By Corresponding Member of the Russian Medical Academy, Lieutenant-General, Army Medical Corps, Boris GAIDAR, Head of the S. M. Kirov Military-Medical Academy
Looking back into the history of this branch of our medical science one has to admit the leading role in the establishment and successful functioning of the neurosurgical service in Russia of the oldest school of medicine in St. Petersburg. Most heads of neurosurgery departments of local hospitals in various parts of Russia, as well as leading experts in this field (including those attached to the Army Medical Corps) "learned their ropes" in our Northern Capital-in the Scientific-Research Institute of Neurosurgery named after A. Polenov and the St. Petersburg Military-Medical Academy.
Functioning in Russia by the start of the 19th century were two medical schools of higher learning: the Department of Medicine of the Moscow State University and the St. Petersburg Medical-Surgical Academy. The latter was founded back in 1798 and had seven chairs, including the Chair of Surgery. It was distinguished right from the start by its high level of specialized education and practical training with lectures and classes being on a par with the latest theoretical and practical achievements in this field of medicine, including brain surgery. The respective chair, and later a clinic attached, were headed right from the start by Professor I. Bush and later his disciple Dr. H. Salomon. Even in those early years when craneocerebral surgery as such did not yet exist, local surgeons carried out operations for brain traumas, on peripheral nerves and other sections of the nervous system.
The list of distinguished graduates of our Academy who provided major contributions to the development of microsurgery includes V. Bekhterev, S. Fyodorov, A. Polenov, and V. Shamov, to mention but a few.
In 1897 Professor Bekhterev set up-for the first time in the world within the walls of a Military-Medical Academy (as the St. Petersburg Medical-Surgical Academy was called)-a special operating theater for brain surgeries and a ward for post-operation patients. The two years later the same Chair started training specialists in neurosurgery. In 1913, Professor Bekhterev, as president of the Psychoneurological Institute
established in 1908, presented a report to the then Minister of Public Education on the activities of his center. He stressed the emergence of surgical neurology in St. Petersburg as a special branch of "practical medicine". Thanks to that a large number of successful surgeries of the brain and spinal cord began to be conducted, and also operations on peripheral nerves.
During those years Russian medicine (medical centers of St. Petersburg, to be more exact) were far ahead of other countries in the development of what was known as surgical neuropathology, or brain surgery. No other country possessed specialized clinics and chairs of this kind.
Starting from the 1920s the organizational development of neurosurgery and educational activities in this field in Leningrad (as the city was then called) were associated with the name of Professor A. Polenov (member of the USSR Medical Academy since 1945). During the 1930s-1940s he and his pupils and associates published a number of books and manuals which summed up a wealth of experience accumulated in practical neurosurgery by that time. In 1938 he suggested an amalgamation of his Clinic of Neurosurgery of the State Institute of Traumatology with what was called the Scientific and Practical Institute of Surgical Neuropathology. The new scientific research center (now the Russian Institute of Neurosurgery named after A. Polenov) attracted the prime of Leningrad specialists working in the field. It provided the basis for the Chair of Neurosurgery headed by Professor A. Polenov and later by his best pupils-Professor I. Babchin and Professor A. Zemskaya.
1948 saw the establishment at the Faculty Clinic of the Department of Neurosurgery with a two-year course of training of neurosurgeons for military hospitals. The project was initiated by Lieutenant-General V Shamov, Member of the USSR Medical Academy. He was also the editor of a two-volume work entitled "Experience of Soviet Medicine in the Great Patriotic War".
In 1945 Professor V Galkin, Head of the Chair of Pathological Physiology of the Naval Medical Academy (during the Great Patriotic War he was Surgeon General of the Soviet Navy) started a course of lectures on neurosurgery. Established at the same time at the Academy Clinic of Nervous Disorders was an operating theater and a specialized department.
1956 saw an amalgamation of Army Medical and the Naval Medical academies. The unification of these two schools-of Academician of the USSR Academy of Sciences Shamov and Prof. Galkin-turned out to be very fruitful for the progress of neurosurgery. Set up within the reorganized Military-Medical Academy were a Chair and Clinic of neurosurgery. Their subsequent development was associated with the names of such
outstanding neurosuigeons as Prof. V. Hiljko, Member of the USSR Medical Academy, and Prof. B. Samotokin.
The scientific activities of the Chair of Neurosurgery of the Military-Medical Academy in the 1960s-1970s embraced the most urgent problems in this field and its Clinic became one of this country's main centers in the fields of angioneurosurgery, neurooncology and neurotraumatology. As early as in 1969 Prof. Hiljko started using (one of the first in the world) surgical microscope and microsurgical equipment for operations for aneurisms* and brain tumors. 1973 saw the publication by these medical researchers of a monograph entitled "Aneurisms and Arterial-Sinusal Anastomoses" for which they were awarded the Burdenko Prize of the Presidium of the USSR Medical Academy.
In 1982 Prof. Hiljko and Prof. Yu. Zubkov published a book "Intravascular Surgery"- the first serious generalization of knowledge and experience in this field of medical science in Russia and other countries. Later on the work was translated into different languages, and it presents considerable interest to specialists up to this day.
The 1980s in general saw rapid progress in the development of modern diagnostic methods and therapy of war-time traumas of the skull and brain. This was associated in many respects with the generalization of experience of surgeries on the spine and the spinal cord conducted in the Kabul Hospital during the war in Afghanistan.
In the 1990s specialists of this Chair were actively developing-under the guidance of the author of this article-new areas of what is known as the minimal-invasive neurosurgery associated with the treatment of brain disorders caused by viruses, bacteria, etc. These included endovideoscopic monitoring in complicated surgeries in oncological cases and vascular pathologies of the brain and spinal cord; superselective chemotherapy of malignant neoplasms of the brain; stereotaxic biopsy and criodestruction in neoplasms of the brain.
For the past two years this Chair and the Neurosurgical Service of the Armed Forces of the Russian Federation have been headed by Colonel Prof. V. Parfenov. He was one of the first in St. Petersburg to introduce the dopplerographic diagnostics of brain vessels. At the present time this clinic of the Military-Medical Academy holds the pride of place in this country in the ultrasonic methods of diagnostics of brain disorders, intra-operational monitoring of cerebral haemodynamics, endovasal surgical interventions in cases of arteriovenal malfunctions and brain aneurisms, neuroorthopedic corrections of the spine and complex therapies of brain tumors.
Prepared at the Chair and published in 2002 was a practical guide for doctors called "Practical Neurosurgery" which contains the main data on the clinical picture, diagnostics and treatment of neurosurgical disorders and lesions of the central and peripheral nervous systems. It also generalizes a wealth of experience in rendering neurosurgical aid to victims of military conflicts and natural disasters.
Since its inception the activities of the Chair and the Neurosurgery Clinic of the Military-Medical Academy have been inseparably associated with the Russian (former Leningrad) Scientific-Research Institute of Neurosurgery named after A Polenov. Since 1950s (when it was headed by Academician of the USSR Academy of Sciences Shamanov) it has been the main center on problems of neurosurgery of the NARKOMZDRAV of the Russian Federation. Its main objective was the establishment in this country of a network of neurosurgical centers and the training of practical specialists in this field.
In the years since 1961 the first inter-regional neurosurgical centers were established under the guidance of the Institute Director Prof. V. Ugryumov-the Chief Neurosurgeon of the RSFSR Ministry of Health, and the then Head of the Organizational-Methodological Department, Prof. M. Potanina. Alongside with the organization of this country's neurosurgical service our Institute experts, working in conjunction with our municipal health authorities, have been setting up and helping to expand neurosurgical clinics in Leningrad. At the present time specialized medical aid of this kind is provided in seven municipal and one departmental clinics, five scientific-research institutes and also at the Military-Medical Academy. The total number of neurosurgical hospital beds in St. Petersburg is 1,148 (including 140 beds for children) and the availability of such hospital beds today reaches 2.35 for 10 thous. people (this ratio for the Russian Federation in general is 1.08 beds).
Experts of the Scientific-Research Institute of Neurosurgery named after Polenov are actively working on various applied and fundamental programs on problems of neurosurgery. Over the past several years alone they published 87 monographs, 5 atlases and over 300 methodological recommendations for doctors and 72 collections of scientific works, not to mention hundreds of magazine articles. They have to their credit three scientific discoveries and 195 authorship certificates for inventions and also several patents.
Summing it up, it would be quite fair to say that the medics of St. Petersburg have been providing a tangible contribution to the organization and successful functioning of our comprehensive system of neurosurgical medicine. Today it includes 11 inter- regional centers consisting of 286 departments staffed by 2,346 doctors and several thousands of middle-rank and junior medical staff. The total number of its hospital beds amounts to 15,770, including 1,562 beds for children. Most heads of neurosurgery hospital sections in different regions of Russia and also many leading neurosurgeons (including army ones) underwent their basic training in the Northern Capital. This being so, it is only fair to say that its two oldest medical centers-the Military-Medical Academy and the Scientific-Research Institute of Neurosurgery named after A. Polenov- have been and remain this country's leading therapeutic- diagnostic, teaching and methodological and organizational centers in the field of neurosurgery.
* Aneurism-local dilation of blood vessel or cardiac cavity due to dis-tention and diverticulation of its wall.- Ed.