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Thoralf M. Sundt, Jr.
Surg Neurol 1989;31:169-71
169
Thoralf M. Sundt, Jr.
Few contemporary neurosurgeons will ever develop the large clinical series of intracranial aneurysms (1,048), arteriovenous malformations (231), and endarterectomies (1,641) performed by Thoralf M. Sundt, Jr., M.D., of the Mayo Clinic, in a period of less than 20 years. He has contributed over 200 scientific articles and book chapters on vascular neurosurgery. His scientific endeavors comprise important clinical observations and excellent laboratory investigations. He has been an extremely effective Program Director and Head of Department of Neurosurgery at the Mayo Clinic since 1980. He is on the Editorial Board of the Journal of Neurosurgery and served as Chairman from 1985 to Address reprint requests to." Patrick J. Kelly, M.D., Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota 55905. Received October 3, 1988; accepted October 12, 1988.
© 1989 by Elsevier Science Publishing Co., Inc.
1987. He is Chairman of the Credentials Committee of the American Board of Neurological Surgery. One might assume that Sundt's accomplishments resulted from a long-standing commitment to medicine. But his early background was far afield from neurosurgery. His grandfather, M. M. Sundt, a ship's carpenter, was born in Norway, built barns in Wisconsin in the 1880s and later forts in the Southwest for the U.S. Army during the Indian wars. Two of his 12 children went to West Point and embarked upon successful Army careers. Thoralf M. Sundt, Sr., Thor's father, enlisted in the U.S. Army during World War I and fought in France. Another of the 12 children established the M. M. Sundt Construction Company in Tucson, Arizona. Thor's father met his future wife while studying architecture at the University of Pennsylvania. Following graduation, Thor Sundt, Sr., rapidly ascended to Chairman of the Board of Methodist Architects of Philadelphia. Unfortunately, Methodist Architects folded during the Great Depression. Thoralf Sr. took the young family that then included three boys (among them Thoralf M. Sundt, Jr., born April 3, 1930) to Tucson to join his brother and M. M. Sundt Construction Company. During World War II their company rose to major prominence. The building of Los Alamos was just one of their accomplishments. Thor and his brothers worked for the company during their youth. Young Thor carried a tool box, following his father on jobs, and was convinced that he, like his father, was going to be a contractor. In fact, his older brother and younger brother now serve as respective President and Vice President of M. M. Sundt, Inc. But Thor later decided to follow the military tradition of his father and uncles. Thor passed the entrance examination for the U.S. Military Academy at West Point and was recommended to the U.S. Military Academy by his Arizona Senator. After passing the qualifying examination ("the hardest examination I ever had to pass") he entered West Point in 1948 at age 18. The rigors of West Point were not for everyone: of the original 800 cadets that entered West Point with him, only 500 graduated. But Thor thrived at the 0090-3019/89/$3.50
170
Surg Neurol 1989;31:169-71
Military Academy and upon graduation was totally committed to an Army career. He was assigned to the Engineers in Korea in 1952. The young Second Lieutenant was a platoon leader and later company commander in the 32nd Regimental Combat Team, which engaged the enemy in many well-known encounters. His platoon was the last to leave the battleground on Pork Chop Hill where Thor fully expected to be among the 60% to 70% casualties sustained by many of the units in that battle. But he escaped injury and was awarded the Bronze Star with oak leaf cluster. After the Korean War, military service lost its luster. A peacetime army career was uninteresting: "Practicing for war was boring," Sundt said. An early interest in medicine seeded by his maternal grandfather and uncle, both physicians, which had been suppressed by his enthusiasm for a military career, began to surface and direct him. He gained the prerequisite credits for medical school from the University of Arizona and enrolled in the University of Tennessee Medical School in 1956. After being inspired by neuroanatomist Simon Brusch and neurosurgeons Eustace Semmes and Francis Murphey, he considered nothing but neurosurgery. He entered the University of Tennessee's neurosurgery residency program following graduation from medical school and a rotating internship at John Gaston Hospital in Memphis. His neurosurgery residency included six months of medical neurology at the Mayo Clinic. While at the Mayo Clinic he was impressed by the large number of uncommon neurosurgical cases treated there and by the skill of the neurosurgeons, particularly Collin MacCarty and Ross Miller. He planned to return to Mayo upon completion of his residency. Back in Memphis, the otolaryngologist, John Shae, suggested that the operating microscope could be valuable in neurosurgical procedures. Excited, Dr. Sundt's persistence finally convinced Dr. Murphey to purchase a microscope for the neurosurgery laboratory in 1963. In the early 1960s direct approaches on intracranial aneurysms were associated with unacceptable mortality and morbidity. During procedures witnessed in Memphis, Sundt noted that the aneurysm was often ripped from the parent vessel. The hole in the wall of the parent artery was difficult to close except by clipping the vessel proximally and distally, usually with serious neurologic complications. In 1964, while still a resident, Sundt conceived and developed the encircling clip graft, in collaboration with George Kees of Cincinnati. But Sundt realized that a clip encircling some parent vessels could obstruct perforating vessels and produce infarction. This stimulated his interest in stroke. He accepted a research fellowship at the Mayo Clinic
Kelly
after completing his residency. There he and Dr. Jerry Waltz from the Department of Neurology organized a stroke laboratory. They developed an experimental model for stroke in cats in which the sylvian fissure was opened using the operating microscope and the middle cerebral artery was clipped. They made important observations on the microvascular changes in stroke and studied hypervolemic hemodilution which they found could reduce neurologic damage in small infarcts. His vascular laboratory was well-established by the time he returned to Memphis, following completion of his research fellowship in 1966. He rejoined the faculty of the University of Tennessee and the Semmes Murphey Clinic. Between 1966 and 1969 he operated on more than 150 intracranial aneurysms using the operating microscope and microsurgical techniques that he had perfected in his vascular laboratory at the Mayo Clinic. In April 1969 he was offered a staff position at the Mayo Clinic and returned. Sundt thrived on the pace at the Mayo Clinic. In addition to performing a large number of aneurysm procedures and endarterectomies, his inventive mind was constantly deriving methods for improving these operations. In collaboration with Dr. Jack Michenfelder and Dr. Frank Sharbrough, he instituted continuous EEG monitoring and cerebral blood flow measurements during carotid endarterectomy. He devised a carotid shunt in 1969. These contributions and his technical skill resulted in much lower morbidity in patients undergoing carotid endarterectomy in comparison to endarterectomies performed by vascular surgery at that time. After 1971, carotid endarterectomy was firmly established as a neurosurgical procedure. Open intracranial surgery on aneurysms was also advanced by his incisiveness, surgical skill, and the operating microscope. He reported these results in a classic paper in the New England Journal in 1978, reporting a series of 310 patients and an overall surgical mortality of 5%, with 1.6% in a group of patients with normal preoperative neurologic function. This is generally accepted as the "gold standard" in aneurysm surgery today. However, some patients did not do well following aneurysm surgery due to cerebral vasospasm. This prompted his intense interest in cerebral vasospasm. His many laboratory investigations on the pathophysiology, biochemistry, and possible modes of treatment of vasospasm are documented in numerous papers and book chapters. Thor's personal life is as successful as his academic neurosurgical career. He married Lois Baker in 1952, having met her while still a cadet at West Point. He and Lois have been married 36 years. They have three
Thoralf M. Sundt, Jr.
children: Thor Sundt III, who is completing training as a cardiac surgeon; John Howard, an attorney; and Laura, who is Vice President and Comptroller of American Southwest Mortgage Company. Thor and Lois live modestly. Thor, drawing on his background in construction, designed their home which sits in a forest of pine trees, all of which were planted by Thor himself. In his spare time, he plays the violin and enjoys art and military history. In spite of his monumental academic achievements, international reputation, and his immense surgical skill, Thor is unpretentious and uncomplicated. He is kind to patients, colleagues, residents, and nurses. At all times he will believe the best about an individual. He will not waste a minute thinking about an individual he does not like. His military background has produced an efficient program director who deals with problems immediately. He does not procrastinate. It is not unusual for him to pick up the telephone to deal with a problem before the person who brought it to his attention has finished his
Surg Neurol 1989;3 l:169-71
171
sentence. In spite of his heavy surgical schedule and administrative responsibilities, he is always available to members of his department and to residents. His loyalty to his colleagues and friends is admirable and his personal courage in his battle against multiple myeloma has been an inspiration to all of his colleagues. Sundt continues to develop new approaches for the surgical treatment of giant aneurysms and arteriovenous malformations. He is constantly designing new instrument prototypes and better aneurysm and vascular clips. He and George Kees continue their fruitful collaboration and have developed an entire series of excellent aneurysm clips: the necessity for each clip arising from Thor's vast experience in routine and difficult aneurysms throughout his career. His continued presence, leadership and professional example keep his laboratory and department productive. PATRICK J. KELLY, M.D.
Rochester, Minnesota
169
Thoralf M. Sundt, Jr.
Few contemporary neurosurgeons will ever develop the large clinical series of intracranial aneurysms (1,048), arteriovenous malformations (231), and endarterectomies (1,641) performed by Thoralf M. Sundt, Jr., M.D., of the Mayo Clinic, in a period of less than 20 years. He has contributed over 200 scientific articles and book chapters on vascular neurosurgery. His scientific endeavors comprise important clinical observations and excellent laboratory investigations. He has been an extremely effective Program Director and Head of Department of Neurosurgery at the Mayo Clinic since 1980. He is on the Editorial Board of the Journal of Neurosurgery and served as Chairman from 1985 to Address reprint requests to." Patrick J. Kelly, M.D., Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota 55905. Received October 3, 1988; accepted October 12, 1988.
© 1989 by Elsevier Science Publishing Co., Inc.
1987. He is Chairman of the Credentials Committee of the American Board of Neurological Surgery. One might assume that Sundt's accomplishments resulted from a long-standing commitment to medicine. But his early background was far afield from neurosurgery. His grandfather, M. M. Sundt, a ship's carpenter, was born in Norway, built barns in Wisconsin in the 1880s and later forts in the Southwest for the U.S. Army during the Indian wars. Two of his 12 children went to West Point and embarked upon successful Army careers. Thoralf M. Sundt, Sr., Thor's father, enlisted in the U.S. Army during World War I and fought in France. Another of the 12 children established the M. M. Sundt Construction Company in Tucson, Arizona. Thor's father met his future wife while studying architecture at the University of Pennsylvania. Following graduation, Thor Sundt, Sr., rapidly ascended to Chairman of the Board of Methodist Architects of Philadelphia. Unfortunately, Methodist Architects folded during the Great Depression. Thoralf Sr. took the young family that then included three boys (among them Thoralf M. Sundt, Jr., born April 3, 1930) to Tucson to join his brother and M. M. Sundt Construction Company. During World War II their company rose to major prominence. The building of Los Alamos was just one of their accomplishments. Thor and his brothers worked for the company during their youth. Young Thor carried a tool box, following his father on jobs, and was convinced that he, like his father, was going to be a contractor. In fact, his older brother and younger brother now serve as respective President and Vice President of M. M. Sundt, Inc. But Thor later decided to follow the military tradition of his father and uncles. Thor passed the entrance examination for the U.S. Military Academy at West Point and was recommended to the U.S. Military Academy by his Arizona Senator. After passing the qualifying examination ("the hardest examination I ever had to pass") he entered West Point in 1948 at age 18. The rigors of West Point were not for everyone: of the original 800 cadets that entered West Point with him, only 500 graduated. But Thor thrived at the 0090-3019/89/$3.50
170
Surg Neurol 1989;31:169-71
Military Academy and upon graduation was totally committed to an Army career. He was assigned to the Engineers in Korea in 1952. The young Second Lieutenant was a platoon leader and later company commander in the 32nd Regimental Combat Team, which engaged the enemy in many well-known encounters. His platoon was the last to leave the battleground on Pork Chop Hill where Thor fully expected to be among the 60% to 70% casualties sustained by many of the units in that battle. But he escaped injury and was awarded the Bronze Star with oak leaf cluster. After the Korean War, military service lost its luster. A peacetime army career was uninteresting: "Practicing for war was boring," Sundt said. An early interest in medicine seeded by his maternal grandfather and uncle, both physicians, which had been suppressed by his enthusiasm for a military career, began to surface and direct him. He gained the prerequisite credits for medical school from the University of Arizona and enrolled in the University of Tennessee Medical School in 1956. After being inspired by neuroanatomist Simon Brusch and neurosurgeons Eustace Semmes and Francis Murphey, he considered nothing but neurosurgery. He entered the University of Tennessee's neurosurgery residency program following graduation from medical school and a rotating internship at John Gaston Hospital in Memphis. His neurosurgery residency included six months of medical neurology at the Mayo Clinic. While at the Mayo Clinic he was impressed by the large number of uncommon neurosurgical cases treated there and by the skill of the neurosurgeons, particularly Collin MacCarty and Ross Miller. He planned to return to Mayo upon completion of his residency. Back in Memphis, the otolaryngologist, John Shae, suggested that the operating microscope could be valuable in neurosurgical procedures. Excited, Dr. Sundt's persistence finally convinced Dr. Murphey to purchase a microscope for the neurosurgery laboratory in 1963. In the early 1960s direct approaches on intracranial aneurysms were associated with unacceptable mortality and morbidity. During procedures witnessed in Memphis, Sundt noted that the aneurysm was often ripped from the parent vessel. The hole in the wall of the parent artery was difficult to close except by clipping the vessel proximally and distally, usually with serious neurologic complications. In 1964, while still a resident, Sundt conceived and developed the encircling clip graft, in collaboration with George Kees of Cincinnati. But Sundt realized that a clip encircling some parent vessels could obstruct perforating vessels and produce infarction. This stimulated his interest in stroke. He accepted a research fellowship at the Mayo Clinic
Kelly
after completing his residency. There he and Dr. Jerry Waltz from the Department of Neurology organized a stroke laboratory. They developed an experimental model for stroke in cats in which the sylvian fissure was opened using the operating microscope and the middle cerebral artery was clipped. They made important observations on the microvascular changes in stroke and studied hypervolemic hemodilution which they found could reduce neurologic damage in small infarcts. His vascular laboratory was well-established by the time he returned to Memphis, following completion of his research fellowship in 1966. He rejoined the faculty of the University of Tennessee and the Semmes Murphey Clinic. Between 1966 and 1969 he operated on more than 150 intracranial aneurysms using the operating microscope and microsurgical techniques that he had perfected in his vascular laboratory at the Mayo Clinic. In April 1969 he was offered a staff position at the Mayo Clinic and returned. Sundt thrived on the pace at the Mayo Clinic. In addition to performing a large number of aneurysm procedures and endarterectomies, his inventive mind was constantly deriving methods for improving these operations. In collaboration with Dr. Jack Michenfelder and Dr. Frank Sharbrough, he instituted continuous EEG monitoring and cerebral blood flow measurements during carotid endarterectomy. He devised a carotid shunt in 1969. These contributions and his technical skill resulted in much lower morbidity in patients undergoing carotid endarterectomy in comparison to endarterectomies performed by vascular surgery at that time. After 1971, carotid endarterectomy was firmly established as a neurosurgical procedure. Open intracranial surgery on aneurysms was also advanced by his incisiveness, surgical skill, and the operating microscope. He reported these results in a classic paper in the New England Journal in 1978, reporting a series of 310 patients and an overall surgical mortality of 5%, with 1.6% in a group of patients with normal preoperative neurologic function. This is generally accepted as the "gold standard" in aneurysm surgery today. However, some patients did not do well following aneurysm surgery due to cerebral vasospasm. This prompted his intense interest in cerebral vasospasm. His many laboratory investigations on the pathophysiology, biochemistry, and possible modes of treatment of vasospasm are documented in numerous papers and book chapters. Thor's personal life is as successful as his academic neurosurgical career. He married Lois Baker in 1952, having met her while still a cadet at West Point. He and Lois have been married 36 years. They have three
Thoralf M. Sundt, Jr.
children: Thor Sundt III, who is completing training as a cardiac surgeon; John Howard, an attorney; and Laura, who is Vice President and Comptroller of American Southwest Mortgage Company. Thor and Lois live modestly. Thor, drawing on his background in construction, designed their home which sits in a forest of pine trees, all of which were planted by Thor himself. In his spare time, he plays the violin and enjoys art and military history. In spite of his monumental academic achievements, international reputation, and his immense surgical skill, Thor is unpretentious and uncomplicated. He is kind to patients, colleagues, residents, and nurses. At all times he will believe the best about an individual. He will not waste a minute thinking about an individual he does not like. His military background has produced an efficient program director who deals with problems immediately. He does not procrastinate. It is not unusual for him to pick up the telephone to deal with a problem before the person who brought it to his attention has finished his
Surg Neurol 1989;3 l:169-71
171
sentence. In spite of his heavy surgical schedule and administrative responsibilities, he is always available to members of his department and to residents. His loyalty to his colleagues and friends is admirable and his personal courage in his battle against multiple myeloma has been an inspiration to all of his colleagues. Sundt continues to develop new approaches for the surgical treatment of giant aneurysms and arteriovenous malformations. He is constantly designing new instrument prototypes and better aneurysm and vascular clips. He and George Kees continue their fruitful collaboration and have developed an entire series of excellent aneurysm clips: the necessity for each clip arising from Thor's vast experience in routine and difficult aneurysms throughout his career. His continued presence, leadership and professional example keep his laboratory and department productive. PATRICK J. KELLY, M.D.
Rochester, Minnesota