CORRESPONDENCE TOPIC
Obituary, Hugo V. Rizzoli, MD, FACS
Hugo Victor Rizzoli (1916-2014)
“If we have seen farther, it is because we stand on the shoulders of giants.”—Sir Isaac Newton. Hugo Victor Rizzoli, one of the true giants of American neurosurgery, passed away peacefully on December 4, 2014, at the age of 98. He was born in Newark, New Jersey, the son of Italian immigrants. He received a Distinguished Alumnus Award from the Johns Hopkins University where he completed his Bachelor's degree in 1936 and his MD in 1940. At Hopkins, he fell under the influence of Walter E. Dandy and became his most exemplary disciple. After initial training in surgery, he was assigned to neurosurgery as the Harvey Cushing Fellow, and completed his residency under Dr Dandy in 1944. In those days, the 2 general surgery residents who were destined to complete the Halsted residency were each assigned to the “Brain Team” the year before being Chief Resident, so valuable was the experience in neurosurgery considered.1 It is alleged that the Brain Team made constant rounds that were never completed in a 24-hour day! Dr Rizzoli exemplified “Neurosurgery in the Nation's Service” with his activities with the Armed Services during and after
NEUROSURGERY
CORRESPONDENCE
World War II. He served our wounded soldiers, sailors, and airmen at stateside veterans' hospital facilities, most notably Halloran General Hospital and later Walter Reed U.S. Army Hospital where he was Chief of Neurosurgery until his discharge from the Army in 1946. Those few neurosurgeons who served during the war gained enormous experience and were able to make important advances in neurosurgical care. He decided to remain in Washington, DC, and began private practice, covering a number of area hospitals and making his name as a skilled and collegial physician and surgeon. He became well known for his expertise in diagnosing and treating lumbar disc herniations and for his excellent results in brain surgery, primarily for tumors and trigeminal neuralgia. He joined the faculty of the George Washington University Hospital and helped to develop the neurosurgical programs at the Washington Hospital Center and Children's Hospital National Medical Center, which ultimately became integral parts of the George Washington Residency Training Program. He continued his activities and support at Walter Reed, both clinically and in the neuropathology efforts there. He collaborated with the neurosurgical research and clinical activities at the National Institutes of Health and in the development of new imaging modalities such as positron emission tomography with Giovanni di Chiro. He fostered the weekly neuro-ophthalmology conferences at the Washington Hospital Center with David Cogan and Mel Alper. Being situated and well placed in Washington, DC, Dr Rizzoli had the opportunity to participate in the care of many highly placed figures there and abroad, always with discretion and expertise. His neurosurgical altruism made him pivotal to collaborative clinical, humanistic, and educational activities globally, resulting in the Humanitarian Award of the American Association of Neurological Surgeons. During his tenure as Neurosurgery Department Chair at George Washington, he trained numbers of residents who went on to become leaders in the practice and advancement of neurosurgery. These included Wolfgang Koos, who became Professor and Chairman of Neurosurgery at the University of Vienna, Austria, and Najmaldin Karim, who is not only an accomplished neurosurgeon, but is also a current leader of the Kurdish State. The loyalty and dedication that Dr Rizzoli instilled in his trainees was truly remarkable. The Hugo V. Rizzoli Chair of Neurological Surgery at George Washington University was established in his honor. One of the legacies of Dr Rizzoli's academic career was the publication, with his colleague Norman Horwitz, of 2 books on the subject of the complications of neurosurgery. This was a bold venture at a time when complications were not openly discussed and were often the subject of malpractice suits. These books opened the door not only for honest reporting, but also for meaningful improvement in surgical outcomes. His many other
VOLUME 76 | NUMBER 5 | MAY 2015 | E641
Copyright © Congress of Neurological Surgeons. Unauthorized reproduction of this article is prohibited.
CORRESPONDENCE
publications reflected his expertise and his care for his patients. He was quick to adopt the operating microscope and microsurgical techniques and was always eager to explore new technology and innovative methods and concepts. His activities in organized neurosurgery were legion. He was a Director of the American Board of Neurological Surgery; Vice President of the American Association of Neurological Surgery, the American Academy of Neurological Surgery, and the Neurosurgical Society of America; a member of the Society of Neurological Surgeons; and honored guest of the Congress of Neurological Surgeons. His many awards included the War Department's Commanders' Award for Civilian Service, status of Cavaliere from the Italian Government, and the Meritorious Service Award of the Medical Society of the District of Colombia. The first Annual Hugo V. Rizzoli Lecture of the Uniformed Services University of Health Sciences was given in November 2000. Dr Rizzoli's wife, Helen Hay Vargo Rizzoli, predeceased him. He is survived by 4 children, Hugo Jr, Pamela Pia, Paul, and Robert, and 3 grandchildren. To the superb background in clinical and investigative neurosurgery that he received from Walter Dandy, Dr Rizzoli added his own brand of quiet and thoughtful excellence in practice, research, and education. His impact on the specialty, his patients, and those fortunate enough to be his students will long be remembered. Disclosure The authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article.
Edward R. Laws, MD* Paul B. Rizzoli, MD‡ Departments of *Neurosurgery and ‡Neurology Harvard Medical School Boston, Massachusetts 1. Rizzoli HV. Dandy's brain team. Clin Neurosurg. 1985;32:23-37. 10.1227/NEU.0000000000000710
In Reply: Anatomical Variations of the Presigmoid Suprabulbar Infralabyrinthine Approach We greatly appreciate the interest in our work1 and the comments by Borghei-Razavi and colleagues. In their letter, the authors stress certain issues to be addressed when using minimally invasive partial petrosectomy. Borghei-Razavi and colleagues had performed a meticulous anatomic study of 60 temporal bones, and they had defined 12 landmarks measuring 27 different distances using a 2-point caliper.2
E642 | VOLUME 76 | NUMBER 5 | MAY 2015
Besides several distances, their data included measurement of the horizontal distance, defined as the distance between the junction of the sigmoid sinus and the posterior fossa dura to the inferior (K) and superior (L) half of the mastoid part of the facial nerve, and measurement of the vertical distance, defined as the inferior plane of the posterior semicircular canal to the superior plane of the jugular bulb (T). For the horizontal distance, they noted that the range of variation is different between K (3.5-9.6 mm) and L (5-10.3 mm) on the basis of the mastoid level of the fallopian canal. They recommended defining the horizontal distance at 2 different levels on the basis of the inferior and the superior half of the mastoid part of the facial nerve. According to their study,2 the mean distance was 6.78 mm for K and 7.45 mm for L. The authors did not mention in their study whether this slight difference was statistically significant. Considering this only minimal difference of mean values (about 0.6 mm), however, we do not think that this additional distance measurement adds further relevant information for surgical planning. For the vertical distance, T, they detected a high jugular bulb in some cases with even no measurable distance between the labyrinth and the jugular bulb (range, 0-9.3 mm). The authors emphasized this point. This is certainly true, although a very high riding jugular bulb (T, 0 mm) is a rather rare anatomic condition. To estimate the level of the jugular bulb, they refer to the anatomic correlation of the thickness of mastoid cortex at point M (intersection of a direct line from the mastoid tip to the asterion and the vertical line from the superior part of the external auditory canal to the former line) to the actual height of the jugular bulb. This correlation is called Münster correlation by the authors. However, according to their newer study,3 the Pearson correlation coefficient was only 0.291, which is not a strong correlation. In our view, the height of the jugular bulb can easily be detected on high-resolution computed tomography scans in bone windows, which is absolutely mandatory for preoperative imaging in surgery of this anatomically sophisticated region. The height of the jugular bulb may be theoretically anticipated or estimated with the described correlation method, but certainly, one should not rely solely on this anticipatory estimation. As shown by our work and that of Borghei-Razavi and colleagues, partial petrosectomies need meticulous planning, and they are suited only for selected cases. Disclosure The authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article.
Zafer Cinibulak, MD Joachim K. Krauss, MD Makoto Nakamura, MD Department of Neurosurgery Medical School Hannover Hannover, Germany
www.neurosurgery-online.com
Copyright © Congress of Neurological Surgeons. Unauthorized reproduction of this article is prohibited.
Obituary, Hugo V. Rizzoli, MD, FACS
Hugo Victor Rizzoli (1916-2014)
“If we have seen farther, it is because we stand on the shoulders of giants.”—Sir Isaac Newton. Hugo Victor Rizzoli, one of the true giants of American neurosurgery, passed away peacefully on December 4, 2014, at the age of 98. He was born in Newark, New Jersey, the son of Italian immigrants. He received a Distinguished Alumnus Award from the Johns Hopkins University where he completed his Bachelor's degree in 1936 and his MD in 1940. At Hopkins, he fell under the influence of Walter E. Dandy and became his most exemplary disciple. After initial training in surgery, he was assigned to neurosurgery as the Harvey Cushing Fellow, and completed his residency under Dr Dandy in 1944. In those days, the 2 general surgery residents who were destined to complete the Halsted residency were each assigned to the “Brain Team” the year before being Chief Resident, so valuable was the experience in neurosurgery considered.1 It is alleged that the Brain Team made constant rounds that were never completed in a 24-hour day! Dr Rizzoli exemplified “Neurosurgery in the Nation's Service” with his activities with the Armed Services during and after
NEUROSURGERY
CORRESPONDENCE
World War II. He served our wounded soldiers, sailors, and airmen at stateside veterans' hospital facilities, most notably Halloran General Hospital and later Walter Reed U.S. Army Hospital where he was Chief of Neurosurgery until his discharge from the Army in 1946. Those few neurosurgeons who served during the war gained enormous experience and were able to make important advances in neurosurgical care. He decided to remain in Washington, DC, and began private practice, covering a number of area hospitals and making his name as a skilled and collegial physician and surgeon. He became well known for his expertise in diagnosing and treating lumbar disc herniations and for his excellent results in brain surgery, primarily for tumors and trigeminal neuralgia. He joined the faculty of the George Washington University Hospital and helped to develop the neurosurgical programs at the Washington Hospital Center and Children's Hospital National Medical Center, which ultimately became integral parts of the George Washington Residency Training Program. He continued his activities and support at Walter Reed, both clinically and in the neuropathology efforts there. He collaborated with the neurosurgical research and clinical activities at the National Institutes of Health and in the development of new imaging modalities such as positron emission tomography with Giovanni di Chiro. He fostered the weekly neuro-ophthalmology conferences at the Washington Hospital Center with David Cogan and Mel Alper. Being situated and well placed in Washington, DC, Dr Rizzoli had the opportunity to participate in the care of many highly placed figures there and abroad, always with discretion and expertise. His neurosurgical altruism made him pivotal to collaborative clinical, humanistic, and educational activities globally, resulting in the Humanitarian Award of the American Association of Neurological Surgeons. During his tenure as Neurosurgery Department Chair at George Washington, he trained numbers of residents who went on to become leaders in the practice and advancement of neurosurgery. These included Wolfgang Koos, who became Professor and Chairman of Neurosurgery at the University of Vienna, Austria, and Najmaldin Karim, who is not only an accomplished neurosurgeon, but is also a current leader of the Kurdish State. The loyalty and dedication that Dr Rizzoli instilled in his trainees was truly remarkable. The Hugo V. Rizzoli Chair of Neurological Surgery at George Washington University was established in his honor. One of the legacies of Dr Rizzoli's academic career was the publication, with his colleague Norman Horwitz, of 2 books on the subject of the complications of neurosurgery. This was a bold venture at a time when complications were not openly discussed and were often the subject of malpractice suits. These books opened the door not only for honest reporting, but also for meaningful improvement in surgical outcomes. His many other
VOLUME 76 | NUMBER 5 | MAY 2015 | E641
Copyright © Congress of Neurological Surgeons. Unauthorized reproduction of this article is prohibited.
CORRESPONDENCE
publications reflected his expertise and his care for his patients. He was quick to adopt the operating microscope and microsurgical techniques and was always eager to explore new technology and innovative methods and concepts. His activities in organized neurosurgery were legion. He was a Director of the American Board of Neurological Surgery; Vice President of the American Association of Neurological Surgery, the American Academy of Neurological Surgery, and the Neurosurgical Society of America; a member of the Society of Neurological Surgeons; and honored guest of the Congress of Neurological Surgeons. His many awards included the War Department's Commanders' Award for Civilian Service, status of Cavaliere from the Italian Government, and the Meritorious Service Award of the Medical Society of the District of Colombia. The first Annual Hugo V. Rizzoli Lecture of the Uniformed Services University of Health Sciences was given in November 2000. Dr Rizzoli's wife, Helen Hay Vargo Rizzoli, predeceased him. He is survived by 4 children, Hugo Jr, Pamela Pia, Paul, and Robert, and 3 grandchildren. To the superb background in clinical and investigative neurosurgery that he received from Walter Dandy, Dr Rizzoli added his own brand of quiet and thoughtful excellence in practice, research, and education. His impact on the specialty, his patients, and those fortunate enough to be his students will long be remembered. Disclosure The authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article.
Edward R. Laws, MD* Paul B. Rizzoli, MD‡ Departments of *Neurosurgery and ‡Neurology Harvard Medical School Boston, Massachusetts 1. Rizzoli HV. Dandy's brain team. Clin Neurosurg. 1985;32:23-37. 10.1227/NEU.0000000000000710
In Reply: Anatomical Variations of the Presigmoid Suprabulbar Infralabyrinthine Approach We greatly appreciate the interest in our work1 and the comments by Borghei-Razavi and colleagues. In their letter, the authors stress certain issues to be addressed when using minimally invasive partial petrosectomy. Borghei-Razavi and colleagues had performed a meticulous anatomic study of 60 temporal bones, and they had defined 12 landmarks measuring 27 different distances using a 2-point caliper.2
E642 | VOLUME 76 | NUMBER 5 | MAY 2015
Besides several distances, their data included measurement of the horizontal distance, defined as the distance between the junction of the sigmoid sinus and the posterior fossa dura to the inferior (K) and superior (L) half of the mastoid part of the facial nerve, and measurement of the vertical distance, defined as the inferior plane of the posterior semicircular canal to the superior plane of the jugular bulb (T). For the horizontal distance, they noted that the range of variation is different between K (3.5-9.6 mm) and L (5-10.3 mm) on the basis of the mastoid level of the fallopian canal. They recommended defining the horizontal distance at 2 different levels on the basis of the inferior and the superior half of the mastoid part of the facial nerve. According to their study,2 the mean distance was 6.78 mm for K and 7.45 mm for L. The authors did not mention in their study whether this slight difference was statistically significant. Considering this only minimal difference of mean values (about 0.6 mm), however, we do not think that this additional distance measurement adds further relevant information for surgical planning. For the vertical distance, T, they detected a high jugular bulb in some cases with even no measurable distance between the labyrinth and the jugular bulb (range, 0-9.3 mm). The authors emphasized this point. This is certainly true, although a very high riding jugular bulb (T, 0 mm) is a rather rare anatomic condition. To estimate the level of the jugular bulb, they refer to the anatomic correlation of the thickness of mastoid cortex at point M (intersection of a direct line from the mastoid tip to the asterion and the vertical line from the superior part of the external auditory canal to the former line) to the actual height of the jugular bulb. This correlation is called Münster correlation by the authors. However, according to their newer study,3 the Pearson correlation coefficient was only 0.291, which is not a strong correlation. In our view, the height of the jugular bulb can easily be detected on high-resolution computed tomography scans in bone windows, which is absolutely mandatory for preoperative imaging in surgery of this anatomically sophisticated region. The height of the jugular bulb may be theoretically anticipated or estimated with the described correlation method, but certainly, one should not rely solely on this anticipatory estimation. As shown by our work and that of Borghei-Razavi and colleagues, partial petrosectomies need meticulous planning, and they are suited only for selected cases. Disclosure The authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article.
Zafer Cinibulak, MD Joachim K. Krauss, MD Makoto Nakamura, MD Department of Neurosurgery Medical School Hannover Hannover, Germany
www.neurosurgery-online.com
Copyright © Congress of Neurological Surgeons. Unauthorized reproduction of this article is prohibited.
