History of Latin America's contibution to world neurosurgery

It has been a great honour and pleasure to be invited to speak in front of this prestigious audience at the Academia Mexicana de Cirugía, to which I am honoured to belong myself, on an historical subject of great importance for the knowledge and information of new generations.

In this summary, I do not intend to talk about the anthropological aspects of the exploration of the nervous system, which for various reasons have existed in the history of mankind, but will simply talk about the contribution made by enlightened pioneers from Latin America to the development and evolution of this specialised field of surgery during the twentieth century.

In 1957, the first International Congress of Neurosurgery took place in Brussels, Belgium, with delegations from neurosurgery societies from Europe, North America and South America.

Twelve years before, the first Congreso Sudamericano de Neurocirugía took place in Montevideo. Considered a milestone in the history of international neurosurgery, it was organised by Alejandro Schroeder from Uruguay, Elyseu Paglioli from Brazil and Ramon Carrillo and Rafael Babini from Argentina.

A year before, in 1944, the Chilean neurosurgeon Alfonso Asenjo and his Uruguayan colleague Alejandro Schroeder had met in Montevideo to establish a system of scientific union to promote development and education.

Afterwards they informed their colleagues Ramón Carrillo and Rafael Babini, from Argentina, and also Elyseu Paglioli from Brazil (Porto Alegre), about their decision and together they founded a Permanent Committee, naming it the Congresos Sudamericanos de Neurocirugía. They developed the appropriate regulations and set a date for the first meeting, stipulating the observance of a congress every two years, alternating the host country.

A year later, from 1 to 4 March 1945, the Congress took place in Montevideo under the presidency of Schroeder.

Only free topics would be presented as they did not have much time.

This international undertaking achieved full completion, due not only to the prestige of the founders but also because of the shared understanding and progressive spirit of the South American neurosurgeons.

In 1955 Mexico was incorporated into the Committee and from that point its name was changed to Latin American Congresses of Neurosurgery (Congresos Latinoamericanos de Neurocirugía).

The permanent committee carried out exemplary work for thirty-five years, during which some members were replaced by choice and democratic spirit.

In 1979 during the Congresos Latinoamericanos de Neurocirugía, which took place in the city of Buenos Aires, the Latin American neurosurgery organisation was completed with the foundation of the Federación Latinoamericana de Neurocirugía (FLANC), which immediately joined the World Federation of Neurosurgical Societies (WFNS).

In 1993 the International Congress of Neurosurgery took place in the city of Acapulco, Mexico, presided over by Dr Mauro Loyo Varela and with Dr Fernando Rolls Frank as General Secretary.

At this Congress, the author had the honour of being appointed president of the WFNS.

This resulted from and signified a global recognition of all our pioneering professors, who with unequalled excellence laid the foundation stone of modern neurosurgery in our continent. We, along with future generations, are and will be responsible for continuing the task to preserve the values that inspired them: study, work, honesty and ethics.

Certainly those members of the Permanent Committee were not the only pioneers of American neurosurgery today, with its international prestige, must pay tribute to many more, of whom I cannot fail to mention and give a brief summary of the following:

Alejandro Schroeder, Uruguay

Designated in 1937 professor and director of the Instituto de Neurología de Montevideo. At an international level, he opened paths, cementing strong fraternal bonds with colleagues in the region, making possible the scientific and institutional integration of Latin American neurosurgery.

Román Arana Iñiguez, Uruguay

Schroeder's successor to the same office in 1957. He published extensively, reporting about his studies on the stimulation of the human fornix, the epileptic activity in isolated cortical areas (in collaboration with Segundo, Austt and Migliaro), the stimulation of the brain in the monkey (with French and Segundo) and the experimental intracranial hypertension (with Austt, Azambuja, Roig and Villar). His book, Neuroanatomía, written in collaboration with Maria A. Rebolla, was used in many medical schools across the world.

Alfonso Asenjo Gómez, Chile

On 19 May 1950, the Ministry of Public Education created the Instituto de Neurocirugía e Investigaciones Cerebrales de Chile, with Dr. Asenjo as director.

This institute did not only have an impact in Chile but also in South America.

Dr. Asenjo was the first president of the Sociedad de Neurocirugía de Chile, established on 14th April 1957. He also created the Congresos Sudamericanos de Neurocirugía and was awarded the National Award for Sciences (Premio Nacional de Ciencias) in 1972.

Luciano Basauri, Chile

His preference for neurosurgery started in Salvador Hospital and the Instituto de Neurocirugía where he became part of Dr Asenjo's team which was also joined by his colleagues Reinaldo Poblete and Juan Luis Fierro, with whom he created the Sociedad de Neurocirugía de Chile. During the course of his long professional career, doctor Basauri showed a special interest for paediatric neurosurgery. He was president of the International Society for Pediatric Neurosurgery (ISPN), founder of the FLANC and its general secretary.

Elyseu Paglioli, Brazil

He was born on 28 December 1898 in Caixas do Sul and died in Porto Alegre on 22 December 1985.

Together with Alejandro Schroeder and Rafael Babini, he organised the first congress of neurosurgery in Latin America in 1945. He was the leader and unquestionable teacher for generations of neurosurgeons in South America's Southern Cone.

Paulo Niemeyer, Brazil

He was born in Rio de Janeiro on 14 April 1914 and died on 10 March 2004.

He was the last member of the Permanent Committee.

Eminent Brazilian and Latin American neurosurgeons graduated from his prestigious and internationally renowned school of neurosurgery.

His scientific production, which includes all the speciality subjects, is without doubt one of most original and important of America.

Manuel Velasco Suárez, Mexico

He was professor in the School of Medicine at Universidad Nacional Autónoma de México for more than 50 years. In 1989 he obtained the Medal for Academic Merit and the title of Professor Emeritus. He achieved the establishment of the Instituto Nacional de Neurología, Neurocirugía y Psiquiatría, which was inaugurated in February 1964. From 1989, the Institute took his name: the Instituto de Neurología y Neurocirugía Manuel Velasco Suarez. He was the Director of the Institute from 1964 to 1970 and continued as Director Emeritus until his death.

The Institute is one of the leading centres with significant international recognition, which represents a unique opportunity to design programmes, guidelines for medical attention and strategies for neurological, neurosurgical and neuropsychiatric conditions.

José Humberto Mateos Gómez, Mexico 1928–2009

He was one of the most renowned Mexican neurosurgeons with unquestionable prestige at both a national and international level.

He began his career in neurosurgery with the professor Velasco Suárez. Later, in July 1953, he moved to Washington D.C. to start his specialisation in neurosurgery in Dr James W. Watts's programme. In January 1962 he was appointed founder and head of the Hospital General del Centro Médico Nacional of Instituto Mexicano del Seguro Social, until 1977 when he was replaced by Dr Mauro Loyo Varela as head of department. When he retired from the Instituto Mexicano del Seguro Social, in 1991, as head of the Department of Surgery, Dr José Humberto Mateos Gómez arrived at the National Institute of Neurology and Neurosurgery (Instituto Nacional de Neurología y Neurocirugía) as professor in that speciality. In 1996 he became Editor of the journal Archivos de Neurociencias, the official publication of the institute where he wrote almost all of the leading articles.

He was without a doubt the promoter and the leader of neurosurgeons in Mexico and an example for all Latin America.

Esteban D. Rocca, Perú

He organised the Congresos Latinoamericanos and was member of the Permanent Committee in the Congresos Latinoamericanos de Neurocirugía.

In 1947 he created the first Neurosurgery Department of Perú in Hospital Obrero in Lima. From that point, neurosurgery spread from that department throughout the country, with the training of specialists with national and international influence and the publication of scientific works and more than 20 volumes on neurosurgery, which made a great contribution to the diffusion of neurosurgery in the Latin American continent.

Manuel Balado, Argentina

He was the father of neurosurgery in Argentina.

In 1923 he travelled to the USA to be trained as neurosurgeon in Mayo Clinic under the direction of Alfred Adson.

When he returned from the USA he was appointed head of Room 1 in the Instituto de Clínica Quirúrgica of the Universidad de Buenos Aires. Balado started to discretely give to the General Surgery room the mark of a neurosurgery room. In 1937 this led to the creation of the Neurosurgery Department, which was one of the first in the world, preceding those of Paris and Berlin by several years.

Balado was the creator of the iodoventriculography, a diagnosis method that produced a fundamental progress in the diagnosis and the treatment of the posterior fossa tumours at that time. In addition, in 1930, he introduced in Argentina electroencephalography and described fundamental aspects of the neuropathology, along with wise Pio del Rio Ortega from Spain.

Ramón Carrillo, Argentina

Balado's pupil, Carrillo worked with Ariens Kappers in Amsterdam for three years.

In Buenos Aires, he continued the studies he had started at Ariens Kappers's laboratory on comparative anatomy of the nervous system and standardised the iodoventriculography technique.

The creation in 1943 of the Instituto de Neurocirugía of the School of Medicine in Buenos Aires, in the Costa Buero Pavilion, is the result of his vision and organisational ability.

I conclude this editorial by thanking the Academia Mexicana de Cirugía and its authorities, represented in this case by the scholar Dr Alejandro Reyes Fuentes, for having given me the opportunity to pay tribute, in front of this qualified audience, to the true founders of medicine and surgery in Latin America. These pioneers who had the courage to dedicate themselves to a speciality in a time when so little technology and resources were available, started, with talent and effort, the long journey towards the construction of modern surgery of the nervous system.