal Cord". It became the basis for a future monograph. Since 1966 this X-ray room was headed by T.E. Rameshvili. She defended the thesis for a degree of Candidate of Medical Science in 1967. Its title was "Roentgenodiagnosis of Tumors of the Middle Cranial Fossa". Soon T.E. Rameshvili was appointed an assistant professor. In 1979 her second thesis "Cerebral Aneurysms and Arteriosinusal Anastomoses: Role of Roentgenologic Examination in Multimodality Diagnosis and Estimation of Treatment Efficacy" was defended successfully and she was granted a degree of Doctor of Medical Science.
In 1969 V.I. Grebenyuk defended his thesis for a Doctor's degree "Closed Trauma of the Spine and Spinal Cord". It reflected all new therapeutic-and-diagnostic aspects of this pathology and described a new method of eliminating neglected dislocations with the help of a special instrument, designed by the author, i.e. a retractor for reduction of vertebral dislocations.
All investigations were carried out under the guidance of B.A. Samotokin, who was extremely sensitive to appearance of new basic trends of neurosurgery development in general and its military field constituent in particular. His thesis for a Doctor's degree "Open Craniocerebral Injuries and Problems of Organization of Expert Care in the Soviet Army" (1967) was based on personal observations of combat gunshot penetrating craniocerebral wounds, sustained at the Leningrad Front during the Great Patriotic war; besides, it described open craniocerebral peace-time wounds, treated in military hospitals, and contained recommendations on organization of specialized neurosurgical care in the time of war and peace.
Academician of the USSR Academy of Medical Science, Professor A.I. Arutyunov (director of the Burdenko Neurosurgical Institute) was an official opponent of B.A. Samotokin during defense of his thesis. He visited the Clinic and appreciated the activity of the Chair. A.I. Arutyunov expressed his deep satisfaction and even amazement, as, according to his words, the Chair with its scanty staff managed to carry out research and therapeutic work analogous to that of a big research Institute.
A new period in the Clinic's life began on October 1, 1970 after its move to the ground floor of the former Sukhoputny Hospital, founded by Peter the Great in 1717 (fig. 10). The Clinic had 85 beds and there was a department of resuscitation and intensive care. An operating room was equipped with a centralized system, supplying each operating table with nitrous oxide, suction device and oxygen.
Modern building of clinic neurosurgical
About 220-260 patients with tumors of the brain and spinal cord, various aneurysms of cerebral vessels were operated in the Clinic annually. New surgical methods were worked out. They included intravascular embolization of arteriovenous aneurysms and carotid-cavernous anastomoses (V.A. Khilko, V.F. Yankin), reduction and fixation of dislocations in the cervical spine with the help of anterior corporodesis (V.F. Yankin, V.I. Grebenyuk). Operations were performed in 50% of admitted patients. In spite of growing craftsmanship of neurosurgeons and anesthesiologists postoperative mortality was high and made 25% in cerebral tumors and 5% in aneurysms of cerebral vessels.
A surgical block had three operating tables, an operating room for urgent interventions and two dressing rooms. The operating room was equipped with a TV observation system (later an analogous system was installed in the above-mentioned resuscitation unit), modern apparatus and instruments, automatic devices for artificial pulmonary ventilation.
In 1967 there appeared a Swedish device, known as Elema. Used together with an existing roentgenologic apparatus, it allowed to carry out serial angiographic examination in two projections. Tridoros Optimatic 800 angiographic complex (Siemens) was acquired in 1979.
A number of physicians was not very large. There were 3 senior doctors in charge (medical officers), one civil neurosurgeon and doctors, working in various laboratories and rooms (the X-ray room, etc.). A heavy burden of training and treating fell on four lecturers, who were heads of clinical departments at the same time.
Beginning with 1971, annual numbers of admitted patients and performed operation were 900-1000 and 400 respectively. An operating microscope, manufactured by the Krasnogvardeets plant, allowed to start performing microsurgical operations in 1971. V.A. Khilko was the first neurosurgeon in Leningrad, who used a balloon-catheter during an operation for carotid-cavernous anastomosis. In 1973 artificial thrombosing of aneurysms and embolization of AVM in a magnetic field were introduced. They permitted to avoid complex operations. Investigations in this field were summarized in the thesis for a Candidate's degree "Some Aspects of Artificial Thrombosing of Aneurysms of Cerebral Arteries and Carotid-Cavernous Anastomoses" (1975), written by V.F. Yankin.
Since 1979 selective angiography and intravascular operations (embolization and occlusion of AVM with a baloon-catheter) became a routine procedure. Microsurgical instruments and use of an optoelectronic transducer widened the possibility of surgical treatment of cerebrovascular diseases.
In 1970 V.A. Khilko defended his thesis for a Doctor's degree, entitled "Intra- and Extracranial Aneurysms". The attempts to solve this problem demonstrated his bright talent of a scientist and neurosurgeon. In 1973 the book "Aneurysms and Arterio-Sinusal Anastomoses" by B.A. Samotokin and V.A. Khilko was published. They were awarded the prize of the Presidium of the Academy of Medical Science (1974).
A period, which began in 1970, was extremely successful from the point of view of research and introduction of new methods of treatment into practice. Theses for a Candidate's degree by G.I. Sikorsky ("Problems of Diagnosis and Surgical Treatment of Cerebral Meningiomas", 1974) and by V.N. Rudenko ("On Peculiarities of Clinical Use of Urea Hypertonic Solution in an Acute Period of Craniocerebral Trauma and in Aneurysms of Cerebral Vessels", 1975) were defended. The thesis for a Candidate's degree by V.I. Kichuk (1976) was devoted to replacement of blood loss after operations for tumors, aneurysms of cerebral vessels and severe craniocerebral trauma.
In 1976 the work at determining borders of nonviable tissues in contusion foci of craniocerebral trauma and glial tumors was started. It resulted in the thesis for a Candidate's degree, written by B.P. Savenkov and entitled "Determination of Borders of Cerebral Tumors and Contusion Foci with the Help of Their Staining by Dimifen Blue" (1983). It became a practical manual for neurosurgeons, interested in this problem.
Anesthesiologic service became much better. In 1974-1979 it was headed by V.F. Lukachina, who was a senior doctor in charge. Then its head was A.N. Khlunovsky, who made a valuable contribution into development of anesthesiology and resuscitation in neurosurgery. His Candidate's thesis "High Epidural Block in Prevention of Pulmonary Complications and Its Effect on Dynamics of Cellular and Humoral Immunity in Craniocerebral Trauma" was defended in 1983. Thanks to improvement of surgical technique and anesthesiologic support, postoperative mortality in cerebral tumors and vascular pathology reduced from 25% up to 16-15% and 0-1.4% respectively.
Beginning with 1970, the Chair of Neurosurgery gained great prestige among neurosurgical establishments of the country. Its head B.A. Samotokin acquired a title of Honored Science Worker of the Russian Federation in 1975. He became a Hero of Socialist Labor in 1979.
Professor V.A. Khilko, a talented and outstanding neurosurgeon and Samotokin's disciple, was appointed the Chair's head in 1982. A post of an assistant head was filled by Candidate of Medical Science E.I.Usanov. B.V. Gaidar, a former neurosurgeon of the Sredne-Aziatsky military district, became an advanced student of the Chair in 1980. He began to study problems of surgical treatment of cerebrovascular pathology, disorders of cerebral hemodynamics and reactivity of cerebral vessels in an acute period of craniocerebral trauma. His thesis for a Candidate's degree "Diagnostic and Prognostic Value of Brain Reactivity Indices in an Acute Period of Severe Craniocerebral Trauma" was defended in 1984. After that B.V. Gaidar became a senior lecturer of the Chair (1985).
The professorial-teaching staff of the Chair of Neurosurgery with graduates of the Faculty
of the Leading Medical Personnel (1991)
Khilko's appointment was a new and powerful impulse for further improvement of surgical and research activity. "Intravascular Surgery", written by him in cooperation with Yu.N. Zubkov, was published in 1982. The employees of the Chair, guided by V.A. Khilko, wrote the book "Tumors of the Pituitary Gland and Chiasmal-Sellar Region", which saw the light in 1985.
B.A. Samotokin and V.A. Khilko were awarded the USSR State prize for their outstanding service (1985). V.A. Khilko was elected a writing member of the USSR Academy of Medical Science in 1988; he became an academician of the Russian Academy of Medical Science in 1999.
There were certain changes in educational programmes. A term of training at the Faculty of the Armed Forces Leading Medical Staff became longer and made 3 years. It resulted in more profound and high-quality training of military neurosurgeons, who were to serve in military hospitals.
Use of microsurgical technique led to improvement of operations for cerebral tumors, in particular, of Blumenbach's clivus and the brain stem. A spectrum of surgical interventions in cerebrovascular pathology widened. Advanced methods of diagnosis and surgical treatment of various cerebrovascular aneurysms were applied. The results of research in this field were summarized in the thesis for a Candidate's degree, written by V.E. Parfyonov and entitled "Reactivity of Cerebral Circulation and Ways of Its Correction in an Acute Period of Craniocerebral Trauma" (1988) and in the thesis for a Doctor's degree "Principles of Optimization of Cerebral Hemodynamics in Brain Pathology" by B.V. Gaidar (1990). The latter was given the rank of professor in 1992.
In 1987 the Clinic acquired TC-62 Doppler (EME). It opened new horizons in diagnosis of cerebrovascular pathology, as there was a possibility to monitor a state of cerebral hemodynamic in critically ill patients (B.V. Gaidar, V.E. Parfyonov, D.V. Svistov). The first operations, aimed at creation of extra-intracranial microanastomosis in occluding lesions of cerebral arteries, were made in 1989 (Yu.A. Shulev, B.V. Gaidar, D.V. Svistov). In 1993 D.V. Svistov, who was a lecturer of the Chair, defended the thesis for a Candidate's degree "Perioperative Transcranial Dopplerography in Arteriovenous Malformations of the Brain".It was the first fundamental study in Russia, which described possibilities of noninvasive dopplerographic diagnosis of arteriovenous malformations in pre- and postoperative periods, as well as during an operation.
Experience of surgical treatment of compression forms of osteochondrosis demanded revision of indications for an operation and more radical interventions, based on microsurgical technique. Investigations in this field allowed A.I. Verkhovsky to defend the thesis for a Candidate's degree, entitled "A Clinical Picture and Surgical Treatment of Relapsing Lumbar-Sacral Radiculitis" (1983).
The 80s were extremely important from the point of view of working out modern methods of diagnosis and treatment of combat trauma of the skull, brain, spine and spinal cord. It was conditioned by the war in the Republic of Afghanistan. Neurosurgeons of the Chair and military districts, rendering expert care in this region, summarized personal experience of their work in the Kabul hospital. In 1985 and 1992 Yu.A. Shulev, a lecturer of the Chair, defended theses for a Candidate's and Doctor's degrees respectively. They were "Peculiarities of Surgical Treatment of Blast Craniocerebral Wounds" and "Craniocerebral Injuries Caused by Explosions". A.I. Verkhovsky, the Chair's lecturer, analysed a clinical picture, pathogenesis of neurologic complications in gunshot wounds of the spine and spinal cord and used modern surgical methods of treatment and rehabilitation of the wounded. His experience was described in "Modern Gunshot Wounds of the Spine and Spinal cord", being a thesis for a Doctor's degree. A title of the doctoral thesis by E.I. Usanov, an assistant head of the Chair, was "Organization of Expert Care Rendered to Casualties with Wounds of the Skull, Spine and Peripheral Nerves" (1992). V.P. Orlov, who worked his way up from the Chief Neurosurgeon of the Pribaltyisky Military district and the first neurosurgeon of the 40th Army to the Chair's lecturer and an assistant professor, defended his Candidate thesis "Efficacy of Tidal Drainage in Gunshot Craniocerebral Wounds" in 1985. This method permitted to reduce the rate of postoperative infectious complications in surgical debridement of gunshot craniocerebral wounds. The experience of many neurosurgeons of different military districts, who had been participants of the Afghan war, was summarized in numerous articles and theses.
The Chair's lecturers visited many countries with the purpose of rendering expert neurosurgical care to casualties.
Shustin V.A., examining a patient in Syria as an expert in neurosurgery
In 1956-1957 V.A. Shustin worked in Syria, where he treated patients, trained personnel and helped to organize a system of neurosurgical care. He was decorated with the Order "For Honor and Services", which is the highest military award of this country. Some specialists (M.M. Tanaskov, 1962-1963; A.F. Panichev, 1964-1965; R.I. Zhitnyuk, 1965-1966) went to the Republic of Cuba; they treated patients and took an active part in organization of neurosurgical service. In 1970 M.M. Tanaskov flew to Peru for rendering neurosurgucal care to victims of an earthquake. Yu.V. Orlov, a senior doctor in charge, worked as a neurosurgeon in Ethiopia (1979-1981) and Yu.N. Podkolzin, the Chair's lecturer, was in Syria (1973) during a military conflict in the Near East. All of them were decorated with orders and medals of these states.
The work of neurosurgeons of the Chair during the war in the Republic of Afghanistan was extremely difficult. Among them there were Yu.A. Shulev (1983-1984), A.I. Verkhovsky (1984-1985), V.P. Savenkov (1985-1986), V.F. Teplyashin (1986-1989), Yu.M. Baranenko (1984-1986). While in Afghanistan they were at the head of a neurosurgical department of the Kabul military hospital. The above neurosurgeons were decorated with orders of the USSR and the Republic of Afghanistan.
In 1988 B.V. Gaidar and V.P. Savenkov were sent to Armenia for rendering neurosurgical care to numerous victims of an earthquake. After that B.V. Gaidar was decorated with the Order "For Service to Motherland in the Armed Forces" and V.P. Savenkov with the Order of Honor.
In 1992 Head of the Chair of Neurosurgery V.A. Khilko, who was 62 years old, retired from the Armed Forces, but he continued to work as a professor. His disciple, Doctor of Medical Science, Professor B.V. Gaidar was appointed a new head of the Chair and a Chief Neurosurgeon of the Russian Armed Forces. B.V Gaidar is a famous scientist, experienced lecturer and neurosurgeon, performing filigree operations on all segments of the nervous system.
Candidate of Medical Science V.P. Savenkov became a senior lecturer (1992).
Candidate of Medical Science, Assistant Professor, Colonel of Medical Service V.E. Parfyonov was appointed an assistant head of the Chair in 1994. Two years later he defended his Doctor's thesis "Transcranial Doppler in Neurosurgery". He is a professor since 1998.
The 90s became a new stage in the history of the Chair and Clinic. In 1997 Candidate of Medical Science, Assistant Professor, Colonel of Medical Service Yu.A. Shcherbuk was appointed an assistant head on clinical work. He defended his Doctor's thesis "Intraoperative Endoscopic Monitoring in Neurosurgery" in 2000 and became a professor in 2001. Candidate of Medical Science, Assistant Professor, Lieutenant-Colonel of Medical Service D.V. Svistov filled the post of a senior lecturer in 1997. There appeared some new well qualified lecturers and senior doctors in charge. Several Doctor's and Candidate's theses of great practical value were defended.
In December 2000 Head of the Chair, Professor B.V. Gaidar was appointed a chief of the Medicomilitary Academy by the Decree of the President of the Russian Federation. He was given a rank of a major-general. Since that moment the Chair and neurosurgical service of the Armed Forces was headed by Doctor of Medical Science, Professor, Colonel of Medical Service V.E. Parfyonov.
The main trends of research and medical activity of the Chair and Clinic of Neurosurgery are as follows:
At present the Clinic has 4 departments with bed capacity of 100. It is equipped with necessary up-to-date apparatus and devices. The Clinic is famous both in Leningrad and Russia, as it occupies the leading position in ultrasonic diagnosis of brain diseases, intraoperative monitoring of cerebral hemodyna-mics, endovasal interventions for AVM, aneurysms and obliterating diseases of carotid arteries, transsphenoidal surgery of neoplasms in the chiasmal-sellar region, neuroorthopedic correction of spinal disorders in acute and remote periods of trauma, miltimodality therapy of brain tumors.
Almost every neurosurgeon of the Chair and Clinic has a great experience in field neurosurgery, gained during combat operations in the Republic of Afghanistan (Assistant Professors V.P. Savenkov and V.P. Orlov, Head of Resuscitation Unit Yu.M. Baranenko) and antiterrorist operations in Chechnya (V.P. Savenkov, V.P. Orlov, B.V. Martynov, S.M. Idrichyan, Yu.V. Dikarev, A.V. Polezhaev, S.V. Toptygin, V.A. Manukovsky). Besides, doctors, studying at the Faculty of the Leading Medical Staff, advanced students of the Chair and interns take an active part in rendering expert neurosurgical care in Chechnya as well (V.N. Fatkullin, V.E. Chernov, A.A. Chirkov, N.V. Matveev, K.E. Korostelyov, V.A. Kravchuk, A.N. Chirkin).
The Chair and Clinic of Neurosurgey of the Medicomilitary Academy are the leading diagnostic, therapeutic, educational and organizational neurosurgical center in the Russian Armed Forces and Saint Petersburg.