Neurosurgery

V.Danilov, O.Dorofeyeva

Neurosurgery in Kazan: History, current status and perspectives.

 

In November, 1897, Professor Vladimir Bekhterev, the head of Department of Mental and Nervous Diseases, opened a surgical neuropathology department with 20 beds (operating room, bandaging room and recovery rooms) in the new building of clinic for nervous system diseases in Military Medical Academy (Saint Petersburg). It was the first specialized Neurosurgery department in the world. V. Bekhterev was the first to develop the neuropathology in surgical direction in the history of medicine. He used to write: "... either surgeon must meet a situation head-on armed with knowledge, bearing responsibility both for accuracy of recognition and for the consequences of operations, or neurologists should study the surgical techniques within their specialty thoroughly, and they must put them to work" (Миронович Н.И., 1964; Кондаков Е.Н., 2006).

      In 1905 the American neurosurgeon G.Cushing pointed out the need for making surgery the neurological one. This resulted in a new specialty - surgical neuropathology or neurosurgery that appeared early in the 20th century.  

    Due to his active participation in the organization of surgical care delivery to patients suffering from various central and peripheral nervous system diseases, establishing the first neurosurgery department, the first hospital for patients with neurotraumas, the first special institute and training of specialists in neurology, V.Bekhterev is considered to be one of the prime movers of neurosurgery in Russia. 

 

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Professor V.Bekhterev

 

The idea of combining neurology and surgery occurred to Vladimir Bekhterev when he was working at the Kazan University (1885 -1893). This was not an accident, since the nineties of the last century were characterized by a happy coincidence for the Kazan University. During this period, the university created the conditions and material prerequisites for studying the problems of morphology, physiology and pathology of the nervous system. This was the time for formation of the world-famous Kazan school of anatomists, physiologists, pathologists and clinicians. The head of Department of anatomy was master of his trade and excellent lector, Professor A.Fortunatov (1891 – 1904)*, V.Tonkov (1905 – 1915), world-famous anatomist, followed him as the head. Department of Histology was headed by one of the founders and creators of the neurogenic theory K.Arnstein (1871 -1903). Professor N.Mislavsky (1891 - 1909), student of physiologist N.Kovalevsky and histologist K.Arnstein, was in charge of the research and educational work of the physiology department. In 1887, the clinic of nervous diseases was opened, led by Professor D.P.Skolozubov (1887-1892), where medical students listened to a systematic course of lectures, followed by patients presentation. Outstanding Kazan surgeon Professor Lev Levshin did much for the future development of the nervous system surgery. He offered separate and in-depth study of head injuries and diseases in the course "Theoretical, operative and special surgery".

 

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Kazan Imperial University

 

L.Levshin did the important analysis of his foreign colleagues’ works on neurosurgery: Bergn, Dsirne, Kocher, Winter, Krause, Binswanger, Vogt, Esmarch, Kroilein. As a result, he prepared and published one of the first Russian guidelines for neurosurgery - "Injuries and diseases of the cranial and facial integument" (1902) and "Head injuries" (1903).       

On V.Bekhterev’s initiative, the fourth Russian scientific society of neurologists and psychiatrists was found in Kazan on May, 29, 1892. Bekhterev was elected its first chairman. Famous Kazan surgeons A.Malinovsky, V.Razumovsky, A.Vishnevsky and others were members of the Society. 

In autumn, Livery Darkshevich (1892-1917), a young, well-educated scientist, was elected the head of nervous diseases department in Kazan University on the recommendation of Moscow University professor A.Kozhevnikov and Professor V.Bekhterev. He managed to create an excellent (for its time) neurologic clinic with operating room to perform neurosurgery procedures within a short time (Попелянский Я.Ю., 1976).

 

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Prof. L.Darkshevich "Old Hospital" of Kazan University.
First floor is Clinic of Nervous Diseases

 

Active research work done by famous scientists in the University, attracted young talented people. Surgeon L.Malinovsky made a report "On the surgical treatment of the central nervous system diseases" within one of first meetings of the Society in February, 1893. The report was highly appreciated by V. Bekhterev, having shaped the future surgery of the nervous system. V. Bekhterev encouraged surgeons and neurologists to work together in all areas: surgery of the peripheral nervous system, neurooncology, surgery of congenital abnormalities, traumatic brain and spinal injuries, surgery of degenerative lesions of the spine with compression of neural structures. 

Development of neurosurgery would have been impossible without the participation of surgeons. Many of them carried out interventions in the skull and the brain from time to time. But among the famous Kazan surgeons late of 19th century it was V. Razumovsky who devoted his life to neurosurgery completely. 

        27-year-old medical doctor Vasily Razumovsky returned to Kazan in 1885 after a brilliant defense of his thesis “On the question of atrophic processes in the bones after transection of nerves" in Pathology Laboratory of Medical-Surgical Academy (St. Petersburg) with Professor N.Ivanovsky. The author was the first in his homeland who suggested an idea about the trophism of the nervous system that was developed in the works of L.Orbeli, A.Molotkov and many others.

 

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Prof. V.Razumovsky

 

V.I.Razumovsky, having risen from the prosector to head of the department of surgery (1896-1909), was the one who was systematically engaged in solving problems of practical neurosurgery. He was extremely productive in its surgical activities in the clinic of nervous diseases of professor L.Darkshevich, a brilliant diagnostician, and promoted the implementation of surgical treatment methods. In 1893, V.Razumovsky performed Horsley’s operation (extirpation of an area of cerebral cortex) for Jacksonian and Kojewnikoff epilepsy for the first time in Russia. In 1902, he reported long-term outcomes in 9 patients. In his work "On the surgical treatment of cortical epilepsy (traumatic and non-traumatic)" professor V.Razumovsky wrote: "When prof. L.Darkshevich and I began to perform this operation in the first half of the 90s of the last century we wanted to make a new material on this subject, but we had not developed any technique or surgical indications yet. The point of epileptogenic zones itself was challenged."

V.Razumovsky can justly be called a pioneer of neurosurgery in our country. In 1895, operating on the brain, he perfected the technique of osteoplastic craniotomy and proposed the special gouges, that facilitated access technique. He performed the trigeminal ganglion extirpation (1903) for trigeminal neuralgia for the first time in Russia. He reported on successful transection of sensory portion of trigeminal nerve root (1904) in 1908 at the VIII Russian surgical congress, and called it "physiological extirpation." V.Razumovsky was first to implement this method in the clinical work and used it in his neurosurgical practice repeatedly. He performed trigeminal ganglion alcohol block (to prevent corneal trophic disorders) in a patient with trigeminal neuralgia on one side of seeing eye for the first time in Russia (1909).

The peripheral nervous system was also the object of regard for clinicians and physiologists during this period. In 1900 N.Mislavsky and then in 1903 I.Levin demonstrated experimentally the possibility of functional substitutability in suturing of heterogeneous nerves for the first time. Somewhat later (1909) I.Tsypkin experimentally established the fact of conduction and reflexes reactivation after suturing the previously transected posterior roots. In 1904, at the IV Congress of Russian surgeons V.I.Razumovsky made a report "On long-term results of operations on the nerves in neuralgia." In this report, the author shared his experiences in the use of alcohol as its perineural administration or applications in the surgical treatment of neuralgia and causalgia for the first time. He has made his report three years earlier than the famous French neurologist Sicard (1907), who is accounted to priority of proposal. V. Razumovsky left Kazan in 1909, when he was appointed to rector of newly rediscovered Saratov University and was the organizer of the medical faculty there. V.Razumovsky reported on his experience in the field of neurosurgery gained in Kazan in the monograph "The latest data on craniocerebral surgery", which was a special, 10th part of multivolume guide "Surgery in Russia" (St. Petersburg, 1913). Essentially, this is one of the first Russian monographs on systematic exposition of the problems of brain neurosurgery (Shilovtsev S., 1958).

Alexander Vishnevsky, the prominent in the subsequent surgeon and academician, who graduated from the Kazan University in 1899, became V.Razumovsky’s successor in neurosurgery in Kazan from 1910. Four years later, in the laboratory of Professor N.Mislavsky he defended his PhD thesis "On the peripheral innervation of the rectum." A.Vishnevsky became interested in neurosurgery early. His first scientific publications are «Topography of the cerebellum" and "On the Technique of osteoplastic performance of ablative surgery of the frontal sinus" (1908). In 1911 a paper "A few words about the modified conventional craniotomy technique" was published. There the author proposed to close defects of the skull bones with decalcified bone plate, harvested before surgery. It was the first suggestion to organize banks of tissues for use in transplantation.

 

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Professor A.Vishnevsky

 

Since the autumn of 1910 after training in Paris clinics involved in surgical treatment of diseases of the nervous system, Vishnevsky has become a consultant surgeon in Neurological Clinic, headed by Prof. L.Darkshevich, and systematically was engaged in the surgical treatment of diseases of the central and peripheral nervous systems. His suggestions introduced at this time remain relevant up to date. He believed that the operations on the brain or spinal cord must be preceded by scrupulous study of the pathophysiological changes caused by disease, careful topical diagnosis, individual surgical approach based on the data obtained in advance, and when possible - experiment. Surgical procedures were performed by Vishnevsky only after detailed studying the disease pattern, a detailed examination of the patient, discussing the disease pattern and surgical planning with the prominent neurologist - Professor L.Darkshevich. Collaboration of a surgeon and a neurologist is a fundamental principle that Vishnevsky promoted throughout the period of his activity in Kazan.

Within the first three years of his work in the clinic of L.Darkshevich (1910-1912), Vishnevsky performed an unprecedented number of neurosurgical procedures: 14 osteoplastic craniotomies, more than 20 punctures of cerebral ventricles, two neurolysis operations on brachial plexus with the transection of the clavicle, spinal tumor removal in two patients, etc. Some of the operations were occasional (removal of racemose hemangioma, tuberculoma, skull defect closure with cortical plate of the tibia, the extirpation of the cortical lesions in two patients with Kozhevnikov’s epilepsy, etc.). L.Darkshevich used to say: "... all operations were carried out with great technical perfection, postoperative period was extremely favorable...".

Vishnevsky headed the department of surgery as well as continued to give the patients neurosurgical treatment. Thus, the report of the faculty surgical clinic for 1928/29 academic year indicated that Vishnevsky performed seven interventions in the cranial cavity, two operations on the spinal cord, etc. In subsequent years of his work he was particularly interested in patients with pyoinflammatory and traumatic lesions of the central nervous system. He suggested the method of vagosympathetic block on the neck that has gained worldwide recognition and widespread during the Great Patriotic War (Zakharyan S, 1973; M. Rosengarten, Albitsky V, 1974).

 

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Surgical Clinic of the Kazan Medical University named after A. Vishnevsky.
Here A. Vishnevsky operated on the brain and spinal cord.

 

The well-known neurologist and neurosurgeon Paul Emdin participated in a large group of L.Darkshevich’s students. He grew up within the walls of Kazan University and completed his PhD thesis on "Changes in striated skeletal muscle after nerve transection" here. In 1924 P.Emdin headed the clinic of nervous diseases in Rostov-on-Don, which soon became the neurological-neurosurgical center of North Caucasus. He developed a technique of suboccipital puncture in relation to the differential diagnosis of tumors of the posterior cranial fossa. P.Emdin used to train the famous Soviet scientists neurosurgeons, neurosurgical centers heads: D.G.Schafer (Sverdlovsk), H.I.Garkavi (Gorky), V.A.Nikolsky (Rostov-on-Don). Thus, the effect of L.Darkshevich school of neurosurgical spread across the country (Popelyansky Y., 1976).

After Vishnevsky left Kazan in 1934, professor Vasily Gusynin presented neurosurgery. A graduate of the University of Warsaw (1913), he had been teaching operative surgery and topographic anatomy for 10 years in Samara University, then headed the department of surgery, and in 1931 headed the Department and Clinic of military surgery in Kazan State Institute for Advanced Training of Physicians.

 

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Professor V.Gusynin

 

Teaching the military surgery determined clinic head’s specialization in neurotraumatology that coincided with his aspirations. His academic career and practical activities were particularly prominent during the Great Patriotic War. During this period, Kazan was a rear base for the front. The building of the former Kazan Agricultural Institute (65 Karl Marx Street) was turned into Neurosurgical Hospital № 1667 with 1000 beds, where Professor V.Gusynin was the key advisor and performed the most complex surgical interventions.

 

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Building of Agricultural University.
Neurosurgical Hospital № 16-67 was located here

 

Since the end of 1941 and till 1944, Kazan neurosurgeons had been working together with the staff of the Moscow Neurosurgery Institute (professors A.Arendt, M.Rappoport, N.Leybzon, etc.) and Moscow Brain Research Institute (professors S.Blinkov and A.Luria) that was evacuated to Kazan. In 1944 after the relocation of the hospital number 1667, the Neurosurgical Hospital No 4497 with 400 beds was organized in the building of school No 5 (3 Volkova Street). Later it became (1945) Kazan Institute of orthopaedics and reconstructive surgery and then was renamed into the Research Institute of Traumatology and Orthopedics. The founder of the Institute was one of the most prominent orthopedist and traumatologist professor L.Shulutko. He participated in the opening the neurosurgery department for treatment of patients with lesions of the central and peripheral nervous systems - the first of five modern neurosurgical departments in Kazan (Gafarov H., U. Bogdanovich, 1993).

 

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The building of Research Center of Tatarstan for Restorative Traumatology and Orthopaedics where the first neurosurgical department in Kazan is located

 

Professor V.Gusynin student, senior research fellow Galina Knirik (1945 – 1976) performed neurosurgical operations there, and later she headed the neurosurgery department of the Institute. Severe war and post-war period, as well as issues the institution faced, determined research and practice subjects for V.Gusynin’s and his students works. Studies focused mainly on problems of diagnosis and treatment of traumas of central and peripheral nervous systems. 

 

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The contribution of Kazan neurosurgeons in the treatment of patients during the Great Patriotic War was recognized within I All-Russian Conference of Neurological Surgeons (1950) in Kazan. 

 

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Participants of the First All-Russian Neurosurgery Conference.
Among them – members of the Academy of Sciences V. Shamov, A. Arutyunov, prof. I. Babchin, prof. V. Ugriumov, prof. I. Vaskin, prof. A.Sozon-Yaroshevich, prof. V. Galkin, etc.

 

In 1954, Kazan interregional neurosurgical center was organized on the basis of the Neurosurgery department of Kazan research institute for traumatology and orthopedics. Chief medical specialist G.Knirik headed it until 1974.

Professor Nikolai Komarov was the academic adviser for neurosurgical department of Kazan research institute from 1955 to 1965; simultaneously he headed the department of topographic anatomy and operative surgery in Kazan state institute for advanced training of physicians. His PhD thesis (1951) was performed at the hospital data and is devoted to secondary surgical debridement of craniocerebral gunshot wounds. Later the problem of secondary management of wounds of the skull and the brain had become a priority for many years for the departments. Their staff was first to develop the method of traumatic skull bones defects closure by compression.

 

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Professor N.Komarov

 

  Research in this area served as the basis for L.Nikoshin PhD thesis «Compression method of calvarial bone defects reconstruction" (1974).

In 1955, G.S.Knirik passed her PhD defense "Pathogenetic substantiation for surgical treatment of the gunshot wound effects on the sciatic nerve in the later stages after damage". The main conclusions of this work are still relevant up to date. In 1957, Neurosurgical Clinic neurologist S.Grinberg passed her PhD thesis on some issues of diagnosis of spinal tumors.

In 1965 Khaim Moiseevich Shulman, the leader in Kazan neurosurgery in the second half of 20th century, passed his PhD thesis. He was educated at Leningrad Neurosurgical Research Institute named after A.Polenov. His research project "Clinical picture and surgical treatment of lumbar osteochondrosis complicated with posterior disc hernias" was one of the first prominent researches on surgical vertebroneurology in our country. 

 

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Professor Kh.Shulman

 

        In 1975, another member of the neurosurgical clinic of Kazan Research Institute A.Kirillov passed his PhD thesis "Neurohumoral relationships and opportunities to increase the organism resistance in traumatic brain injury." V.Krylov passed his PhD thesis "Changes in the functional state of the cholinergic system and respiratory function in severe traumatic brain injury" in 1980.

Number of clinical staff were PhD students at the Scientific Research Institute of Neurosurgery named after N.N. Burdenko (Moscow) and Leningrad Research Neurosurgery Institute named after prof. A.Polenov and passed their PhD theses: " Traumatic skull defects reconstruction in children" ( Busyrev V., 1970), " A comprehensive study of blood flow and brain metabolism in severe traumatic brain injury " ( E. Valeev, 1973), "Changes in the central and peripheral hemodynamics in the surgical treatment of patients with brain tumors" ( Kalashnikov A., 1978), "Multifocal echoencephalography in the diagnosis and surgical treatment system of brain tumors " ( Ibatullin M., 1984 ).

And now neurotraumatology remains the dominant theme for the neurosurgery department staff (Head - E.Valeyev, MD, PhD) of Research Center of Tatarstan for Restorative Traumatology and Orthopaedics. Yelgizar Valeyev’s PhD thesis (1988) is devoted to the diagnosis of severe traumatic brain injury and to optimization of treatment with the help of its impact on kinin system.

 

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Y.Valeyev, MD, PhD

 

The state of the kallikrein-kinin and adrenocorticotropic systems, transcapillary exchange, the microcirculatory bloodstream and rheological properties of blood were studied comprehensively in this paper. This allowed to find out their role and relationship with severe traumatic brain injury and to prove the leading influence of vasoactive kinins polypeptides with their excessive activation on the development of edema - swelling of the brain. These data are of great theoretical importance to clarify the pathophysiological mechanisms of post-traumatic brain edema and can be the basis for development of pathogenic antiedematous therapy. New facts were obtained for the determination of active kinins influence on the formation of contusion loci, thereby a direct impact on this process in order to prevent increasing the area of brain tissue necrosis was made possible.

New data on the content of biologically active substances in the afferent blood and the blood flowing from the brain, as well as in the cerebrospinal fluid was obtained. That helps to predict the outcome of traumatic brain injury. A complex of curative interventions in severe traumatic brain injury was developed, that is aimed at accelerating the liquor sanitation, fast drugs delivery to lesions, deceleration of excessive kinin formation in the lesion, the correction of violations of hypothalamic-pituitary-adrenal axis, microcirculation, hemorheological and electrolyte shifts. Researchers specified indications and contraindications for the use of proteolytic enzymes inhibitors, developed methods of administration and doses, proved the motivation for use of Contrykal with simultaneous endolumbar and intracarotid infusions to limit the areas of brain tissue necrosis in the treatment of brain contusion loci.

      Staff of the department productively works on the treatment of spinal cord injuries, implementing their proprietory designs into operations stabilizing the spinal cord. In this direction, K.Timershina passed Ph.D. thesis "Surgical treatment of unstable fractures of the thoracic and lumbar spine" (1997), R.Tumakaeva did her PhD thesis "Surgical treatment of compound spinal injuries in the lower thoracic and lumbar spines" (2004). PhD thesis of I.Valeyev "Stabilizing operations in spine trauma (complications and ways to prevent them)" is prepared for passing.

The staff’s excellence in matters of traumatic pathology of the spine and spinal cord proves expediency of clinic specialization as the center for spinal cord injuries treatment in our republic.

In 1966, based on the newly constructed 15th city hospital (now - Emergency Hospital), neurosurgical department with 60 beds was opened. Along with the urgent care delivery to the population of the city and the republic, it took over the functions of the Hospital for selective neurosurgery in the republic. The department was organized and headed by H.Shulman, MD, PhD.

 

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Emergency Hospital (15th city clinical hospital)

 

After he left for the Kazan State Medical University, the department of neurosurgery was headed by the Board Certified physicians Y. Menyalkin (1969-1974), R.Sarymsakov (1974 - 1983), V.Yakovlev (1983 - 1999). The department had been in charge of R.Karimov, MD, PhD, since 1998. Professor Kh.Schulman was the advisor of the department. Its staff was involved in research in addition to their usual work. T.Litvinov prepared his PhD thesis about the consequences of traumatic brain injury. Since 1983, the department had been specialized in providing urgent neurosurgical care. Construction of new buildings hospital emergency and modern equipment offer great promise for this neurosurgical department.

In 1966 Kh.Schulman started teaching neurosurgery in Kazan Medical Institute at the department of nervous diseases for the first time in Kazan. Professor L.Omorokov headed the department. Three years later, the Neurosurgery course was organized (Kh.Schulman, Associate professor) at the Department of Traumatology and military surgery (the Head - Professor G.Nikolayev). Neurosurgery Residency training started since that time (V.Danilov, G.Ziyeva, R.Karimov, etc.).

In 1979 Kh.Schulman passed his PhD thesis “Compression form and neurosurgical treatment of lumbar osteochondrosis”. In this work, he proved the principles of neurosurgical treatment of lumbar osteochondrosis compression forms and developed a new operating technique. The structure of the lumbar spine disorders in patients operated on with neurosurgical and combined techniques was studies before the surgical treatment and during analyzing the long-term results. The causes affecting the results of surgical treatment were ascertained and the optimal conditions for their correction were outlined. Based on the investigations of physical and mechanical properties and dynamics of degenerative-dystrophic disc changes, he found out that one of the involutional process presentations is the degradation of their structure, which under certain conditions, leads to the development of spine malfunction. 

The technology of quick-setting polyurethane preparation that provides intervertebral discs express prosthesis possibility directly into the patient's body. Implementation of the suggested technique has improved treatment outcomes, reduced the time of hospitalization, reduced the duration of permanent total and partial disability in postoperative period, return the majority of the operated to work activities.

The study has determined a new, physiologically reasonable solution to the problem of neurosurgical treatment of compression forms of lumbar osteochondrosis. Along with these, principles and methods of express prosthesis developed offer the prospect of a wider using the research results not only in neurosurgery, but also in other medical specialties.

Kh.Schulman research contributed to the development of a new direction - the functional spine surgery. It seems to go down in history as Schulman procedure. Following his thesis, the publishing office of the Kazan University published a monograph "Surgical treatment of compression forms of lumbar osteochondrosis with intervertebral disc prosthesis."

V.Danilov prepared his PhD thesis "Strength and elasticity of human intervertebral discs in dynamics" (1976) within the abovementioned area.

The authors obtain the significant value of the ultimate load, tensile strength, burst margin, elasticity and modulus of elasticity of all spinal intervertebral discs in men and women between the ages of 0 and 90 years.

           Comparison of significant values of the ultimate load of intervertebral discs and adjacent vertebrae in ontogenesis allowed them to conclude that the strength dynamics of disc coincided with that of the vertebral bodies. The strength equality of disc and adjacent vertebrae in the spine segment was established. Along with the vertebral neuro-muscular system condition, it allows for its fixation and buffer function and thereby creates optimal conditions for proper functioning of the spinal column within physical activity.

      They defined a concept, according to which the decrease in the strength of the spinal column in ontogenesis is the essence of degenerative-dystrophic process in the spine. And if a decrease in the strength develops simultaneously in the disc and adjacent vertebrae, while maintaining the strength of each element equal, the spine function are not disrupted, and this is not considered a disease. This variant of reducing the spine strength characterizes the essence of the spine degenerative changes of the spine.

       The formation of the strength degree in the vertebral segment interferes with the fixation function of the intervertebral disc, primarily. The strength value determines the severity of disorders in the segment, where various forms of condition disorders, especially its hypermobility develop. Statnamic inconsistency of spine when detected radiographically, is probative sign of degenerative disk disease.

The results of the spine strength study allowed them to explain the most common site of traumatic and degenerative disc diseases.

 The neurosurgery department was organized on the basis of neurosurgery course by order of Ministry of healthcare in 1981 in the Kazan Medical Institute. It was headed by Professor Kh. Schulman (1981-1986). V. Danilov, MD, PhD, A.Kalashnikov, MD, PhD, and R.Yagudin worked at the department.

During these years, Student’ scientific circle was very active. It contributed to the interest of the future neurosurgeons S. Tanyashin (Moscow) and R.Gimranov (Moscow), MD, PhD, A.Gorozhanin (Moscow), I.Shamelashvili (St. Petersburg), A.Ivankin (Penza), I.Pushkin (Kazan), PhD.

 

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Republican clinical hospital of the Republic of Tatarstan

 

 Commissioning of the new complex of the Republican Clinical Hospital (1982) allowed to open an independent department of selective neurosurgery (heads: G.Savkin (1980 -1985), Y.Menyalkin (1985 -1991), A. Gorozhanin (1991 -1994), L.Dyudin (1994 - 2006), T.Bikmullin (since 2006)). Its team together with staff of the university department took over the Kazan interregional neurosurgical center (Head - Prof. Kh.Shulman). They performed almost all types of neurosurgery procedures, except for stereotactic surgery. In 1986 department of nervous diseases and department of neurosurgery in Kazan medical institute merged into a single department of neuropathology, neurosurgery and medical genetics (Head - Professor M.Ismagilov). Research priorities were problems of pathogenesis, diagnosis and surgical treatment of spinal osteochondrosis (Kh.Shulman, V.Danilov); traumatic brain injury (Kh.Shulman, R.Yagudin, Y.Evseev); study of cerebral circulation control system in patients with brain tumors and its pharmacological treatment of its disotders (V.Danilov, A.Gorozhanin). E.Yevseev passed his Ph.D. thesis "Disorders in the coagulation system in acute closed craniocerebral injury" (1986). Teaching assistant R.Yagudin passed his PhD thesis "5-nukleotidase and intraoperative electrothermometry in diagnosis of brain crush injury lesions" in 1990. 

Cerebral circulation was studied in the framework of scientific program of the Academy of Sciences "Brain circulation". It was awarded the Honorary Diploma of the Physiology Department, Academy of Sciences of USSR.

The possibilities of pharmacological correction were studied in collaboration with pharmacologists of Kazan Medical University (Professor I.Studentsova, Professor R.Khafizyanova, Professor R.Garaev, etc.) and with A.E. Arbuzov Institute of organic and physical chemistry (B.Arbuzov, A..Vizel, A.Muslinkin, etc.).

On the basis of the abovementioned studies, Valeriy Danilov passed his doctoral thesis on "The cerebral circulation control system in patients with brain tumors and pharmacological correction of disorders" in 1994.

 

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Professor V.Danilov

 

In this study it was shown that patients with brain tumors of different morphology and localization have compromised arterial flow to the brain, autoregulation of skull venous drainage and inadequate blood supply to brain tissue when its functional metabolic activity changes. The author found that in the implementation of the normalizing influence of piracetam and Sirmione on the functional state of the nervous system is affected by their ability to correct the responsiveness of cerebral blood vessels. The cerebral vasoactive new domestic drug dimephosphon was proved to lie in its ability to normalize the activity of the cerebral circulation control system. Dimephosphone was proved to cause the neurologic impairment regression in patients with disorders of cerebral circulation in brain injury, in conditions of intracranial hypertension of different genesis. These studies contributed to widespread dimephosphone clinical use in new indications - as vasoactive agents to normalize the functions of the CNS, as well as in ampoule form for intravenous injections (minutes of Formulary Commission for Ministry of Healthcare USSR No 19 of December, 20, 1990, order of the Minister of Health and Medical Industry of the Russian Federation № 304 of December, 28, 1993).

 For implementing the original domestic drug dimephosphone into medical practice for new indications - as vasoactive agents normalizing the functions of the nervous system, V. Danilov in the group of authors was awarded the State Prize of the Republic of Tatarstan in 1994 in science and technology. Within this theme, A.Gorozhanin prepared his PhD thesis "Influence of dimephosphon, sermione, piracetam on cerebral vascular responsiveness and local cerebral blood flow" (1993).

        In 1994 pediatric neurosurgery department was opened at the Children's Republican Clinical Hospital of Ministry of Health of the Republic of Tatarstan. Its head is V.Ivanov, consultant physician is prof.V.Danilov.

 

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Children's Republican Clinical Hospital of Ministry of Health of the Republic of Tatarstan

 

The department implemented modern methods of integrated treatment for children with tumors of different localization, all variants of bypass surgeries for hydrocephalus, including endoscopic perforator surgery of the third ventricular floor. They gained the unique experience in treating the infants with myelocele, combined with various defects of the brain, spinal cord and craniovertebral junction, and the children with congenital arachnoid cysts.

On the basis of the experience, the following PhD theses were prepared: V.Ivanov "Brain and spinal cord in children with myelocele," B.Pashayev "Malfunction of modern valve bypass systems for the treatment of children with hydrocephalus”, E.Badriev "Congenital arachnoid cysts of the brain and spinal cord (the diagnosis and management)", E. Fatykhova "Lliquor circulation loss in infants with perinatal infection."

Neurosurgery department of Children's Republican Clinical Hospital is a potential federal Center for Pediatric Neurosurgery.

In 1996, on the initiative of the head of the neurology, neurosurgery and medical genetics department professor M.Ismagilov postgraduate education of neurologists and neurosurgeons was organized to improve the quality of residents and interns training. It was led by V.Danilov, MD, PhD. He contributed to opening the postgraduate school in neurosurgery for the first time in Kazan (postgraduate students: S.Martynenko, A.Nemirovsky, F.Fatykhova).

On September 1, 2000, the department of neurology and neurosurgery was opened at the Faculty of Postgraduate Education for Kazan Medical University on the initiative of the rector, the member of Academy of Sciences Professor N.Amirov. 

 

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Department of neurology and neurosurgery for Kazan medical university

 

Prof. V.Danilov, Prof. Shulman’s student, was elected the head of the department. Educational activities of the department included continuing education of doctors in matters of modern instrumental diagnosis, indications for surgical treatment of patients with diseases and traumatic lesions of the nervous system, their intensive care and rehabilitation. 

Full continuing education of doctors in matters of indications for surgical treatment and opportunities would be possible in a clinic with modern high-tech solutions. Therefore, together with the leadership of the Interregional Clinical Diagnostic Center (ICDC), one of first Russian new medical institutions of high medical technologies, the Ministry of Health of the Republic of Tatarstan, neurosurgeons of the department spent a lot of effort on the field of concern for neurosurgery department of ICDC and purchased modern equipment for it. Neurosurgery clinic of ICDC (started in July 2006) is the fifth neurosurgical institution in Kazan - modern European high-tech medical clinic (microsurgery, stereotaxis, endovideomonitoring, transnasal-transsphenoidal approach to chiasmosellar lesions, intraoperative physiological monitoring). The head of the neurosurgery department in ICDC is A.Alekseyev, PhD, the senior specialist in neurosurgery in ICDC - prof. V.Danilov.

 

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Interregional clinical diagnostic center

 

One of the main research areas of the department of neurology and neurosurgery is evidence-based medicine of socially significant neurosurgical pathology and organization of health care delivery in the Republic of Tatarstan.

The first postgraduate student S.Martynenko passed his PhD thesis "Improving the medical care delivery to patients with surgical vascular pathology of the brain (by the materials for Kazan)" (2003).

Teaching assistant A.Alekseyev presented his PhD thesis "The primary tumors of the central nervous system by the materials of the Republic of Tatarstan" (2005).

Teaching assistant R.Karimov upholded thesis "Traumatic Brain Injury by the materials of Kazan” (2006).

Associate Professor Murat Ibatullin analyzed a unique research experience in one of first modern magnetic resonance imaging scanners - BMT-1100 tomograph, Bruker (Germany), with a magnetic field intensity of 0.28 Tesla equipped with workstation Silikon Graphic and defended his doctoral thesis "Magnetic resonance diagnosis of tumors and multiple brain lesions on the mean-field imagers "(2002).

 

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M.Ibatullin, MD, PhD

 

The most important diagnostic criteria for differential diagnosis of tumors of different localization and histostructure, as well as the multiple brain lesions were highlighted for the first time in his paper. Various MRI techniques informative value was assessed comprehensively using the group of MR characteristics selection with homogeneous features of MR visualization. This approach is suitable for the informative value evaluation of the MR tomography techniques on any field density, and thus is universal. In this paper, M.Ibatullin specified the range of diagnostic situations when the use of specific MR techniques is necessary.

The external PhD student V.Filatov passed his PhD thesis "Comprimise factors and indications for surgical treatment in patients with chronic compression lumbosacral radiculopathy with degenerative-dystrophic lesions of the spine" (2006).

PhD student A.Nemirovsky did pioneer research and based on it prepared to his PhD thesis "Aseptic meningitis syndrome in patients with brain tumors in the early postoperative period."

The significant event for Kazan neurosurgery was the creation of the Neurosurgical society of the Republic of Tatarstan. Its founders were Professor V.Danilov, the Head of the Neurosurgery department of the Republican Clinical Hospital L.Dyudin and neurosurgeon A.Nemirovsky. The decision on state registration of this organization was made by the Main directorate of the Ministry of Justice of the Russian Federation in the Republic of Tatarstan, on April 2, 2004 at No 222.

 On the general meeting of the association Professor V.Danilov was elected the chairman of its board. The purpose of the organization "Neurosurgeons Association of the Republic of Tatarstan" is to contribute to improving the neurosurgery and practicing it in the Republic of Tatarstan, as well as to protect its members’ social rights. The Association brought together more than 60 neurosurgeons from Kazan, Nab.Chelny, Almetyevsk, Chistopol, Bugulma, Yelabuga and Leninogorsk.

      As part of educational activities, the courses of general improvement in neurosurgery and pediatric neurosurgery were organized recently by the department of neurosurgery (head - prof. O. Dreval) and the department of pediatric neurosurgery (Head – the Member of Academy of Sciences, Professor. A .Konovalov) in Kazan.

      The close contacts of neurosurgeons of the republic and Kazan with leading experts in Burdenko Neurosurgery Institute (Moscow) and the A. L. Polenov Russian Neurosurgical Research Institute ( St. Petersburg ) , the Department of neurosurgery of the Russian Military Medical Academy ( St. Petersburg ) and Neurosurgery department in the Sklifosovsky Research Institute of Emergency Care, in Ekaterinburg , Nizhny Novgorod and other Russian cities contribute to improving the quality of specialized care provided to the population.

    International relationships are also developed. Prof. V.Danilov, M.Ibatullin, MD, PhD, and A.Nemirovsky undertook training course in neurosurgical clinics in the US.

     The head of Neurosurgical clinic of the Medical Faculty in the University of Bern (Switzerland) - the leading neurosurgeon, student of M. Yaşargil - prof. R. Sailer was the teacher and friend of Kazan neurosurgeons. Prof. V.Danilov, M.M.Ibatullin, MD, PhD, teaching assistant A. Alekseyev, doctors B.Pashayev and M.Volodyukhin.

          Thus, neurosurgeons of Tatarstan carry out the precepts of their teachers – the pioneers of Russian neurosurgery effectively. They provide the emergency and selective neurosurgical care to the population of the Republic of Tatarstan and make a contribution to the development of neurosurgery and the implementation of educational programs.

 

 

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*Years of heading the departments and clinics are in between the brackets.

 

 

Literature

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