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Neuroscience and Neurosurgery in Southeast Europe

March 2015
International Neuroscience Journal 1(1)

DOI:10.17795/inj1230

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Lukas Rasulic

Klinički centar Srbije

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International Neuroscience Journal. 2015 March; In Press(In Press):e1230.

Published online 2015 March 28. Test Document Type

Neuroscience and Neurosurgery in Southeast Europe

Lukas Rasulic 1,*

1 School of Medicine, University of Belgrade, Beograd, Serbia

*Corresponding author : Lukas Rasulic, School of Medicine, University of Belgrade, Visegradska 26, 11000 Beograd, SERBIA. Tel/Fax: +381-6320591, E-mail: lukas.rasulic@kcs.ac.rs

Received: March 2, 2015 ; Accepted: March 12, 2015

Keywords: History of Neurosciences; Neurosciences in Southeast Europe

mercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribution of the material only for non-commercial

use, provided the original work is properly cited.

1. Introduction

Neuroscience emerged as a consequence of the endeav-

ors of many who conspired to illuminate the structure of

the nervous system, the manner of communication with-

in it, its links to reﬂexes and relation to more complex

behavior (1). It is an interdisciplinary science that col-

laborates with many diﬀerent ﬁelds such as chemistry,

computer science, engineering, linguistics, mathemat-

ics, medicine, genetics, and allied disciplines including

philosophy, physics, and psychology. The scope of neuro-

science has broadened to include diﬀerent approaches

used to study the molecular, cellular, developmental,

structural, functional, evolutionary, computational and

medical aspects of the nervous system.

Recently, neuroscience and particularly neurogenet-

ics, has made signiﬁcant achievements mostly due to

the contribution of the novel powerful technologies as

for example array-CGH (Comparative genomic hybrid-

ization) and NGS (Next-generation sequencing). Our un-

derstanding of genetic variation underlying heritable

neurological diseases, the detection of novel risk factors

of common disorders and therapeutic interventions as a

part of individualized medicine strategies have changed

at a rate never possible before. The revolution in tech-

nologies and massive parallel sequencing are about to

become part of routine clinical testing as a great num-

ber of rare disease genes have been recently identiﬁed.

Generating the sequence data, however, is only half the

run. In a diagnostic setting, the present challenge is to de-

velop reliable and user-friendly bioinformatics pipelines

for working with the vast amounts of sequence data. A

comprehensive bioinformatics workﬂow requires data

ﬁltering, quality checking, variant annotation and inter-

pretation etc. in order to identify the pathological reason

for a given disease.

Neurosurgery is ﬁnal stage of helping patients, as the

result of all these eﬀorts, but as much as surgical skill and

technical advances are important, only understanding

new discoveries in other ﬁelds of neuroscience can open

new possibilities in treatment of patients with neurologi-

cal disorders. The new trend in the training of the new

generations is to ﬁll the gap between the tremendous

achievements of Biomedicine and clinical applications

and to enhance research collaboration.

In the light of the very fast research achievements and

their application into clinical neurological and neuro-

surgical practice, the International Neuroscience Journal

(INJ) appears just on time. It is important for the journal

to elucidate the novel research and scientiﬁc achieve-

ments in the ﬁeld of neuroscience and to provide broad-

er collaboration possibilities between the researchers in

this ﬁeld. Multidisciplinary collaboration is required for

successful application of clinical trials at local country

level, which also requires communication at interna-

tional level. It is highly expected the International Neuro-

science Journal to build bridges between vast spectrum

of neurosciences and neuroscientists and to help them

work together for the patients’ beneﬁt.

Southeast Europe is a region consisted geographically

and demographically from 14 countries within United

Nations, in alphabetical order: Albania, Bosnia and Herze-

govina, Bulgaria, Croatia, Cyprus, Greece, Hungary, Mace-

donia, Moldova, Montenegro, Romania, Serbia, Slovenia

and Turkey.The ﬁrst known use of the term “Southeast

Europe” was introduced by Austrian researcher Johann

Georg von Hahn (1811-1869) as broader term than tradi-

tional “Balkans”. Although boundaries can vary greatly

due to the political, economic, historical, cultural and

geographic consideration of the observer, Southeast Eu-

rope region can be deﬁne among above mentioned coun-

tries and actual intention and consideration of Kosovo as

a subject of territorial dispute vs. independent country

(Wikipedia).

Neuroscience and neurosurgery in Southeast Europe

in general has signiﬁcant historical background and

Rasulic L

important actual contribution to the global scientiﬁc

quantum. Each country from the region has strong rep-

resentatives and important achievements through the

time within wide spectrum of basic neurosciencies up to

the neurosurgery.Having in mind those facts and taking

in consideration importance of details in this ﬁeld, writ-

ing an Editorial for International Neuroscience Journal

Section Southeast Europe Volume 1, as regional editor-in-

chief, about neuroscience and neurosurgery in Southeast

Europe was more than diﬃcult job. Among huge number

of important people and facts in this subject doing my

best to integrate all important things and not to miss

something I would kindly like to express my deepest grat-

itude and respect to the Members of the Editorial Board

of the International Neuroscience Journal Section South-

east Europe and distinguished colleagues (Acknowledg-

ments) for helping me creating this Editorial with their

active participation (Bulgaria, Croatia, Greece, Macedo-

nia, Romania and Serbia).

Writing this Editorial, at the moment of ﬁnishing it

due to the deadline I could not reach relevant informa-

tion about neuroscience and neurosurgery in Albania,

Cyprus, Hungary, Montenegro and Slovenia. I hope that

in some of the following Volumes of International Neuro-

science Journal, Section Southeast Europe, we will be able

to publish important facts about historical background

and current status of neuroscience and neurosurgery

in Albania, Cyprus, Hungary, Montenegro and Slovenia,

as well as data about neuroscience in Greece and Mace-

donia. Chapters considering neuroscience and neuro-

surgery in Bosnia and Herzegovina, Moldova and Turkey

were written according to the relevant data from the

available literature and sources of information.

Finally, taking in consideration diﬀerent modalities of

writing this Editorial, it seemed most appropriate to me

to involve distinguished representatives in neuroscience

and neurosurgery from each country, in order to obtain

relevant details regarding neuroscience and neurosur-

gery in Southeast Europe.

2. Neuroscience and Neurosurgery in

Bosnia and Herzegovina

The department was established in 1970 by Professor

ZdravkoBesarovic, a general surgeon, as a specialist unit

distinct to that of General Surgery, the neurosurgical

unit at Sarajevo University Medical Center. It started out

as a small unit with eighteen beds. In 1979, it was formally

recognized as the University of Sarajevo, Department of

Neurosurgery and the number of beds had increased to

thirty. The ﬁrst neurosurgeon to complete his training

in Bosnia and Herzegovina was DrFarukKonjhodzic, who

later took over as Head of Department.

During the war years (1992-1995), the department car-

ried on as a functional unit despite the severe lack of

resources. As Serbian forces surrounded Sarajevo and

cut oﬀ all electricity and water, the neurosurgeons per-

severed on stubbornly achieving miraculous results.

The workload which consisted largely of cases of neu-

rotrauma, was handled by ﬁve main neurosurgeons.

Two of them, Dr Kemal Custovic and DrNerminaIblizovic

still work within the unit in professorship and operative

roles respectively. Through the constant shelling, starva-

tion, hopelessness and exhaustion, the neurosurgeons

worked tolerantly to save their patients.

In the aftermath of the war, there were severe organi-

zational problems and staﬀ shortages as the department

struggled to get back on its feet. The neurosurgical team

was drastically reduced in number. The current head of

department, Dr Kemal Dizdarevic, took over leadership of

the unit during this period of chaos. A young neurosur-

geon at that time, he took it upon himself to re-establish

the credibility of the department. He realized that the

macrosurgical techniques were outdated and needed

revision. Under his mentorship, microsurgery, neuroen-

doscopy and stereotaxy were introduced as the standard

operative method. The introduction of microsurgery to

the unit spelt a new era in its history. Today, the majority

of operative work (eg. aneurysmal clipping, tumour re-

section, discectomies. etc.) is carried out microsurgically.

The Neurosurgical Intensive Care Unit (NICU) was

opened in 2002. It is the ﬁrst and only intensive care unit

dedicated solely to neurosurgical management in the

country. With eight beds and sixteen nursing staﬀ (four-

teen nurses and two matrons) to provide round the clock

monitoring, the opening of this unit has contributed

signiﬁcantly to improving the mortality and morbidity

ﬁgures. This unit carries out all manner of conservative,

perioperative management of neurosurgical patients.

Monitoring is carried out on four levels – morphological,

clinical, physiological and biochemical. This last method

of biochemical monitoring is carried out via a cerebral

microdialysis analyzer. The readings obtained allow for

better understanding (and hence management) of in-

trinsic brain biochemistry in cerebral ischaemia. Cur-

rently, this is the only neurosurgical department within

Southeastern Europe to utilize such technology in peri-

operative management.

Today, the Department of Neurosurger y is housed in the

same building as Emergency Department within the com-

plex of the Sarajevo Clinical Center. It consists of three

main divisions – the NICU (discussed above), the High De-

pendency Unit (HDU) and the general ward. The HDU has

a nine-bed capacity whilst the general ward carries thirty-

three beds. Currently, specialist services oﬀered include

cerebrovascular, skull base, neurooncological, spinal

and paediatric neurosurgery. This is the only unit in the

country that has the facilities and expertise to carry out

aneurysmal clipping. The majority of aneurismal cases

are treated in the acute phase. This move towards priori-

tizing early surgical intervention was pioneered within

Bosnia and Hercegovina by DrDizdarevic. Hence, refer-

rals are accepted from all over the country and patients

often travel for days to have access to the services oﬀered.

Rasulic L

Approximately 750 operations are carried out per year

within the unit. The majority of complex neurosurgical

cases are referred here. The staﬀ are trained personally

by DrDizdarevic in such operations and are recognized

throughout Bosnia and Hercegovina for their skills. The

department has also sought to establish itself within the

region by hosting an annual workshop in skull base sur-

gery. This workshop which is currently in its 4th year has

been well received by neurosurgeons all over Europe and

America.

Noteworthy neurosurgeons who have attended the

workshop in the past include Professors Hillman (Swe-

den), Link (USA), Sterno (Slovakia), Harder (Sweden), Pebo

(Sweden), Hernesniemi (Finland), Lehecka (Finland),

Winkler (Germany), Ozek (Turkey), Rusnak (Austria),

Tulleken (The Netherlands), Cavallo (Italy), Nordstrom

(Sweden), Chudy (Croatia). Professor Al-Mefty and Profes-

sor Yasargil will be attending the upcoming workshop in

September this year. Clinically, morbidity and mortality

ﬁgures show marked improvement with each year as new

strategies for neurosurgical management are explored

and developed. The overall mortality in the NICU (where

the majority of patients are emergency admissions) is

12%. This mortality rate include considerable number of

brain dead patients with intracranial pathology who can

be admitted only in our NICU.

There are seven consultant neurosurgeons and three

residents. The nursing staﬀ total seventy in number with

four matrons on hand to oversee smooth running of the

department. The average nurse has at least four years of

medical education whilst matrons have a minimum of

seven years. There are about twenty-two axillary medical

staﬀ.

3. Neuroscience and Neurosurgery in

Bulgaria

Bulgaria is a country located in southeastern Europe

with a territory of 111 square kilometres (16th largest

country in Europe) and a population of 7.4 million (21st

largest in Europe). Bulgaria is a parliamentary repub-

lic, member of the European Union (EU), NATO and the

Council of Europe.

Neuroscience in Bulgaria has long traditions and world-

wide recognized achievements. Some neuropathies have

been recognized clinically and studied at genetic level for

the ﬁrst time in Bulgaria.(2, 3) Our neuroscientists were

among the ﬁrst in Europe to study genetic characteristics

in endogamous Gypsy groups in association with neu-

rological pathologies. These tremendous results were

achieved by profound ﬁeld work and establishment of

close contacts to the Gypsy community leaders, which

was done by the team of Prof. IvailoTournev (Department

of Neurology, Alexandrovska Hospital, Soﬁa, Bulgaria).

In neurogenetics, the Bulgarian geneticists are also

well recognized by their outstanding publications.(4-

9) A number of private mutations were detected in our

patients’ groups, showing high genetic heterogeneity

of the Bulgarian population. Due to the precise clinical

description in clinically ambiguous cases, it became pos-

sible to focus genetic tests to particular gene(s) and this

way the diagnosis was clariﬁed at molecular level for a

number of cases.

Some ongoing clinical trials as for example for trans-

thyretin (TTR)-related familial amyloid polyneuropathy,

Niemann-Pick disease, type C1, Pompe disease etc., en-

gaged again our multidisciplinary eﬀorts to ﬁnd the pa-

tients, to clarify their clinical diagnosis, to determine the

molecular cause of the disease and to reassure adequate

therapy.

The regional neurological and neurosurgical clinics

through regional clinical genetics and molecular ge-

netic counselors refer patients for genetic testing to the

National Genetic Laboratory, Soﬁa (for common disease)

or to the Genetic Medico-Diagnostic Laboratory “Genica”,

Soﬁa (mostly for rare disease). The tight collaboration net

between clinicians and geneticists reassures adequate

behavior in personalized treatment, family counseling,

prevention and prenatal diagnostics.

Nowadays, the multidisciplinary team-work between

neurologists, neurosurgeons, clinical and molecular ge-

neticists is the driving force of development of neurosci-

ence in Bulgaria.

The ﬁrst neurosurgical procedures in Bulgaria were

performed in a general surgery clinic in the capital Soﬁa

by Dr N. Vasilev (a student of Cl. Vincent, France) in 1937

and by Dr Ph. Philipov (a student of W. Toennis, Germany)

in 1939 (10). The surgeries included mainly patients with

trauma and craniocerebraltumours. In 1936, Dr Ph. Phili-

pov and Dr G. Tenchov accomplished the ﬁrst pneumoen-

cephalography, which is considered as an inauguration

of the Bulgarian neuroradiology.

The ﬁrst Bulgarian neurosurgical manuscript was pub-

lished in 1941 in the Bulgarian journal “Military-sanitary

reﬂection” and was entitled “On the cranial injuries and

their evacuation”. This was a review paper, pretending

to be an up-to-date comprehensive manual on the treat-

ment of the war-time neurotrauma.

In 1942 was founded the ﬁrst Bulgarian neurosurgical

ward at the Neuro-psychiatric Clinic of University Hospi-

tal “Alexandrovska”, Medical University of Soﬁa. The ward

was organized and headed by Dr. Ph. Philipov and includ-

ed two inpatient rooms, one operating theatre and one X-

ray cabinet. During the Second World War the whole clin-

ic was transformed to a military neurosurgical hospital

with 240 beds, where were treated traumatic brain, spine

and peripheral nerves injuries. In 1946 the neurosurgical

ward was enlarged in Neurosurgical center.

In 1958 was established the Section of Neurosurgery as

a part of the Bulgarian Society of Neurology, Psychiatry

and Neurosurgery. The independent Bulgarian Society

of Neurosurgery was founded in 1975 and currently is a

member of EANS (European Association of Neurosurgical

Societies) and WFNS (World Federation of Neurosurgical

Rasulic L

Societies).

In 1961 was published the ﬁrst issue of the journal “Neu-

rology, psychiatry and Neurosurgery” (Soﬁa) and in 1991-

its last volume.

In 1992 was initiated the journal “Bulgarian neurosur-

gery” as an oﬃcial journal of the Bulgarian Society of

Neurosurgery.

The duration of the neurosurgical residency program

in Bulgaria is 5 years and its structure, content and qual-

ity is corresponding to this in the other EU countries.

Bulgaria has university neurosurgical clinics in Soﬁa,

Varna, Plovdiv, Stara Zagora and Pleven and military neu-

rosurgical center in Soﬁa (11, 12). They represent reference

centers for their regions. In the last decade, some private

hospitals oﬀer various range of neurosurgical services.

Currently, the top neurosurgical clinics in Soﬁa and Varna

are equipped with state-of-the-art diagnostic imaging fa-

cilities (MRI, multislice helical CT, PET-CT, SPECT, Biplane

Angiography System, C-arm), EEG, EMG, SSEP, operating

microscopes, neuronavigation systems, neurosurgical

micro-instruments, neuroendoscopic systems and in-

struments, ICP monitors, biochemical, neuropathologi-

cal and genetic laboratories.

The leading university neurosurgical clinics in Soﬁa and

Varna cover the full range of neurosurgical pathology

and procedures. Even without oﬃcial sub-specialization

well developed are neurooncology, vascular neurosur-

gery, endovascular treatment, spinal neurosurgery, pedi-

atric neurosurgery, functional neurosurgery and partly

skull base neurosurgery. Bulgarian neurosurgeons in

their daily practice adhere ﬁrmly to the World’s and Eu-

ropean’s guidelines and standards of excellence.

Within a period less than a century, our distinguished

teachers Prof. Ph. Philipov, Prof. P. Petrov, Prof. L. Karaguio-

zov, Prof. M. Vanev, Prof. A. Karkesselyan, Prof. V. Bussarsky,

Prof. K. Romansky, Prof. St. Gabrovsky and Prof. M. Mari-

nov, by their devotion to the neurosurgical clinical prac-

tice, scientiﬁc work and education created the Bulgarian

Neurosurgical School and put it on the neurosurgical

map of Europe and of the world.

The number of the Bulgarian neurosurgeons is about

120. Unfortunately, nowadays exists negative trend for

professional emigration of the Bulgarian neurosurgeons

to the richer health market of western Europe’s countries

of the European Union, mainly Germany, UK and France.

The problem is getting worse with the time and most

probably Bulgaria will face shortage of neurosurgeons

within the next decade.

Bulgaria has a national social security system and the

neurosurgical treatment of all Bulgarians is covered by

this system or by other governmental funds. The neu-

rosurgical grafts for adults however, are not covered by

the system and the patients must pay them alone, which

sometimes imposes signiﬁcant problems. Due to the pe-

culiarities of the Bulgarian health system, namely the

existence of only one National Health Insurance Fund

without any competitors and the model of neurosurgical

service payment by the so called “Clinical Paths”, as well

as to the global and national economic crisis, the neuro-

surgical services in Bulgaria are not receiving suﬃcient

funding. Profound reorganization of the health system

and of the model of remuneration of the neurosurgical

work represents the only possible solution of this prob-

lem.

4. Neuroscience and Neurosurgery in

Croatia

In the ﬁeld of Neuroscience the leading position in

Croatia holds the Croatian Institute for Brain Research

founded in 1990. Its founder and Head, Academician

IvicaKostovi has a rewarded career in Neurohistology

and Neuroembriology (13). Croatian Institute for Brain

Research actively cooperates with some of the great-

est names in the ﬁeld of Neuroscience: PaskoRakic,

KrešimirKrnjevi , Tamas Freund, Oleg Krishtal and oth-

ers.Interactive and interdisciplinary surrounding at the

Croatian Institute for Brain Research ensures that the

broad spectrum of experimental methods in molecular,

cell and behavioral analysis can be applied to every scien-

tiﬁc problem.

Among medical specialties, Neurosurgery is by far, one

of the most technically advanced. A gigantic step forward

has been done from the time of ancient Mayas' preform-

ing skull trepanation with peaked stone to the now-a-

days neurosurgeons operating with devices such as neu-

ronavigation orcavitron ultrasound aspirator.

Croatia has a century long history of performing neuro-

surgical procedures. In 1927 the famous Croatian otorhi-

nolaryngologist, Professor Ante Šercer (1896-1968) pub-

lished a report of surgical treatment on 10 patients with

pituitary adenomas (14).

After the World War II, in 1945, Professor Danko Riessner

(1907-1973), Head of the Surgical Clinic at the University

Hospital Zagreb founded the Neurosurgical ward. Profes-

sor Danko Riessner is therefore considered a founder of

Neurosurgery in Croatia.

Operating microscope has brought revolution in the

ﬁeld of Neurosurgery. The work of Professor Mahmut

Gazi Yasargil became worldwide known. Professor Ivan

Jeli i (1929-2012) from Zagreb Medical School has spent

a year in Zurich, Switzerland as a Professor Yasargil pupil.

Upon returning to Zagreb, Professor Jeli i had adopted

microsurgical technique and is considered the founder

of modern microneurosurgery in Croatia. Professor

Jeli i together with his colleague Dr. AntoMatkovi pub-

lished the ﬁrst book on Neurosurgery in 1988.

Croatia, as the 28th state of the European Union is try-

ing to follow modern trends in Neurosurgery.

Neurosurgeons in Croatia are capable of performing

the whole armamentarium of neurosurgical procedures,

including awake brain tumor surgery, functional epilep-

sy surgery, cerebrovascular surgical and interventional

procedures, minimal invasive spine procedures and com-

Rasulic L

plex spine surgery. The scientiﬁc and publishing work of

older colleagues is being continued and a novel book for

medical students and neurosurgical residents has been

published recently (15).

The International Neuroscience Journal (INJ) is, in our

opinion, established to ﬁll the gap between clinicians-

neurosurgeons and pure neuroscientists. INJ and its cre-

ator, Professor MadjidSamii has recognized the need of

close collaboration and critical discussion between neu-

roscientists and neurosurgeons. We are honored that we

can contribute a small puzzle in this historical project of

tremendous importance.

5. Neurosurgery in Greece

5.1. Historical Landmarks

Neurosurgical operations in Greece are as old as the his-

tory of Greek civilization. The ﬁrst, primitive neurosurgi-

cal operations were skull trephinations, rather related to

religious ceremonies than to medical therapeutic actions

(16). The ﬁrst archeological ﬁndings were discovered in

Crete and indicate skull trephinations performed for

some kind of ceremonial reasons (Bronze Age, Minoan

era of Greek civilization, 3000-1050 BC) (17).

Nevertheless, the technical knowledge that was ac-

quired from these “ceremonial” trephinations, was used

in the ﬁrst therapeutic skull operations performed a

couple of centuries later. Archeological ﬁndings in My-

cenae, Peloponnese, clearly show that a craniectomy was

successfully performed, in late Bronze Age (Mycenaean

civilization 1400-1200 BC) (18, 19).

Ancient Greek Medicine comes to its peak in the “Golden”

5th BC century. Hippocrates (460-377 BC) wrote an essay

“About Head Injuries” (“Περίτωνενκεφαλή τραυμάτων’’),

deﬁning the indications for surgical skull fracture repair

and describing in detail the surgical trephination tools

and techniques (17). He also argued that Epilepsy was

not a “Sacred” but a Brain disease (“…αλλά γαρ αίτιος ο

εγκέφαλος το τουτου πάθεος...’’= ‘’…brain is responsible

for this aﬀection…’’).

In Hellinistic Period (2nd-3rd Century BC), Erasistratus

and Herophilus give an impetus in medical knowledge.

Erasistratus discriminated the sensitive from the motor

nerves (“reinvented” 2000 years later by Bell and Ma-

gendie), described the connection between the lateral

and third ventricles (foramen of Monro) and he thor-

oughly studied the anatomy and physiology of cerebel-

lum. Apart from the well-known “torcularHerophili”, He-

rophilus gave detailed anatomical descriptions of the

brain and other parts of the human body (20).

In Roman Period, Galen (in Greek means “calm”) from

Pergamon (AD 129-217,) expanded and further improved

the medical knowledge founded by Hippocrates and de-

veloped by Herophilus and Erasistratus, by correcting

some of their misunderstandings. He described in detail

the head injury surgical treatment. He also proposed pe-

ripheral nerve injury repair, using kind of glue derived

from chicken egg.

In Byzantine Period, medicine was further ﬂourished.

Paul from Aegina is one of the very prominent Byzantine

physicians (AD 7th century) who wrote seven medical

books, covering the whole spectrum of medical practice.

He described a suturing technique for nerve repair that

is similar to the contemporary epineural sewing tech-

nique, as it was described by Flourens, Baudens and Heu-

ter, almost 13 centuries later.

5.2. Contemporary Period

5.2.1. 19th-mid 20th Century

The ﬁrst neurosurgical operations were systematically

performed in late 19th century, as it was reported in 1877,

by a general surgeon, Prof. S Magginas. The same author

publishes a General Surgery book, in 1893, where speciﬁc

chapters are devoted to head injuries, brain tumors, hy-

drocephalus and spine disorders. In 1894, S. Apostolides

publishes a book “Topographic Physiology of Brain Cor-

tex”, where ﬁve neurosurgical operations were reported.

In early 20th century, several General Surgeons (Konto-

leon E., Mermigkas K., Geroulanos M., Makkas M.) used to

perform neurosurgical procedures (21) Two of them, Mer-

migkas and Makkas, published General Surgery books de-

scribing neurosurgical procedures. An ENT physician, N.

Taptas, pioneered in trigeminal neuralgia treatment, us-

ing injections through foramen ovale (Athens, 1909). Be-

tween 1920 and 1940, more sophisticated neurosurgical

operations were performed by General Surgeons, most

of the time under the supervision of Prof I. Patrikios, a

prominent Greek Neurologist who founded, in 1933, the

Neurological Clinic at Evangelismos Hospital.

The ﬁrst Neurosurgical Clinic was established in Athens,

in Cancer Hospital AgiosSavvas, in 1939. Heliades K. was

the Director of this clinic and the ﬁrst surgeon involved

systematically in neurosurgery, trained by Clovis Vincent

in France.

5.2.2. Mid-20th Century – Today

After the end of the Second World War and the Greek

Civil War that was followed (1949), routine neurosurgical

practice starts again. In 1951, Assoc. Prof. Griponisiotis B.

is the ﬁrst Director of the Neurosurgical Clinic in Evan-

gelismos Hospital, in Athens and subsequently, in 1967

he was elected as the ﬁrst Professor of Neurosurgery in

Aristotelian University of Thessaloniki. He founded the

ﬁrst University Neurosurgical Clinic in Greece, in AXEPA

Hospital, in Thessaloniki (22).

In 1953, one of the pioneers in Greek neurosurgery, D.

Economos, establishes a neurosurgical clinic in Athens

Polyclinic Hospital. Dr. Economos was trained neurosur-

gery in Paris by Vincent, Demartel, Guillome, David and

in Canada by Penﬁeld. He was an innovative neurosur-

Rasulic L

geon and raised the Neurosurgical practice at its high-

est level. He simultaneously developed all the peripheral

supporting ﬁelds of our specialty, like neuroradiology,

neurophysiology and neuropathology. He used to per-

form all pioneer neurosurgical operations at that time

and he showed a very high level of expertise. In 1966 the

Hellenic Neurosurgical Society was established and he

was the ﬁrst President.

Ten years later, in 1962, another pioneer neurosurgeon,

I. Taptas, was appointed Director in AgiosSavvas Neuro-

surgical Clinic. Apart of being an expert neurosurgeon,

he was worldwide recognized as pioneer in cavernous

sinus anatomy investigation (23-25). His work on cavern-

ous sinus was the basis VinkoDolenc used to further ex-

plore in detail the anatomy and surgery of this compli-

cated neurosurgical area.

Both D. Economos and I. Taptas, established all the prin-

ciples of modern neurosurgery in Greece and many high-

ly competent Greek Neurosurgeons followed their steps

and further developed our specialty in this country.

The same year, 1962, the neurosurgical clinic of General

Hospital of Piraeus was established (Chairman Dr. Vato-

poulos K.) The following decade many new departments

were established. Among them, the ﬁrst Neurosurgi-

cal Clinic in Children’s hospital was started in Athens

(Head Dr. Komninos S.). In Thessaloniki, Dr. Foroglou G.

succeeded Professor Griponisiotis as chairman of the

only University Neurosurgical Department at that time,

in AXEPA Hospital. Prof. Foroglou was very active in Eu-

ropean Neurosurgical aﬀairs within the frame of the Eu-

ropean Association of Neurosurgical Societies (EANS). He

encouraged many young Greek neurosurgeons to attend

the EANS training courses and he worked hard at that

time to tighten the connections among European neuro-

surgeons, including those coming from eastern socialis-

tic European countries.

In eighties and nineties some more neurosurgical de-

partments were established. Prof Papadakis N. started

the department of neurosurgery at the local university

in Patra, Peloponnese. A couple of new departments were

started in peripheral Greek towns like Alexandroupolis,

Ioannina, Kavala, Larisa,Herakleion and Chania (Crete).

In eighties, another pioneer neurosurgeon, Dr. D. Rolo-

gis, Director of the Athens General Hospital Neurosurgi-

cal Department, introduced the surgical microscope in

the routine neurosurgical practice. Shortly after him,

a prominent neurosurgeon in Thessaloniki, Dr. C. Anto-

niades, did the same in northern Greece and ever since

micro-neurosurgery became the standard, routine neu-

rosurgical technique, all over the country. Dr. Rologis

was and still is a very innovative neurosurgeon, very ex-

perienced in vascular neurosurgery and in early nineties

he was able to foresee the capacity of the endovascular

procedures. He subsequently convinced and supported

the author of this article to train interventional neurora-

diology techniques. In 1995 the ﬁrst endovascular proce-

dure was performed in Athens by myself and since 1996

endovascular procedures have been part of the standard

neurosurgical practice in our country. As a consequence,

more than 50% of the endovascular surgeons in Greece

are active neurosurgeons and our country along with

Austria and Holland, are prototype European countries,

where many neurosurgeons are actively involved in en-

dovascular procedures. Two of these European Vascular

Neurosurgeons (Gruber A. and Andreou A.) are members

of both ESMINT and Vascular Committee of EANS.

In 1999, Prof D. Sakas was elected and appointed Chair-

man and Head of the University Neurosurgical Clinic in

Evangelismos Hospital, in Athens. Despite Dr. Karakalos

in seventies and early eighties used to perform stereo-

tactic functional procedures in Voula Hospital, Athens,

Prof Sakas was introduced in a routine basis and fur-

ther developed functional neurosurgery in Greece. His

work is worldwide recognized and he is Chairman of the

Neuromodulation Committee of WFNS since 2007 and

President of the European Society of Stereotactic and

Functional Neurosurgery (ESSFN) since 2010. Functional

procedures are also performed in several neurosurgical

departments (Patra, Larisa, Thessaloniki etc.).

In Thessaloniki, Prof Foroglou was succeeded by Prof.

K. Polyzoides and Prof. P. Selviarides. Both of them are

pioneer neurosurgeons in northern Greece with a great

contribution in Greek Neurosurgery. Prof. Polyzoides is

Chairman and Head in AXEPA University Clinic and expe-

rienced tumor surgeon. Prof. Selviarides continues Prof G

Foroglou’s activity in EANS aﬀairs and he is national del-

egate in EANS Training Committee since 2008. He is also

President of the EANS Post-Graduate Educational Com-

mittee since 2011. He used to be fellow in Mainz (Head

Prof. Pernezsky) and he ﬁrst introduced in Greece the

key-hole concept in micro-neurosurgery.

Currently, all contemporary neurosurgical techniques

are well developed in the most prominent neurosurgical

units, in the country. Functional, vascular, skull base, tu-

mor (including awake craniotomies) and spine surgery,

are highly developed in various neurosurgical centers.

Nevertheless, most neurosurgical units throughout

Greece evolved without the beneﬁt of central planning.

The country has witnessed an ever-increasing case load

and the dilemma of choosing between a few centralized,

well equipped, large centers oﬀering comprehensive

specialty training and the need for evenly distributed

smaller units, remains unresolved. Moreover, Greek neu-

rosurgeons are proportionally to the population, more

than needed and this is an additional problem demand-

ing our attention.

The Hellenic Neurosurgical Society is an active member

of EANS and WFNS. Greek Neurosurgeons are actively in-

volved in the activities of both EANS and WFNS and they

are meticulously working to host the next EANS Congress

in 2016, in Athens (President P. Selviarides). Moreover,

there is a vivid interest to develop our relationships with

colleagues from our neighbouring countries and there-

fore we are keen to support all SeENS’ activities.

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6. Neuroscience and Neurosurgery in

Moldova

Institute of Neurology and Neurosurgery operates ac-

cording to the Government Decision no. 1326 of 14 Decem-

ber 2005 " On measures for optimizing the infrastructure

of science and innovation " by decision of MH no. 15 -p §

3 of 01.02.2006 "On the change of name of medical insti-

tutions under the Ministry of Health " as a predecessor

of Public medical institution, The Scientiﬁc and Practi-

cal Center of Neurology and Neurosurgery, is registered

through state Registration Chamber decision of Ministry

of Information Development of RM no. 1003600150602

of 02.06.2006 and accredited according to the Decision

of the National Council for Accreditation and Attestation

no. 49/AC October 30 , 2008 "On the assessment and ac-

creditation of the Institute of Neurology and Neurosur-

gery".

INN is the only curative- preventive specialized institu-

tion, which provides highly skilled nursing inpatient and

outpatient stage patients with diseases of the nervous

system, is the scientiﬁc basis intended for scientiﬁc inves-

tigations , development and practical implementation of

the latest scientiﬁc and clinical basis in practice by USMF

"N. Testemi anu"’s staﬀ and the College of Medicine’ s

staﬀ.

INN provides highly skilled nursing inpatient and out-

patient services

7. Neurosurgery in Macedonia

The beginnings of the neurosurgery in Macedonia is

connected with the foundation of the Medical faculty in

Skopje-Macedonia in 1947. The ﬁrst cranial trepanations

in compressive traumatic haematomas were performed

by a general surgeons. The very ﬁrst neurosurgical instru-

mentarium was supplied in 1952.

Neurosurgical department as a part of the Surgical clin-

ic in Skopje is established on October 3rd, 1958.

First chief of the neurosurgical department is Prof.

drPetarTofovic, who with assistance of Prof. drDragojevic

– the head of all surgery departments, was leading the

department. After that the department joined two more

specialists-neurosurgeons: Prof. drPetarRuskov and Prof.

drMirkoMircevski.

During the 70’s, operative treatments from the general

neurosurgery are becoming a routine. First CT scan is ob-

tained in 1978. First micro neurosurgical intervention is

performed in 1982. At the same year Department became

a Neurosurgical Clinic. At that time six neurosurgery spe-

cialist were part of the Clinic and routine neurosurgical

interventions were performed at daily basis.

Since 2001 neurosurgical clinic has two operating the-

aters, its own neurointensive care, and neurosurgical

ward consisting of 45 beds.

First operative neurosurgical microscope is obtained in

1995 and CUSA in 2001. New microscope Pentero and neu-

roendoscope, and possibility of navigation and evocated

potential were obtained in 2010.

Nowadays, at the neurosurgical clinic, we operate on all

pathological processes in the area of neurosurgery. Until

now, directors of the Clinic were Prof. PetarTofovic (1958-

81), Prof. JovicaUgrinovski (1981-89), Prof. MirkoMircevski

(1989-95), Prof. IlijaPangovski (1995-2002) Prof. SpaseJo-

vkovski (2002-05), Prof. KirilLozance (2005-06) and Prof.

AleksandarCaparoski (2006- present).

We treat 1500 patients per year, of which approximately

1000 are operated on (200 tumors, 170 cerebrovascular

cases, 200 degenerative cases of the vertebral column,

100 hydrocephalus, 100 craniocerebral trauma, 60 con-

genital malformation, 30 peripheral nerves, and other).

In Republic of Macedonia there are 24 neurosurgeons,

of which 9 are employed by the neurosurgical clinic, part

of medical University St. Cyryl and Methodius, Skopje,

city hospital- Skopje has 2, Clinical hospital Tetovo has 3,

Clinical Hospital Bitola has 2, Clinical Hospital Stip has 1,

and city Hospital in Ohrid has 1 neurosurgeon and 4 neu-

rosurgeons are employed in the private hospitals.

Neurosurgery Clinic is aﬃliated with the Medical Fac-

ulty in Skopje. Until now there are 10 neurosurgeons with

PhD thesis and 3 with master thesis. Publishing activities

include 12 books of neurosurgery and numerous papers

published in scientiﬁc journals. Also, Macedonian neu-

rosurgeons actively attend neurosurgery congresses and

symposia around the world with published papers.

Macedonian Society of Neurosurgeons is active mem-

ber of EANS, WFNS and SEENS.

8. Neurosurgery and Neuroscience in

Romania

The history of Romanian Neuroscience and Neurosur-

gery is deeply connected with the one of Western Europe.

Modern Romania has been established in the territory it

occupies nowadays by the Great Union in 1918, after the

First World War. It was formed through the union of The

Romanian Country (previously formed in 1859 by the

union of the Principalities of Moldavia and Walachia)

and Transylvania. The beginnings of modern medicine

in Moldavia and Walachia were greatly inﬂuenced by the

medical school of France, since the large majority of the

founders of this medical school graduated in Paris and

Montpellier. In Transylvania, at that time part of Austro-

Hungarian Empire, the medical school was inﬂuenced by

the schools of Vienna and Budapest.

The beginning of Romanian neurosurgery is related, as

in other parts of Europe, to the activity of some brave and

also visionary surgeons. We consider it a duty of honor to

present a brief summary of the activity of the most im-

portant personalities, who greatly inﬂuenced the devel-

opment of neuroscience and neurosurgery not only on

Romanian territory but also in Europe.

9. The Pioneers of Neurosurgery

LUDOVIC RUSS-SENIOR (1816-1888) native from Austria,

graduated the medical school in Vienna, and moved to

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Iasi in 1844 at the “Sf. Spiridon” Hospital, where he would

conduct the department of general surgery for 44 years.

In Iasi, 1847, he performed the ﬁrst Romanian mentioned

trepanation for a clinically diagnosed extradural hema-

toma. In the same year, he performed the ﬁrst operation

with ether anesthesia, some months after the ﬁrst public

demonstration of painless surgery using sulfuric ether

made by John Collins Warren and William T.G. Morton.

Ludovic Russ-Senior also has the merit of being the ﬁrst

to present the “Skull Anatomy for trephination” in his

general surgery course, edited in 1863.

NICOLAE TURNESCU (1818-1890) graduated medicine in

Paris, and became professor of surgery at the Bucharest

Faculty of Medicine. In 1856 he published (in “Buletinul

Oﬁcial” Nr.89/1856) the ﬁrst successful surgical treatment

for hydrocephalus in Romania, consisting in an external

ventricular drainage associated with iodine injections.

This was the second ventricular puncture mentioned in

literature, after those performed by Dr. Vrenard, Presi-

dent of Medical College from Chicago, Illinois, in 1854.

From a historical point of view, based on the literature

that we have had access to, the starting point of Roma-

nian Neurosurgery could be placed between 1890 and

1900, thanks to three great surgeons and their constant

interest in a new and developing surgical ﬁeld.

ANASTASIEVICI LEONTE (1853-1914), graduated the Fac-

ulty of Medicine in Bucharest in 1875 and is the ﬁrst Ro-

manian surgeon who constantly approached neurosur-

gical pathology according to the modern principles of

asepsis and antisepsis, chloroform general anesthesia,

Chapionniere’s cranial topography and neurological

presentation. Between 1886 and 1891 he performed 22

“trephinations” (craniectomies) for diﬀerent pathologies

including severe trauma, neglected skull fractures, epi-

lepsy and spontaneous intracerebral hemorrhage. Along

with N. Bardescu, he summarized all these cases in the

article “Intervention chirurgicaledans les afectioncere-

brales” published in the in Revue de Chirurgie [vol IX, Oc-

tomber 1891, p.813, Paris], this being considered the ﬁrst

Romanian systematic approach on the role of surgery

in cerebral pathology. According to the Romanian litera-

ture, A. Leonte performed the ﬁrst successful removal of

an Epidural Hematoma on the 11th of July 1888, the ﬁrst

sagittal sinus suture on the 11th of Dec. 1888 (in literature

this feat is attributed to Henri Duret), the ﬁrst removal of

a spontaneous intracerebral hematoma in Oct. 1890 (this

seems to be the second case in European literature after

the case presented by Championniere). In the same year,

1890, he performed the ﬁrst “trephination” (in fact a de-

compressivecraniectomy) for idiopathic epilepsy.

GEORGE ASSAKY (1855-1899, began his medical studies in

Montpellier and continued in Paris. In 1886 he presented

his PhD thesis entitled “De la suture des nerfs a distances”,

highly appreciated by the Academy of Medicine in Paris.

Because of this work, he is considered one of the pioneers

of the peripheral nerves surgery in Europe, and also one

of the promoters of experimental surgery. Due to his in-

terest in craniocerebral topography, he is considered one

of the promoters of Romanian neurosurgery.

NICOLAE BARDESCU (1862-1937), graduated in Bucharest.

His mentors, Prof. AnastasieviciLeonte and George Assaky

signiﬁcantly inﬂuenced his surgical career. The PhD the-

sis entitled “Contributions to the study of cranial trephi-

nation” represents only the beginning of a prodigious

activity in the ﬁeld of neurosurgery. Up to 1906 he pub-

lished 111 scientiﬁc papers regarding cranial injury, spine

and spinal cord injury, complications of the head injury,

cranioplasty, surgical treatment of trigeminal neural-

gia. In 1894 he performed the ﬁrst surgical removal of

an intracranial tumor noted in the Romanian literature:

“Cerebral sarcoma. Jacksonian Epilepsy”. Reviewing the

existent publications, Bardescu speciﬁed that up to his

intervention, in literature there were 28 published cases

of operated brain tumors, with a mortality of 46.5%. In

1895 NicolaeBardescu was the ﬁrst to perform a resection

of Gasser’s ganglia for trigeminal neuralgia.

THOMA IONESCU (1860-1926), graduated medicine in

Paris, where he also sustained his PhD thesis in 1892. At

the age of 35, as a professor of Anatomy in Paris, he ac-

cepted to become professor of Topographical Anatomy at

the Faculty of Medicine in Bucharest, and also Professor

of surgery at the Coltea hospital. Considered the founder

of modern surgery in Romania, his interest in the ﬁeld of

neurosurgery was based on a continuous eﬀort of docu-

mentation and personal experience. His major interest

was the surgical treatment of epilepsy, where he advo-

cated for sectorial corticectomy (1887), no deeper than

one centimeter. Continuing the development of surgery

in epilepsy he favored the Doyen’s technique of temporal

craniectomy, but more than that, he introduced a new

method of osteoplastic craniotomy. In 1897 he argued for

the necessity of dural opening in temporal craniectomy

in order to prevent the devastating consequences of

brain edema (one year before Jaboulay, who was credited

by Harvey Cushing with this idea). In search for a better

solution, ThomaIonescu proposed and performed cervi-

cal bilateral sympathectomy for epilepsy, based on the

presumption that the pathogenic role of cerebral ﬂow

changes in this pathology. This idea made logic, since

in nowadays Vagal Nerve Stimulation (VNS) is method

of choice in epilepsy. Along with his interest in epilepsy,

ThomaIonescu introduced the Krönlein technique in our

country, for lateral approach of the orbit, operating 5 pa-

tients at the time when only 17 cases were reported in the

literature. He also introduced and demonstrated the Cer-

vical Spinal Anesthesia, during his visits in the USA and

the United Kingdom.

AMZA JIANU (1881-1962), graduated Medicine in Bucha-

rest, former student of ThomaIonescu, he became the

closest collaborator of this great surgeon. At the age of 31

he was promoted Professor of surgery in Iasi. In 1910 he

published an original paper on decompressivecraniec-

tomy (“Decompresivekraniectomie“ Dtsch. Z. Chir., 1910,

vol. 107). He was the ﬁrst Romanian surgeon who suc-

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cessfully removed an acoustic neuroma (case published

along with Bacaloglu in Rev.de Med. 1914-1915, XXXIV, 760-

775, and cited by Harvey Cushing in his “Tumors of the

NervusAcusticus” from 1917). The interest in the ﬁeld of

neurosurgery is also demonstrated by the attention he

gave to surgical treatment of trigeminal neuralgia, spi-

nal cord pathology (he performed 12 laminectomies for

previously diagnosed cases with Lipiodol), introducing

an original procedure for surgical treatment of facial pa-

ralysis “Sternocleidomastiodianmyoplasty- Lexer-Jianu

technique”. In 1931 he successfully removed the ﬁrst su-

prasellar tumor in Romania. He also encouraged A. Moru-

zzi, D. Bagdasar and Dem. O. Vasiliu toward the newly de-

veloped specialty - Neurosurgery.

10. The School of Neurology

At the turn of the centuries, Neurology became an in-

dividual specialty in our country. The ﬁrst physician who

dedicated his activity to this new developing medical

ﬁeld was GHEORGHE MARINESCU (1864-1938), graduated

medicine in Bucharest, he specialized in neurology in

Paris, at Salpetriere Hospital, under the patronage of Pro-

fessor Charcot, working along with Pierre Marie, P. Blocq

and Gilles de la Tourette. Between 1889 and 1897 he alter-

natively worked in Paris, Frankfurt, Berlin, being highly

interested in the pathology of nervous system. There are

some very valuable studies dating from this period, like

pathological changes in acromegaly (along with P.Marie),

medullary center of breathing (with J.Gad), a pathologi-

cal atlas of neurological disorders (with P. Blocq). In 1898,

along with cameraman C. M. Popescu, he produced the

ﬁrst medical video in the world: “The walking changes

in organic hemiplegia”. His researches in the pathology

of nervous system were published in 1909 in Paris as a

monography entitled “La cellule nerveuse” (The nervous

cell), prefaced by Ramon y Cajal. Due to his prodigious

activity, Gheorghe Marinescu is considered not only the

ﬁrst Romanian neurologist, but also the most important

one.

In the same period, In Transylvania, at that time part of

Austrian-Hungarian Empire, the foundation of a Faculty

of Medicine in the new established Franz Josef University

(1872) from Cluj (Kolozsvar/Klausenburg) represented the

start point of a systematic educational and research ac-

tivity in this region. From a neuroscientiﬁc point of view,

some personalities must be mentioned: ENDRE H GYES

(1847-1906), professor of Pharmacology, was especially

interested in the connection between the equalization

of the ocular muscle with the labyrinth (vestibule reﬂex

10), thus achieving notorious discoveries in the ﬁeld as

early as the beginning of the 1880’s. KÁROLY LECHNER

(1850-1922) professor of Psychiatry and Neurology was

remarked for the research he conducted in the pathol-

ogy of reﬂexes, dealing with hallucinations and the issue

of consciousness. He was one of those who, for the ﬁrst

time, proved the continuity of acquired reﬂexes.

Founder of an actual school of Neurology, GHEORGHE

MARINESCU’s activity was continued by other great re-

searchers in this ﬁeld of neuroscience, their contribution

to the development of the specialty in Romania and in

Europe being of outmost importance. From the gallery

of his followers we have to mention: ANGHEL RADOVICI

(1885-1956) former assistant and collaborator of Prof. Ma-

rinescu, along whom he described the “palmo-mentoni-

er reﬂex”. He also authored the monograph "La syphilis

nerveuse" (1928). NICOLAE IONESCU-SISESTI, specialized

in Neurology with Georges Guillain in Paris, he became

the closest collaborator of Gheorghe Marinescu in Bucha-

rest, and also his successor. His work in the ﬁeld of neu-

rology was focused on spinal cord tumors and brainstem

physiology, authoring two important monographs: “Tu-

meursmédullairesassociées à un processussyringomyé-

lique” (1929), and “La Syringobulbie - contribution à la

physiopathologie du tronccérébral (1932). CONSTATIN I.

PARHON (1879-1965), graduated in Bucharest, in 1900 he

sustain his PhD thesis entitled “Contribution to the vas-

cular motility in hemiplegia”. In 1909 published, along

with M. Goldstein, “Les secretions internes”, considered

the ﬁrst textbook of endocrinology. His fruitful collabora-

tion with AmzaJianu, and also of his successor Leon Bal-

iﬀwith surgeon AlexandruMoruzzi, created the premises

for the establishment of the ﬁrst Neurosurgical Unit in

Romania in Iasi, in 1933, this unit being also the third in-

dependent Neurosurgical Service in Europe, after Profes-

sor H. Olivecrona’s clinic in Stockholm and the Neurosur-

gical Clinic at the Military Hospital in Sankt Petersburg.

11. The Founders of Neurosurgery

Alexandru Moruzzi (1900-1957) the founder of the ﬁrst

Neurosurgical service in Romania graduated Medicine in

Paris and trained in neurosurgery, in the service of Prof.

Thiery de Martel (during 1929-1930). The Service of Neuro-

surgery was established in the Socola Hospital on the 1st

of January 1933. After 18 months of intense neurosurgical

activity, he published the ﬁrst paper encompassing his

experience in spinal cord tumors, along with Prof. Baliﬀ

and M. Ferdman: 13 cases of spinal cord tumoral compres-

sion. Between 1934 and 1941, when Romania engaged in

the World War II, he performed 329 neurosurgical inter-

ventions. After the end of the WWII, in 1947, he emigrated

in Venezuela and after that in United States.

One year after the establishment of Neurosurgical ser-

vices in Iasi, in November 1934, in Bucharest, 2 neuro-

surgical services were founded. The ﬁrst one within the

Bucharest Central Hospital headed by Dr. DumitruBagda-

sar, and the second one in Witting Hospital headed by Dr.

Dem. O. Vasiliu.

DumitruBagdasar(1893-1947) began his career as neurol-

ogist, at the Colentina Hospital in Bucharest, in the Clinic

directed by Prof. Dr. Gheorghe Marinescu. His formation

as a neurosurgeon was coached by H. Cushing, at Boston

(1927-1929). As Cushing did in the US, Bagdasar turned

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neurosurgery from butchery to brilliance. Between 1931

and 1941 he performed 1800 surgical interventions. De-

spite the fact that at the beginning the neurosurgical

services have had only 8 beds, through his activity he

progressively developed his service and surgical perfor-

mances. His original contributions in neurosurgery have

materialized in numerous scientiﬁc publications in do-

mains like posterior cordotomy, cerebral tuberculosis,

spinal cord tumors. In 1941, D. Bagdasar, State Draganescu

and ConstantinArseni performed an original surgical

treatment in craniostenosis. DumitruBagdasar became

the ﬁrst Professor of Neurosurgery in Romania in 1946.

Unfortunately, he died too early, in 1947, at the age of 54

years.

Dem O. Vasiliuwas a personality unfairly neglected by

the oﬃcial history of Romanian neurosurgery. Trained in

neurosurgery by H. Cushing, C. Frazier, C. Elsberg and W.

Dandy for a period of two and a half years, he introduced

the PEG in Romania in the diagnosis of brain tumors, and

also performed the ﬁrst lobectomy for invasive gliomas.

He developed a special interest in clinical and surgical

aspects of congenital arachnoid cysts. He strongly advo-

cated for a systematic development of neurosurgery as

an individual specialty.

Between 1941 and 1944, for a period of almost four years,

part of Transylvania, including Cluj/Kolozsvar, was an-

nexed to Hungary. In that period prof. KÖRNYEY ISTVAN,

the founder of Hungarian neurosurgery and already a fa-

mous European neurosurgeon moved to Cluj in order to

organize a neurosurgical service in Cluj/Kolozsvar in 1941.

12. The Continuators

NICOLAE OBLU (1912-1995) Became head of the Neuro-

surgical Unit at the Socola Hospital in Iasi in 1951. In 1964

this unit was transformed into a neurosurgical clinic,

and also became a center of postgraduate courses. Prof.

N. Oblu has the great merit of establishing the ﬁrst Neu-

rosurgical Hospital in Romania, in 1972, as a result of his

tremendous eﬀort and perseverance.

CONSTANTIN ARSENI (1912-1994) graduated Medicine

in Cluj in 1935, between 1936 and 1946 he worked in the

Neurosurgical Unit of Prof. D. Bagdasar. In 1946, after the

disappearance of Prof. Bagdasar, Arseni, at the age of 34,

became the head of the Neurosurgical Dept. Due to his

eﬀorts and political inﬂuence, in 1975, the largest Neuro-

surgical hospital in the world, at least for that time, was

opened, having 650 beds and 19 operating theaters. Be-

cause of his tremendous work (more than 32.200 surger-

ies and 54 monographs) he is considered the founder of

contemporary neurosurgery.

SOFIA IONESCU-OGREZEANU (1920-2008) was the ﬁrst

woman neurosurgeon in the world. Her priority was rec-

ognized in 2005 at the WFNS Congress in Marrakesh. She

started her work in the neurosurgical ﬁeld in 1943, under

the guidance of D. Bagdasar, then she became member of

the team directed by C. Arseni. Her major ﬁelds of activ-

ity were brain tumors and spinal degenerative pathology.

13. The Developers

STEFAN TRISTAN IACOB (1920-1976), graduated the Fac-

ulty of Medicine in Bucharest at the Medical-Military

Institute in the period of 1939-1945. After a period of

training in neurology, he completed his formation in

neurosurgery under the supervision of D. Bagdasar and

C. Arseni (1946-1949). In 1949 he was transferred to Cluj,

establishing the neurosurgical department in the same

building where Prof. Kornyey previously worked. His sci-

entiﬁc work was impressive, more than 280 papers and 4

monographs alone or in collaboration (Neuropathology

of the war-1943, vertebral sciatica along with C. Arseni). As

a founder of the neurosurgical school in Cluj, he highly

contributed to the formation of great neurosurgeons,

the most worldwide known being Prof. Ladislau Steiner.

LEON DANAILA trained in neurosurgery under the guid-

ance of Prof. Arseni together with whom he worked for

20 years. In 1981 he established the Vascular Neurosurgi-

cal Department. What professor Yasargil made for World

Neurosurgery, prof. Danaila made for Romanian Neuro-

surgery. In 2011 he reported 21.700 microsurgical inter-

ventions and 2760 operated intracranial aneurisms rep-

resenting probably one of the largest series in the world.

AlexandruConstantinovici, was head of Neurosurgical

Hospital in Bucharest between 1990 and 1998, former

President of the Romanian Society of Neurosurgery. He

largely contributed to the development of international

cooperation of Romanian neurosurgery. He promoted

the transsphenoidal surgery in Romania. Under his presi-

dency, the scientiﬁc meetings of RSN became interna-

tional, and English became the oﬃcial language of RSN’s

Conferences and Congresses. In order to develop regional

collaborations, he initiated together with Prof. Ciurea,

the Black Sea Congress in 1999.

ALEXANDRU VLAD CIUREA was specialized in Neurosur-

gery under coordination of Prof. C. Arseni. In 1974 he sus-

tained his PhD thesis entitled “Actual therapeutic aspects

of pituitary adenomas”. In 1997 he became Professor of

Neurosurgery and in 1999 President of RSN up to 2008.

His activity was internationally recognized, being the

Vice-president at large of WFNS between 2005 and 2009,

and Chairman of the Nominating Committee of WFNS

from 2009.An outstanding neurosurgical personality, he

decisively contributed in the Romanian neurosurgery

progress and worldwide knowledge. During his activity

he achieved more than 20.000 surgeries, 27 monographs

as a ﬁrst author and other 21 monographs as a co-author,

being also the main author of more than 180 published

papers (26-28).

14. Neuroscience and Neurosurgery in

Serbia

14.1. Neuroscience in Serbia

Ever since the 1950's a signiﬁcant number of well-estab-

lished researchers and academicians have been involved

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in neuroscience in Serbia. The quality of their work and

results has always been visible through numerous, high-

ly citied publications. The best proof of continuous rais-

ing interest in the ﬁeld of neuroscience in Serbia over

the years is the fact that currently approximately 15% of

all researchers in the ﬁeld of Biology, Biomedicine and

Medicine are actually in the ﬁeld of neuroscience. Fur-

thermore, up to date faculty programs in Neuroscience

have been introduced and students' neuroscience sec-

tion under auspices of Serbian Neuroscience Society,

has gathered both undergraduate and postgraduate stu-

dents of medicine, biology, philosophy, defectology and

many other around the idea on the multidisciplinary

approach to neuroscience.At the same time, a lot has

been done on increasing awareness of the general public

about the importance of neuroscience research in Serbia

and on promotion and visibility of Serbian researchers

and their results. In this line, attempts have been made in

establishing cooperation both within European Research

area and with other international scientiﬁc institutions.

It is clear that strategy for neuroscience in Serbia exists

and that, despite all diﬃculties, there are people who are

eager to prolong the long tradition of neuroscience in

Serbia.

Neuroscience has a long tradition in Serbia since the be-

ginning of the 20th century. Nowadays 16% of researchers

in biology and medicine area, and 3-4% of total 13 760 re-

searchers in Serbia, are in neuroscience. We are going to

mention the greatest neurologists and neuroscientists,

who deserved with their lifetime achievement that some

hospitals, institutes, and even streets bear their name.

Laza K. Lazarevi (1851–1891) was a Serbian doctor, writer

and warrior. After completing his law studies in Belgrade

in 1871 he made his way to Berlin and graduated from the

Faculty of Medicine in Berlin and received his doctor's

degree in 1879 at the same Faculty. He participated as a

ﬁeld doctor in the Serbo-Turkish War in 1876 and 1878,

as well as in Serbo-Bulgarian War in 1885. During the

Serbo-Bulgarian War (1885) he was given the rank of ac-

tive medical colonel and was appointed as an assistant

chief of the Supreme Command of Health Care with

the task to establish the Great reserve military hospital

in Niš. After graduating he was appointed as the Head

of the Internal Department of the General State Hospi-

tal. LazaLazarevi 's contribution to Serbian medicine is

enormous: he was the founder of laboratory diagnostics

in Serbian medicine and he established the ﬁrst modern

geriatric hospital this part of Europe. During his short

professional carrier he managed to publish as many as

78 papers and observations, a great number of which re-

fers to the disease of the nervous system. He published

the ﬁrst description of the Parkinson`s disease in this

region, and scientiﬁc papers about sclerosis of medulla

spinalis, aphasia, muscular dystrophy, brain tumors and

arsenic in treatment of chorea. The best known contribu-

tion of Laza K. Lazarevi was his paper published in Ser-

bian Archives in 1880 where he described a sign that is

today called after him - the "Lazarevi sign".Therefore, it

can be rightly said that Dr. Laza K. Lazarevi was the ﬁrst

Serbian neurologist. Laza K. Lazarevi is considered to be

the progenitor of Serbian realistic psychological story. He

published nine stories and in 1888 became a member of

the Serbian Royal Academy. Clinic for psychiatric disease

in Belgrade is named upon Laza K. Lazarevic.

Richard Burian (1871, Vienna-1954) founded the Institute

of Physiology and Histolog y in Belgrade in 1927. Although

he came to Yugoslavia at the invitation of the School of

Medicine in Ljubljana (today Slovenia), and though a full

Professor of diﬀerent disciplines at Vienna, Innsbruck,

Hannover and Leipzig, it was not until 1920 that he was

made, at the insistence of Professor Milan Jovanovic-

Batut, a full Professor of Physiology at the newly found-

ed School of Medicine in Belgrade. During the winter of

1922/1923, at the School of Medicine in Belgrade, Richard

Burian started with his lectures in German. However, af-

ter two years, he gave all his lectures in the Serbian lan-

guage.

Between 1923 and 1934 he was Dean and Vice Dean of the

Faculty of Medicine. He also campaigned for the estab-

lishment of the Faculty of Veterinary Medicine (1936) and

Faculty of Pharmacy (1939). The personality of Richard

Burian, together with his reputation in science, and au-

thority as a professor, attracted numerous associates not

only at the Institute of Physiology in Belgrade, but also

with other Professors of Physiology within Belgrade (the

School of Veterinary Medicine, the School of Pharmacy

and the School of Agriculture). He also collaborated well

with other schools of medicine in former Yugoslavia: Pro-

fessors MilutinNeskovic, IlijaDjuricic and BozidarNikolic

in Belgrade, AleksandarSabovljev in Sarajevo, Radmilo-

Anastasijevic in Novi Sad, and Aleksandra Volkanoska in

Skopje.

In the ﬁrst few years, within the Institute of Physiology

(today – the Institute of Medical Physiology), scientiﬁc

research was progressing in several departments. These

included Physico-Chemistry, Chemical Physiology, Micro-

chemistry, Electrophysiology (which contained facilities

for photographic recording), graphics working with the

operating theatres.

The focus of his experimental work were: metabolism

of purines, methodology for the study of the nerves and

muscles of mollusks, contraction of injured muscles,

function of neuromuscular synapses, function of biologi-

cal membranes and physiology of swallowing.

Professor Richard Burian was a recipient of several

medals and honors: the Order of the Romanian Crown of

3rd class (in 1931), the Order of Saint Sava of 2nd class (in

1934) and the Order of the Yugoslav Crown of 2nd class (in

1936). In memory and respect of the founder and ﬁrst di-

rector, the Institute of Medical Physiology of the School of

Medicine bears his name. At the suggestion of the School

of Medicine in Belgrade, one street in Belgrade bears the

name of the physiologist Professor Richard Burian.

LjubodragMihailovic (1926-1974) was one of the greatest

Rasulic L

researchers in the area of neurophysiology and neuro-

pathophysiology in the middle of the 20th century and

he published 120 articles during 20 years of active re-

search. The ﬁrst group of articles were related to the bio-

physical an biochemical properties of neurons and their

membrane. He was the ﬁrst scientist in Yugoslavia that

registered electrical phenomena in the neurons by intra-

cellularly placed electrodes. This method allowed him to

conﬁrm that sodium inﬂux is responsible for the genesis

of action potential in leech Retzius cells, and that oxida-

tive metabolism is required for the maintenance of low

resistance between electrotonically coupled cells.

LjubodragMihailovic was the ﬁrst scientist in Yugosla-

via that used molecular techniques in the investigation

of the physiological processes in the brain and pathogen-

esis of neurologic disorders. He with his collaborators

determined RNA quantity in inferior temporal gyrus and

frontal cortex of monkeys that learned visual discrimi-

nation test. Since RNA codes the protein synthesis, he

continued with determination of the role of proteins in

learning and changes in protein levels after electroshock.

These studies found that the amount of acidic proteins

was increased in combination with RNA in inferior tem-

poral gyrus in monkeys that performed visual discrimi-

nation test, and decreased after electroshock during

period of amnesia. This contributed signiﬁcantly to the

understanding of the cellular mechanisms of learning.

The special area of research of LjubodragMihailovic was

the investigation of pathogenetic mechanisms of sei-

zures and epilepsy. A great part of his carrier was devoted

to the investigation of electrical activity of neocortical, al-

locortical and subcortical structures in seizures induced

by electroshocks, and to the mechanisms of neuronal

synchronization in focal seizures with secondary general-

ization. In various experimental models in cats and mon-

keys he studied the eﬀects of anticonvulsive drugs. Ljubo-

dragMihailovic introduced immunoneurophysiological

approach in the research of immunological phenomena

in experimental allergic encephalomyelitis, as well as of

the role of various macromolecules in the learning and

memory consolidation.Through the power of his person-

ality and his personal involvement he established and

developed conditions for research, formed scientiﬁc staﬀ

in the ﬁeld of pathophysiology, neurophysiology and es-

pecially neuropathophysiology at the Institute of Patho-

physiology, Faculty of Medicine in Belgrade, which in his

honor carries the name of LjubodragBubaMihailovi .

The founder of physiology studies in the Balkans and

the pioneer of research on hypothermia, Ivan Djajawas

born 1884 in L'Havre. Djaja gained his PhD at the Sor-

bonne in 1909. In 1910 he established the ﬁrst Chair of

Physiology in the Balkans and organized the ﬁrst Serbian

Institute for Physiology at the School of Philosophy of the

University of Belgrade. His most notable papers were in

the ﬁeld of thermoregulation and bioenergetics. Djaja

became member of the Serbian and Croatian academies

of science and doctor honoriscausa of Sorbonne. In 1952

for the seminal work on the behavior of deep cooled

warm blooded animals he became associate member of

the National Medical Academy in Paris. In 1955 the French

Academy of Sciences elected him as associate member

in place of deceased Sir Alexander Fleming. Djaja died

in 1957 during a congress held in his honor. He left more

than 200 scientiﬁc and other papers and the golden Da-

Vincian credo "Nulla dies sine experimento".

Radoslav K. Andjus (1926-2003) was a professor of physi-

ology and biophysics at the University of Belgrade, Ser-

bia, from 1953 to 1992. He published over 190 papers in do-

mestic and international journals and three textbooks.

The main ﬁeld of his research was thermophysiology. He

studied hypothermia, suspended animation and resusci-

tation, hibernation and biological rhythms, temperature

adaptation and acclimation, and cryoprotection. Ra-

doslavAndjus also contributed signiﬁcantly to the ﬁelds

of brain metabolism, electroretinography, as well as bio-

physical modeling and theoretical biology.

Professor Levi M. Zvonimir (1936 – 2009) was the domi-

nant personality of the Yugoslav neurology from the ear-

ly 80s until his retirement in 2001.

He becomes director of the Neurological Clinic in 1984,

soon after the separation of neurology and psychiatry

from formerly joint discipline neuropsychiatry. In the

coming years neurology was rapidly developing and

modern methods of examination of neurological diseas-

es were introduced. Large number of young talented doc-

tors was employed and close contacts were made with

great neurological centers such as the Karolinska Insti-

tute in Stockholm, Hospital for Neurology Queen Square

London, New York Columbia University, Baylor College

of Medicine Houston and numerous European clinics.

Under leadership of Prof. Levic, scientiﬁc-research teams

were quickly achieve an international reputation (team

for demyelinating diseases, epilepsy, extrapyramidal and

involuntary disorders, neuromuscular diseases and neu-

ropsychology).

Prof. Levic participated in the founding and develop-

ment of the subject of neurology at the Medical Faculty

in Kragujevac, founded and conducted classes in sub-spe-

cialization in Clinical Neurophysiology with epileptolo-

gy. As head of the Department of Neuropsychiatry (1990)

and later Neurology (1991) participated in the creation of

programs and teaching all forms of undergraduate and

postgraduate studies in neurology. Through his books,

articles, lectures and mentoring, signiﬁcantly inﬂuenced

the development of neurology as independent discipline

and profession in our country.

Main ﬁeld of interest of Professor Levic particularly

were problems of multiple sclerosis and epilepsy. He has

participated and led several international and national

research projects. He was a member of 11 scientiﬁc com-

mittees and boards of various societies worldwide. Pro-

fessor Levic published 350 scientiﬁc and research papers,

of which 108 in international journals (42 in extenso and

66 abstracts). He was a visiting lecturer at the Universi-

Rasulic L

ties of Innsbruck, Salzburg, Vienna, Szczecin, Rostock,

Moscow and Houston. Awarded by the Serbian Medical

Society Award for Lifetime Achievement in 1997.

Professor ZvonimirLevi was a great teacher who led and

educated many generations of neurologists. His students

have been highly appreciated by his intuition, experi-

ence, rationalism and thoughtful attitude in performing

clinical ﬁndings and diagnosis. His patients were grate-

ful for his expertise unpainted number of times.

Professor Levi was a great gentleman of Serbian and

Yugoslav neurology who paved the way for modern Ser-

bian neurology 21st century.

On the heritage of these famous neuroscientists, a large

number of members of Serbian Academy of Science and

Art were or are actually devoted to neuroscience with

great success. Among them were/are BogomirMrsulja

(1940-1994), BogdanDjuricic (1950-2008), LjubisaRakic,

VeselinkaSusic, Vladimir Kostic.

This paper was prepared by the members of the Labo-

ratory for Neurophysiology, Institute of Medical Physiol-

ogy “Richard Burian“, Faculty of Medicine, University of

Belgrade: OliveraStanojlovic, Aleksandra Rasic-Markovic,

DraganHrncic, DusanMladenovic, BojanaPetrovic.

14.2. Neurosurgery in Serbia

The beginnings of neurosurgery in Serbia reach back to

the year 1914, when Professor MilivojeKosti performed a

series of neurosurgical procedures mainly on the periph-

eral nervous system and in the extradural space. The pe-

riod is considered a heroic era of neurosurgery, since this

discipline was in its infancy all over the world. It was in

1923 when he had performed the ﬁrst surgical treatment

of a pituitary tumor, using transsphenoidal approach.

Only 13 years after 1910, when the ﬁrst cranial x-ray was

made, MilivojeKosti began to pursue nervous system

surgery. Since he operated in aseptic conditions, he freely

opened the skull and entered the intradural space.

Since he worked in the Military Hospital in Sarajevo dur-

ing the First World War, he was experienced in treatment

of the nervous system trauma.

He noticed the diﬀerence between contaminated and

infected wounds and realized that the infected wounds

could be successfully closed by a primary suture. This fact

was considered to be a fundamental contribution by Har-

vey Cushing to neurological science of this time, since

Cushing, contrary to MilivojeKosti published this obser-

vation in the British Journal of Surgery (1918).

In the year 1940 Slobodan Kosti , Milivoje’s younger

brother implemented new diagnostic technique, x-ray

imaging of air in the ventricular system, ventriculogra-

phy to improve localization of the intracranial lesion. At

that time, even at the best neurological clinics brain tu-

mors could not be precisely localized in more than 50% of

the cases. However, ventriculography introduced by Slo-

bodan Kosti in 1940 could indicate the site of the lesion

precisely in 80% of the cases.

Only eight years after the sensational report by Egaz

Moniz for Almeide Lima in 1931 at the Congress of Neurol-

ogy in Bern, Slobodan Kosti introduced cerebral angiog-

raphy in Belgrade.

On October 31st 1938 MilivojeKosti opened a Depart-

ment of Neurosurgery within The First University Surgi-

cal Hospital in Belgrade, which was the ﬁrst of its kind in

Yugoslavia, and only three years after the ﬁrst neurosur-

gical department had been opened in Germany, in Wurz-

burg.

During the war, both Milivoje and Slobodan Kosti

worked as surgeons in the Military Hospital, and they

both supervised surgical management of craniocerebral

injuries. In the course of the war, waste experience was

gained in management of penetrating and non-pene-

trating cerebral injuries. After the war, owning to great

eﬀorts of Professor Slobodan Kosti , in 1951 when a reor-

ganization of surgical clinic took place, the Neurosurgi-

cal clinic was opened as an independent institution both

in the organizational, ﬁnancial and professional aspects.

At the beginning of 1960 the ﬁrst stereotaxic thala-

mothomy was performed in Belgrade and Yugoslavia.

Functional neurosurgery has been developing ever since

and found its rightful place at the Neurosurgical Clinic.

Neurosurgical treatment of congenital anomalies,

hydrocephalus above all, has always been one of the

problems the Neurosurgical Clinic had to deal with in-

tensively. In early sixties, the ﬁrst surgical treatment of

hydrocephalus was performed implanting the shunt and

one-way valve. Pediatric neurosurgery has also always

been one of important segments of neurosurgery in Bel-

grade, which has led to opening of the Department of Pe-

diatric Neurosurgery which is the only one in the country

even nowadays.

The Clinic for Neurosurgery at Clinical Center of Serbia

is one of the largest European institutions of its kind. The

department has 160 patient beds. There are over 4000

admissions to the Neurosurgical Service each year, 3500

surgeries, and 15 000 emergency or outpatient consul-

tations. There is a strong emphasis on undergraduate

and postgraduate teaching as well as clinical research.

Despite economical problems and the huge sociopoliti-

cal changes that have devastated Serbia during the last 3

decades, the department keeps growing with an optimis-

tic outlook thanks to the joint eﬀorts made daily by each

member of the team.

Clinic for Neurosurgery in Belgrade is a highly special-

ized health, scientiﬁc and educational institution which

is a part of the Faculty of Medicine, University of Belgrade

and also a referral center for all neurosurgical centers in

Serbia, especially for peripheral nerve and brachial plex-

us surgery within the region.

The Clinic for neurosurgery is organized into sections,

each one dealing with clinical investigations and surgi-

cal management of patients as well as postoperative

treatment and referral to the ancillary services needed to

establish ﬁnal diagnosis, such as neuroradiology, neur-

oophthalmology, and biochemistry. The Neurooncologi-

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cal Center is the largest one in Serbia, treating primary

and metastatic brain and spinal tumors with about 700

procedures each year. Treatment protocols include com-

binations of surgery, radiosurgery, traditional brain irra-

diation, adjunctive interventional neuroradiology, and

systemic chemotherapy. Motor mapping under general

anesthesia is routinely used for tumors in eloquent loca-

tions. In October 2012, the Clinic for Neurosurgery added

a new instrument in managing skull base pathology by

performing >50 transnasaltranssphenoidal endoscopic

operations, thanks to the experience acquired in Naples,

Italy, by one of the younger specialists at the Neurosur-

gical Clinic. This new technique is an additional way to

manage skull base pathologies besides the already ex-

cellent microsurgical transsphenoidal and transcranial

approach. The Cerebrovascular Surgery Service plays an

important role within the Neurosurgical Clinic, special-

izing in complex cerebral aneurysms, arteriovenous mal-

formations and carotid artery surgery with>350 cases

per year. The Functional Neurosurgery Program focuses

on epilepsy surgery, treatment of pain and spasticity and

peripheral nerve surgery. In 2012, >50 epilepsy surgeries

were performed. Since March 2012, 10 operations of vagus

nerve stimulation for the treatment for epilepsy have also

been performed. Pediatric neurosurgical diseases are an

important segment of the Clinic’s activities. They are han-

dled by a special Service of Pediatric Neurosurgery with

16 beds where pediatric patients are cared for by a team of

neurosurgeons and pediatric nurses, with the additional

presence of a full-time pediatrician for routine consul-

tation. The program specializes in epilepsy surgery and

the treatment of brain and spinal tumors, craniofacial

anomalies, spinal dysraphismand hydrocephalus. The

Spinal Disorders Program specializes in the treatment of

degenerative and traumatic spinal disorders involving a

multidisciplinary approach to treating patients with spi-

nal diseases. The Department of Neurosurgery has a Level

I Trauma Center, which receives>15 000 visits per year.

There are 6 professors, 3 associate professors and 4 as-

sistant professors from the School of Medicine of the Uni-

versity of Belgrade permanently employed at the Clinic.

They actively take part in the practical and theoretical

realization of the educational program of the School of

Medicine and Clinic for Neurosurgery. Besides university

lecturers, all other neurosurgeons also take part in teach-

ing postgraduates and residents in neurosurgery

Clinic for Neurosurgery is particularly active in post-

graduate education of health care workers. Residents

in neurosurgery come from all parts of the country and

abroad. The Clinic maintains a permanent professional

collaboration with many international neurosurgical

centers where our doctors occasionally go for additional

training. Always keeping in mind the importance of per-

sonal communications among the neurosurgeons, the

Clinic for Neurosurgery has a tradition of inviting the

best known world neurosurgeons to be the guests of the

Clinic in Belgrade and exchange their experience.

The Serbian Neurosurgical Society (SNS) was estab-

lished in 2006 in Belgrade after Montenegro indepen-

dence. After Novi Sad and Niš it is permanently situated

in Belgrade, Clinic for neurosurgery, Clinical Centre of

Serbia. It is a member of EANS and WFNS. Currently there

are 72 active members - neurosurgeons of this Society,

and 28 residents and clinical doctors within the Serbian

Neurosurgical Society.

On October 31st, 2013 there was a celebration of 90th

Anniversary of Neurosurgery in Serbia and 75th Anni-

versary of Clinic for Neurosurgery in Belgrade. On that

occasion Republic of Serbia and Serbian Neurosurgical

Society was host of the The First Congress of Southeast

European Neurosurgical Society, which was inaugurated

as regional neurosurgical society. The Congress was held

on October 31st-November 2nd2013, in Belgrade, where

31 scientiﬁc sessions in which 257 presentations (127 pre-

sentations delivered by 113 of 117 invited faculty speakers

from 32 countries, 62 oral presentation papers and 68 e-

posters) have been held. Additionally, with the number of

Congress attendees 317, accompanying persons, and ex-

hibitors both medical 30 and nonmedical 70, total num-

ber of the Belgrade 1st SEENS Congress participants was

ﬁnally 540, which made us proud and honored (29-39).

15. Neuroscience and Neurosurgery in

Turkey

Modern surgery in Turkey started at military hospitals at

the end of the 19th century in the Ottoman Empire; only

limited procedures in neurosurgery were performed by

general surgeons at the time. CemilTopuzluhadan impor-

tant role in establishing modern surgery in the Ottoman

Empire.Topuzlu presented the neurosurgical drainage of

a brain abscess at the French Surgery Society meeting in

1894 and subsequently published this report in a French

surgical journal.

After formation of the new Turkish Republic in 1923,

the ﬁrst neurosurgical clinic was established by Ab-

dulkadirCahit Tuner. Tuner was originally a neuropsy-

chiatrist, but he was trained in neurosurgery by Förster

in Breslau, Germany, and on returning to Istanbul he

performed the ﬁrst laminectomy for a spinal tumor in

Turkey and craniotomies for brain tumors and neurosur-

gical treatment for trigeminal neuralgia.

The ﬁrst Turkish surgeon to train in neurosurgery was

HamiDilek. Dilek trained in France under Clovis Vincent,

Thierry de Martel, and Guillaume. Dilek played an impor-

tant role in establishing modern neurosurgery in Turkey.

The ﬁrst training program started in 1940, and Cemil

Serif Baydur wrote the ﬁrst neurosurgical textbook in

Turkey. With the inﬂuence of HamiDilek, the bylaws for

specialty training in medicine were accepted in 1947, and

neurosurgery became an oﬃcial discipline. The ﬁrst neu-

rosurgical journal was published by CaferTayyarKankat.

Mustafa Sakarya trained with Walter Dandy. Feyyaz-

Berkay was trained in the United States and became the

ﬁrst board-certiﬁed Turkish neurosurgeon; on returning

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to his home country, he established an independent neu-

rosurgery clinic at Istanbul University.

In the early 1950s, the ﬁrst neurosurgery clinics were

located in Istanbul. After the establishment of neurosur-

gery clinics in Istanbul, modern neurosurgery programs

were started in Ankara by Nurhan Avman and Aykut Er-

bengi. These two neurosurgeons were trained in Boston

under Poppen. In Turkey, Nurhan Avman established

the neurosurgery department at Ankara University, and

AykutErbengi established the neurosurgery department

at Hacettepe University. During the establishment of the

neurosurgery department at Hacettepe University, Pool,

Sachs, and Wilson served in Ankara and contributed to

the growth of the department. In 1967, ErdemTunçbay

established the neurosurgery department at Ege Univer-

sity in Izmir. In the late1960s, these three departments

brought renewed energy to Turkish neurosurgery.

After the 1980s, international ties and collaborations

increased signiﬁcantly. Increased numbers of neuro-

surgeons visited and were trained at international cen-

ters, and many world-renowned neurosurgeons came

to Turkey to share their experience. Scientiﬁc research

also increased rapidly, and Turkish neurosurgeons had

signiﬁcant roles in the international collaboration for

the advancement of neurosurgery. At the present time,

all modern neurosurgical procedures are performed in

Turkey at 53 university hospitals, 67 governmental teach-

ing hospitals, 202 governmental general hospitals, and

private institutions.

There are two neurosurgical societies in Turkey. The

Turkish Neurosurgical Society was founded in 1985; it has

961 members and is based in Ankara. It organizes annual

scientiﬁc meetings and publishes and distributes the

Turkish Neurosurgical Journal in Turkish and in English.

The Turkish Neurosurgical Society has 24 regulatory com-

mittees and 8 teaching groups (pediatric neurosurgery,

spinal and peripheral nerve surgery, neuro-oncology,

stereotactic and functional neurosurgery, neurovascular

surgery, neurotrauma and neurologic intensive care, sur-

gical neuroanatomy, and education of trainers).

The Nervous System Surgery Society was founded in

2005 in Istanbul with an aim to increase the quality of

neurosurgery. The Nervous System Surgery Society has

109 members, organizes annual scientiﬁc meetings, and

publishes and distributes the Journal of Nervous System

Surgery in Turkish and in English.

Neurosurgery is a well-established medical specialty in

Turkey that closely follows as well as leads technical and

scientiﬁc advances of global neurosurgery. The main aim

in Turkey is to increase quality and ensure standardiza-

tion of patient care and residency training (40).

16. Founding of South East European

Neurosurgical Society (SeENS) and

International Neuroscience Journal (INJ)

As with all initiatives, the South East European Neuro-

surgical Society (SeENS) began as an Idea - an idea thor-

oughly engulfed in the pillars of knowledge, sharing,

support and advancement through borderless collabora-

tion. It is based in the basic human thirst for knowledge

and betterment of oneself, as well as his/hers surround-

ings. In short, SeENS is all about the people it brings to-

gether.

Having all this in mind, and given the fact that we come

from the Balkans (a rather turbulent area to live and work

in, even in the best of times) we rather soon realized the

importance of teamwork, support and sharing. For with-

out any one of these three, chances are you won't make it

in this place - and this is no understatement.

With all the ingredients needed for the Idea's growth

and development, such as clear guidelines, common

goals and good professional climate, the SeENS slowly

but surely started to surface in the real world. The South

East European Neurosurgical Society began taking shape,

and as it did so, so was our mission clearer to all partici-

pating parties...and there is a number of them, as will be

outlined in more detail soon.

The South East European Neurosurgical Society become

a professional society, a sort of guild, dedicated to the bet-

terment of all things related to Neurosurgery as a whole.

The region of it's inﬂuence, as the name clearly states,

is that of South East Europe. The Society has to provide

support to all neurosurgeons and help them advance in

their craft. By doing so, it does not only inﬂuence their

individual lives, but the region as well - with more educat-

ed, trained and adapted neurosurgeons, faster and more

reliable operations, better recovery rates, more success

stories are more realistic in obtaining...the possibilities

are endless!

Southeast Europe Neurosurgical Society (SeENS) is cur-

rently in the process of registration as an aﬃliated re-

gional society member of the World Federation of Neu-

rosurgical Societies (WFNS) with the oﬃcial continental

recommendation of European Association of Neurologi-

cal Societies (EANS) like an oﬃcially aﬃliated regional

society member of EANS.

European Association of Neurosurgical Society (EANS

17. Southeast Europe Neurosurgical Society

(SeENS) - Driving Principles Behind the Idea

After SeENS has been founded and legally accepted into

the neurosurgical society worldwide, it is important as

ever to promote, endorse and fulﬁll the founding prin-

ciples on top which the society was built - sharing knowl-

edge, organizing workshops and master classes, building

professional networks and training centers are just some

of the cornerstones that constitute the building blocks of

SeENS.

Through this realization, the SeENS came to be – its main

objective is to create a place of learning, support and ad-

vancement for all our colleagues on the region of South-

East Europe. We feel that in these turbulent times it is our

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responsibility and duty to stand together and provide a

sanctum of knowledge for all those that seek it.

Being part of SeENS is all about responsibility – no lon-

ger does one represent his personal beliefs but also those

of his peers, his friends, his colleagues; personal integrity

- one must take a stance and be prepared to stand behind

his/hers words; teamwork - we do work for all neurosur-

geons that have given us their trust.

And it is with this mission and vision that we continue

to improve SeENS every day. For with an open mind (com-

ing from a neurosurgeon, this expensive can speak vol-

umes) and heart it is that we put our labors and eﬀorts

into SeENS, all towards creating a better environment for

neurosurgery as an art and craft, not only in South East

part of Europe but the world as a whole.

Putting our strengths and weaknesses together, we are

able to achieve unity as it was never before imagined. The

times we live in are challenging and turbulent so it is our

duty, and our privilege, to create a better perspective for

neurosurgery and the many patients that are in need of

us.

The ﬁrst SeENS Congress was held on October 31st-No-

vember 2nd 2013, in Belgrade, where 31 scientiﬁc sessions

in which 257 presentations (127 presentations delivered

by 113 of 117 invited faculty speakers from 32 countries,

62 oral presentation papers and 68 e-posters) have been

held. Additionally, with the number of Congress attend-

ees 317, accompanying persons, and exhibitors both med-

ical 30 and nonmedical 70, total number of the Belgrade

1st SEENS Congress participants was ﬁnally 540, which

made us proud and honored.

The second SeENS Congress is to be held on October

22nd-25th 2015 in Sarajevo, Bosnia and Herzegovina.

Southeast Europe Neurosurgical Society (SeENS) ap-

peared almost simultaneously with the idea of the Inter-

national Neuroscience Journal (INJ) (39). Among all other

regions, this coincidence to have regional section in such

distinguished international, i.e., global scientiﬁc journal

is of outmost importance for Southeast Europe neurosci-

ence and neurosurgery. This fact will strongly contribute

to interactive strengthening between basic neuroscien-

cies and neurosurgery in Southeast Europe with mutual

major goal to improve quality of lives of all people, espe-

cially patients.

18. Final Remarks

Since the beginning of my career, I had the luck and priv-

ilege to meet many like-minded people that soon became

my teachers and, as the years passed us by, have grown

into people I fondly call friends. Our mutual friendship

is one based on professional interest, similar goals and

hunger for knowledge - and, as a team, we slowly but

steadily managed to gather all of these. Of course, as the

saying goes, the more we've been learning the clearer the

lacks and gaps in our knowledge...but it was much easier

to point them out to each other and even easier to patch

them with the techniques and experience we were miss-

ing. And this goes on until this day.

In my opinion The International Neuroscience Journal

is unique and outstanding opportunity which will inte-

grate together all renomed people worldwide who de-

voted their lives to take care about the progress expand-

ing their knowledge in neurosciences and neurosurgery

to make a lasting impression to the world of tomorrow...

today. My congratulations, honor and respect to Profes-

sor MadjidSamii, whose energy is spiritusmovens for

constant activities and eﬀorts which are leading to bet-

ter tomorrow. I am more than convinced that The Inter-

national Neuroscience Journal will be a state of the art

in neuroscience and neurosurgery scientiﬁc sky giving

possibility to all, especially young neuroscientists for

their future development and achievements considering

scientiﬁc, educational, professional, academic and social

networking, highlightened by multicultural identity, fo-

cus, and culture of all. All above mentioned is of outmost

importance, particularly for Southeast Europe.

Acknowledgements

I would kindly like to express my deepest gratitude and

respect to the Members of the Editorial Board of the In-

ternational Neuroscience Journal Section Southeast Eu-

rope and distinguished colleagues for helping me creat-

ing this Editorial with their active participation.

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UniversitätsSpital Zürich: 80 years of neurosurgical patient care in Switzerland

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ACTA NEUROCHIR

Background The predecessor of today’s Department of Neurosurgery, UniversitätsSpital Zürich (USZ), was founded 80 years ago as the first independent Swiss clinic dedicated to neurosurgical patient care. On the occasion of this anniversary, we aimed to highlight the history of neurosurgery as a specialty at the USZ, and to put it into the historical context of Swiss and European Neurosurgery. MethodA literature review was conducted and we searched the archives of the USZ and the city of Zurich, as well as those of Swiss journals to extract relevant published articles, books, historical reports and pictures. The USZ Department of Medical History, the Museum of Medical History and the Swiss National Library were contacted to provide source material. To further verify the content, (emeritus) faculty from the USZ and external experts on the history of Swiss neurosurgery reviewed the manuscript. ResultsSurgeries of the head and spine had occasionally been conducted in Zurich by the general surgeons, Rudolf Ulrich Krönlein and Paul Clairmont, before an independent neurosurgical clinic was founded by Hugo Krayenbühl on 6 July 1937. This was the first Swiss department dedicated to neurosurgical patient care. Besides providing high-quality medicine for both the local and wider population, the department was chaired by eminent leaders of neurosurgery, who influenced the scientific and clinical neurosurgery of their time. As such, it has long been regarded as one of the top teaching and research hospitals in Switzerland and in Europe. Conclusions On the occasion of its 80th anniversary, we have performed an in-depth review of its development, successes and challenges, with a special focus on the early decades. Reflecting on the past, we have identified common denominators of success in neurosurgery that remain valid today.

A brief retrospective of the history of neurosurgery in Croatia

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The beginnings of neurosurgery in Croatia date to the end of the 19th century when Teodor Wickerhauser performed the first craniotomy in the country in 1886. Exactly 60 years later, in 1946, Danko Riessner founded a separate neurosurgical ward in Zagreb and is therefore considered the founder of Croatian neurosurgery. His main scientific contribution was a paper on the shifting of brain masses, published in 1939. The Department of Neurosurgery at the University of Zagreb was founded in 1974 as one of the first institutions of its kind in Southeast Europe. Finally, the Croatian Neurosurgical Society was founded in 1992 to promote the neurosurgical profession and science at the national level. This historical vignette aimed to provide a brief chronology of the most important events and notable people in the history of Croatian neurosurgery, as well as to commemorate its founders and highlight its development from the beginning to its current state of proficiency and expertise.

The Concept and Current State of Neurosurgery in Southeast Europe

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Lukas Rasulic

The term "Southeast Europe" was introduced by Austrian researcher Johann Georg von Hahn in the 19th century as a broader termthan the traditional "Balkans," designating the region settled by several different nations, mostly alike, but also richly diverse. The mostappropriate definition describes the inhabitants as the people geographically, demographically, and culture related to SoutheasternEurope (1).Contemporary neurosurgery in the Southeast Europe region has recently witnessed remarkable progress, guided by the "Think globally,act locally" concept as an essential driving force. This slogan has long been in use in environmental contexts and has been gainingincreased significance in various disciplines over the past decades. In international education, this slogan was first introduced in 1950and popularized by Stuart Grauer in 1989 (2). Neurosurgeons in Southeast Europe genuinely implement the concept of thinking globallyand acting locally, working together to expand the horizons to the benefit of our patients and our well-being and recognition in themodern world. This mini review aims to highlight the development and progress of the Southeast Europe neurosurgical society (SeENS)as a regional neurosurgical society dedicated to neurosurgical education, research, capacity building, and exchanging experienceswithin the Southeast region of Europe.

Professor Bajram Preza (1923-2007), a leading academic figure in the Albanian medicine

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Sci Progr

Professor Bajram Preza was a career neurologist with a strong background in research both in neurology and psychiatry. After a period of study in Sarajevo in the immediate post-WWII period, he completed his studies in medicine and a fellowship in neuropsychiatry in Nizhny Novgorod (formerly Gorky). A highly prolific author, he holds the laurels of the first medical dissertation sustained in the University of Tirana (1958) as well as for publishing the first student's textbook on medicine (Semiotics of nervous diseases, 1964) in Albania. He led the Clinic of Neurology in Tirana for more than three decades, while relentlessly lecturing, publishing and editing a diversity of medical papers, translations and original works that have shaped the professional education of entire generations of future Albanian physicians.

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Feb 2022
J Neurosurg Sci

Background: The expanding field of global neurosurgery calls for a committed neurosurgical community to advocate for universal access to timely, safe, and affordable neurosurgical care for everyone, everywhere. This study aims to (i) assess the current state of global neurosurgery activity amongst European neurosurgeons and (ii) identify barriers to involvement in global neurosurgery initiatives. Methods: Cross-sectional study through dissemination of a web-based survey, from September 2019 to January 2020, to collect data from European neurosurgeons at various career stages. Descriptive analysis was conducted on respondent data. Results: Three hundred and ten neurosurgeons from 40 European countries responded. 53.5% regularly follow global neurosurgery developments. 29.4% had travelled abroad with a global neurosurgery collaborative, with 23.2% planning a future trip. Respondents from high income European countries predominantly travelled to Africa (41.6%) or Asia (34.4%), whereas, respondents from middle income European countries frequently traversed Europe (63.2%) and North America (47.4). Cost implications (66.5%) were the most common barrier to global neurosurgery activity, followed by interference with current practice (45.8%), family duties (35.2%), difficulties obtaining humanitarian leave (27.7%) and lack of international partners (27.4%). 86.8% would incorporate a global neurosurgery period within training programmes. Conclusions: European neurosurgeons are interested in engaging in global neurosurgery partnerships, and several sustainable programmes focused on local capacity building, education and research have been established over the last decade. However, individual and system barriers to engagement persist. We provide insight into these to allow development of tailored mechanisms to overcome such barriers, enabling European neurosurgeons to advocate for the Global Surgery 2030 goals.

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Spyridon Magginas was among the Greek doctors of the turn of the century who trained abroad with the hope of returning to their native country to offer their services. He became a professor in the “Othonion University” of Athens to promote surgery among young physicians. He was raised in an upper social class family and, reportedly, had an arrogant behaviour, which occasionally led him to have ineffective patient interactions. His patient, and an important Greek writer, Emmanuel Rhoides, nicknamed him the “surgeon beast” for neglecting his case. However, Magginas was an innovative surgeon and in 1902, completed the first successful radical nephrectomy in Greece, and possibly one of the first few globally of the 20th century. A key factor in his success was the prioritisation and application of strict antisepsis.

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The modern period of neurosurgery in Bosnia and Herzegovina began with the first neurosurgical procedure performed by Dr. Karl Bayer in 1891 on 3 patients with depressed skull fractures and epilepsy. In 1956 the Department of Surgery in Sarajevo designated several beds specifically for a neurosurgical unit. A significant milestone in the history of neurosurgery in Bosnia and Herzegovina was the establishment of the Division of Neurosurgery at the Clinical Center University of Sarajevo in 1970. The first neurosurgeon to complete his training in Bosnia and Herzegovina was Dr. Faruk Konjhodžić. The first female neurosurgeon was Dr. Nermina Iblizović. Presently, there are 7 neurosurgical departments in the country, located in Sarajevo, Tuzla, Zenica, Mostar, Banja Luka, Bihać, and Foča. The Association of Neurosurgeons in Bosnia and Herzegovina, founded in 2003, is a member of the European Association of Neurosurgical Societies and the World Federation of Neurosurgical Societies. The aim of this historical paper is to provide a concise chronology of important events and mention key individuals who have contributed to the development of modern neurosurgery in Bosnia and Herzegovina.

XXVI SPECIAL ISSUE e-supplement final

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Oct 2020

One Novel and One Recurrent Mutation in IGHMBP2 Gene, Causing Severe Spinal Muscular Atrophy Respiratory Distress 1 With Onset Soon After Birth

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Feb 2013

A family with 2 siblings with severe spinal muscular atrophy with respiratory distress 1 (SMARD1) was genetically proved to be caused by mutations in IGHMBP2 gene. Both patients developed progressive muscular weakness and respiratory distress and died before 6 months of age. One novel deletion, c.780delG;p.(Gln260Hisfs*24), inherited from the father and a nonsense mutation, c.1488C>A;p.(Cys496*), inherited from the mother were detected. An attempt was made to correlate the genetic-clinical data available in the literature. The clinical case presented in this study might be considered as the most severe form of spinal muscular atrophy respiratory distress 1 reported so far, presumably because of the total absence of IGHMBP2 enzyme activity.

Neurological Symptoms, Genotype-Phenotype Correlations and Ethnic-specific Differences in Bulgarian Patients With Wilson Disease

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Jul 2012
NEUROLOGIST

The aim of our study was to characterize the neurological symptoms in Bulgarian patients with Wilson disease (WD), to investigate genotype-phenotype correlations, and to test whether there are differences in phenotype between patients of different ethnic origin. A total of 126 Bulgarian patients with WD were included in the study. Detailed history, physical and neurological examination, laboratory investigation of copper metabolism, slit-lamp examination, abdominal ultrasound, magnetic resonance imaging/computed tomography of the brain, molecular genetic testing, and statistical analysis were performed. Eighty-two patients demonstrated neurological signs. Tremor and dysarthria were most frequently observed. Rigidity, bradykinesia, and pyramidal signs were found in >25% of the patients. Dystonia, chorea, athetosis, ballismus, and epilepsy were rarely observed. We identified a total of 27 mutations of ATP7B. The most frequent mutation is p.H1069Q found on at least 1 allele in 78% of the patients. We did not find a significant correlation between p.H1069Q homozygosity and age of onset, ceruloplasmin level, and urinary copper excretion. The patients homozygous for p.H1069Q presented more frequently with hepatic signs. Mutations predicted to cause production of truncated protein are associated with earlier age at onset and lower ceruloplasmin level. In contrast to Bulgarian patients, Roma patients had an earlier disease onset and more frequent hepatic manifestation. WD presents with a variety of neurological signs. The mutation p.H1069Q is not uniformly associated with late onset and neurological presentation. Frameshift and nonsense mutations lead to severe phenotype. There are ethnic-specific differences in disease manifestation.

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Perspectives in International Neurosurgery: Neurosurgery in Bulgaria

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Dec 1981

Perspectives in Neurosurgery

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Novel Mutations in the DYNC1H1 Tail Domain Refine the Genetic and Clinical Spectrum of Dyneinopathies

Article

Mar 2015
HUM MUTAT

The heavy chain 1 of cytoplasmic dynein (DYNC1H1) is responsible for movement of the motor complex along microtubules and recruitment of dynein components. Mutations in DYNC1H1 are associated with spinal muscular atrophy (SMA), motor and sensory neuropathy (HMSN), cortical malformations, or a combination of these. Combining linkage analysis and whole exome sequencing, we identified a novel dominant defect in the DYNC1H1 tail domain (c.1792C>T, p.Arg598Cys) causing axonal HMSN. Mutation analysis of the tail region in 355 patients identified a de novo mutation (c.791G>T, p.Arg264Leu) in an isolated SMA patient. Her phenotype was more severe than previously described, characterized by multiple congenital contractures and delayed motor milestones, without brain malformations. The mutations in DYNC1H1 increase the interaction with its adaptor BICD2. This relates to previous studies on BICD2 mutations causing a highly similar phenotype. Our findings broaden the genetic heterogeneity and refine the clinical spectrum of DYNC1H1, and have implications for molecular diagnostics of motor neuron diseases. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Transmission disequilibrium of DISC1 haplotypes in Bulgarian families with affective disorder

Article

Sep 2013

A family with fragile X syndrome, Duchenne muscular dystrophy and ichthyosis transmitted by an asymptomatic carrier

Article

Mar 2013
CLIN GENET

The human X chromosome carries regions prone to genomic instability: deletions in the Xp22.31 region, involving the steroid sulfatase gene (STS) cause X-linked ichthyosis; rearrangements in the Xp21.2 region are associated with Duchenne or Becker muscular dystrophies (DMD or BMD); and the Xq27.3 unstable region, containing the (CGG)n repeat expansion in the FMR1 gene is associated with fragile X syndrome. We report on a family with two affected boys, the elder diagnosed with fragile X syndrome, the younger with DMD, and both suffering from severe ichthyosis. The family was analyzed by polymerase chain reaction, multiplex ligation-dependent probe amplification and haplotype analysis. The mother proved to be an asymptomatic carrier of all three non-contiguous mutation events, involving the STS gene, the DMD gene and a FMR1 expansion. To the best of our knowledge, this is the first description of an asymptomatic carrier of three different X-linked disorders, involving severe genetic rearrangements on both long and short arms of the X chromosomes. The boy with fragile X syndrome has inherited a triple recombinant maternal X chromosome, this way inheriting the FMR1 expansion and ichthyosis, originating most probably from different maternal Xes and excluding the DMD gene deletion. The transmission of these extremely defective maternal chromosomes to the next generation involved several recombinations.

Use of intracerebral electrodes to evaluate drugs that act on the central nervous system

Article

Dec 2006
ANN NY ACAD SCI

Not Available Bibtex entry for this abstract Preferred format for this abstract (see Preferences) Find Similar Abstracts: Use: Authors Title Return: Query Results Return items starting with number Query Form Database: Astronomy Physics arXiv e-prints

Ueber die Stellung der Purinkörper im menschlichen Stoffwechsel

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Jan 1970

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