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History of Neurosurgery in Helsinki and Finland 2 2. Aarno Snellman, founder of Finnish neurosurgery The first neurosurgical operations in Finland were performed in the beginning of the 20th century by surgeons such as Schultn, Krogius, Faltin, Palmn, Kalima and Seiro, but it is Aarno Snellman who is considered the founder of neurosurgery in Finland. The Finnish Red Cross Hospital, which was the only center for Finnish neurosurgery until , was founded in by Marshall Mannerheim and his sister Sophie Mannerheim as a trauma hospital.
It is in this same hospital where the Helsinki Neurosurgery is still nowadays located. Already during the first years the number of patients with different head injuries was so significant that an evident need for a trained neurosurgeon and special nursing staff arose. In , professor of surgery Simo A. Brofeldt sent his younger colleague, year old Aarno Snellman, to visit professor Olivecrona in Stockholm. Upon his return, he performed the first neurosurgical operation on 18th September This is generally considered as the true beginning of neurosurgery in Finland.
Figure Angiography in Finland The initially relatively poor surgical results were mainly due to insufficient preoperative diagnostics. Realizing the importance of preoperative imaging, Snellman convinced his colleague from radiology, Yrj Lassila, to visit professor Erik Lysholm in Stockholm. The procedure was quite risky for the patients; there was one death in the first 44 cases, i. There were also some less expected complications such as one situation, when the surgeon injecting the contrast agent got an electric shock from the X-ray tube and fell unconscious to the floor!
Fortunately, the assistant was able to save the situation and as Snellman stated in his report, "no one was left with any permanent consequences from this dramatic situation". Before the number of cerebral angiographies was only per year, but with the introduction of the percutaneous technique at the end of , the number of angiographies started gradually to rise, with more than cerebral angiographies performed in On one hand the war effort diminished the possibilities to treat civilian population, on the other hand the high number of head injuries boosted the development of the neurosurgical treatment of head trauma.
During this period several neurosurgeons from other Scandinavian countries worked as volunteers in Finland helping with the high casualty load. After the war, it became evident that neurosurgery was needed as a separate specialty.
Aarno Snellman was appointed as a professor of neurosurgery at the Helsinki University in and the same year medical students had their first, planned course in neurosurgery. The next year, Teuvo Mkel, who worked in neurosurgery since and took care of the head injury patients, was appointed as the first assistant professor in neurosurgery. An important administrative change took place in when the Finnish government decided that the state would pay for the expenses for the neurosurgical treatment.
With this decision neurosurgical treatment became, at least in theory, available for the whole Finnish population. The limiting factors were hospital resources there was initially only one ward available and the relatively long distances in Finland. This is one of the reasons why especially in the early years, e. Neurosurgery remained centralized in Helsinki until , when the department of neurosurgery in Turku was founded, later followed by neurosurgical departments in Kuopio , Oulu and Tampere Neurosurgical units in Finland and the years they were established.
The first operating microscope came to the neurosurgical department in Helsinki in The economic department of that time managed to postpone purchase of this microscope by one year as they considered it a very expensive and unnecessary piece of equipment. Initially, the microscope was used by neurosurgeons operating on aneurysms, small meningiomas, and acoustic schwannomas. Laboratory training in microsurgical techniques was not considered necessary and surgeons usually started to use them immediately in the operating room OR.
A Turkish born neurosurgeon Davut Tovi from Ume held a laboratory course in Helsinki in January , during which he also demonstrated the use of the microscope in the OR while the intraoperative scene could be observed from a TV monitor. Interestingly, during the first years of microneurosurgery on aneurysms, intraoperative rupture made the neurosurgeon often to abandon the microscope and move back to macrosurgery so that he could "see better" the rupture site.
But the younger generation already started with microsurgical laboratory training, among them Juha Hernesniemi, who operated his first aneurysm in He has operated all of his nearly aneurysms under the microscope. In Hernesniemi visited Yaargil in Zrich, and after this visit started, as the first in Finland in , to use a counterbalanced microscope with a mouthswitch.
Surgery on unruptured aneurysms in patients with previous SAH started in , and the first paper on surgery of aneurysms in patients with only incidental, unruptured aneurysms was published in Endovascular treatment of intracranial aneurysms started in Finland in Changes towards the present time During the last decades of the 20th century, advances in the society, technology, neuroimaging, and medicine in general also meant an inevitable gradual progression in neurosurgery, which had its impact on Helsinki Neurosurgery as well.
Transferring a critically ill patient to a routine CT scan might have had catastrophic consequences. However, little by little, significant advances in neuroanesthesiology began to lead to safer and less tumultuous neurosurgical operations. Development in this field also had its impact on neurointensive care, and invasive monitoring of vital functions both at the ICU and during transfer of critically ill or anesthetized patients - as well as e. The staff included only six senior neurosurgeons, three residents and 65 nurses.
Operations were long; in a routine craniotomy, in addition to intracranial dissection and treatment of the pathology itself, just the approach usually took an hour, and the closure of the wound from one to two hours. With no technical staff to help, scrub nurses had to clean and maintain the instruments themselves at the end of the day, meaning that no elective operation could start in the afternoon.
All surgeons operated sitting; unbalanced microscopes had no mouthpieces. Convexity meningiomas and glioblastomas were even operated on without a microscope. The attitude towards elderly and severely ill patients was very conservative compared with present day standards for example, highgrade SAH patients were not admitted for neurosurgical treatment unless they started to show signs of recovery. International contacts and visitors from abroad were rare.
The staff did participate in international meetings, but longer visits abroad and clinical fellowships took only seldom place. Scientific work was encouraged and many classical pearls of scientific literature were produced, such as Prof. However, it was very difficult especially for younger colleagues to get proper financial support for their research at the time. Doing research was a lonely job research groups, as we know them now, did not really exist at the Department, and the accumulation of papers and scientific merit was slow.
Probably no one anticipated the pace and extent of changes that were about to take place when the new chairman was elected in In only three years, the annual number of operations increased from to , the budget doubled from 10 to 20 million euros. It is a common fact in any trade, that the election of a new leader or a manager is followed by a "honeymoon" period, during which the new chief fiercely tries to implement changes according to his or her will, and to some extent the administration of the organization is supposed to support the aims of this newly elected person he or she was given the leadership position by the same administration, after all.
In this particular case, however, people in the administration got cold feet because of the volume and the speed of the development. Since the Department had the same population to treat as before, where did this increase in patient numbers come from? Were the treatment indications appropriate? Could the treatment results be appropriate? Soon, an internal audit was initialized, questioning the actions of the new chairman. The scrutiny continued for over a year.
The treatment indications and results were compared to those of other neurosurgical units in Finland and elsewhere in Europe, and it became evident that the treatment and care given in the Department were of high quality. The new chairman and his active treatment policy also received invaluable support in form of Professor Markku Kaste, the highly distinguished chairman of Department of Neurology.
After the rough ride through the early years, the hospital administration and the whole society started to appreciate the reformation and the high quality of work that still continues.
But what was the anatomy of this unprecedented change? Surely, one person alone, no matter how good and fast, cannot operate additional patients a year.
The size of the staff has almost tripled since today, the staff includes 16 senior neurosurgeons, six nine trainees residents, nurses and three OR technicians, in addition to adminis22 trative personnel.
The number of ICU beds has increased from six to The most significant change, however, was probably the general increase in the pace of the operations, mostly because of the example set by the new chairman, "the fastest neurosurgeon in the world". The previous rather conservative treatment policy was replaced by a very active attitude, and attempts to salvage also critically ill patients are being made, and often successfully. Chronological high age per se is no longer a "red flag" preventing admission to the Department, if the patient otherwise has potential for recovery and might benefit from neurosurgical intervention.
Despite the increased size of staff, the new efficient approach to doing things meant more intense and longer workdays. However, perhaps somewhat surprisingly, the general attitude among the staff towards these kind of changes was not only of resistance.
The realization of the outstanding quality and efficiency of the work the whole team in the Department is doing, has also been the source of deep professional satisfaction and pride, both among the neurosurgeons and the nursing staff. An important role in the acceptance of all these changes played also the fact that Prof.
Hernesniemi has always been intensely involved in the daily clinical work instead of hiding in the corridors of administrative offices. The price for all this has not been cheap, of course. The workload, effort and the hours spent to make all this happen have been, and continue to be, massive, and require immense dedication and ambition. What else has changed?
For sure, much more attention is being paid to the microneurosurgical technique in all operations. Operations are faster and cleaner, the blood loss in a typical operation is minimal, and very little time is spent on wondering what to do next.
Almost all operations are performed standing, and all the microscopes are equipped with mouthpiec- History of Neurosurgery in Helsinki and Finland 2 es and video cameras to deliver the operative field view to everybody in the OR. Operative techniques are taught systematically, starting from the very basic principles, scrutinized and analyzed, and published for the global neurosurgical community to read and see.
Postoperative imaging is performed routinely in all the patients, serving as quality control for our surgical work. The Department has become very international. There is a continuous flow of long- and short-term visitors and fellows, and the Department is involved in two international live neurosurgery courses every year. The staff travels themselves, both to meetings and to other neurosurgical units, to teach and to learn from others.
The opponents of doctoral dissertations are among the most famous neurosurgeons in the world. The flow of visitors may sometimes feel a bit intense, but at the end of the day makes us proud of the work we do.
The scientific activity has increased significantly, and is nowadays well-funded and even the youngest colleagues can be financially supported. The visibility of the Department and its chairman in the Finnish society and the international neurosurgical community has definitely brought support along with it.
Overall, the changes during the past two decades have been so immense that they seem almost difficult to believe. If there is a lesson to be learned, it could be this: with sufficient dedication and endurance in the face of resistance, almost everything is possible. If you truly believe the change you are trying to make is for the better, you should stick to it no matter what, and it will happen.
History of Neurosurgery in Helsinki and Finland 2 2. Aarno Snellman, founder of Finnish neurosurgery The first neurosurgical operations in Finland were performed in the beginning of the 20th century by surgeons such as Schultn, Krogius, Faltin, Palmn, Kalima and Seiro, but it is Aarno Snellman who is considered the founder of neurosurgery in Finland. The Finnish Red Cross Hospital, which was the only center for Finnish neurosurgery until , was founded in by Marshall Mannerheim and his sister Sophie Mannerheim as a trauma hospital. It is in this same hospital where the Helsinki Neurosurgery is still nowadays located. Already during the first years the number of patients with different head injuries was so significant that an evident need for a trained neurosurgeon and special nursing staff arose. In , professor of surgery Simo A. Brofeldt sent his younger colleague, year old Aarno Snellman, to visit professor Olivecrona in Stockholm.
Live Demonstration Course in Operative Microneurosurgery
Shakazshura A series of 12 patients and review of the literature. On one hand the war effort diminished the possibilities to treat civilian population, on the other hand the high number of head injuries boosted the development of the neurosurgical treatment of head trauma. Helsinki Microneurosurgery Basics and Tricks Thousands of people are diagnosed every year with tumors of the brain and the rest of the nervous system. Microsurgical treatment of third ventricular colloid cysts by interhemispheric far lateral transcallosal approach — experience of patients.