History of Home Neurosurgery: Some Pages
Part IV

Kondakov E.N.

Polenov Research Neurosurgical Institute Saint Petersburg, Russia

 

A Period of Surgical Neuropathology
(Organizational Aspects of Neurosurgery Development)

N.N. Burdenko wrote, that by that time the existing neurosurgical personnel had already overcome such "…inescapable stages of the discipline, as mastering technique of a surgical intervention; mastering technique of diagnostic operations; acquiring skills, necessary for more precise neurologic analysis and estimation of a neurologic status on the basis of operative data; elaborating more accurate conceptions of histogenesis of pathologic processes; analyzing physiologic and pathophysiologic components in various forms of the CNS pathology; synthetic drawing of clinical, morphologic and pathophysiologic parallels".

This multifield activity conditioned success of adjacent disciplines and there appeared many interesting reports, written by otoneurologists (D.N. Rutenburg, G.S. Zimmerman, 1935; O.G. Ageeva-Maikova, 1939), psychiatrists (A.S. Shmaryan, 1936), rentgenologists (A.K. Yanovsky, 1935; M.B. Kopylov, N.N. Altgauzen, Ya.I. Geinisman, etc). Besides, some specialists carried out thorough research in liquorodiagnosis and developed liquorodynamic tests (D.A. Shamburin, 1933; L.S. Kadin, A.A. Arendt, 1935). Clinical aspects of bioelectric activity of the cortex were studied (S.A. Sarkisov, 1935; A.V. Lebedinsky).

The results of different investigations were presented at the I, II and III Sessions of the Neurosurgical Council, held in 1935, 1936 and 1937. These Sessions demonstrated a great interest in brain tumors, successful development of diagnosis, wider use of complex methods in research, carried out with participation of physiologists and pathoanatomists.

New pathogenetic views on histogenesis of brain tumors, traumatic diseases of the nervous system and their further development were described in reports by L.I. Smirnov (1936), V.M. Gakkel (1939). Correlation between micromorphologic data and a clinical picture was studied by Kh.I. Garkavi (1935), L.O. Korst and others.

Works by N.N. Burdenko and his school in the field of cerebral oncologic diseases were of great scientific and practical importance. They promoted development of topical diagnosis, classification of tumors and their forms, technique and methods of surgical and postoperative treatment. N.N. Burdenko formulated the main principle of neurosurgery, which runs as follows: "Anatomic accessibility, technical and physiologic possibility, minimum traumatizing of the brain tissue and thorough hemostasis".

An achieved level of clinical and pathomorphologic experience resulted in publication of the manual Morphology of the Nervous System by L.I. Smirnov (1938); collected articles Brain Tumors and Problems of Neurosurgery (Rostov-on-Don, 1936) and Tumors of the Central Nervous System, edited by Z.I. Geimanovich (Kharkov, 1936) and appearance of theses Tumors of the Spinal Cord by V.V. Lebedenko (1935) and Cerebral Meningiomas by K.G. Terian (1937), etc.

Neurosurgery obtained official recognition as a new specialty during prewar years. The Leningrad Neurosurgical Institute, which had been under the authority of Lengorzdravotdel (the Leningrad Municipal Department of Public Health) before, became subordinate to the People's Commissariat of Public Health of the Russian Federation (the Order of the USSR People's Commissariat of Public Health, issued on November 13, 1940). The Moscow Institute of Neurosurgery was reorganized to the Central Neurosurgical Research Institute. In 1944 it was one of the first medical establishments, included into the newly-formed Academy of Medical Science of the USSR.

There appeared several monographs, promoting solution of some problems of a clinical course, diagnosis and treatment of brain tumors and abscesses. Among them one can mention monographs Foundations of Neurosurgical X-ray Diagnosis by M.B. Kopylov (1940), Conservative Treatment of Brain Abscesses by A.N. Bakulev (1940), Materials on Surgery of the Posterior Cranial Fossa by I.M. Grigorovsky (1940) and theses Neurological Diagnosis of Tumors of the Frontal Lobe by Yu.M. Rappoport (1393), On Ependymal and Choroidal Brain Tumors by M.P. Biryukov (1940), etc.

During the Great Patriotic war many neurosurgeons were sent to different fronts; as for the activity of existing Institutes, it was devoted to problems of rendering specialized care to casualties with wounds of the brain and spinal cord.

L.A. Polenov worked in besieged Leningrad. He edited the following manuals, which were of extreme importance for front and base hospitals:

  1. A title-page of Technique of Operations on the Central and Peripheral Nervous System in Wartime Injuries by Babchin I.S., Terpugov E.A., Bondarchuk A.V., Vaskin I.S. (1941).
  2. A title-page of Fundamentals of Military Neurosurgery by Bondarchuk A.B., Vaskin I.S., Kudrin I.S. (1943).
  3. A title-page of Principles of Practical Neurosurgery by Babchin I.S. (1943).

As for the Moscow neurosurgical school, it is necessary to mention B.G. Egorov, who was one of the disciples of N.N. Burdenko. Egorov created a surgical block (1928) in a new neurosurgical clinic. Later it became the Central Research Institute of Neurosurgery. Then he headed a neurosurgical sector of this Institute. Egorov B.G. was the first in the country to perform angiography with administration of a contrast substance into external and internal carotid arteries.

He defended a thesis for a Doctor's degree in 1945. It served the basis for a monograph, entitled Neurinoma of the Eighth Nerve. Surgical Treatment of Neurinomas of the Acoustic Nerve and Anatomic Substantiation of Its Methods and published in 1949.

One cannot, but mention Arutyuov A.I., who was an outstanding neurosurgeon and organizer of the USSR neurosurgical service. During WWII he was a surgeon in the 6th and 9th armies of the Southern Front, a surgeon-in-chief of the North-Caucasian, South-West and Third Ukrainian Fronts. Then Arutyunov became a surgeon-adviser of the Chief Military-and-Sanitary Department of the Red Army. Arutyunov defended his thesis for a Doctor's degree in 1944. It was entitled Gunshot Wounds of Major Vessels and Their Treatment at Evacuation Echelons. His monograph Gunshot Wounds of Major Vessels and Their Surgical Treatment was published in 1949. Arutyunov A.I. took an active part in organization of the Research Neurosurgical Institute, attached to the Ministry of Public Health of the Ukrainian Soviet Socialist Republic. He headed the Burdenko Research Neurosurgical Institute in 1964-1975.


Prof. Vladimir Nikolaevich
Shamov (1882-1962)

Neurosurgical service of the Red Army was headed by V.N. Shamov. He was an inspecting neurosurgeon of the Chief Military-and-Sanitary Department and a deputy surgeon-in-chief of the Red Army. Shamov did much for successful organization of both blood transfusion service at the fronts and expert neurosurgical care.

His manuals, published before the war, include:

  • Injuries and Diseases of Cerebrospinal Nerves (1929) and Errors,
  • Complications and Risks in Operations on Peripheral Nerves (1937).

In 1939 V.N. Shamov became a head of the Chair of Faculty Surgery (the Kirov Medicomilitary Academy), where he opened a 30-bedded neurosurgical unit. It was reorganized into the Chair of Neurosurgery in 1956. At the same time he guided research, carried out at the Leningrad Institute of Blood Transfusion. Organization of neurosurgical care and experience accumulation were accompanied by development of theoretical and clinical problems, pertaining to trauma of the central and peripheral nervous system. Morphology of its wounds was studied successfully. The results of this activity were presented in some articles and monographs (L.I. Smirnov, P.E. Snesarev).

Physiologists worked at development of fundamentals of bioelectric diagnosis in cerebral wounds V.S. Rusinov, S.A. Sarkisov) and different electrophysiologic methods, used in injuries of the spinal cord and peripheral nerves (P.K. Anokhin, F.G. Ivanov-Dyatlov). A clinical picture and diagnosis of complicated and uncomplicated craniocerebral wounds were studied at their different stages (S.N. Davidenkov, Yu.V. Konovalov, Ya.I. Razdolsky, M.Yu. Rappoport). Great attention was paid to treatment of penetrating and non-penetrating wounds and their complications (A.A. Arendt, B.G. Egorov, E.M. Morgorin, B.A. Samotokin, V.N. Shamov and others). Such hemostatic substances as thrombin (B.A. Kudryashov), metonin and vicasol (A.V. Palladin) were introduced.

The VI Session of the Neurosurgical Council was held in January of 1944. Neurosurgeons of all the fronts and different base hospitals took part in it. The participants discussed some organizational problems and paid great attention to trauma of the central and peripheral nervous system. It allowed to share gained experience and attain certain unity of theory and practice.

The wartime was characterized by a growing number of articles and monographs in general and those, describing diagnosis and treatment of injuries of the peripheral nerves in particular (G.A. Rikhter, S.I. Polonsky, 1943; M.P. Saradzhishvili, 1943; F.I. Golub, 1944 and others). It is worth to mention a monograph by V.A. Negovsky, entitled Experience of Treatment of Agonal States and Clinical Death in the Army (1945).

The war did not cause discontinuation of personnel training and a lot of theses were defended (N.N. Altgauzen, 1942; I.D. Zhitnyuk, 1942; V.V. Arkhangelsky, 1943; I.L. Ioffe, 1943; E.P. Tsiptitsky, 1944; B.G. Egorov, 1945; Ya.M. Bune, 1945; K.P. Chikovani; 1945; V.A. Nikolsky, 1947). Some of them were logic completion of investigations, started before the war; others summarized experience, gained during it.

For example, one can mention such theses for a Candidate's degree, as Liquorrhea and Liquor Fistulas in Gunshot Petentrating Wounds of the Skull by B.A. Samotokin (1949) and Gunshot Marginal Osteomyelitis of the Skull Bones, Their Pathogenesis and Treatment by L.P. Revekin (1945).

Field neurosurgery was born and got firmly established in battles of the Great Patriotic war. Professor V.N. Shamov, analyzing the wartime activity of neurosurgical service and the Polenov Neurosurgical Institute in his program speech, estimated it as a period of field neurosurgery.

A.L. Polenov is known as a great scientists, physician, instructor and public figure. He was a Director of the Neurosurgical Institute, Full Member of the USSR Academy of Medical Science, Honored Science Worker. Professor. A.L. Polenov died on July 19, 1947.

Having taken into account his outstanding services, the USSR Council of Ministers issued a Decree to name the Leningrad (Russian at present) Research Neurosurgical Institute after A.L. Polenov (October 1947).


Decree N3588 of
the USSR Council of Ministers


Unveiling a bronze bust in honor of Academician
Andrei Lvovich Polenov in front of the building of the
Neurosurgical Institute, named after him (1954)

Unveiling of Polenov's bust near the Institute building took place on October 25, 1954. It was created by N.V. Dydyskin (a sculptor) and Yu.N. Smirnov (an architect). Besides, memorial plaques were placed in regional hospitals of Ulyanovsk and Orel and the Kronstadt Military Naval Hospital.

Shamov V.N. was a head of the Chair of Faculty Surgery (the Medicomilitary Academy) and one of the most devoted disciples of Prof. S.P. Fedorov. He was appointed a director of the Leningrad Neurosurgical Institute named after Polenov and neurosurgeon-in-chief of the Russian Federation Ministry of Public Health in 1947.

Thus, the Institute acquired a status of the leading establishment of the Ministry of Public Health in the field of neurosurgery. One of the most important goals of its activity was organization and development of neurosurgical care in the Republic.

The Moscow Central Neurosurgical Institute was reorganized into the Burdenko Institute of Neurosurgery with a threefold increase of a number of beds. In 1950 there appeared the Ukrainian Neurosurgical Institute. New neurosurgical departments were opened in the Moscow Hospital named after S.P. Botkin, Moscow Regional Research Clinical Institute and medical establishments of such cities as Voronezh, Lvov, Riga, Simferopol, Tartu, Tallinn.

Publication of Experience of Soviet Medicine Gained during the Great Patriotic War of 1941-1945 (50 volumes) was completed in 1953. The IV of them was devoted to gunshot craniocerebral trauma (ed. by V.N. Shamov, B.A. Samotokin, 1950). Injuries of the spine and spinal cord were described in the XI volume (ed. by A.N. Bakulev, 1952). Injuries of peripheral nerves were discussed in the XX volume (ed. by V.G. Egorov, N.I. Mironovich, 1953). Gunshot Wounds of the Skull and Brain by E.M. Margolin (1957) was a considerable contribution to the above publications, treating problems of surgical anatomy and operative surgery, closely connected with practical activity of a neurosurgeon.

The information on trauma of the spine and spinal cord, presented in the XI volume, unification of classifying notions, developed by V.L. Pokotilo (1913) and N.S. Kosinskaya (1952), as well as data of clinical-surgical, rentgenologic and neurologic studies allowed to elaborate a uniform neurosurgical classification of gunshot wounds of these anatomic structures. Main provisions of this classification have not lost their importance up to now.

Order N115 of the Russian Federation Minister of Public Health (1956) established posts of regional and territory not-on-permanent-staff neurosurgeons; it specified rights and duties of these specialists. Order N194 of the same Ministry (1960) contained instructions on further steps in organization of neurosurgical departments in republican, territory and regional hospitals; besides, it approved a new framework of neurosurgical service in the form of interregional centers and departments, attached to them.

In 1959 Surgery of Injuries of the Nervous System was published. It was a practical manual for general surgeons, written with active participation of Prof. V.N. Shamov and edited by him. Its goal was to give them information on diagnosis and treatment of injuries and wounds of different segments of the central and peripheral nervous system.

V.N. Shamov died, when he was in his eightieth year (March 30, 1962). It had happened 22 days before he and Prof. S.S. Yudin were awarded the Lenin Prize for development and introduction of a method of preparing and using defibrinated blood.

V.N. Shamov was an outstanding Soviet surgeon, Lenin Prize Winner, Academician of the USSR Academy of Medical Science, Lieutenant-General of Medical Service. A memorial plaque in his honor was placed on the building of the Neurosurgical Institute on October 10, 1987. It was created by V.E. Gorevoy (a sculptor) and N.A. Sokolov (an architect).

One of the most important events in a train of marked achievements in formation and development of home neurosurgery was organization of the Leningrad Society of Neurosurgeons on the initiative of Prof. Babchin I.S., who was one of the most devoted followers of A.L. Polenov. Its prototype was monthly scientific conferences, organized by Polenov in 1938. Their materials were published as brochures with a circulation of 400.

Organization of the Society promoted more fruitful work, strengthened traditions and continuity of ideas of the Petersburg-Leningrad neurosurgical school.

In 1992 the Leningrad Society of Neurosurgeons was reorganized into the Saint Petersburg Association of Neurosurgeon.

The Association was named after Prof. I.S. Babchin in March 1997. It took place on a day of opening a memorial plaque in honor of its creator.


A cover of Transactions of
Scientific Conferences…
(1941)

During the Great Patriotic war Prof. V.S. Galkin was a neurosurgeon-in-chief of the Navy. Then Galkin became a head of the Chair of Pathophysiology of the Medicomilitary Academy, where he organized a course in neurosurgery (1945). An operating room and 25-bedded department for neurosurgical patients were deployed in the Clinic of Nervous Diseases.


Prof. Vsevolod Semenovich
Galkin (1898-1957)


Prof. Iosif Markovich
Irger (1910-1982)

Amalgamation of the Medicomilitary and Medical Naval Academies in 1956 created conditions for organization of an independent chair of neurosurgery with a 65-bedded clinic. Merging of personnel of two schools, guided by Academician Shamov V.N. and Prof. Galkin V.S., turned out to be rather prospective for further development of such a complicated branch of medicine as neurosurgery. It resulted in organizing the Chair and Clinic of Neurosurgery in the Medicomilitary Academy in 1956. The next historical period was connected with names of Prof. B.A. Samotokin and Academician of the Russian Academy of Medical Science V.A. Khilko.

It should be emphasized, that 1958 was a starting point of teaching neurosurgery at medical Institutes of the country, which had a special clinical base. This discipline became compulsory for all medical and pediatric faculties of medical institutes at the end of 1975. A course in neurosurgery was read at chairs of nervous diseases. The first edition of Neurosurgery (1971) was prepared for publication by Prof. I.M. Irger. It became a handbook for thousands of students and doctors (the second edition appeared in 1982). It was the only textbook on neurosurgery during many years, if not to take into account manuals by A.L. Polenov (1935), A.V. Bondarchuk (1959) and Operative Neurosurgery by V.M. Ugryumov, A.V. Abrakov, I.S. Vaskin (1959). Among the latest textbooks for students of medical Institutes, one can mention Neurology and Neurosurgery by E.I. Gusev, A.N. Konovalov, G.S. Burd (2000) and Neurosurgery by S.V. Mozhaev, A.A. Skoromets, T.A. Skoromets (2001).

Many years ago Prof. A.L. Polenov said: "… Fundamentals of neurology should occupy a proper place in a program of medical Institutes from student days". His words turned out to be prophetic.

Thus, nearly 70 years passed between the first course in surgical neuropathology and full-value introduction of neurosurgery into the system of medical education. It was a period, during which thoughts and dreams of pioneers of home neurosurgery became a reality.

Neurosurgery became a recognized independent discipline at the end of the 50-60s. This fact can be confirmed by presence of a rather big section, devoted to neurosurgical interventions, in Clinical Essays on Operative Surgery, edited by A.N. Bakulev (1954).

One more proof of it is special chapters and sections in textbooks and manuals on nervous diseases. An example is Nervous Diseases. A Handbook for Students and Doctors by such leading neurologists as N.K. Bogolepov, S.N. Davidenkov, I.Ya. Razdolsky, A.V. Triumfov and I.N. Filimonov (1956).

Neurosurgery for a Practitioner by A.V. Bondarchuk (1956) is also an illustration of wide acknowledgement of a new specialty by medical community of the country. According to the author's opinion, the goal of this textbook was "…to arm practitioners with initial information on clinical symptoms, diagnosis and surgery of injuries and diseases of the nervous system, demanding emergency diagnosis and surgical treatment".

A period of surgical neuropathology can be defined as a classical one, as these years were characterized by formation of a specialty structure and specific arsenal of diagnostic neurosurgical methods, development of surgical interventions and accesses, fundamental research in pathophysiology and pathomorphology of diseases and injuries of the nervous system, elaboration of main principles of teaching neurosurgery.

Part III