Roots and Routes of Russian Neurosurgery (from Surgical Neurology towards Neurological Surgery)

Abstract

Regular and purposeful neurosurgical interventions started at the end of the nineteenth century. Both surgical and neurological roots of the emerging speciality could be traced. The surgical roots of neurosurgery were the invention of anaesthesia, aseptics and antiseptics which made brain operations relatively safe and markedly reduced postoperative mortality. The neurological roots were the improvement of topical diagnosis in neurology and the understanding of the anatomy and physiology of the nervous system. The first operating room at the neurology department of the Russian Military Medical Academy was established in 1897 by the famous Russian neurologist and psychiatrist Vladimir Bekhterev (18571927). According to Bekhterev, neurology should become a surgical speciality like gynaecology or ophthalmology and “neurologists will take a knife in their hands and do what they should do”. Bekhterev's pupil Ludwig Puusepp (18751942) became the first full-time Russian neurosurgeon (“surgical neurologist”). He headed the first university course in surgical neurology in the world organised in 1909 at Bekhterev's Psychoneurological Institute in St. Petersburg and became professor of surgical neurology in 1910. The role of neurologists might be illustrated by the development of a stereotactic instrument named “encephalometer” designed by D. Zernov in 1889 and improved by G. Rossolimo in 1907. The idea was to map cerebral structures in degrees of latitude and longitude similar to mapping the terrestrial globe in order to localise the brain lesion and enhance its minimally invasive removal. Nevertheless, there was a general trend to replace surgical neurologists by neurological surgeons. This happened in the 1930's. Neurosurgery in Russia was developing at Neurosurgical Research Institutes in Moscow (1932) and Leningrad (1926) as a complex speciality in connection with allied sciences (neuroradiology, neurootology, neuroophthalmology, neuropsychology etc.). The huge referral area made it possible to develop subspecialties like paediatric neurosurgery, vascular, skull base, functional neurosurgery by organising special departments within these Institutes. The set of provincial neurosurgical centres had also appeared in the 1930's. In 1937, a special neurosurgical periodical called “Voprosy neurochirurgii” (“Problems of Neurosurgery”) was launched. According to N.N. Burdenko (18761946), neurosurgical interventions were viewed as experiments on humans in order to confirm the neurophysiological concepts of Pavlov and Bekhterev based on animal models. They had to follow three basic principles: anatomical availability, technical possibility and physiological permissibility. Neurologists played a crucial role in the establishment and promotion of this new speciality, but their role has changed.