The abode of thought: this philosophical image of the human brain suggests something lofty and unfathomable. But from the standpoint of medical treatment, the brain is a vulnerable element. Cerebral strokes are among the most widespread illnesses in the world. Only in the last few decades have surgeons learned to neutralize vessel nodes that can cause intracranial hemorrhages, a common variety of strokes, and to avert other cerebral disasters by applying fundamentally new methods.
Recovery is achieved by a timely blocking of pathological dilatations, such as sacral aneurysms, arteriovenous malformations, and other dangerous vascular anastomoses and defects. In Ukraine, this long-awaited medical breakthrough may be largely attributed to the research and achievements of the talented neurosurgeon Viktor Shchehlov. Thirty-three years ago, in 1974, at the Institute of Neurosurgery headed by Andrii Romodanov, a pioneer in this complicated field of neurosciences, academician, and Hero of Socialist Labor, Viktor Shchehlov made the first daring attempt to carry out an intracerebral vascular reconstruction simultaneously in both brain hemispheres without trepanation (a form of surgery in which a hole is drilled or scraped into the skull). Catching the wave of the future, Romodanov, who was a brilliant surgeon in times of war and peace, organized a special clinical ward and gave his blessing to the new trend. An absolutely new page was written in the Kyiv chronicles of central nervous system surgery.
AT THE DAWN OF DESTINY
The rise of Viktor Shchehlov, Meritorious Doctor of Ukraine, to the top of his profession makes for an intriguing tale. Born and raised in the Kherson region, he graduated from the Kharkiv Medical Institute and has been a surgeon for about four decades. Shchehlov’s biography shows the importance of intellect in any walk of life. The boy from Ukraine’s steppe country was struck by the well-disposed attitude of the famous anatomist, Prof. R. D. Synelnykov. At his mentor’s invitation, he began to visit his progressive home, where his exposure to the world of art led to a two-year stint at the conservatory.
He began his career as a doctor at a district hospital tucked away in Sumy oblast, where he showed excellent practical results. Later he worked in the surgical ward of the Sumy regional hospital, diligently mastering all the latest methods. When Shchehlov, who dreamed of becoming a neurosurgeon, left to “conquer the metropolitan sky” in the late 1960s, he had about 700 of the most diverse and complicated operations under his belt and his hand was already subtle and masterful. The pattern of entering the realm of neurosurgery was largely the same as for his young colleagues, but Viktor displayed unusual passion and self-denial in absorbing the experience and lessons of such luminaries as Andrii Romodanov, Yurii Zozulia, Heorhii Pedachenko, Mark Brotman, Borys Pelts, Yurii Brodsky, and Borys Khominsky. Chance is a great selector. On Romodanov’s recommendation, Shchehlov was sent to the Moscow-based Nikolai Burdenko Institute of Neurosurgery to do an internship with Prof. Fedir Serbynenko. Serbynenko was a pioneer of intravascular reconstructions in brain surgery, one of the standard- bearers of the great neurosurgical revolution, who used a new invention, the cylinder-type catheter, to perform this type of bloodless operation. Recognizing that he was facing the chance of a lifetime, Shchehlov picked up the baton.
But it would be an oversimplification to say that things went smoothly. Among the components of success were not only faultless “travels,” under X-ray control, to the risk zone on the brain vessel map after angiography but also the safe delivery and planting of the cylinder. While the doctor in this type of procedure may be compared to a missile carrier, the catheter is the missile itself. According to Shchehlov’s concept, the detachable miniature cylinders should be diverse and individual in their architectonics, depending on the established picture of a given pathology. Shchehlov designed and implemented not only a set of such catheters but also a special substance to inject into the affected vessels.
FROM QUANTITY TO NEW QUALITY
Extremely delicate operations with astounding results are a normal routine for the team. In the past five years there has not been a single failed operation on deep-brain arteriovenous malformations. The medical center has a sophisticated angiography machine with a wonderful diagnostic potential, and vascular reconstruction, restoration, and blocking, with due account of specific tasks and new application points, are a daily occurrence.
Shchehlov’s first triumph was the bilateral neutralization of pathological anastomoses in a patient. But he did not rest on his laurels. The endovascular neurosurgery department worked with a truly creative spirit, and it was only natural that at his clinic quantity finally turned into quality, thanks to its unique research and surgical potential. In November 1996, a self-sufficient Center for Endovascular Neurological X-Ray Surgery of Ukraine was established under the government’s auspices, and the Kyiv-based “Lefty” (a fictional Russian craftsman who shoed a steel flea — Ed.) was appointed its director. The center began operating independently in April 1997. The decisive role in this strategic breakthrough was played by A. F. Vozianov, a prominent surgeon and the president of Ukraine’s Academy of Medical Sciences, and V. V. Frolkis, vice-president of the academy.
“The spirit of the Academy of Medical Sciences, this council of contemporary medicine, is perhaps the main factor that promotes the prolific development of its subordinate institutions, including the Center of Endovascular and Neurological Surgery,” Shchehlov says pensively. “It means not only daily professional control but also favourable intellectual support and freedom to create. All the things that we are discussing here are the visible fruits of the academy’s style.”
There is a phrase: “New wine in old bottles.” Shchehlov was aware that the bottles should also be new. In other words, there was a burning need to establish an original school of research and application. He felt it was his duty to meet the state’s expectations because the opening of the center was supported on a high level.
Details often explain everything. Extremely strict with himself, Shchehlov would always mentally go through all kinds of diagnostic and surgical options before reaching for the scalpel. He applied the same yardstick to his pupils and followers. One of the mandatory conditions for advancing in the profession was regular work with a special simulator that has no equal. Thanks to the efforts of engineers of the Artem Company, the device reproduces all the vessels that lead deep into the brain’s tissues, and before taking the clinical “baptism of fire,” novices walk down these virtual electronic roads hundreds and hundreds of times. Any mistakes and irregularities are spotlighted and discussed. This is only one of the many thresholds that must be crossed.
Is it too much or too little if a neurosurgeon has performed more than 10,000 operations over the years? There are 60 beds at the center, so this is an impressive pace. Although there is a rising generation of neurosurgical experts, Shchehlov is the one who usually performs the most complicated reconstructions, such as radical surgery for an aneurysm of the vein of Galen. He has won recognition from leading endovascular and neurological surgery clinics in Western Europe, the US, and Japan. His clinic is a superclass institution, and the Kyivan aficionado of microvascular and cerebral surgery has joined an elite group of leaders in the most promising branch of restorative medicine.
A GLIMPSE INTO TOMORROW
The fundamental study The Academy of Medical Sciences of Ukraine (1998) states: “The Center of Endovascular Surgery was one of the world’s first neurosurgical clinics to begin performing endovascular reconstruction in cases of intracranial aneurysm, as well as the reconstruction of carotid arteries and bilateral carotid-and-cavernous anastomoses. The center’s treatment methods are extensively used, which has allowed surgeons to apply such techniques as endovascular chemotherapy for intensively vascularized brain tumors.”
What are the prospects for the Shchehlov clinic? This medical facility makes wide use of all innovations in this branch of medicine, such as stents at the initial stages of ischemic strokes, metal coils with controlled memory for blocking intracranial aneurysms and malformations, and conducts daring reconstructive vascular experiments aimed at solving several acute medical problems. The center has a history of cooperating with otolaryngologists and ophthalmologists. D. I. Zabolotny, director of the Kolomiichenko Institute of Otolaryngology and Corresponding Member of the Academy of Medical Sciences of Ukraine, says that they cooperate in treating difficult-to-localize tumors, when specialists from the two branches need to join forces. In such cases, endovascular surgeons penetrate the thin vessels of the facial cranium, supplying chemicals to the nidus or, if necessary, blocking it to allow the tumor to be removed.
This kind of healing is truly fantastic, as are most of the center’s other achievements. For instance, the clinic can widen the field of vision by its own ground-breaking method in cases where traditional ophthalmologists are unable to cure a retinal lesion.
Naturally, the path traveled has not been strewn only with roses because responsibility is extremely high. At the same time, Ukraine has a real opportunity to prevent a lot of cerebral maladies. “In reality,” Shchehlov emphasizes, “the number of latent, temporarily ‘mute,’ intracranial vascular aneurysms is far larger than it is believed to be. In Kyiv alone, 5,000 people are at risk from these kinds of ‘time bombs.’ This is not more than a picture of reality, a hint at the necessity of having adequate statistics based on medical checkups. In my view, one of the reliable ways of preventing strokes could be a brain computerized tomography program for people with neurological symptoms and some dangerous signals. Such ‘golden standards’ already exist. In that case, both expected and routine preventive battles against aneurysms could turn into a strong medical and social ‘bridgehead’ indispensable in both economic and ordinary social terms.”
The recurring question is: if only we had known! Andrei Mironov, the actor, may not have died on stage when an aneurysm ruptured in his middle cerebral artery. If help had arrived in time, he would have been saved, like hundreds of the clinic’s patients.
“There shall no evil befall thee, neither shall any plague come nigh thy dwelling,” a psalm says. The territory of the war against misfortunes, which Prof. Shchehlov and his associates have discovered and reoccupied, is a good illustration of those passionate expectations. People like Dr. Shchehlov convincingly prove that Ukraine’s intellectual reserves are formidable and promising. One of medicine’s cardinal goals is to spot and support these areas of goodness. Of course, these reflections are not intended to belittle the fascinating quests of other neurosurgical clinics. But as Virgil said, “Sic itur ad astra. (Thus do we reach the stars.)
