- Email: [email protected]
Rhoton and His Influence on Japanese Neurosurgery
Accepted Manuscript Rhoton and His Influence in Japanese Neurosurgery Toshio Matsushima, M.D PII:
S1878-8750(16)30417-X
DOI:
10.1016/j.wneu.2016.06.032
Reference:
WNEU 4191
To appear in:
World Neurosurgery
Please cite this article as: Matsushima T, Rhoton and His Influence in Japanese Neurosurgery, World Neurosurgery (2016), doi: 10.1016/j.wneu.2016.06.032. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT
Title: Rhoton and His Influence in Japanese Neurosurgery
Neuroscience Center, Fukuoka Sanno Hospital
SC
1
RI PT
Toshio Matsushima, M.D.1
M AN U
Key words: Albert L. Rhoton, Microsurgical anatomy, Japan, Education of surgical anatomy, Japanese microsurgical anatomy seminar, Running Title: Rhoton and Japan
TE D
Correspondence: Toshio Matsushima, M.D.
Neuroscience Center, Fukuoka Sanno Hospital, 3-6-45 Momochihama, Sawara-ku, Fukuoka, 814-0001, Japan
EP
E-mail: [email protected]
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Tel: 81-92-832-1100
Fax: 81-92-832-3061
1
ACCEPTED MANUSCRIPT
Dr. Rhoton made a significant contribution to the development of neurosurgery in Japan. He was invited to many Japanese meetings
RI PT
including the annual meetings of the Japan Neurosurgical Society and the Japanese Congress of Neurological Surgeons. He was instrumental in first introducing the concept of, and then disseminating the new knowledge
SC
gained from, the study of microsurgical anatomy as a means to improve the techniques and outcomes of microsurgery. Forty-one Japanese fellows from
M AN U
Japan studied in Dr. Rhoton’s laboratory and helped, on their return, to promote the usefulness of the laboratory’s work for clinicians. In this honorary article, I would like to focus on how the knowledge and techniques that Dr. Rhoton passed on to his fellows spread and flourished in Japan through his fellows’ activities.
TE D
Most Japanese fellows were not good at communicating in English. Dr. Rhoton, however, was very kind and patient in listening to the poor English spoken by his
EP
Japanese fellows. Dr. Rhoton’s own speech, slow and soft, was easily understood by the Japanese fellows, and this was greatly appreciated. Because of his contribution to
AC C
medicine and his compassionate personality, Dr. Rhoton was widely respected by Japanese neurosurgeons, regardless of whether or not they had trained with him. The first Japanese fellow was Dr. Shigeaki Kobayashi of Shinshu University, who
trained with Dr. Rhoton at the Mayo Clinic from the late 1960s to the early 1970s, before Dr. Rhoton moved to the University of Florida. They realized the necessity of the precise study of anatomy through the operating microscope in order to preserve the facial nerve during the removal of an acoustic neurinoma, and published a paper titled
2
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“Nervus intermedius” in the Journal of Neurosurgery in 1968 (1). To the best of my knowledge, this was one of the first articles on microsurgical anatomy, and Dr. Rhoton
RI PT
established this field as a new research area in neurosurgery directly related to surgical procedures.
In 1972, Dr. Rhoton assumed the position of Director of the Division of
SC
Neurosurgery in the Department of Surgery at the University of Florida, established a research laboratory (Rhoton Lab) for microsurgical anatomy and began his untiring
M AN U
work. Subsequently, a total of 41 young Japanese doctors (all neurosurgeons except for 1 plastic surgeon and 1 otolaryngologist) studied under him as research fellows. After returning to Japan, these young doctors not only propagated the knowledge and techniques they had learned at the Rhoton Lab throughout Japan but also actively
universities.
TE D
worked as clinicians utilizing their expertise. Eight of them became chairmen at their
EP
The most significant contribution to Japanese neurosurgery by these fellows was the establishment of the annual meeting of the Japanese Society for Microsurgical
AC C
Anatomy (2). The first meeting of the Society was organized at Kyushu University in Fukuoka in 1986, when Dr. Rhoton was invited to attend the retirement ceremony of Prof. K. Kitamura from the Department of Neurosurgery at Kyushu University. (Fig.1) Dr. Evandro de Oliveira, from Sao Paulo, Brazil also participated in the meeting. Since then, this meeting has been held yearly, and this year the Society will celebrate its 30th anniversary. The meetings have been successful, often attracting over 800 participants at one
3
ACCEPTED MANUSCRIPT
time, even during the early years when neurosurgeons in Japan numbered no more than 4000, less than half the current number. The proceedings of the meeting, published in
RI PT
Japanese annually and called “Surgical Anatomy for Microneurosurgery,” often sold more than 3000 copies. (Fig.2) They are very popular among Japanese neurosurgeons as practical anatomy textbooks written in Japanese and have played an important role in
SC
neurosurgical education and development.
For the purposes of facilitating the education of young neurosurgeons, the Japan
M AN U
Neurosurgical Society asked Dr. Rhoton to lend his support in the making of a video series on microsurgical anatomy. He kindly accepted the request and the series was produced as a collaborative project by the Japan Neurosurgical Society and the University of Florida between 1992 and 1993. For this project, 9 former Rhoton fellows
TE D
visited the University of Florida to produce educational video tapes on 10 topics. (Fig.3) In accordance with the increased demand for international seminars on
EP
microsurgical anatomy, the first International Symposium on the Microsurgical Anatomy was held in October, 2002 in Matsumoto, Japan (President: T. Matsushima),
AC C
as one of the satellite symposia of the 61st annual meeting of the Japan Neurosurgical Society. (Fig. 4) Dr. Erdener Timurkaynak from Ankara, Turkey and Dr. Evandro de Oliveira from Sao Paulo, Brazil, both former research fellows at the Rhoton Lab, have organized subsequent international meetings, three times in Turkey and once in Brazil, inviting Dr. Rhoton as their co-President and several other experts from around the world as speakers. These international seminars have contributed to the professional development of many neurosurgeons not only in their host countries but also in
4
ACCEPTED MANUSCRIPT
neighboring regions. Dr. Rhoton, then, not only originated the concept of microsurgical anatomy but
RI PT
also promoted the use of anatomy-based surgical techniques throughout the world. I would also like, however, to write about what I knew of his personality.
When he traveled, he always carried a heavy suitcase full of the slides and papers
SC
he was working on at the time. His habit of working continuously resulted in more than 500 scientific papers and chapters. He compiled his life’s work into a single textbook
M AN U
entitled “Rhoton: Cranial approaches and surgical anatomy”. (3)
He did not drink. He not only spent his evenings but also most of his weekends working. He appeared to enjoy his research as if it were his hobby. In fact, he said to me when I was a fellow, “Study hard and it will become your hobby”. I then thought it was
TE D
only a joke, but now, as I have become older, I understand what he really meant. He visited Japan quite a few times, and at parties he often urged a few young
EP
fellows to do push-ups with him. (Fig. 5) As far as I know, no one was ever able to do more push-ups than Dr. Rhoton. He never skipped his daily jogging or iron array
AC C
training, even while traveling. It was his continuous self-training that fuelled the enormous energy and passion he brought to his work. As Dr. Rhoton became older, he used the words “competence” and “compassion”
many times in his speeches. He said that it was a great challenge for a neurosurgeon to care for his/her patients with competence and compassion. In fact, he spent considerable time with his patients both before and after surgery, helping them understand the nature of their illness and the surgery they underwent.
5
ACCEPTED MANUSCRIPT
During his early career, he realized the great potential for developing our knowledge of microsurgical anatomy to refine the techniques of microneurosurgery and
RI PT
thereby improve the standards of care given to patients, and so he began the relentless research which was to last for more than 40 years until his recent death. In conclusion, let me quote a phrase from his book:
SC
“Our work is not complete in any area…There is no ‘finish line’… Future anatomical study will continue to yield new insights throughout the future of our specialty.
M AN U
Insights gained from the other medical sciences and new technologies, when combined with our increasing knowledge of microsurgical anatomy, will create new surgical
AC C
EP
TE D
possibilities, therapies, and cures”. (3, p. vi)
6
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Acknowledgment We express our thanks to Professor emeritus Shigeaki Kobayashi, Shinshu
RI PT
University for his valuable suggestions. We are also grateful to Ms. Jessica L, Striley for her critical reading of this manuscript and to Mrs. Sumiko Matsushima for her valuable
SC
secretarial assistance in preparing this manuscript.
M AN U
References
1) Rhoton AL, Kobayashi S, Hollinshead WH: Nervus intermedius. J Neurosurg 29: 609-618, 1968
2) Matsushima T, Kawashima M, Matsushima K, Wanibuchi M: Japanese neurosurgeons and the microsurgical anatomy, Neurol Med Chir (Tokyo) 55, 276-285,
TE D
2015
3) Rhoton AL Jr: Rhoton: Cranial anatomy and surgical approaches.
Neurosurgery.
AC C
EP
Lippincott Williams & Wilkins, pp 3-7, 2003
Legends
Fig. 1: Prof. Rhoton, Prof. K. Kitamura (the president) and the lectures in the first meeting of the Japanese Society for Microsurgical Anatomy (formerly the Japanese Microsurgical Anatomy Seminar) in Fukuoka, (with permission from Neurologia medico-chirurgica)
7
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Fig. 2: Proceedings of the 20 annual meetings of the Japanese Society for Microsurgical Anatomy
(with permission from Neurologia medico-chirurgica)
Neurosurgical Society and the University of Florida
(with permission from
SC
Neurologia medico-chirurgica)
RI PT
Fig. 3: One of the video series produced as a collaborative project by the Japan
Fig. 4: The first International Symposium on the Microsurgical Anatomy held in
Fig. 5: Dr. Rhoton in Japan
M AN U
October, 2002 in Matsumoto, Japan
A: Dr. Rhoton right after he ran a marathon at the Japanese Congress in Kyoto B: Dr. Rhoton after he enjoyed the hot spring in Matsumoto
TE D
C: Dr. Rhoton enjoying karaoke at a hot spring hotel in Ureshino
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D: Dr. Rhoton and his fellows doing push-ups at a party in Saga
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S1878-8750(16)30417-X
DOI:
10.1016/j.wneu.2016.06.032
Reference:
WNEU 4191
To appear in:
World Neurosurgery
Please cite this article as: Matsushima T, Rhoton and His Influence in Japanese Neurosurgery, World Neurosurgery (2016), doi: 10.1016/j.wneu.2016.06.032. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT
Title: Rhoton and His Influence in Japanese Neurosurgery
Neuroscience Center, Fukuoka Sanno Hospital
SC
1
RI PT
Toshio Matsushima, M.D.1
M AN U
Key words: Albert L. Rhoton, Microsurgical anatomy, Japan, Education of surgical anatomy, Japanese microsurgical anatomy seminar, Running Title: Rhoton and Japan
TE D
Correspondence: Toshio Matsushima, M.D.
Neuroscience Center, Fukuoka Sanno Hospital, 3-6-45 Momochihama, Sawara-ku, Fukuoka, 814-0001, Japan
EP
E-mail: [email protected]
AC C
Tel: 81-92-832-1100
Fax: 81-92-832-3061
1
ACCEPTED MANUSCRIPT
Dr. Rhoton made a significant contribution to the development of neurosurgery in Japan. He was invited to many Japanese meetings
RI PT
including the annual meetings of the Japan Neurosurgical Society and the Japanese Congress of Neurological Surgeons. He was instrumental in first introducing the concept of, and then disseminating the new knowledge
SC
gained from, the study of microsurgical anatomy as a means to improve the techniques and outcomes of microsurgery. Forty-one Japanese fellows from
M AN U
Japan studied in Dr. Rhoton’s laboratory and helped, on their return, to promote the usefulness of the laboratory’s work for clinicians. In this honorary article, I would like to focus on how the knowledge and techniques that Dr. Rhoton passed on to his fellows spread and flourished in Japan through his fellows’ activities.
TE D
Most Japanese fellows were not good at communicating in English. Dr. Rhoton, however, was very kind and patient in listening to the poor English spoken by his
EP
Japanese fellows. Dr. Rhoton’s own speech, slow and soft, was easily understood by the Japanese fellows, and this was greatly appreciated. Because of his contribution to
AC C
medicine and his compassionate personality, Dr. Rhoton was widely respected by Japanese neurosurgeons, regardless of whether or not they had trained with him. The first Japanese fellow was Dr. Shigeaki Kobayashi of Shinshu University, who
trained with Dr. Rhoton at the Mayo Clinic from the late 1960s to the early 1970s, before Dr. Rhoton moved to the University of Florida. They realized the necessity of the precise study of anatomy through the operating microscope in order to preserve the facial nerve during the removal of an acoustic neurinoma, and published a paper titled
2
ACCEPTED MANUSCRIPT
“Nervus intermedius” in the Journal of Neurosurgery in 1968 (1). To the best of my knowledge, this was one of the first articles on microsurgical anatomy, and Dr. Rhoton
RI PT
established this field as a new research area in neurosurgery directly related to surgical procedures.
In 1972, Dr. Rhoton assumed the position of Director of the Division of
SC
Neurosurgery in the Department of Surgery at the University of Florida, established a research laboratory (Rhoton Lab) for microsurgical anatomy and began his untiring
M AN U
work. Subsequently, a total of 41 young Japanese doctors (all neurosurgeons except for 1 plastic surgeon and 1 otolaryngologist) studied under him as research fellows. After returning to Japan, these young doctors not only propagated the knowledge and techniques they had learned at the Rhoton Lab throughout Japan but also actively
universities.
TE D
worked as clinicians utilizing their expertise. Eight of them became chairmen at their
EP
The most significant contribution to Japanese neurosurgery by these fellows was the establishment of the annual meeting of the Japanese Society for Microsurgical
AC C
Anatomy (2). The first meeting of the Society was organized at Kyushu University in Fukuoka in 1986, when Dr. Rhoton was invited to attend the retirement ceremony of Prof. K. Kitamura from the Department of Neurosurgery at Kyushu University. (Fig.1) Dr. Evandro de Oliveira, from Sao Paulo, Brazil also participated in the meeting. Since then, this meeting has been held yearly, and this year the Society will celebrate its 30th anniversary. The meetings have been successful, often attracting over 800 participants at one
3
ACCEPTED MANUSCRIPT
time, even during the early years when neurosurgeons in Japan numbered no more than 4000, less than half the current number. The proceedings of the meeting, published in
RI PT
Japanese annually and called “Surgical Anatomy for Microneurosurgery,” often sold more than 3000 copies. (Fig.2) They are very popular among Japanese neurosurgeons as practical anatomy textbooks written in Japanese and have played an important role in
SC
neurosurgical education and development.
For the purposes of facilitating the education of young neurosurgeons, the Japan
M AN U
Neurosurgical Society asked Dr. Rhoton to lend his support in the making of a video series on microsurgical anatomy. He kindly accepted the request and the series was produced as a collaborative project by the Japan Neurosurgical Society and the University of Florida between 1992 and 1993. For this project, 9 former Rhoton fellows
TE D
visited the University of Florida to produce educational video tapes on 10 topics. (Fig.3) In accordance with the increased demand for international seminars on
EP
microsurgical anatomy, the first International Symposium on the Microsurgical Anatomy was held in October, 2002 in Matsumoto, Japan (President: T. Matsushima),
AC C
as one of the satellite symposia of the 61st annual meeting of the Japan Neurosurgical Society. (Fig. 4) Dr. Erdener Timurkaynak from Ankara, Turkey and Dr. Evandro de Oliveira from Sao Paulo, Brazil, both former research fellows at the Rhoton Lab, have organized subsequent international meetings, three times in Turkey and once in Brazil, inviting Dr. Rhoton as their co-President and several other experts from around the world as speakers. These international seminars have contributed to the professional development of many neurosurgeons not only in their host countries but also in
4
ACCEPTED MANUSCRIPT
neighboring regions. Dr. Rhoton, then, not only originated the concept of microsurgical anatomy but
RI PT
also promoted the use of anatomy-based surgical techniques throughout the world. I would also like, however, to write about what I knew of his personality.
When he traveled, he always carried a heavy suitcase full of the slides and papers
SC
he was working on at the time. His habit of working continuously resulted in more than 500 scientific papers and chapters. He compiled his life’s work into a single textbook
M AN U
entitled “Rhoton: Cranial approaches and surgical anatomy”. (3)
He did not drink. He not only spent his evenings but also most of his weekends working. He appeared to enjoy his research as if it were his hobby. In fact, he said to me when I was a fellow, “Study hard and it will become your hobby”. I then thought it was
TE D
only a joke, but now, as I have become older, I understand what he really meant. He visited Japan quite a few times, and at parties he often urged a few young
EP
fellows to do push-ups with him. (Fig. 5) As far as I know, no one was ever able to do more push-ups than Dr. Rhoton. He never skipped his daily jogging or iron array
AC C
training, even while traveling. It was his continuous self-training that fuelled the enormous energy and passion he brought to his work. As Dr. Rhoton became older, he used the words “competence” and “compassion”
many times in his speeches. He said that it was a great challenge for a neurosurgeon to care for his/her patients with competence and compassion. In fact, he spent considerable time with his patients both before and after surgery, helping them understand the nature of their illness and the surgery they underwent.
5
ACCEPTED MANUSCRIPT
During his early career, he realized the great potential for developing our knowledge of microsurgical anatomy to refine the techniques of microneurosurgery and
RI PT
thereby improve the standards of care given to patients, and so he began the relentless research which was to last for more than 40 years until his recent death. In conclusion, let me quote a phrase from his book:
SC
“Our work is not complete in any area…There is no ‘finish line’… Future anatomical study will continue to yield new insights throughout the future of our specialty.
M AN U
Insights gained from the other medical sciences and new technologies, when combined with our increasing knowledge of microsurgical anatomy, will create new surgical
AC C
EP
TE D
possibilities, therapies, and cures”. (3, p. vi)
6
ACCEPTED MANUSCRIPT
Acknowledgment We express our thanks to Professor emeritus Shigeaki Kobayashi, Shinshu
RI PT
University for his valuable suggestions. We are also grateful to Ms. Jessica L, Striley for her critical reading of this manuscript and to Mrs. Sumiko Matsushima for her valuable
SC
secretarial assistance in preparing this manuscript.
M AN U
References
1) Rhoton AL, Kobayashi S, Hollinshead WH: Nervus intermedius. J Neurosurg 29: 609-618, 1968
2) Matsushima T, Kawashima M, Matsushima K, Wanibuchi M: Japanese neurosurgeons and the microsurgical anatomy, Neurol Med Chir (Tokyo) 55, 276-285,
TE D
2015
3) Rhoton AL Jr: Rhoton: Cranial anatomy and surgical approaches.
Neurosurgery.
AC C
EP
Lippincott Williams & Wilkins, pp 3-7, 2003
Legends
Fig. 1: Prof. Rhoton, Prof. K. Kitamura (the president) and the lectures in the first meeting of the Japanese Society for Microsurgical Anatomy (formerly the Japanese Microsurgical Anatomy Seminar) in Fukuoka, (with permission from Neurologia medico-chirurgica)
7
ACCEPTED MANUSCRIPT
Fig. 2: Proceedings of the 20 annual meetings of the Japanese Society for Microsurgical Anatomy
(with permission from Neurologia medico-chirurgica)
Neurosurgical Society and the University of Florida
(with permission from
SC
Neurologia medico-chirurgica)
RI PT
Fig. 3: One of the video series produced as a collaborative project by the Japan
Fig. 4: The first International Symposium on the Microsurgical Anatomy held in
Fig. 5: Dr. Rhoton in Japan
M AN U
October, 2002 in Matsumoto, Japan
A: Dr. Rhoton right after he ran a marathon at the Japanese Congress in Kyoto B: Dr. Rhoton after he enjoyed the hot spring in Matsumoto
TE D
C: Dr. Rhoton enjoying karaoke at a hot spring hotel in Ureshino
AC C
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D: Dr. Rhoton and his fellows doing push-ups at a party in Saga
8
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