University of Chicago - Department of Surgery

History

Neurosurgery was founded at the University of Chicago in 1928 by Percival Bailey. At the time, a distinguished faculty in the basic sciences of neurology had been in existence for a quarter of a century. In fact, the American School of Comparative Anatomy, which linked brain structure with behavior and function, was born at The University of Chicago. Bailey was a product of this school, first acquiring a Ph.D. in embryology at the University of Chicago before obtaining his M.D. from Northwestern University. After an internship and further studies in neuropathology under George Boris Hassin in Chicago, in neurosurgery under Harvey Cushing in Boston, in neurology under Pierre Marie in Paris, and in psychiatry under Henri Claude and Gasten Gation de Clerambalt in Paris, Bailey returned to Chicago where he began to build a neurosurgical service. The school he founded reflected a multidisciplinary approach to neurosurgical problems.

Several key historical figures have had strong associations with the University of Chicago. Paul Bucy, together with Heinrich Kl�ver, a morphologist, neuropharmacologist, and behavioral scientist, paved the way for a major understanding of the temporal lobe by describing the Kl�ver-Bucy syndrome. A. Earl Walker, under the stimulus of Steven Polyak, another morphologist renowned for his work on the retina, laid the foundation for all subsequent understanding of the thalamus. W.H. Sweet obtained a background in morphology and in physiology that entered into his remarkable contribution to the study of pain. Ralph Cloward, branching off from morphology and function, would later lead in technology. Francis Murphy and Joseph Evans, both of whom interned in Chicago, and Oscar Sugar, who worked in basic science, were sufficiently stimulated by the contact to embrace a neurosurgical career. From abroad came John O'Connell, who later returned to head St. Bartholemew in London, Stender in Berlin, Araki and Tanaka in Kyoto, and Juntendo in Tokyo. Shimuzu, who arrived later, went on to become the chairman at the University of Tokyo. Perhaps the most unusual trainees were Clovis Vincent and his two associates Marcel Kline and Pierre LeBeau from Paris, who returned to establish the second major neurological school France. From this critical period, a series of classic texts emerged that remain the foundation of our current neurosurgical knowledge: Bailey's Intracranial Tumors; Bailey, Bucy, and Douglas Buchanan's Intracranial Tumors of Children; Roy Grinker and Bucy's Textbook of Neurology; and Walker's Primate Thalamus.

During the period of World War I to World War II, basic science faded and the neurosurgical faculty dispersed at the University of Chicago. Bailey left in 1939 to join neurosurgery at the University of Illinois but soon moved on to establish the Illinois Institute of Psychiatry in his continued pursuit of the relationship between structure and function. Bucy succeeded Bailey in 1939 but left in 1941 to become chair at Northwestern University. Walker followed, but when he went to war, there was no one left. Bailey's distinguished school had disintegrated.

Sweet had returned to Harvard where he later became the chairman at Massachusetts General Hospital. Murphy had departed to Memphis. Although there were no students of Bailey's school left to carry on, Bailey's traditions were widely transplanted in key centers around the United States, in Europe, and in Japan. Walker returned for a brief period after the war but left once again in 1947 to assume the chair of neurosurgery at Johns Hopkins. Theodore Rasmussen's appointment was the next major point in the history of the specialty. He had already established himself as an authority on the morphology and function of the sensory-motor cortex and had coauthored, with Wilder Penfield, a classic work on the human cortex that summarized and analyzed the existing body of information on the response of the human cortex to electrical stimulation. Rasmussen is one of the four (Penfield, Jasper, Rasmussen, and Feindel) who laid the basis of the modern surgical management of epilepsy. He added surgical innovation and technique to the basic investigation and education, which had been the hallmarks of Bailey's school. The basic science support, which once had been enjoyed, was no longer present at the University of Chicago, and in 1954, Rasmussen returned to Montreal where he succeeded Penfield.

Follwowing Rasmussen, Cloward was persuaded to take over as the chief until a permanent successor became available. A precise, meticulous, and above all, innovative surgeon, Cloward did not owe his skills to his basic training. They were peculiarly his own. During this return to Chicago, he perfected some of his techniques of lumbar interbody fusion, which were to become a basis for his widely acclaimed and adopted anterior cervical fusion.

Joseph Evans had a love affair with Chicago since his days as an intern, but it was difficult to persuade him to leave Cincinnati. Nevertheless, he arrived at the University of Chicago in late 1950�s and brought with him his commitment to the study of head injury. The head injury laboratory, founded by Evans, was to persist until the late 1970s, the last distinguished investigator there being Allen Crockard of London. The training of neurosurgeons from abroad continued, and among the distinguished group of that period were Shozo Ishii, Chairman of Neurosurgery at Juntendo University in Tokyo and later President of that University; Charas Suwanwela, Chairman of Neurosurgery at Chulalongkorn University in Bangkok and later Dean of that medical school; Professor Mimo Vailati of Bari, Italy; and Professor Boris Klun of Lublijana, Yugoslavia. Joseph Ransohoff of the New York Hospital and Nicholas Zervas of the Massachusetts General had been students of the University of Chicago, but did not train in neurosurgery. John Jane underwent part of his neurosurgical training there.

Sean Mullan, who joined Evans in 1955, succeeded him in 1967. In the tradition of the school, he produced an early text, this time for students. In the 1960s, the investigation of morphology, pathophysiology, and function turned more and more to an exploration of surgical technology, resulting in a series of early articles on remolding of the deformed cranium, transoral cranial base surgery, cervical body replacement, anterior approach to the thoracic spine, and anterior metal fixation of the thoracic spine, all of which have become incorporated into modern neurosurgical technique. Percutaneous cordotomy and, later, percutaneous compression gangliolysis for trigeminal pain were introduced. Some of these techniques were found to be applicable to carotid cavernous fistulae, dural sinus fistulae, vein of Galen aneurysms, and certain selected aneurysms. Sean Mullan retired as Chief of Neurosurgery in 1992.

Bryce Weir took over from Mullen as the chief of neurosurgery. Weir was a preeminent neurovascular surgeon who continued to build the Section of Neurosurgery. His own work focused on both clinical and surgical aspects of vascular neurosurgery. He published numerous works, including Aneurysms Affecting the Nervous System, Subarachnoid Hemorrhage: Causes and Cures, and Cerebral Vasospasm, Under his leadership, the section grew and became a world-renowned center for vascular neurosurgery. In 2001, Bryce Weir stepped down as the chief of the section to become the Interim Dean of the Biological Sciences Division of the University of Chicago.

In 2002, Richard G. Fessler became the section chief. Having trained at the University of Chicago, Fessler returned from the University of Florida at Gainsville to lead the section. A leading authority on minimally invasive spine surgery, a pioneer in microendoscopic surgery and the first physician in the United States to perform a human embryonic spinal cord transplant, Fessler currently serves as the John Harper Seeley Professor and Chief of Neurosurgery at the University of Chicago Hospitals. His textbooks, including Current Techniques in Spinal Stabilization, Neurotrauma, Lumbar Interbody Fusion Techniques, and Outpatient Spinal Surgery. His most recent book, An Anatomical Approach to Minimal Access Spine Surgery, has set the standard for minimally invasive spine surgery.

Under Dr. Fessler�s leadership, the section has grown to include 11 full-time neurosurgeons, who provide specific expertise within each of the different areas of neurosurgery. Moreover, each faculty member carries an active research program and the section receives substantial NIH and private research funding. The residency training program is growing and represents the focus of the section�s educational goals. The outlook for the future is based on the desire to excel as the preeminent neurosurgical program in the world.