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Leading neurosurgeon lectures on advances in field – The Montana Neuroscience Institute Foundation is a great asset to the Missoula Research Community

Montana is known for its abundance of big sky, deer and antelope – and brain surgeons.

By GINNY MERRIAM of the Missoulian

The United States has one neurosurgeon for every 67,000 people. But Montana has one per 40,000, 20 of them clumped in practices in five cities, Missoula neurosurgeon Nick Chandler told a Missoula audience Tuesday night at the Montana Neuroscience Institute Foundation http://www.umt.edu/mnif/ lecture series.

In Missoula, where surgeons and scientists collaborated to create the research center the Montana Neuroscience Institute, neurosurgeons perform about 1,000 major neurosurgical operations a year.

"We pretty much do everything," Chandler said. "There’s very little we have to send out."

Archaeology tells us that people have been opening each other’s skulls with tools since at least 7000 B.C. But most of the advances in brain surgery have come in the past 150 years – and many of those in the lifetimes of today’s surgeons, Chandler said. The brain surgery his father practiced is vastly different from Chandler’s practice today, he said.

"I’ve done every brain surgery with a microscope," he said, "and my father didn’t do any."

Back in the Neolithic Period, people removed portions of the skull, probably with obsidian blades rubbed through the bone. Removing a piece of skull, called trephination, could have been done to relieve pressure from a bleeding brain. The ancient intentions are lost to us because there were no written records, Chandler said. But some people lived considerable times after the operations; scientists can tell today that the skull bone healed.

For modern brain surgery to become possible, Chandler said, medicine had to develop anesthesia, methods of sterilizing instruments and sterile procedures during surgeries. Those came along in the late 1800s. What moved it along significantly was exploration of which areas of the brain control which functions of the body, pioneered in the last quarter of the 1800s. French surgeon Paul Pierre Broca found the brain’s speech center, now called "Broca’s area."

"So now we can make people hold still, we can sterilize our instruments and hopefully we can locate the part of the brain we need to operate on," Chandler said. "So there was some excitement."

But the first results were "really dismal," he said, perhaps reflected in the numbers: From 1886 to 1896, 500 brain surgeries were performed; between 1896 and 1906, there were 80.

Harvey Cushing, an American neurosurgeon who lived until 1939, removed more than 2,000 brain tumors in his career and took the mortality rate for such operations from 50 percent to 10 percent.

Today, neurosurgeons operate on brains for injuries and trauma, skull fractures, bleeding of the brain, blood clots and tumors. They’re able to learn a wealth of anatomical information and use it to plan and execute surgeries. Missoula neurosurgeons can use an image guidance system that stores all the information about the patient’s brain collected by scans and other pictures and then helps plan the surgery. Working through microscopes allows surgeons to see the tiniest brain anatomy.

"I go sit in the CT scan while it scans the patient, have a cup of coffee, and I know right where the tumor is," he said. "We can take them right into surgery."

Missoula has drawn a collection of specialists who work together on neurological disorders and surgeries and a collaboration of surgeons and scientists who have drawn research money to the partnership between St. Patrick Hospital and the University of Montana that has become a National Institutes of Health research center.

"It’s a fun time to be a neurosurgeon because new inventions are coming so quickly," Chandler said.

"I’d kind of like to practice for 100 years," he said. "But I won’t."

Chandler’s talk was the last in the lecture series until it resumes in the new year.

Reporter Ginny Merriam can be reached at 523-5251 or at [email protected]

http://missoulian.com/articles/2003/12/04/news/local/news03.txt

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