Neurosurgery - Fulltext: Volume 43(4) October 1998 p 914-925 ...

Neurosurgery - Fulltext: Volume 43(4) October 1998 p 914-925 The History of Neurological Surgery at Northwestern University.

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Neurosurgery: Volume 43(4) October 1998 pp 914-925

The History of Neurological Surgery at Northwestern University

Engelhard, Herbert H. MD, PhD; Grant, John MD; Ciric, Ivan S. MD; Wetzel, Nicholas C. MD, PhD; Batjer, H. Hunt MD

Division of Neurosurgery, Department of Surgery, Northwestern University Medical School, Chicago, Illinois

Received, November 24, 1997. Accepted, May 28, 1998.

Reprint requests: Herb Engelhard, M.D., Ph.D., Neurological Surgery, Suite 500, 233 East Erie Street, Chicago, IL 60611.

Article Outline ● Abstract ● ALLEN BUCKNER KANAVEL AND THE

ROOTS OF NEUROSURGE... ● THE LOYAL DAVIS ERA ● THE PAUL BUCY ERA ● CHILDREN'S MEMORIAL HOSPITAL ● EVANSTON HOSPITAL ● THE ANTHONY RAIMONDI ERA ● THE FORMATION OF

NORTHWESTERN MEMORIAL HOSPITAL A...

● THE CURRENT AND FUTURE STATUS OF NEUROSURGERY AT ...

● ACKNOWLEDGMENTS ● REFERENCES ● Citing Articles

Figures/Tables ● Figure 1 ● Figure 2 ● Figure 3

Abstract TOP THE RESIDENCY PROGRAM in neurological surgery at Northwestern University was founded in 1924 by Loyal Davis and was formally accredited by the American Board of Neurological Surgery in 1946. Allen Kanavel, mentor to Davis, was one of the original members of the Society of Neurological Surgeons. Five individuals have served as chief of neurosurgery at Northwestern: Davis, Paul Bucy, Anthony Raimondi, Albert Butler, and H. Hunt Batjer. Davis was the first surgeon west of the Appalachians to limit his work to neurosurgery. Between 1954 and 1963, there were two independent neurosurgery residency programs at Northwestern, one headed by Davis and the other by Bucy. A master surgeon and superb teacher, Bucy trained more than 65 residents and became one of the greatest authors and leaders in the field of neurosurgery. Neurosurgical training at Northwestern has traditionally emphasized excellence of patient care, strong resident and student teaching, and basic science research. Through the years, a major strength of the program has been its clinical volume and diversity. Four hospitals have played major roles in the program: Northwestern Memorial Hospital (created by the merger of Chicago Wesley Memorial Hospital and Passavant Memorial Hospital), Children's Memorial Hospital, Evanston Hospital, and

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● Figure 4 ● Figure 5 ● Figure 6 ● Figure 7 ● Table 1

the Veterans Administration Lakeside Hospital. This article traces the development of neurological surgery at Northwestern, with an emphasis on its historical background and the contributions of Kanavel, Davis, and Bucy. The present philosophy and structure of the training program and the program's future under the direction of Batjer are also described.

The training program in neurological surgery at Northwestern University has had a long and colorful history. Northwestern has trained 69 board-certified neurosurgeons since the founding of the American Board of Neurological Surgery in 1940, yet surgeons had been receiving training in neurosurgical techniques at Northwestern for many years by the time the Board was established. Two of the early "giants" in neurological surgery, Loyal Davis and Paul Bucy, served as the first two chiefs of neurosurgery at Northwestern. Their training programs coexisted for 9 years in separate hospitals, Passavant Memorial and Chicago Wesley Memorial, on opposite sides of the intersection formed by Superior Street and Fairbanks Court, on the near north side of Chicago. To understand the history of neurosurgery at Northwestern, it is helpful to first know a little about the history of Northwestern University in general and about the hospitals that now function together under the umbrella of the McGaw Medical Center.

Northwestern University was chartered in 1851. Two of its founders, John Evans and Nathan S. Davis, also founded the American Medical Association. In 1857, the town of Ridgeville was renamed in honor of Evans. N.S. Davis served as president of the American Medical Association in 1864 and as an original editor of JAMA (1,4). What was to become Northwestern's Medical School was founded in 1859 as the medical department of Lind University. Later, it continued under the name of Chicago Medical College, becoming affiliated with Northwestern in 1870. The Great Chicago Fire occurred on October 8, 1871. It leveled 2,200 acres, claimed nearly 300 lives, and left 94,000 homeless (3). Almost 16,000 buildings, including six hospitals and medical schools in the area, were burned to the ground (3). The Chicago Medical College, however, was among the institutions that were spared (4). It changed its name to the Northwestern University Medical School in 1891 and affiliated Wesley Hospital in 1893. The Medical School initiated many reforms well before the time of Abraham Flexner. The Chicago units of the University began concentrating on the near north side after land was purchased in 1920. Construction of the Montgomery Ward building containing lecture rooms, laboratories, and outpatient clinics was completed in 1926. By 1935, Chicago had become the nation's second largest city, with a population of 3.4 million. It housed the national headquarters for the AMA, the American Hospital Association, and the American College of Surgeons.

Passavant Memorial Hospital was named after the Reverend William A. Passavant (1821-1894), who founded a small mission hospital in Chicago with the support of Mayor Ogden on July 28, 1865 (1,3). Only two hospitals had previously existed in Chicago, and citizens opposed them as "dreaded centers of contagion" (1). In 1871, the hospital was destroyed in the Great Fire. The ruins were sold by Passavant for $8.50 (3). Subsequent attempts to rebuild the facility were unsuccessful until, finally, funds were received from the Ogden estate after the Mayor died and a new 65-bed building was erected in 1885 at Superior and Dearborn Streets (1). Christian Fenger (1840-1902) a world-renowned surgeon on the staff of the early Passavant Memorial Hospital, is known to have performed operations on the brain (3). He became the first chairman of surgery at Northwestern University. In 1925, the old Passavant Memorial Hospital closed because the "aging hospital plant was inadequate to meet the demands made imperative by the rapid acceleration of medical progress" (1). The new 200-bed hospital opened its doors at its present (Streeterville) site at Superior Street and Fairbanks Court on June 10, 1929 (Fig. 1). The new hospital was quite "posh" in comparison with the other hospitals of the day. It featured white linens and silverware for its patients.

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FIGURE 1. Passavant Memorial Hospital, located at the southeast corner of Superior Street and Fairbanks Court on the new Northwestern medical campus, circa 1929. Luxurious in comparison with other hospitals of the day, it featured silverware and white linens for its patients but quickly fell on hard times during the Great Depression.

The stock market crash of October 1929 produced some very difficult years for Passavant Memorial and the other Northwestern hospitals (4). Passavant Memorial Hospital was saved mainly because of a gift from Edith L. Patterson, whose deceased brother Floyd had amassed a fortune through inventing an improved barbed wire, having two barbs (3). It is said that the ghost of Patterson, who actually lived in the hospital and died in the late 1950s, still haunts the floors of the old operating suites on the 11th floor. In 1948, Passavant Memorial Hospital was the site of an historic achievement in medical education: the first large-scale use of television as a teaching medium. As part of a week-long demonstration, live operations and classes were beamed via closed circuit television to the participants at the American Medical Association Annual Convention (3). Major renovation of Passavant Memorial Hospital was conducted in the late 1950s, including the addition of a shielded neurosurgical operating room with electroencephalographic monitoring. The Jennings Pavilion was added to the west side in 1966. Passavant Memorial Hospital still houses the main floor for neurosurgical inpatients.

Wesley Hospital was founded in 1888, being named after John Wesley, the physician and preacher who founded the Methodist Church. The original three-bed hospital was located at Dearborn and Ohio Streets. The hospital soon moved to expanded quarters, first to 355 East Ohio Street, near Pine (now Michigan) Avenue (4), then to the intersection of Dearborn Avenue and 25th Street (Fig. 2A). The nucleus of the current 23-story, 575-bed structure opened at its present site on December 5, 1941, 2 days before the attack on Pearl Harbor. The X-shaped design around an elevator core was considered to be extremely modern and practical at that time (Fig. 2B). The building was christened The Cathedral of Healing. In 1954, Wesley Memorial merged with Chicago Memorial Hospital (originally called the Hahnemann Hospital, 1853) to become the Chicago Wesley Memorial Hospital. A large addition to the hospital, the Allison Pavilion on Chicago Avenue, was completed in 1959. The neighboring 26-story Carriage House, for housing residents and nurses, was acquired in 1970 (1).

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FIGURE 2. A, Wesley Hospital, located at the corner of Dearborn Avenue and 25th Street, as it appeared in 1891. It was later sold to the city of Chicago and converted into a housing project. B, Wesley Memorial Hospital, newly located at the northwest corner of Superior Street and Fairbanks Court. Dubbed the Cathedral of Healing, its X-shaped design around a central elevator core was considered to be very innovative at that time.

ALLEN BUCKNER KANAVEL AND THE ROOTS OF NEUROSURGERY AT NORTHWESTERN TOP Surgeons training at Northwestern learned about procedures involving the nervous system just after the turn of the century, under the guidance of Kanavel (1874-1938). Before that, Edmund Andrews and J.B. Murphy had reported operations on the trigeminal ganglion as early as 1890. Prominent neurologists were available on the faculty, such as Walter Hay, James Jewell, Hugh Patrick, and Archibald Church (2). Kanavel (Fig. 3A) was an energetic, skillful, and versatile surgeons who was an expert in many fields of surgery, including surgery of the brain, spine, and peripheral nerves (21,25). He was a gentleman and an acute diagnostician who knew "more about the hand than anyone in the world" (8). Kanavel was born in Kansas and received A.B. and M.D. degrees from Northwestern in 1896 and 1899, respectively. He pursued a postgraduate course in Vienna, Austria, then interned at Cook County Hospital. Consistent with the surgeons of his era, Kanavel was largely self-instructed in the art of applying surgery to disorders of the nervous system and did not limit his practice to neurological surgery (20,21). Kanavel was the first to describe (in 1909) the infranasal transsphenoidal approach to the pituitary gland (Fig. 3B) (9,22), a few months before it was reported by Oskar Hirsch. During this period, Kanavel, Dean Lewis, and Ernest Sachs were the only surgeons in the Midwest who practiced any neurosurgery (20). In 1910, a Northwestern colleague of Kanavel's, urologist Victor Lespinasse, introduced a small cystoscope into the ventricles and coagulated the choroid plexus in an unsuccessful attempt to treat hydrocephalus in two infants. Kanavel saw patients and operated at Wesley, Cook County, and Passavant Memorial Hospital (8). Kanavel was a master of effective extemporaneous speaking and was held in extremely high regard by his colleagues.

FIGURE 3. A, Allen B. Kanavel (1874-1938). Kanavel was a gentleman and multitalented surgeon, skilled at operations involving the nervous system. Kanavel was one of the original members of the Society of Neurological Surgeons. One of his students was Loyal Davis. B, illustration from Kanavel's 1909 article (9) describing the infranasal transsphenoidal approach to the pituitary.

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When the United States entered the First World War in 1917, the Surgeon General decided that the Army needed to have men trained in neurosurgery and summoned a group of surgeons to Washington, DC, to consider the matter. Kanavel, along with Sachs, Charles Frazier, Lewis, William Spiller, and Hugh Patrick, "responded at once" (20). The group was informed that the Army was planning to set up "a hundred hospitals" and wanted a neurosurgeon for each hospital. They therefore decided to establish three schools in which general surgeons could be trained in surgery of the nervous system: one in New York, a second in Chicago, and a third in St. Louis (20). Kanavel became a Colonel in the United Stated Army Medical Corps and served at the Base Hospital Unit Number 12 in France along with other members of the Wesley staff (4). Kanavel was one of the 19 original members of the Society of Neurological Surgeons, which was founded in 1920 (20,21). He became fifth chairman of the Department of Surgery at Northwestern University that same year, a post he held until 1929. In 1920, Kanavel also accepted Davis into perceptorship, to be trained in surgery with an emphasis on surgery of the nervous system (21).

In the latter part of his career, Kanavel became a renowned author, editor, and leader within organized surgery. His chapter in the 1930 edition of Ochsner's Surgery, "Diagnosis and Treatment of Tumors, Inflammations and Abscesses of the Brain," displays his sophisticated knowledge of neurological diagnosis and surgical treatment. He also wrote about the anatomy of the trigeminal nerve (11) and of the laminectomy procedure (10). His text, Infections of the Hand, went through six editions. He was editor of Oxford Surgery and coeditor of the Medical School's Quarterly Bulletin, which was a clinically significant publication at that time. Kanavel was one of the founders of the journal Surgery, Gynecology and Obstetrics and acted as its associate editor and then as its editor until 1938 (8,23). He was a founder, governor, regent, and president (1931-1932) of the American College of Surgeons. In his later years, he suffered from glaucoma, which made it painful to read, and radiation damage to his hands, which made it difficult to scrub (from memorial addresses presented on June 1, 1938, in the Archibald Church Library, Northwestern University.) At the time of his retirement, Kanavel and his wife bought a house in Pasadena, CA, and he frequently traveled between Chicago and the West Coast. Kanavel, truly a remarkable person who made many contributions to the science of surgery in its many branches (22), died in an automobile accident near Mojave, CA, at the age of 64.

THE LOYAL DAVIS ERA TOP Davis (1896-1982) was born in Galesburg, IL, and attended Northwestern Medical School, receiving his M.D. in 1918, M.S. in 1921, and Ph.D. in 1923. After graduation from Northwestern, Davis was accepted into the coveted internship at Cook County Hospital and practiced general medicine for 14 months in his hometown of Galesburg. This, however, did not suite him, and he returned to Northwestern. There, Kanavel was responsible for setting him on the course of a neurosurgical career. He first encouraged Davis to study with Lewis J. Pollock, head of the Department of Neurology and Psychiatry, and Stephen W. Ranson, renowned neuroanatomist (8,19). Pollock was an outstanding neurologist, as well as a colorful figure at neurology meetings, because of his keen mind and excellent sense of humor. Ranson (1880-1942) was the giant of neuroanatomy at that time, being the eventual author of more than 200 publications and the textbook, The Anatomy of the Nervous System, which went through seven editions after its initial publication in 1920. Horace W. Magoun discovered the reticular formation while working in Ranson's laboratory (13). Davis's studies focused on decerebrate rigidity and peripheral nerve injury (19). Kanavel arranged for the young Davis to have a "finishing" course with Harvey Cushing, which he pursued from September 1923 through October 1924 (8,23). Davis's time with Cushing pro-found ly influenced him; he patterned his subsequent professional life after Cushing's (24).

After returning to Chicago in 1924, Davis was appointed to the Attending Staff of Wesley Hospital and

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established Chicago's first neurosurgical service (8). His first neurosurgical residents were Hale Haven, David Cleveland, John Martin, and George Perret. They were succeeded by more than 30 additional residents in surgery and neurosurgery (8). Davis was the first surgeon west of the Appalachians to limit his work to neurosurgery, long before neurosurgery had become a distinct specialty (3). The first three chiefs of neurosurgery in the Chicago area, Davis, Eric Olberg, and Perceival Baily, all had graduated from Northwestern's Medical School. When the new Passavant Memorial Hospital opened, Davis became primarily based there. Davis was a strict, quiet, and meticulous surgeon whose performance in the operating room has been described as awe-inspiring (15). In the laboratory, Davis and his residents refined stereotactic techniques, analyzed the effects of hypothalamic lesions on carbohydrate metabolism and central sympathetic regulation, and studied decerebrate rigidity, as produced by an "anemic" technique (19). Davis insisted on participation in laboratory research as a requirement for the academic surgeon (15).

Bleeding was a major problem confronting Davis, Cushing, and other neurosurgeons during this period. Cushing first used the Bovie electrocautery in 1927. W.T. Bovie was recruited from Boston to Northwestern that same year, and his electrocautery unit became available in Chicago. Apparently, within a short period, Bovie committed some sort of infraction and was released from the faculty. Davis had a meteoric rise through the academic ranks at Northwestern, becoming chairman of the Department of Surgery at Northwestern in 1932, at the age of 36 years. He and neurologist Pollock coauthored the text Peripheral Nerve Injury in 1933. Davis's examination of peripheral nerve function was particularly impressive (19). His text Neurological Surgery was published in 1936. In 1940, Davis became one of the founders and original members of the American Board of Surgery. In July 1942, Davis was chosen by the Surgeon General's office to be the senior neurosurgical consultant to the European Theater of Operations, eventually becoming full colonel (8,19) (Fig. 4). During his tenure with the Army, he suggested improvements in the design of helmets and military vehicles (8), studied high-altitude frostbite (3), and was one of the delegates of the Allied Surgical Mission to Russia. He was awarded the Legion of Merit in 1945 (19).

FIGURE 4. Loyal Davis (1896-1982) in military attire, circa 1945. Davis founded the neurosurgical training program at Northwestern University and became chairman of surgery at the age of 36 years. A neurosurgeon par excellence, his contributions as an author, editor, educator, and surgical leader made him one of the giants of the adolescent field of neurosurgery during the mid-20th century.

After the War, Davis emerged nationally as one of the outstanding educators and leaders among surgeons. He served as president of the Society of Neurological Surgeons (1945-1946) and helped found the American Board of Neurological Surgery. He became a governor of the American College of Surgeons and then served as regent, vice chairman, chairman, and president (1963). He was editor for 44 years of Surgery, Gynecology and Obstetrics, and he also edited Christopher's Textbook of Surgery. In 1957, he was elected president of the American Surgical Association, which he considered his highest honor (19). Davis was a vocal opponent of the practice of fee splitting, which was prevalent during that time. His views on subjects were sometimes controversial; he was not one to mince words (24). Davis was an excellent

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author, ultimately producing several books, including biographies and fiction, and almost 200 articles and book chapters. In 1973, he published his fascinating autobiography, A Surgeon's Odyssey (8).

In retrospect, Davis has been described as a surgeon who was very concerned for his patients, insistent on excellence in the hospital and in the research laboratory, and keenly interested in surgical education (24). A perfectionist, he was tough on his students and residents. One of the milestones for the Northwestern Medical students was to pass Davis's senior student "interview." Davis wanted to be remembered not merely for the surgical education of his students but also for the contributions he made to their development as "principled men and women" (24). Davis was always present at his patient's brain cuttings; each one was a tremendous learning experience. The typical Davis Residency included 1 year each of internship, general surgery, neurology, and laboratory research, in addition to 3 years of clinical neurosurgery, for a total of 7 years. Many residents who served under Davis went on to prominent academic careers, including Martin, Joseph Tarkington, Perret, Daniel Ruge, Frank Padberg, Nicholas Wetzel, Richard Davis, and Sanford Larson. Later, Davis's research interests became directed toward the surgical treatment of essential hypertension, which was accomplished by removing portions of the sympathetic nervous system (8). He reported his series of 1215 verified intracranial tumors in 1952 and 637 operations for trigeminal neuralgia in 1958 (15). Practicing in Chicago had its interesting moments. Once, Davis was called upon to examine Al Capone's son, who had recovered from a brain abscess. Capone was in prison at the time (8).

Neurosurgical training at the Veteran's Administration (V.A.) hospitals grew in prominence during the Davis era. The new V.A. Research Hospital opened across Huron Street just south of Passavant Memorial Hospital in 1954 (1). Before that time, residents at Northwestern rotated through the 75-bed neurosurgical ward at the Hines V.A. Hospital. Northwestern's Medical School was the first to be tightly linked with a V.A. hospital (8). After 1954, Northwestern residents rotated through the V.A. Research Hospital, which eventually became known as the V.A. Lakeside Hospital. Wetzel ran the neurosurgical service of the V.A. Lakeside Hospital for most of its existence. This association with a V.A. hospital, for the benefit of patient research and student and resident education, became a model for other academic medical centers. The neurosurgical floor at the V.A. Lakeside Hospital was on 14 West. A single operating room was usually used. In addition to Wetzel, V.A. Lakeside Hospital's neurosurgery attendings have included Tarkington, Ruge, R. Lawrence Ferguson, J. Thomas Brown, Herbert H. Engelhard, and George Cybulski.

Late in life, Davis held a consultant position at the Barrow Neurological Institute, which was directed by John Green, one of his former students. Davis, the "neurologic surgeon par excellence" (15), who had contributed so broadly to the adolescent field of neurosurgery, died in 1982 at the age of 86 years. Elements of the surgical curriculum he established, emphasizing patient contact and operating room participation, still exist at Northwestern today (8). Attending physicians at Northwestern University wear long gray lab coats, a tradition that has been attributed to Davis. He was survived by his children Richard Davis, who became professor of neurosurgery at the University of Pennsylvania, and Nancy Davis Reagan, former actress and former First Lady. A large portrait of Davis continues to hang in the first floor corridor of Passavant Pavilion.

Davis's surgical partners were Martin, Tarkington, Ruge, and Wetzel. John Martin (1904-1996) became an associate to Davis in the practice of neurosurgery after completing his residency in 1936. He served in the Mediterranean Theater of Operations during World War II and was awarded the Bronze Star. Martin wrote solid scholarly articles both in anatomy and in neurosurgery, including several wonderful descriptions concerning his military experiences (14). He left Northwestern in 1952 and rejoined the Army to head the Army's Department of Neurosurgery and help found the neurosurgery residency program at Walter Reed

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Hospital. He was retired as a full colonel and remained a consultant in neurosurgery to the Surgeon General of the United States until his death. Daniel Ruge, M.D., Ph.D. (born in 1917), became attending physician in 1952, acting, for the most part, as Davis's representative at Wesley. Ruge was a general neurosurgeon, but he developed a particular interest in spinal cord injury and edited the text Spinal Cord Injuries, which appeared in 1969. In 1976, Ruge joined the V.A. Spinal Cord Injury Program in Washington, DC. Later, Davis volunteered Ruge as the personal physician to President Reagan. Nicholas Wetzel, M.D., Ph.D. (born in 1920), became an attending at Passavant Memorial Hospital in 1952 and at V.A. Lakeside Hospital in 1954. Clinically, he had particular interests in stereotactic and vascular neurosurgery, performing the first percutaneous angiograms and fractional pneumoencephalograms at Northwestern. Wetzel authored important articles on a variety of neurosurgical topics and for more than 30 years served as associated editor of Surgery, Gynecology and Obstetrics. Outside the hospital, he was an avid mountain climber, climbing Mount McKinley in 1962. After leaving Passavant Memorial Hospital, he continued as professor and chief of neurosurgery at the V.A. Lakeside Hospital until his retirement in 1987.

THE PAUL BUCY ERA TOP Paul C. Bucy (1904-1992) was a man of exceptional intelligence, integrity, and charm, who was also endowed with creativity and vision (6). A master neurosurgeon and superb teacher, Bucy trained more than 65 residents and became one of the greatest authors and leaders in all of neurological surgery. Born in a small town in Iowa, he received his B.S., M.S. (neuropathology), and M.D. (1927) degrees from the University of Iowa (21). He became interested in neurosurgery when he acquired Ranson's Textbook of Neuroanatomy as a freshman in medical school (5). He completed an internship in general surgery at Henry Ford Hospital in Detroit, then joined Percival Bailey's program at the University of Chicago as his first resident (5). In 1930, he studied abroad under many individuals, including Norman Dott (Edinburgh), Gordon Holmes (London), and Otfrid Foerster (Breslau). He and Heinrich Klüver discovered what became known as the Klüver-Bucy syndrome (resulting from bilateral temporal lobectomy) in 1937 (5,12). After working with John Fulton at Yale, he investigated the motor systems of monkey and man and pioneered the early surgical treatment of movement disorders (21). He became head of neurosurgery at the University of Chicago in 1939. He moved from the University of Chicago to the University of Illinois for financial reasons in 1941. He was rejected from service in World War II because of mitral stenosis.

Bucy joined the faculty of Northwestern University in 1954, when the staff of Chicago Memorial Hospital, where he was an attending neurosurgeon, merged with Wesley Hospital to become the Chicago Wesley Memorial Hospital. He continued his previously established training program at Wesley. Because of this, from 1954 to 1963, there were two separate neurosurgery training programs at Northwestern. One was centered at Passavant Memorial Hospital under the direction of Davis and the other at Wesley under Bucy. Bucy professed that he held no animosity toward Davis, yet Davis was undoubtedly displeased that another neurosurgeon of such stature was practicing just across the street. Bucy's first associates on the faculty were Harold Robert Oberhill and Edir B. Siqueira. Oberhill's retractor for lumbar laminectomies is still used at Northwestern Memorial Hospital today. Bucy ran a large and active research laboratory, focusing on movement disorders and spinal cord injury. Based on his studies of the pyramidal tract, he postulated the existence of the extrapyramidal pathways (6). Clinically, he was a superb surgeon who could perform a subtemporal retrogasserian rhizotomy in 18 minutes, skin to skin (6). Bucy enjoyed operations on pituitary adenomas, acoustic schwannomas, and malignant gliomas, for which he advocated radical removal. He had an exceptional knowledge of neuroanatomy and uncanny surgical instincts (6). In 1956, Bucy himself had to undergo surgery to correct the mitral stenosis.

Bucy (Fig. 5) served on the editorial board of the Journal of Neurosurgery from 1950 to 1961 and later was

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chairman of the editorial board. In 1961, Bucy was elected president of the International Congress of Neurological Surgery. In 1963, he became sole chief of neurosurgery at Northwestern when Davis retired as chairman of surgery and chief of neurosurgery. Bucy's residency program usually included 3 years of training and contained three residents per year. Residents under Bucy would often rotate to outside institutions, such as the L'Hopital Foch in Paris. In 1966, the opening of Wesley's new two-room neurosurgical operating suite, which had long been a dream for Bucy, was a major event for neurosurgery at Northwestern. The dedication address was presented by Bronson Ray of the New York Hospital-Cornell Medical Center. Ray had trained at Northwestern from 1928 to 1929. The McGaw Medical Center of Northwestern University was also formed in 1966, to foster the cooperative effort of the member institutions: Chicago Wesley Memorial Hospital, Passavant Memorial Hospital, Children's Memorial Hospital, Evanston Hospital, the Rehabilitation Institute of Chicago, the Chicago Maternity Center (later renamed the Prentice Women's Hospital), the V.A. Research Hospital, and Northwestern University (3). Other neurosurgical faculty members who joined various Northwestern institutions during Bucy's tenure included Robert W Swanson, Kiyoshi Sato, Francisco Gutierrez, Ferguson, Ronald Jones, Thomas Stilp, and K.V. Pillay. Only Gutierrez continues an affiliation with Northwestern today

FIGURE 5. Paul Clancy Bucy (1904-1992). A man of great intelligence, integrity, and charm, Bucy was a master neurosurgeon and a superb teacher. Bucy, who served as second chief of neurosurgery at Northwestern, was a prolific author and world traveler. During the course of his long and illustrious career, he occupied nearly every leadership post in organized neurosurgery.

Bucy was a prolific author, having written almost 600 published articles, letters, and editorials. He was coauthor (with Grinker and Sahs) of the fifth edition of the textbook Neurology and also wrote Intracranial Tumors of Infancy and Childhood with Bailey and Douglas Buchanan. He was a founding member of the Harvey Cushing Society and the American Board of Neurological Surgery. His eloquence and clarity of thought were characteristics that destined him to become a great neurosurgical leader (6). Bucy served as president of the American Association of Neurological Surgeons (1951-1952), the Society of Neurological Surgeons, and the World Federation of Neurological Surgery. He also served as chairman of the American Board of Neurological Surgery and on the editorial board of the Journal of Neurosurgery for many years. He founded the journal Surgical Neurology in 1973, serving as editor for 14 years. He was awarded the Cushing Medal in 1980. He was a frequent congressional witness, particularly concerning topics related to spinal cord injury (7). Despite his lofty accomplishments, he was always willing to take the time to help and advise aspiring neurosurgeons, whether they were students at home or physicians struggling in underserved areas of the world. In his personal life, Bucy was an insatiable reader, a literary scholar, and a worldwide traveler. He became president of the Chicago Literary Club (6). He and his wife, Evelyn, wrote a book about their travels, Beyond All Dreams (1986).

Bucy retired as chief of neurosurgery at Northwestern in 1972 and moved to Tryon, NC. Many of the residents who trained at Northwestern under Bucy went on to distinguished careers in neurosurgery across the country and around the world, including Patrick Kelly, Narayan Sundrasen, George Dohrmann, Green,

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Ivan Ciric, Ferguson, David McLone, Hirokazu Naito, Franklin Wagner, Tadanori Tomita, Barth Green, Husameddin Gokay, Leonard Cerullo, Theodore Eller, Yoon S. Hahn, Roongtam Ladpli, Shizuo Oi, Gutierrez, Brown, Michael Jerva, Nadason Armugasamy, Leonard Kranzler, Arthur Kobrine, Eugene George, Fabian Isamat, Richard Jelsma, William Coxe, Hajime Handa, Ronald Ignelzi, Vutikit Thanaphum, and Kenneth Murray. In all, Bucy trained more than 65 neurosurgeons. Bucy was an exceptional person with warmth, charisma, great intellectual breadth, and natural leadership ability. He died in 1992 at the age of 87 years, the last surviving founding member of the Harvey Cushing Society.

CHILDREN'S MEMORIAL HOSPITAL TOP Children's Memorial Hospital was founded in May 1882 by Julia Porter in memory of her son Maurice, who had died from rheumatic fever. The original building was a three-story house on the corner of Belden Avenue and Halsted Street. It had eight beds and cared for sick children on a free basis (1). Porter soon purchased additional land at Fullerton Avenue and Orchard Street and a new 20-bed hospital was erected. In 1903, the name was changed to The Children's Memorial Hospital; decade by decade, the hospital expanded as additional construction took place. The neighborhood in which Children's Memorial Hospital grew is a remarkable one; the Biograph Theater (where John Dillinger was shot) and DePaul University are close by. For many years after its inception, the physicians of the Hospital were affiliated with several different schools, including Rush Medical College, the University of Chicago, and Northwestern University. Pediatric surgery was founded at Children's Memorial Hospital by Willis Potts in the 1940s. The first pediatric neurologist at Children's Memorial Hospital was Buchanan, a Scotsman who had trained at Queen's Square Hospital in London. He was recruited by Bucy to come to Children's Memorial Hospital in 1932 (17). While at Children's, Buchanan was on the faculty of the University of Chicago. The first text dealing with a pediatric neurosurgery subject, Brain Tumors in Infancy and Childhood, was written by Bailey, Bucy, and Buchanan in 1936. Most of the patients reported in this monograph were initially seen at Children's Memorial Hospital by Buchanan and were then transferred to the University of Chicago for their surgery by Bucy.

In 1952, a pediatric neurosurgery service was formally initiated, with the appointment of Luis V. Amador as chief of neurosurgery at Children's Memorial Hospital. Amador (born in 1920), an amiable individual and excellent surgeon, graduated from Northwestern University Medical School in 1944. He completed his residency in neurosurgery under Eric Oldberg at the University of Illinois in 1950, and in 1952 he still had his academic appointment there. Amador practiced at several hospitals in the city (later including Northwestern Memorial Hospital) and thus had a part-time commitment to Children's Memorial Hospital. He was author of many articles and the text Brain Tumors in the Young. During that period, much of the neurosurgery was performed by fellows, many of whom came from Sir Wylie McKissock's program in London. These fellows were fully trained neurosurgeons wanting to develop a special interest in pediatric neurosurgery. Fellows who trained at Children's Memorial Hospital during that period included Kenneth Till, Sanat Bhagwati, and Handa (who became chief at the University of Tokyo), among many others. These men went on to become leaders of pediatric neurosurgery throughout the world. Jerva, who had trained with Bucy and John Shillito in Boston, headed the pediatric neurosurgical service from 1965 until 1969.

In the mid 1960s, the departments at Children's Memorial Hospital became more tightly linked with Northwestern University. Pediatric neurosurgery joined Northwestern University's training program in neurological surgery in 1969. At that time, Anthony J. Raimondi (see below) was appointed head of neurosurgery at Children's Memorial Hospital and professor of neurosurgery at Northwestern University. Luis Yazagaray joined the staff at Children's Memorial Hospital as attending surgeon. The Myelomeningocele Multidisciplinary Care Clinic was opened in 1972. Satoshi Matsumoto, later to become chief of neurosurgery at Kobe University, Japan, was Raimondi's first resident. Matsumoto was instrumental

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in sending subsequent residents to Children's Memorial Hospital for training in pediatric neurosurgery. One of these was Tomita, who joined the faculty at Children's Memorial Hospital as director of neurological oncology after completing his residency in 1980. Kiyoshi Sato (later chief of neurosurgery at Juntendo University, Japan, and president of the International Society of Pediatric Neurosurgeons) and Koreaki Mori (later chief of neurosurgery at Kohchi University, Japan) also trained during this period. In 1972, Raimondi was appointed chief of the Division of Neurological Surgery at Northwestern University, decreasing the amount of time he was able to devote to Children's Memorial Hospital. Raimondi stepped down as head of neurosurgery at Children's Memorial Hospital in 1977 and, after 1979, practiced solely at Northwestern Memorial Hospital.

David G. McLone, M.D., Ph.D. (born in 1938), became head of neurosurgery at Children's Memorial Hospital in 1979 and full professor in 1984. McLone completed his neurosurgical residency at Northwestern under Bucy and Raimondi in 1975. McLone's research efforts have been directed at studying neural tube closure and the cerebrospinal fluid pathways, among other topics. He has served on the editorial boards of several journals, including Neurosurgery and Fetal Medicine, and as associate editor of Child's Brain, the Journal of Pediatric Neurosciences, Pediatric Neuroscience, and Pediatric Neurosurgery. McLone has been chairman of the Section of Pediatric Neurosurgery of the American Association of Neurological Surgeons, president of the American Society of Pediatric Neurosurgeons, and chairman of the American Board of Pediatric Neurosurgery. He is currently the president of the International Society of Pediatric Neurosurgery and editor-in-chief of Pediatric Neurosurgery. An endowed Chair in Pediatric Neurosurgery was established in his honor in July 1997.

A formal Pediatric Neurosurgery Fellowship Program was instituted at Children's Memorial Hospital in 1985. Neurosurgical trainees from Children's are now practicing on every continent, with the possible exception of Australia. Past "full-time academic" neurosurgeons at Children's Memorial Hospital who have subsequently left the faculty include Yoon S. Hahn, Bruce Storrs, Robert Dauser, Keith Aronyk, and Mark Dias. The current full-time faculty at Children's Memorial Hospital includes McLone as head of neurosurgery, Tomita as director of neuro-oncology, and John Grant. Gutierrez, Brown, Ferguson, and Martin G. Luken III currently have appointments at Children's Memorial as part-time attending neurosurgeons. Residents from the University of Illinois (Chicago) also rotate through Children's Memorial Hospital. Under McLone's guidance, the hospital has maintained its reputation as one of the leading pediatric neurosurgical facilities in the world.

EVANSTON HOSPITAL TOP The city of Evanston (current population, 73,200) is the closest northern suburb of Chicago, situated along Lake Michigan. The history of Evanston Hospital can be traced to 1893, when the Evanston Emergency Hospital Association purchased and remodeled an eight-room frame cottage at 806 Emerson Street. During the ensuing year, 36 patients were treated and the citizens of Evanston realized that a larger hospital was needed. Funds were raised, and 4 acres of land were purchased on Ridge Avenue. The first building was opened to patients in February 1898 as "a first class hospital, equipped with all the means and appliances that science and money can provide..." (1). This became the nucleus of the present-day Evanston Hospital complex, which is located six blocks from the Evanston campus of Northwestern University and approximately 12 miles from downtown Chicago. Evanston Hospital was first approved for the training of interns in 1913. In 1930, the medical staff and the Hospital became fully affiliated with the Northwestern University Medical School. The close association between Evanston Hospital and Northwestern University has continued to the present day. The Evanston Hospital Corporation, including the sister institution Glenbrook Hospital, renamed itself Evanston Northwestern Healthcare in 1997 to reflect this close association.

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Joseph Tarkington (1916-1988) started the neurosurgical service at Evanston Hospital while he was a partner with Davis and Martin. In 1953, he left practice with Davis to become the first full-time neurosurgeon at Evanston Hospital. Tarkington had trained with Wilder Penfield and William Cone, in addition to Davis. Before that, neurosurgeons such as Adrien VerBrughen from Rush Presbyterian Hospital occasionally came from Chicago to operate at Evanston Hospital. Tarkington quickly established a reputation as a skilled surgeon and developed a wide referral base. Ciric (born in 1933) joined Tarkington in 1967, after completing his residency with Bucy and fellowships in New York with Henry Zimmerman and in Montreal with Jules Hardy. His pituitary surgery program, established in 1967, quickly achieved national recognition. Also in 1967, Northwestern neurosurgery residents began rotating at Evanston Hospital. Ciric brought microneurosurgical techniques to the Chicago area and used them extensively in neurosurgical procedures. He also established a microneurosurgical laboratory at Evanston Hospital in the mid 1970s, for the training of residents. Because of his efforts, Evanston Hospital emerged as a leading center for microneurosurgery. Ciric became head of neurosurgery at Evanston Hospital in 1983, professor of neurological surgery at Northwestern University in 1985, and has held the Bennett-Tarkington Chair in neurological surgery since 1988. Ciric has authored numerous publications and served on the editorial boards of Surgical Neurology and Neurosurgery. Subsequent additions to the Evanston Hospital neurosurgery faculty include Theodore Eller (1979), Jeff Cozzens (1985), and Sami Rosenblatt (1995). The neurosurgical service at Evanston Hospital functions as one of the cornerstones of the training program in neurological surgery at Northwestern University. The four neurosurgeons at Evanston Hospital enjoy an outstanding reputation, with special expertise in brain tumors, vascular neurosurgery, epilepsy surgery, functional neurosurgery, and cranial base surgery.

THE ANTHONY RAIMONDI ERA TOP Anthony J. Raimondi (born in 1928), third chief of the Division of Neurosurgery at Northwestern University (Fig. 6), was one of the pioneers of modern pediatric neurosurgery. Born in Chicago, he pursued his undergraduate studies at the University of Illinois, and received his M.D. from the University of Rome "La Sapienza" in 1954. After completing training in general surgery at Wesley and Presbyterian Hospitals in Chicago, he served as Captain in the United States Army Medical Corps and was assigned to be General Surgeon to the 28th General Hospital, La Rochelle, France, from 1957 to 1959. As a neurosurgical resident under Joseph Evans at the University of Chicago, he came to Children's Memorial Hospital with Buchanan (see above) on Friday afternoons. He developed an intense interest in pediatric neurosurgery and spent a year with Amador at Children's Memorial after completing his residency in 1962. Raimondi then went to Cook County Hospital to head the neurosurgery program there. Early in his career, Raimondi contributed to the understanding of brain tumors and their effects on the blood-brain barrier, through studies using electron microscopy. He joined the staff of Children's Memorial Hospital in 1969 and Passavant Memorial Hospital in 1970. He wrote extensively on mostly pediatric topics, including the use of laminotomy and the treatment of hydrocephalus. He was instrumental in developing a one-piece shunt system for treating hydrocephalus, which decreased the number of shunt revisions required, and also the abdominal trocar (18). Raimondi became chief of neurosurgery at Northwestern in 1972, also serving as professor of anatomy.

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FIGURE 6. Anthony J. Raimondi (born in 1928). Charismatic third chief of the Division of Neurosurgery at Northwestern University, Raimondi was one of the pioneers of modern pediatric neurosurgery.

During his time as chief of neurosurgery at Northwestern, Raimondi emphasized the traditions of professorial teaching and dedication to basic research. He thought that a neurosurgical residency should provide an education, not just a "training". The Northwestern residency program was designed to produce "neurosurgical academicians who could function as subspecialists or general neurosurgeons" (Raimondi, personal communication). Raimondi emphasized the importance of acquiring an education in neuroradiology as part of the training of a neurosurgeon (16). Even in his later years as chief, his residents were required to spend at least 6 months in neuroradiology, performing their own angiography and myelography. His residency program was 7 years in length and included basic science research and often extramural clinical rotations. The main neurosurgical research facility was located on the 14th floor of the Searle Building. Attending and resident neurosurgeons taught neuroanatomy, in addition to neurosurgery, to the medical students. Visiting professors from across the country were invited to Northwestern every 1 to 2 months. Annual awards were presented to the neurosurgical residents for best clinical research, best basic science research, and best pediatric patient care. Neurosurgical faculty members added during the Raimondi era included Cerullo (1977) and Brown (1978). Fifteen of Raimondi's residents have gone on to become chairmen of neurosurgery departments or major pediatric neurosurgery units; others are still climbing academic ladders.

Raimondi was also active as an editor and in his service to the pediatric neurosurgical organizations. He was one of the five founders of the American Association of Neurological Surgeons Section of Pediatric Neurosurgery, founder (and first secretary) of the International Society of Pediatric Neurosurgery, and founder and first executive editor of Child's Brain then Child's Nervous System. He served as president of the International Society for Pediatric Neurosurgery, founder and first president of the American Society of Pediatric Neurosurgery, and president of the European Society of Pediatric Neurosurgery (17). Raimondi's contributions to neurosurgery include several textbooks, including Pediatric Neuroradiology, Concepts in Pediatric Neurosurgery, the Principles of Pediatric Neurosurgery series, and Pediatric Neurosurgery: Theory and Art of Surgical Techniques. He also wrote almost 200 articles and book chapters. In August 1982, Raimondi stepped down as chief of neurosurgery but continued at Northwestern University as professor of neurosurgery and anatomy. Raimondi is currently professor and chairman of pediatric neurosurgery at the University of Rome "La Sapienza," in Rome, Italy.

THE FORMATION OF NORTHWESTERN MEMORIAL HOSPITAL AND THE MODERN ERA OF NEUROSURGERY AT NORTHWESTERN UNIVERSITY TOP Northwestern Memorial Hospital was formed when Passavant and Wesley set aside long-standing rivalries

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and consolidated on September 1, 1972 (1). The press conference announcing the merger was presided over by Mayor Richard J. Daley (3). Each unit was designated a pavilion in the new hospital. At that time, the total of more than 1000 beds made it the largest private hospital in Illinois and the sixth largest in the nation (1). Neither Passavant nor Wesley had ever had "public" or "private" wards. Each patient, regardless of any "standing," was admitted under a specific attending physician and was cared for by the residents and attendings together. This arrangement continues to the present day at Northwestern Memorial Hospital. "Patients First" has been the hospital's time-honored philosophy and motto. Raimondi (see above) succeeded Bucy as chief of neurosurgery at the time the hospitals merged in 1972. In 1972, the hospital was designated a special regional trauma center for the care of patients with spinal cord injuries. The new 18-story Rehabilitation Institute of Chicago moved from 401 E. Ohio Street to its current site in 1974. The Rehabilitation Institute of Chicago, which recently has consistently been rated the premier rehabilitation facility in the country, has been an outstanding resource for Northwestern patients and physicians. In 1975, the newly completed Prentice Women's Hospital and Institute of Psychiatry were added to Northwestern Memorial Hospital. In 1976, "4 West Passavant" became the primary neurosurgery floor for the hospital; before that, neurosurgical patients had been cared for on 11 East Wesley.

On October 8, 1979, the Olson Pavilion of Northwestern Memorial Hospital opened, housing the new operating rooms, emergency room, diagnostic radiology department, and neurosurgical intensive care unit. A "step-down" unit for intermediate-level care was also opened at 4 West Passavant. In 1980, Northwestern Memorial Hospital became the first hospital in the world to open an acute spinal cord injury intensive care unit. In August 1982, David Nahrwold, the new chairman of the Department of Surgery, became acting chief of neurosurgery for a 2-year period. Cerullo served as acting chief of the Division of Neurosurgery from August 1984 until early 1986. Cerullo's interests were focused on spinal disorders and brain tumors, particularly the surgical treatment of acoustic schwannomas. Cerullo pioneered the use of the CO2 laser in neurosurgery, using it clinically as early as 1981. As a faculty member, he and his partner Brown conducted Neurosurgery Laser Workshops that were attended by neurosurgeons from across the country. To his residents, Cerullo imparted superb clinical skills, both in the operating room and at the bedside. He also taught the importance of the "three As" in neurosurgery: availability, affability, and ability. Cerullo left active practice at Northwestern Memorial Hospital in 1987 to found the Chicago Institute for Neurosurgery and Neuroscience, where he continues today as medical director.

Dr. Albert Butler served as Michael J. Marchese professor of surgery and chief of neurosurgery at Northwestern from 1986 to 1993. He attended medical school at Loma Linda University and then received his neurosurgical training under Crutchfield and Jane at the University of Virginia. He was a member of the faculty of the University of Virginia and was then chief of neurosurgery at the State University of New York at Stonybrook before coming to Northwestern. Butler's basic science interests focused on the study of hydrocephalus and the physiology of cerebrospinal fluid; for many years, he served on a National Institutes of Health Study Section. Clinically, he was particularly adept at the surgical treatment of lesions of the third ventricle, but, for the most part, he practiced and taught general neurosurgery. The Program in Stereotactic and Functional Neurosurgery, which included linear accelerator radiosurgery, was established in 1987. The Tarry Research Building, housing the new neurosurgical research laboratories on the 13th floor, opened in the fall of 1991 (Fig. 7A). Additions to the neurosurgery faculty under Butler included Robert Levy (1987), Cybulski (1988), Steven Brem (1989), Engelhard (1991), and Douglas Chyatte (1991). Chyatte subsequently left Northwestern to become head of cerebrovascular surgery at the Cleveland Clinic, whereas Brem (in December 1995) became chief of neurosurgery at the H. Lee Moffitt Cancer Center and Research Institute at the University of South Florida. Butler stepped down as chief in the spring of 1993 and subsequently went into the private practice of neurosurgery on Long Island in New York.

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FIGURE 7. A, Tarry Basic Science Research Building, which houses spacious, ultramodern neurosurgical research laboratories on the 13th floor, opened in 1991. B, new addition to Northwestern Memorial Hospital, dubbed the Redevelopment Project, currently under construction. At a cost of approximately $600 million, it is one of the largest health care construction projects in the country. The 22-story facility is designed to enhance patient care and convenience while accommodating the changes that have taken place, and will continue to occur, in health care delivery.

From 1993 until September 1995, Levy was acting chief of the Division of Neurological Surgery. Levy is currently director of the Comprehensive Pain Clinic and director of functional and stereotactic surgery. He recently served as chairman of the Joint Section of Pain of the Congress of Neurological Surgeons/American Association of Neurological Surgeons. Coauthor or editor of the texts AIDS and the Nervous System (first and second editions) and Neurosurgical Management of Pain and nearly 100 scientific articles, Levy is a nationally recognized expert on acquired immunodeficiency syndrome and the neurosurgical treatment of pain. In 1994, groundbreaking ceremonies were held for the new 2 million-square foot addition to Northwestern Memorial Hospital (see below), which is scheduled to open in 1999 (Fig. 7B). During recent years, Northwestern Medical School has consistently been among the top medical schools in the country for providing medical students for residencies and subsequent careers in neurosurgery. This has been attributed to the type of medical student that Northwestern attracts, the very positive exposure the medical students have to neurosurgery while at Northwestern, and the faculty's enthusiasm in teaching neurosurgery to their students.

THE CURRENT AND FUTURE STATUS OF NEUROSURGERY AT NORTHWESTERN TOP In September, 1995, Hunt Batjer (born in 1951) became Michael J. Marchese Professor of Surgery and fifth chief of the Division of Neurological Surgery at Northwestern University. Batjer attended the University of Texas in Austin and the University of Texas, Southwestern Medical School in Dallas. He continued in the neurosurgical residency program at Southwestern, receiving training under W. Kemp Clark and Duke Samson. While keenly interested in almost every aspect of operative neurosurgery, he quickly showed a particular affinity for complex cerebrovascular problems. He pursued fellowship training, first at The National Hospital-Institute of Neurology at the University of London (London, England) and then at the University of Western Ontario (London, Ontario, Canada), under the supervision of Charles Drake. Returning to the University of Texas, Southwestern Medical School, he rose through the academic ranks, becoming professor in 1993. Recipient of numerous awards and very active in the national neurosurgical organizations, Batjer is immediate past secretary and president-elect of the Congress of Neurological Surgeons. Coeditor of the journal Techniques in Neurosurgery, coauthor or editor of five books, including Intracranial Aneurysm Surgery: Techniques, Cerebrovascular Disease, and the upcoming Textbook of Neurological Surgery, and coauthor of more than 150 chapters and scientific articles, Batjer has become an expert in the field of cerebrovascular disease.

Through the years, a significant strength of the Northwestern Neurosurgical Program has been the volume and diversity of the patients being treated. The Northwestern Neurosurgery Program is currently one of the largest neurosurgical programs in the country, with nearly 3000 procedures being performed annually. Northwestern Memorial Hospital (among all specialties) has more than 33,000 admissions, 7,800 inpatient surgical cases, and 48,000 emergency room visits annually. Northwestern Memorial Hospital's primary

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service area is the home of the nearly 800,000 residents of Chicago's near north side neighborhoods. Yet, the hospital is also a major tertiary referral center, drawing patients from numerous other states and foreign countries. Under Batjer's guidance, the neurosurgical program at Northwestern Memorial Hospital has expanded dramatically, with neurosurgical subspecialization developing according to patient need, training requirements, and faculty interests (Table 1). Since 1995, four additional members have been added to the Northwestern Medical Faculty Foundation as full-time academic neurosurgeons: Jeff Schweitzer (1996), Stephen Ondra (1996), Christopher Getch (1996), and James P. Chandler (1997). Neurosurgical highlights at Northwestern Memorial Hospital currently include complex cerebrovascular problems, interventional neuroradiology, radiosurgery, neuroendoscopy, the surgical treatment of epilepsy and movement disorders, the Comprehensive Pain Program, the Center for Spinal Surgery, the Midwest Regional Spinal Cord Injury Center, and the Multidisciplinary Neuro-Oncology Program. The new Gamma Knife Unit will be operational in the summer of 1998. Brown, Gutierrez, Wesley Yapor, and Cybulski also have neurosurgery appointments at Northwestern Memorial Hospital as contributed service faculty.

TABLE 1. Current Full-time Neurosurgical Faculty at Northwestern Memorial Hospital

Northwestern neurosurgical residents use state-of-the-art facilities and achieve considerable clinical experience in all areas of adult and pediatric neurosurgery. The construction of the new 2 million-square foot hospital addition, dubbed The Redevelopment Project (Fig. 7B), ensures that this will continue to be the case well into the next century. At a cost of approximately $600 million, The Redevelopment Project is the largest privately funded construction project in Illinois and is one of the largest health care construction projects in the country. The ultramodern hospital is expected to set new standards in health care delivery for decades to come by enhancing patient care and convenience, while responding to the changes that have taken place in health care during recent years. Outpatient services are increasingly being used, while more acutely ill patients (requiring even more sophisticated treatment) are cared for during the course of a shorter hospital stay. The Hospital is designed with the space and flexibility to accommodate the further changes in medical technology and health care needs that will present themselves during the years to come. (This information is courtesy of the Northwestern Memorial Hospital Redevelopment Project.)

Currently, the Residency Training Program in Neurologic Surgery at Northwestern University is designed to prepare its graduates for careers in academic or clinical neurosurgery. Whatever the career choice, residents must be able to think through clinical problems in a clear and logical fashion. They must also be prepared for a lifetime of continual reeducation. This is accomplished, in part, by learning how to read journal articles critically and by continually reapplying one's understanding of basic and innovative neurosurgical techniques. The Northwestern program is 5 years long, preceded by 1 year of integrated surgical internship. Two residents are appointed each year through the Neurological Surgery Matching Program based on their academic performance, outside interests, recommendations, and interview at Northwestern. In 1996, the applicant pool consisted of 155 applicants; 35 applicants were interviewed. Clinical rotations through the four hospitals are tailored to the needs and career plans of the individual residents. Changes in resident rotations have been made to respond to the changing trends in the delivery of neurosurgical care. A 6-month rotation is devoted to training in neurology and neuropathology. Residents are strongly encouraged to develop basic science and/or clinical research interests under the guidance of a faculty mentor. Northwestern University is a leading research institution with extensive resources for supporting a wide range of investigative activities. One or more years of the residency can be dedicated to training in basic or clinical research. Current research programs within neurosurgery include studies of

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molecular neuro-oncology and novel therapies for malignant brain tumors (Engelhard), neural tube closure (McLone), seizure electrophysiology (Schweitzer), clinical cerebrovascular surgery (Batjer), and the basic mechanisms and treatment of chronic pain and acquired immunodeficiency syndrome (Levy). Three endowed chairs exist: The Marchese Chair, held by Batjer; The Bennet-Tarkington Chair, held by Ciric; and The McLone Chair, held by McLone. The Edith and Loyal Davis Chair has been traditionally held by the chairman of the Department of Surgery. Neurosurgery at Northwestern Memorial, Children's Memorial, and Evanston Hospitals is strongly supported by neurology and neuroradiology. Residents are expected to participate fully with the faculty in the day-to-day teaching of medical students. Residents are required to take the written examination of the American Board of Neurological Surgery each year after their 1st year of neurosurgical training and must pass the examination before becoming chief residents.

In 1995, two of the leaders of Northwestern University Medical School (Dean Harry Beatty and Nahrwold) thought that neurosurgery at Northwestern could become a nationally preeminent program. At that time, an agreement was made to elevate the Division of Neurosurgery to departmental status, to enhance recruitment capability and facilitate allocation of resources into the clinical and basic neurosurgical disciplines. This transition (from division to department) will be completed in September 1998. This key recognition of the academic stature of the neurosurgical program will markedly enhance the "neuroscience agenda" for the University as a whole. Current neurosurgical initiatives are being directed at better coordinating the large and talented faculty. Shared programs are underway in cerebrovascular disease, neuro-oncology, complex spinal disorders, epilepsy and movement disorders, and radiosurgery. Our goal is to successfully navigate the remarkable turbulence in the current health care arena and become a premier clinical neuroscience center. Outstanding clinical programs will be linked with excellent pre- and postgraduate education. Priority will be placed on keeping the real (not artificial) challenges in mind: too many people die or are disabled from ischemic and hemorrhagic stroke; the prognosis for brain cancer victims remains very poor; and recovery from brain and spinal injury is usually incomplete. The treatment of these and other devastating neurological conditions is the driving force behind our program. Ultimately, our success or failure will be measured by the progress that is made in contributing to the improvement of the health of the public.

ACKNOWLEDGMENTS TOP We thank the many individuals who contributed to the publication of this article, including Susan Sacharski (Archivist, Northwestern Memorial Hospital), Joanne Butler (Northwestern Memorial Hospital), Chris Ann Philips (American Association of Neurological Surgeons), Mary Louise Davis (American Board of Neurological Surgery), and Regina Lenz (Division of Neurological Surgery, Children's Memorial Hospital). Special thanks go to Janeen Fitzpatrick for help with preparation of the manuscript.

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Keywords: Bucy, Paul; Children's Memorial Hospital; Davis, Loyal; Evanston Hospital; History of neurosurgery; Kanavel, Allen; Northwestern Memorial Hospital; Raimondi, Anthony

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