The Future of Neurosurgery 2100-Dr. Ausman's view

Welcome to the sixteenth SNI and SNI Digital Baghdad Neurosurgery Online meeting on August Seventh, two thousand, twenty two,

the meeting, originator and coordinator, Shamar Hodge, and D Universities of Baghdad in Cincinnati.

The lecture is on the future of neurosurgery and medicine, presented by James I, Ausman, M, D, M, A P, H D Dr. Ousmane is Ceo of Surgical Neurology International, and S N I, Digital, Dr.

Ousmane as the former professor of the University Of Minnesota, Michigan, Illinois, and U. C L. A. And is the former head of neurosurgery at Henry Ford Hospital and the University of Illinois at

Chicago.

The lecture is forty minutes, Intergenerational global discussion session is fifteen minutes, and the discussants are from Iraq, Usa, Iran, Sweden, and there are one hundred and twenty two

attendees. From eighteen countries around the world,

video editors are Mustafa Ismail, M, D College of Medicine, University of Baghdad, and Fatima I Add fourth year medical student University of Baghdad, Shimmer Are slated. Talk about the future

of Of neurosurgery and two thousand thirty five, under. What would it be?

That's difficult subjects to? I'm going to try to tell you from my perspective What I think it's going to be in two thousand thirty five, and what it's going to be and twenty one hundred, and I'm

going to give you some specific examples. There's no way I could do it a thorough analysis and fifteen minutes. But what we'll see what what you think about this. Okay. This is the the first slide.

If a patient comes to sexual years old, it comes to you with a sudden hemi paresis arm, and like

Ah, are you examine him? That's what he has. He's got a hemi paresis At that time. Your A C T scan you do, is you to scan, which shows these two little circular encircled dark spots in the brain.

They basically called Lacuna infarcts,

and at the time of forty fifty sixty years ago, nobody knew what to do with him. Nobody knew much about them or Western Much angiography being done.

We had C T scans as you could see at this time, and then there were some M our scans Questions. What do you do?

There is a professor at the time, who is a neurologist, He was at Mass General Hospital, His name wise, she similar Fisher. The main result standing this is a paper you'll get to the a copy of

the speech when you see when it's put up on the S and a digital website with his chalk, and this is one of the finest papers I've read in medicine, Archives of neurology, Nineteen seventy nine C

Miller Fisher capsular, infarcts.

He had these patients, and he asked a question. He said. What's wrong. Why what do they have? Er? What's happening to them and he had a level one that died. He day autopsied patients, and what

he did it as he went ahead of the section, the brain from the Legion,

so he could find out what the artery dissection, the, The, the, the the brain from the Legion,

a thousand to four thousand sections per patient, a thousand to four thousand sections of patience. An incredible amount of work, but what he wanted to do is to trace the source of that infarction,

and this is. This is what he found in doing and what he found is yours, the middle cerebral artery. You see its mark M C A, and offer that is coming a branch. It's called one of the lenticular

strange arteries, which you know, and you see the branches filled with some some blood, but most of it is filled with ananth aroma, and Edith are always made up of macrophages that are filled for

the fact there are other bless the blood vessels around you see the dark blood vessels that a blood in this blood vessel is almost blocked

in the year occasions that he examined you see, in the right panel. Here, he says a a blockage occurred in the lenticular stride arteries within within millimetres of the origin from the middle

cerebral artery. Horizontal, let some middle cerebral artery. Here's the midline of the brain Here is where the you can see that, And if you look at all these different is your ten cases reported?

He's got lesions in a number of these cases all within within reach of the

of of being able to be, and they were seen, Show you work. Here's another case. This all vessel here is filled with macrophages, Atheroma is filled with olympians. This is reported a nineteen

sixty nine, that's forty years ago, and it's because of the fact that here was a the middle cerebral artery. You can see that the interests of logic illustrates commercial special, and they're

irrigating the basal ganglia which you see here in the picture on the right hand side,

While what's the cause of this decision as you see on top twenty percent of strokes? Are the are are are related to this disease? Nobody knows how to treat it. Nobody knows how to diagnosis. This

is now forty years later.

This is something anybody in Baghdad can do. Dr. Miller Fisher did something that you could do. Did a wonderful study, outstanding study. He had patience. He had an idea. He went ahead and

reveal this information.

We did some experiments in the laboratory were dying. You're looking at a surgeon's view, looking down with the frontal lobe elevated, You see the Ah in the yellow and blow the middle cerebral

artery. If she wiped the internal carotid artery label, I see A you see red, the anterior cerebral artery. She the optic nerve, So what we did as we isolated the anterior cerebral artery or the

proximal Middle cerebral artery and the mirror, and the distant little Sarah rudder, we ejected them. With yellow Jai for the digital blue dye for the proximal, and red dye for the anterior

cerebral, because we wanted to see what the distribution of those blood vessels once

to see if we could understand this disease,

and this is another specimen showing that it all is, and exactly what the textbook shares here you see the rail yellow, The yellow vessels. There are many of them. There's only two coming off his

metal, cerebral proximal segment and blow, and there's only two coming off the the anterior cerebral, that ham, said, He sure. These are major vessels.

So what is the blood supply? When we section the brain we found in this is a section. You see the the lateral ventricles. Here, see the the frontal lobes here, and they acceptable was back in the

down in the bottom. This is the basal ganglia which you see a gorgeous palace in the through, and they are. And the putamen and you can see that the red from the a one fills both sides. Not

completely. You see a little yellow hair on the left side and there's your hair are spotted blue on the on the left side, which is in the internal capsule, so what kind of symptoms to a dead

patient present with

this patient would present with an isolated pure hemi paresis, The patient would have some other cent. Perhaps some sensory symptoms we don't know from the yellow where it's going to be, But you

see in the same patient. The distribution is different, and then will we do to section two whole series of different brains. You could do this. You can do this in Baghdad. You can do this any

bullets,

and you'll find if you look at each brand, you see that the distribution here's red is different on one side of the brain than the other and the rest as you can see it well, but it's still yellow on

the this next picture on the bottom. You see it's below. And it's a mixture of yellow blue and red up here in the chop, its mixture of yellow blue and red, and what it means is that the vascular

supply to the brain to the basal ganglia is different between in in one patient, and among patients, so these patients come and they present with an ambulance to the middle cerebral artery. They're

going to have present with different clinical syndromes.

Any other way you can find that out is to demonstrate it

to know what it is,

so here is an example is summary using a new kind of technique that is only available in a few hospitals in the United States. It's not available around the world. It's a seven tesla magnet M. R.

In which you're able to see tiny blood vessels. These are Sub. These are micron, four to eight hundred my grandma blood vessels.

And this is one of seven Tesla scan looks like this is to scan wrister. With actually, I started a chant time where there was no sketch,

and and then in the nineteen eighties we developed T T scans and we developed them are scant

and and here you see the definition. We were thrilled to see what it was with a lower resolution. Them are scan. You probably have these in Nedbank Day Nine on a three Tesla, or in Iraq, and it

shows you the increasing detail that you're seeing and now here's one under seven tests, so there's very few of these around, which shows the incredible detail that you're say. What's the message

from your

messages. If you don't see it. It doesn't mean it's not there. It just means we don't have the technology that allows you to see it.

That's why I asked about the the Gamma Knife and the and the tumors that they were treating with Gamma knife before we had an Mri scans, and she t scans. We had no more in several grams. We didn't

check air around the brain, and if we found that the brainstem was was enlarged to Dr. Hadi would know about this branch, Same as large. We would assume that the brainstem had a tumor

and many of those people were treated with radiation. There was no diagnosis me because it was too dangerous

and it turned out many didn't have that diagnosis and receive the treatment anyway, so you have to know what you're treating before you're treated,

so you do the very best you can, and this is what's happening. This is what's coming in the future. This is going to change the way neuroscience and medicine is practiced because we are going to

see things we have never seen before and it'll change your life and it'll change patients' legs. Here's another one. At one point five tests scan showing virtually very few blood vessels. Then we

get a three test. Those Can you see the blood vessels look at the seven tests. A skin filled with blood vessels.

Can we use the seven Tesla scan to tell us what's going on in the lenticular straight arteries in those twenty percent of the patients who are about to have a stroke because of the fact that one of

those vessels is included like Dr. Fisher show, Are we going to be able to peaked at his ease up ahead of time and treat it

well. There's one way on the way Seven Tesla scanner. Nobody's using it for that year. Will we have angiography

and and air and actor and anchor Ari Sammy was talking about that in in in his hospital, Samara is an interventional radiologists. Interventional radiology is doing this.

I regular angiography can only show you a vessel about a millimeter and and hires maybe sometimes five hundred migrants or eight hundred migrants. It can't show you the blood vessels that are micron

diameter. Those are the size of the unchecked illustrate vessels. They are micron vessels. Some fifty migrants.

I went to the buffalo,

and they had enough hello, and a geographer was able Eva twenty catheter that he was able to put up the lenticular shredders so you could do an angiogram group. We did the Maya, blocking off the

carotid of middle cerebral artery injecting, and it is checking slowly to see that, so you can make the diagnosis.

Once you made the diagnosis, then the question is what are you going to do? How can we save these twenty percent of the people at everybody has red knots. Nothing I can do for you.

It's not not good enough.

Or the wish the truth that says I'm going to talk to you about that. This is an example of a forty five year old man is from Japan. He addition is a visual field deficit, which means the acceptable

answer, and I'll had unacceptable of infarction. They treated him with aspirin.

Came back. Six months later. He was dizziness. He lost consciousness. He had an M R angiogram, which you're both for tebow arteries were colluding.

One of the students presented her One of the residents presented a case today of an aneurysm,

and they didn't know what the vertebral arteries were.

I'll show you

this is in a in a theater or a set of studies. From this man. There's nothing you can do to treat this man. Nobody know

this is his carotid angiogram appear in the upper left -hand corner you can't see opposed to communicating, or you can't see an inch or a library. You can see the bachelorette refills here.

Then you go to the other side. It's the same peers. Have littles swath of of of of filling of the bachelorette or yellow aluminum. Why in just a minute, so there's no communication, virtually no

communication between the posts here circulation in the anterior circulation,

and now we want to head into the seven tests of the Japanese, did a seven Tesla angiogram,

And what did they find they find this very unusual coarseness twisted vessel coming off the crary, and going back to the posterior circulation, and if you look up in the upper right here, you see

it coming off of both arteries, going back and filling the post year cerebral arteries, Ops, and I gotta go back. You see it filling both posterior cerebral arteries here, and that's how he

received a circulation. We didn't know that without an M or Asia grant the angiogram didn't tell us. She does anybody want to do any more on the patient, or did they give up? You can't give up.

This is you? This is your family. You cannot give up.

You have to find the answer and there are people all over the world in rich countries who give up.

There are people we heard 'em out three weeks ago in the fifties, meeting who never gave up the

two doctors, uber the doctors who made their presentation of army didn't give up. They persisted. Students didn't give up. You can't give up just because you have money and you're in a bedroom and

a big country and you're into a developed country. Doesn't mean they all have the smartest people in the world. You don't the

smart people are on this call. In Baghdad, there in Iran, there in China, there and everywhere in the world there in South America,

and don't let the people in the developed world make you think what you have is not good. Because what you have is outstanding. You have talent. You can buy talent. You make talent to create

talent show. This man had this deficit. It explains why he had loss of consciousness. It explains why he had an exceptional for cause. He didn't have enough blood going to the brain, and this is

a blood flow test. If he chose red and yellow amazes a lot of blood going there. If he chose blue and green. There's not in Sierra. After being challenged. His blood flow went down in the

exceptional lobes. That's why he lost consciousness.

So there was a treatment for this man with blood vessel disease, ended a bypass.

So here we are back to. How do we solve this problem. The tooth out. Twenty percent of people who have strokes.

Nobody knows yet,

But this is something you can work on.

This can be shopped. And it turns out that the diseases atherosclerosis. I'm going to come to that. Then. When you get an M R scan, you also see the white matter of the brain that you can see.

We didn't see this forty years ago. We didn't see it twenty years ago or seeing, and now ten years ago, but fiber tract imaging

cause is Tell you what's going on in the brain how complicated is and what is it that we don't see, Because there are magnets out there that are twenty three Tesla.

What don't we know?

So don't be so everybody and and a true. It's true in our country, don't be so confident that you know all the answers cause you don't.

Just because you don't see anything doesn't mean it doesn't exist.

What am I atherosclerosis? This disease is common everywhere in the world. It's been treated for the last seventy or eighty years.

Still nobody until recently knows what this is, and this is what it is. It's an inflammatory disease and here's an example of what happens. What happens is a break in the end. Ethereum in inside.

There's a macrophage that goes inside the blood vessel, and the macrophage goes in the blood vessel. You can see down here where the macrophages in engulfing all these lipid particles which are in

the blood and is becoming a form, so it's filling the blood vessels underneath, he and Ethereum with his yellow cells that are laden with fat. It gets bigger and bigger. Eventually it breakthrough.

And when it breaks for a blood clot forms to the blood vessel kluge.

Up to now we were treating these people were stamped and drudge. That doesn't treat this disease. Everywhere in the world is treating him That way. There is not a treatment for this disease. While

we're antibiotics. Treat this disease. He tried to fail. I'll show you something, so maybe we have to find a treatment at sac, the macrophage macrophages from Boeing and air in diminishing the

patient's blood fat level.

Maybe that's the treatment for these diseases. Maybe that's the treatment for the lacuna infarctions and Dr. Miller Fisher talked about.

I would a my cerebral aneurysms. Do we know about them. We all know we don't even know how they originate,

and we don't know why they grow. We don't know when they're going to rupture. We don't know yet a treat vase or spasm. In Japan. They're concerned about cars. Two to five percent of the

population has aneurysms. Ten percent of the stroke deaths are from aneurysms Fifty percent mortality. That's when I asked Sam or about their paper on this fifty percent died before they got to the

hospital.

That's not very good, and that's not very good everywhere in the world. Because everybody's got that statistic

in Japan. They're worried because there's a large number of people of unruptured aneurysms and they're going to be subject to this disease. What do you do about it while they found if you look at

some of the pathologies are some inflammatory cells around the aneurysm, well as a paper you'll see this came out of Japan. Japanese are outstanding in vascular neurosurgery Better the Americans.

They found that aneurysms were a macrophage mediated inflammatory disease, and I'll show you a diagram, but there's a blood vessel in the bottom. Here's a blood vessel carrying through and into

Celia sell. As it gets through, There's some information that form and appears is green macrophage, and once it gets through his, there's a whole bunch of inflammatory cytokines in all kinds of

small molecules and signaling molecules that are released that says to the macrophages grow bigger and bigger, and when it grows bigger, What happens is it destroys smooth muscle in the aneurysm in

the wall of the vessel in an aneurism thoughts and it keeps getting bigger while how can you stop it While there some drugs out That'll stop it in a shown this, and that it got diagram, and there

are some genetic? Mechanisms at once the macrophages growing tell to keep growing,

so how do you treat their disease? Now we have an idea of what's happening. It's a macrophage does each well. Here's a picture shilling and purple. This is a stain which shows muscle in the in the

blood vessels, and you can see here there's very little muscle where there's very little muscle as an aneurysm.

Now they were able to go back and use a drug that essentially stop this whole mechanism, Because it was centered right here on this gene turned a gene off

and they gave it to the patients a niche in red

and they had another control group where they just let it go, and that group turned out to grip that have aneurysms, The other group you can see There is no, they're smooth muscle all the way

around the walls been repaired.

Does that mean the treatment for aneurysms by the twentieth twenty one hundred is going to be treating a macrophage induced inflammation of the brain that can be stopped by drug treatment?

Is that the future. Yes, it is.

No, The The The The The Japanese want her to go further. They should What I want to know. If I macrophages are. How do I tell us? How do I tell this aneurysm exist? So they went and did some

more experiments. Two people are terrific, So they went to the laboratory. They injected some iron particles into the blood vessel, and if there are no macrophages involved with the aneurism,

none will show up, but they found if you're either macrophages, the iron particles are taken up by the macrophages in his show up in the aneurysm, and they'll show up in the our skin.

So what did they do? They didn't name our skin and your Cmr scan? This is an error scan her macrophage. This is before the treatment with the year before giving the iron. That's what this word up

here means From remarkable. I put it up here iron,

or they give the patient some iron, so that could see it, cause he iron particles in the cells that that are around the macrophage, and this is the subtraction rule, which means you take this view

and the pre, you subtracted from in a post, and you get what's left over and these are the shelves with all the iron,

and so now what you do is you go down and they do they do. They did it. It's a form of an M R I scan, and here's the aneurysm Where the white arrow is here It is after they give the iron,

and when they do the subtraction film, they take the the pre film subtracted from the posted. What did they find around the rim of this aneurysm? Are these dark spots? Those are in red? What are

the? Those are the macrophages with an iron,

And if you look where the yellow is? It's not there. Which means there is muscle there.

It means they've found a way to diagnosis disease using an mri scan before it becomes and kills fifty percent of the people.

Now The problem with this is that the iron used for diagnosis is too toxic causes an allergic reaction, so they're working on it.

This is this is outstanding work so that all comes from working and looking into the biochemistry and molecular biology of what's happening with the disease. There are some people young people in

this chart who aren't going to be a commoner. A they. They're going to become neurologists. Are they're going to go into medicine.

These are things you can do no matter what field you going to neuro surgeries. Do I have to get up to speed on this and you're going to have to have a team of people who are involved in doing this,

not just a surgeon.

And what you're going to find in the twenty first century is an inflammation is a major disease of the twenty first century. If you go back in history ten thousand years ago to Mesopotamia, which

proceeded Iraq, the major diseases infection than people died by the age of thirty, then they began to cure infection. That it took awhile. It took to the eighteen fifties or nineteen hundreds,

and we were able to cure similar to infectious disease went away and people were living longer, so they got atherosclerosis and cancer and other diseases.

You think that's going to be true One hundred years from now, I don't think so,

and here's an article published via a good friend of mine who is a neurosurgeon who's very interested in molecular medicine and has studied the subject in great detail. He wrote about it before many

other people. Went through the same experience, Dr. How'd he did? Dr. Muneer went through and everybody said No. You can't do this. You're crazy. He said Perkins disease is caused by an

inflammation in the brain and what's happening. He said this ten years ago,

and now people are beginning to understand. It's chronic inflammation. Repeated repeated insults to the brain by toxins by infections. What it does, is it it it it it enhances the micro glia which

are the defense cells in the brain. It enhances the microfiche years to go into the round. I just talked to you about macrophages in aneurysms and atherosclerosis, and I showed you that from Dr.

Fisher,

the sales are now hyper sensitized, and if Lori insults come to the brain, then what happens is they? If they become degenerate and wind up discharging, they have what's called him. You know

excited a toxicity where they release all kinds of various chemical substances and messengers, which then go in effect, the surrounding nerves and astrocytes in a kill. The nurse is a chronic

inflammatory disease.

That's what you're in a funk, but you're not going to find much written about, but more more is coming out about why people don't want a believer

or diseases that are going to be caused. Parkinson's Alzheimer's. I had a good friend is a neurologist who loved to develop his own pictures in his own laboratory and he got inhale the toxins and

gave him toxic neuropathy and he died of that disease 'em

y'know in psych, said, Oh, and toxicity chronic inflammation of the brain. Nobody nobody had debt what he had. I've told you atherosclerosis. To say. Everybody is suffering from cold air around

the world. Now we're talking about long culvert long cove. It involves a break. What is it? It is repeated insults to the brain by not only the virus from now buy the vax, each and a vaccines

containing the spike protein, have a F. Alarm the immune system, so that is hyper reactivity. That was one of the causes of early deaths. It was excessive release over release of toxins in an

allergic reaction, but nobody wanted to talk about it.

Arthritis arthritis is common around the world. Almost half the people in the world will get it in their lifetimes. Nobody knows how to treat it. The surgeons to go cut it out. His act was going

to be. There's some studies out there would show that. If you stop cartilage loss, you're gonna stop arthritis. Because the bones will rub together. There's also studies out there that show that

if there's there's a stem cells in the endplates of the T rowe bodies that can be stimulated to Europe to regrow the cartilage. Why don't we see that led in this fine literature. It doesn't make

money.

Rheumatoid arthritis to disease been cured. I had the disease. I was treated with a molecular agent called interest of Edinburgh autoimmune diseases, so chronic inflammation is going to be the

major disease in your lifetime. This can be found everywhere, but nobody's paying attention to her.

What about precision medicine is what is causing her country? It's called molecular medicine or genetic medicine?

What's happening? Phenomenal affects people with sickle cell in Nemea, or some blood disorder. You know about that, Tell the steamier they can go in, and they can cut that abnormal gene out and

cure the disease what they do. Then as a, They take the patient cells out. They get the stem cells. He cut out the abnormal gene. Say, wipe out all the the the the baiters in our blood cells in

the body. And then they put these stem cells back into. Gross. The disease is cured. Cavernous malformations, now been found to be caused by a series of molecular events, and it's related to the

same

signaling chain that causes men in geometry

or position in France. A neurosurgeon has done it outstanding. We're way ahead of everybody else.

Here's the paper mutations in sporadic cavernous malformations. Eighty percent of malformations Nations are cavendish. They can rupture. They can hemorrhages awake. We can treat them. It was it

was some drugs that will stop this cascade, but genetic molecular cascade that ears the crisper. Which is the technique used to to essentially cut Jean songs that are abnormal or can't be done by

inserting virus,

So what's neurosurgery in the twenty first century, and in look like

first of all the disease at the end of the twenty first century, all these diseases are going to be gone

most of you. If you have the right diet, you live appropriately,

are going to live to over one hundred years old. Your average age in in Iraq, now has over seventy.

Vascular disease. I just showed your waist. It's going to be cured neoplasia

tumors. They're going to be cured degenerative diseases. I just showed you inflammatory degenerative diseases of the brain. They're going to be cured spine. We've got to get the spine surgeons to

think differently. That's going to be hard.

Right now. You have to do that, but we have to work in some of the basic reason that causes a major disease involving all people in the world. Trauma will be with us. I must be with us for ever,

but there are people are making progress. They're finding ways to limit the amount of damage in the brain are finding ways to regenerate nerves. There is a a presentation we had a year ago on

repairing the spinal cord, cutting it in half. He had totally putting it together. Dr. Hottie presented this three weeks ago and having it regenerate gonna happen.

Stereotactic and functional. We've seen talks last week about incredible talks, and today

I think it's a wrong name for their disease. It should be neuro cellular and tract disorder. That's a frontier and neurosurgery. It's going to be explosive is going to tell you about psychiatric

diseases. All the kinds of diseases I just presented here today, Many of them that you can't treat a quarter that people in the world or an antidepressant drugs, and or anita

infections. We've already started the end the beginning of the nineteenth century, Nineteen thirties, with antibiotic treatment

pediatrics, we talked this morning about a foley, as it is very important that doesn't help everybody. The article in the New England Journal of medicine, Is this article right here came out

yesterday, and what they're doing is they found that if you can operate on the fetus. In the womb

with a mile, I'm anger negotiator and treated, you reduce the complications of that disease before birth, and after birth by fifty percent.

Fifty percent. What about the fifty percent of people are dying from tourists. Can we fix it? Yes, we can.

I'm sorry to tell you. I think skull base surgery is going to disappear.

It's a means to a decision at a trip.

I think we're going to have to look at medicine differently

My father grew up. He was a private practitioner. Dr. Hottie was in private practice with many of the other people here. That's what they're doing now, But things are getting complicated. We're

going to need to have lots of people involved treating a problem. I just showed you that today these are complicated problems. When you have teams of people, researchers, neurologists, medicine

people, all kinds of different specialists working in teams,

diagnosis of medical disease that can be made by computers. I B, M made a computer where it was able to diagnose medical diseases

was an accurate enough.

We gotta tell 'em medicine. People are now using tele medicine. You can now reach all parts of Iraq by tele medicine. Treat people will

be run using remote surgery, because in the rest of your life, people are going to be going to space.

Really have space diseases in space medicine. You're going to have to operate on people on space.

So that's if you can't see it.

If you can't see anything, It doesn't mean it doesn't exist and this is a picture just taken three weeks ago from the newest telescope. The Webb telescope, looking out into space and add picture

shows you in a very narrow view space, thousands of galaxies, just like ours. Thousands?

What does that mean for the future, hundreds of thousands of galaxies surrounding us?

So much the future fifty percent of your population is under twenty years of age, and seventy five percent is under the age of fifty. That means you're young.

That means by the age by twenty one hundred, the population of Iraq is going to be one hundred million people from forty Megan. Today, that means you lead a lot of doctors. That means you later

need a lot of people working to be able to take care of her.

We have one principal and I found the prints from my whole life, the one principle that surgical neurology When should think about us. There are no characteristics by which we judge a paper, except

scientific fact.

I don't know who sends the paper in I dunno. If it's a male or a female. I dunno. What country it comes from It doesn't matter to me.

And that deals with all the talk about bias. I hear about nowhere. It doesn't matter particularly to a doctor, and the reason is because you're treating a patient, and it doesn't matter what

religion. A patient is what skin color. The patient is. It doesn't and what they believe doesn't matter what they practice. Your obligation is to treat that patient. The very best you can,

and fifty per cent mortality isn't good enough.

So, thank you very much. Fiona. Write me that yet I hope that's been helpful to yield. That's one person's view of the future. Thank you.

Thank you so much part of this mind blowing

toke than in. Guess what's going to happen in the future. It's amazing, really, and they're comparing it to the Webb Telescope Is is very appropriate to think. What can we don't see it. It's not

necessarily as stop there. I remember the gym. A paper written by Richard Win and Matthew heard in the Lancet in December, nineteen, ninety nine about neurosurg detail in the coming hundred years.

Of course, it's not as elaborate as what you presented to really have some new things which I. I'm sure they didn't know anything about that at that time.

Today and they they, they, they went through, or the the The The the the steps, which is going to happen to neurosurgery, they said, the first half of the century, you will have been the

mechanical insurgent, mechanical neurosurgeon, and that robotic and other things, mechanical things, and then the second half will be as exactly what what to upset the biological surgeon. The Bs,

and neurosurgeons would be redundant. They don't have much to do, and the day he said that to thought, they said that when you have some problems with mathematics, you can go to the neurosurgeon

and you put the chip of mathematics on your head and then you go back home and then they will have your good in mathematics, and also they can take at night. You're muddy. They record it, and then

when you have stroke or head injury, and then they can put that money back to you. When you were a cupboard. It's amazing. It's just. I think that's just. Cod, but what you are telling us,

you're telling us facts and amazing facts, and we are really so much thankful for for your effort to get all these things together and to tell us about that, so thank you so much again and your

tank and care, Dr. Azman. I will wait a fair. That is a comment from analysts. Also, at. Actually, it's estimate eighteen dog, and it's an eye opener when

they have a common differ, Id, and I think Oussama has a question or Zama. Yeah, so

I love Dr. Osman. Thank you very much for the fantastic talking. Thank you to the organizing committee

for making this conference and Doctor has for inviting us. I have a bit of a personal question to daughter Respond. If that's all rights, My question is. What got you to where you are with this

level of knowledge and and the comprehensive knowledge about like everything, even outside like medicine?

The question was how Arab Arab, could you say that one hundred I get that knowledge Are what got you to where you are or what got me to Was

how do you can answer the answer their question, and so so so good, I I e Yasser

Abdul, or anyone, It's it's

What was you want? A cheaper? Do better. The most important thing is to be the very best you can,

and excellence is the goal

you're growing up in a world

where mediocrity is a goal as where everybody's gotta be equal.

That's not going to lie to excellence.

I learned long time ago that there are people all over the world who are very smart smarter than I am,

and those are the people who you're competing with those are the people in the United States. That they don't understand. They're not competing with the best people in the United States. Their

competition is the best people everywhere in the world. Some of those people are in Iraq. In. I miss call today outstanding people done outstanding, thanks,

so I think the answer to that no matter what field you choose is to be the very best you can to work very hard and to achieve excellence and that's what you should do.

Thank you, very much, softer, Rossman and Kill Osama For the question am I wonder if Dr. Audi, or upset, I didn't have a comment also?

That was the he guess and one thing I had,

and it's very hard to find many open minded academic cn to walk and talk, and Dr. Osman is one of the exceptions. I have to tell you I have work around the world with many people. I was lucky to

work with very great mentors, But one thing his various vision with the crosswinds video open to anybody, because many unfortunate given us prejudice, and makes nice. I have gone through a lot

myself. Not to buy. My have great people to work Be bought. Bridget didn't exist, but I have to work hard as he mentioned, and that's from city. Kids don't give up. If they don't like you.

They don't like your region All your national. I have gone through one of those, but. Yeah, good to be like the Osman who suffered. I love you young people nor dust, just do your best as he

image.

Thank you, Dr. Ali, Thank you. Yeah, you're a writer. I think we should just take a minute or two to a doctor. Hurry and and and Yeah, sure and edit it and

then

and and she initiates. A were to answer entire dose. Share your favorite answer the question or Sharma. Ashish. How do you get to be where you are and also my good for him to haughty, Because the

young people should not just here for me. I should hear from them as to what and how do you get to be successful

or you want to start an answer their question.

Yeah, you're muted. Yes, Yes, thank you, sir, Thank you, Well, we face these problems. My my personal experience, we face the difficulties during the

the sanctions on Iraq and my mentor, my teacher knows at that time what difficulties we face Even though we are,

we try our best

we enter, We need to struggling to get information from here and there,

Because so we thought that that time we should, the near the surgery has the best we can.

Even we faced difficulties of that time because of the assumption because of the war, because of the. Condition or the circumstances at the time era faced, but I still, we are, he believed that

Nero neurosurgery as our way, and you should be succeeding in this way,

I believe in.

Yes,

you do what you are up. Is I am here, and also the the seasonal bogus itself. After one hundred years, we're facing a new disease are now, where are our thoughts or thinking and the Brisson

diseases which weakens

success in treating, like all the oncology. We don't know what the exact mythology. If we treated by the sways. What's what are mentioned in the future. The disease is also intelligent, and

twelve develops a sales. Not only be viruses, bacteria, bacteriology, Richter about bacteria, also other disease,

and it is.

The one time of treatment, medical surgical biological, and might be another technological advance, technological progress in treatment, It is a button and thank you,

Yeah, Well, My, my Yeah life trip as a full of

for the difficulties, and I really overcome these difficulties, and put that in my memoir, I that I, the age of eleven, I decided to be a doctor, and I worked hard for that, but then I failed

in the third tier to the intermediate, so I had to go to the commercial side rather than science, and the then I went back to science. I last one year of my life, but I didn't mind that because my

goal is to be a doctor and then and there her highschool.

I did not score the enough a total of my marks to get to the medical school, so I went to the engineering, and then for for the first week, they opened the gate for other people to come to the

medical school at night, when there, and then in the first year, I failed in biology,

but then night pasta okay when I came to the clinical. That's my passion, and then I progressed until I was the top graduate and the medical school. When I finished and nineteen sixty six, So the

hurdles in my life that I locked. You can't possibly see them in the memorial to determination to overcome them To reach your goal is the most important thing in life, so you may be pushed sideways

sometimes to away from your path, but you have to struggle to come back to your took path and fulfill your your aim in life.

One one think the thrall spend your saying goodbye. Yeah, you don't mind. You don't care about who said something, but you care about what you said. We have in fact, saying in our culture,

exactly the same.

Let go. A lemon pie were like an umbrella. My God. Don't care about who said, but cared about what was said,

Understanding Center Center Center to America. They need to hear that,

or do you have a question or a? Yeah, Yes,

it's what's about stem cells. So what about stem cell. The cell stem cell progress on neurosurgery.

I'm not. I'm not really very knowledgeable about that. I don't think I can answer, But you're right. Some of the things I read had to do with stem shell, said they were able to reactivate. Ah.

I'm I'm Just after confession, I'm not knowledgeable about it. Yes is while some some progress, but even though it is not so much in neuro urology pumps, and let's be knew that renewed was finally

caught repaired, but not the very very exactly a promising result was Yes, correct

cardiology shows another person has your question.

Yeah, cardone of years of you may not know me. I'm a another neurosurgeon happily. I'm a orthopedic walk -in in Sweden, with fine. Thank you for a presentation to Osman. I ask you or add to your

view that. Maybe in the next fifty or hundred year, we need to do again, all the researchers who has been has been publicly now. Cause I am questioning the result and the outcome of most other

research that has been already publish gated. I. I believe we need to do it again again and again, Because

this is the first thing. Second thing I learned in this country coming from the era of core from pneumonia, If you, too, If you want to be a good surgeon, a good doctor, a good engineer, you

have to question the opinion of your mentor. Don't believe in your monitor. Hundred percent tried to question. Because as you said, you have to struggle to the best by doing that, you have to

question what is your mentor same and tried to discuss with him or hair about other opinion, Thank you,

thank you very much, very very thoughtful. Well, said, Yeah, exactly

where I can't. We hope you enjoyed this presentation?

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The Future of Neurosurgery and Medicine; James Ausman MD; Lenticulostriate arteries; Atherosclerosis Treatment; Macrophages and Aneurysm growth; Micron-vascular disease Treatment

(Lecture-40 minutes; Discussion-15 minutes) (JIA)

Samer Hoz, MD

SNI Digital®, the Global, Interactive, Peer-reviewed, New Video Journal of Neurosurgery and Neuroscience-2024 Edition; "Innovations in Learning" for the 21st century VIDEO EDITORIAL

NEW SNI Digital® Version 4.2

SNI Digital®, the Global, Interactive, Peer-reviewed, New Video Journal of Neurosurgery and Neuroscience-2024 Edition; "Innovations in Learning" for the 21st century

VIDEO EDITORIAL