Historical VignetteEndovascular Neurosurgery: Personal Experience and Future Perspectives
Introduction
Alfred J. Luessenhop (1926–2009) has been regarded as the father of endovascular neurosurgery.1 After completing his residency (Massachusetts General Hospital in June 1959), he performed a landmark procedure (September 1959) in Georgetown University Medical Center (Washington, DC), reported in the Journal of the American Medical Association in March 1960.2 He called the procedure “artificial embolization of cerebral arteries.” The case was “to a large degree, a trial of the theoretical considerations that an embolus” would travel, “excluded from smaller branches to normal brain … to arrest at a point proximal to the malformation …. The carotid artery was exposed, and 4 spherical emboli, made of methyl methacrylate, were introduced under local anesthesia. Immediately after the 4th embolus, the patient became drowsy ….”2
A summary of Luessenhop's life and work was published in 2014.1 Perhaps even more interesting is to read his own perspective, published in 1990.3 There he recognizes the important contribution of Russian surgeons, such as Serbinenko4 and Romodanov and Shcheglov,5 as well as of Gerard Debrun,6 who had to reinvent detachable balloons (because communication was restricted between Russian surgeons and the Western world). Luessenhop also recognized René Djindjian7 as the pioneer in initiating selective catheterization techniques, referring to a 60-case series reported in 1973.
Section snippets
Enthusiasm (the Early Years)
Enthusiasm literally means “having the god enter into the worshipper ….” It came with the rituals devoted to Bacchus. “Much of what is greatest in human achievement involves some element of intoxication, some sweeping away of prudence by passion. Without enthusiasm, life would be uninteresting; with it, it is dangerous. In the sphere of thought, sober civilization is roughly synonymous with science”.8
One of Djindjian's students (and co-author of Ref.7), Jacques Théron, had been invited to
Perhaps We Can Get Better Prepared: The Laboratory
“Most people know what they do. They even know why they do what they do. What they don't know is what what they do does.”
—Foucault
In those days, we were manufacturing our own tools with whatever was available. Tubing was bought by the kilometer, on large spools. The particles we used were obtained by putting chunks of polyvinyl alcohol foam pillows in a kitchen blender.15 Elastic ligatures were made from the elastic waistband of men's underwear (one pair of briefs provided enough fibers for an
Learning from Experience
“Experimental science means the possibility of using past experiences as the servant, not the master, of mind.”
—J. Dewey (Democracy and Education)
Going back to the early 1980s, shortly after being introduced to what Jacques and others could do in the angio suite, I began to avidly read all I could find in the literature at the time. For some reason, I got married and spent most of my honeymoon reading Drake's articles. In passing, I would like to emphasize that reading old articles during your
The Good Practice: Care Trials
“Voltaire is said to have stated that the price of liberty is eternal vigilance. I often feel that the same applies to defending the use of randomized clinical trials (RCTs) because there are incessant attempts to replace them with other forms of investigation for various reasons.”36
I will shortly run out of time for this presentation, and soon we shall all be dead. Thus the matter is urgent. The lesson you can bring home from this lecture is to experience by yourself how it is possible to
Acknowledgments
I thank Tim Darsaut for correcting the manuscript and for countless challenging discussions on these matters over the last 10 years.
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Conflict of interest statement: The author declares that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.