Welcome to the 15th SNI

and SNI Digital Bagdad Neurosurgery Online Meeting held August 7th, 2022.

The meeting originator and coordinator is Samar Hoz from the Universities of Bagdad and Cincinnati.

Today's lecture is the highlights of neurosurgical history in Iraq.

Today's lecture is Professor A. Hadi Al-Khalili, the

former chair of the University

of Bagdad Department of Neurosurgery.

The lecture is 15 minutes and the discussion session is 22 minutes There were more than 100 attendees from 18 countries.

The video editors were Mustafa Ismail.

from the College of Medicine, University of Baghdad,

and Fatima Ayyad, fourth year medical student, also from the University of Baghdad.

So my talk is very simple.

It is about highlights of neurosurgical history in Iraq

and what has been done over the past decades.

In fact, we are honored to have the history of modern neurosurgery linked to Iraq, where Sir Victor Horsley, who is the founder of modern neurosurgery, just prior to Harvey Cushing, who is the real founder of modern neurosurgery.

He was buried in Iraq.

He came with the British Army in 1916.

And then few weeks later,

he suffered from heat stroke And then he was comatose for two days, and then he died and buried in Amara, which is in the just south of Baghdad here in Amara.

There is the war cemetery.

And that is the names of all the people who are buried there.

And you can see that the bridge over Tigris we invent nearly 90 degrees to avoid going through the

symmetry.

So that's the plaque here that I'm standing beside it as in 1981, so I look a bit younger.

Professor Najib Yakubi, he was the

founder of neurosurgery in the past.

He started

the neurosurgery in the 50s and he trained in Europe and then he established and started the neurosurgery hospital impact lab in 1960.

His main interest was

Wain's Le Kottomi of psychosurgery and he did trauma and some other surgical procedures.

And then we have Markoam Parhart, he's an Assyrian from the north of Iraq.

He graduated from Edinburgh University and trained in Stockholm with Oliver Corona and then back to Iraq.

And then his main interest was final surgery and he died in 1960.

He lived by three eminent physicians here in the United States.

The professor after Rassul Saduk

was the third in line and he was graduated from Baghdad University in '48, trained in US in NYU

in 1960 to '65 and back to Iraq '65 and '67.

Well, I was honored to have been one of his students when we were medical students in the fifth year when we studied neurosurgery.

And then he was back to New York in 1967 and remained in NYU as a faculty and then went to private practice.

The real founder of modern neurosurgery, of course, is Professor Saad Mothry who graduated in '56 from Baghdad Medical School.

and went to London in '58 and then '62 got its off RCS and a 65 return to Iraq to start his task of building up the

neurosurgical practice in the country.

I graduated '66 and in '71, went to UK, trained as I said in Germany and

Switzerland, Canada and '76 back and have added to my professional work I had some interest in research which I had

implemented and did some research work in Iraq.

In the '90s or early '90s a total of 12 qualified neurosurgeons were running the show in

Iraq Most of them were qualified with a FRCS from UK but one colleague came from Germany and Berlin.

He was at his training and the other one qualified from France.

Neurosurgical Services in 1950s started at Baghdad Medical School Teaching Hospital under the auspices of leadership of Professor Yachubi.

And then in 1960, as I said before, specialized hospital started in Iraq only for neurosurgery and nothing else.

And then 1990, there was a surgical specialty hospital related linked to the medical school

and had about 20 stories, 20 floors, and each specialty has a

specialty has a floor There is no general medicine, no general surgery, no a BG1,

only special surgical lines.

In 2002,

Dr. Sadhir, with the Neurosciences Hospital affiliated with Ministry of Health was established and they are running a great show there with science and the upgrading of the services.

Number of neurosurgeons in Iraq in 1999, total was 48 neurosurgeon,

worked in 12 neurosurgeons centers.

At that time, population of Iraq was 27 million.

So we had one neurosurgeon serving nearly half a million population at that time.

And when I was in England in the mid-70s, the rate was again, same thing, one neurosurgeon to half a million population at that time.

Diagnostic facilities available before we had the CT scan in 1978 was very simple, or plain X-ray, myelography using myo deal with all its complications and the problems with we didn't have anything else.

We have air and syphallography as a means of diagnosing and geography using direct carotid puncture.

And the ticlicium brain scan That's all we had at that time.

Then in 1978, two CT scans were installed when the neurosurgical hospital and the other in the university teaching hospital in Baghdad.

Surgical procedures were done in

all the centers.

In fact, they did almost everything.

Trauma, neuroplasm, infection, abscesses, and everything else.

But something peculiar to Iraq is high-dattest cysts, which is called by one of our professor, Professor Hadnaji, as cancer of Iraq, because it's really very dangerous if you don't deal with it properly.

And this is a solitary cyst here, behaving like space-occupied lesions, very silent, until it becomes progressive in size and then produces neurological problems, or it can be multiple.

And in which case, treatment is really impossible to secure the patient.

In this case, when the

solitary, it's not structured, you can remove it at the patient is.

really safe and secured.

Neurosurgical training in the country start after 1980, there was no scholarship because of the war in Iraq, the Iraq-Iran war, and then

we had Iran-1991 war, and all the problems.

So nobody can go abroad to get more training.

So training was basically by apprenticeship, but in 1986, an Iraqi board of medical specialists was established and that covers the major medical specialties.

But in 1989, the Iraqi board of neurosurgery was established.

And to get into the Iraqi neurosurgical board, you have to be a graduate of Iraqi medical school or any recognized other medical school, which was not the case at that time because of the difficulties in the country.

So nobody will come from outside Iraq.

And then you have to complete one year of internship.

And then you pass qualifying tests before you be accepted to train and then your research board.

To get the neurosurgical certification of the Iraqi board, you have to have five years of training and rotation with the pediatric and adult neurosurgery submitting research project.

And you have to have a mentor for that project and you have to defend it in front of a committee And then pass written and oral exams.

And then you will be qualified neurosurgeon.

There is another means of getting certification.

That's the Arab board of medical specialties, which is based in Damascus, Syria.

And established in 1978, it covers again major specialties.

But in 1998

started neurosurgical board, but not in Iraq, and Iraq started 2007.

We had

before, well, 2000, after and before micro-neur surgery, we had the brain navigator, brain lab, and we have brain endoscopy.

In fact, before we had brain endoscopy, we used to use the

pediatric cystoscope to get biopsy from the brain tumors, in case it's required.

And 2004,

of course, until 2022, the current year, we have great advancement by our colleagues in Iraq in general.

And Dr. Munir, I hope you will touch on that in details later on.

Research, we had the clinical research, while experimental research, we had some innovations as well.

A clinical research, as I said, this is mandatory for any students of the

Iraqi board to have projects of research.

and that will be part of his requirement.

And we have many individual enjoyed projects and different topics on clinical problems in neurosurgery, including abscesses and

tumors and everything else.

Experimental, we had some project on the cranial nerve this generation because it was found that third nerve can regenerate, but in different ways the nerve fibers will go differently and have different function.

So we did a good project on that, but unfortunately there was some problem at the end.

Then we had spinal cord grafting in mice and we proved that spinal cord grafting can be done.

We use the sciatic nerve for grafting in the hemichordotomy area.

And it was published in the spine in the JRL. in Edinburgh and then we have proceeded to dogs.

And then with dogs, we had implemented the Surinar graft, added to it a momentum and forced by omentary graft.

Some research on biofeedback, but at one time there was treatment of epilepsy when you can take the EEG of the patient and then analyze it and get the alpha waves of the patient to make him hear his alpha waves supposedly to reduce the resistant type of epilepsy.

Pidotid cyst of the brain and orbit did a lot of experimentation on that with the glove filled with water and sex.

And then did CT scan to see the changes and the density of the CT scan to differentiate it from tumor.

Innovation, we had some scale for setting sun sign just to quantitate.

setting sun sign and then instruments for high diet based on this kid's game and there's some simple sign to test the power of coordination and pro-proprioception and of

thalmoscopy made easy by very very simple way but you can't have medical student maybe in five minutes they will be able to see the funders and then have

to know about what's going on in the funders.

Very simple way of doing it.

A current number of neurosurgeons more than 200 neurosurgeons including around 10 female neurosurgeons and over 100 residents now in Iraq and more than 20 neurosurgeons centers with a new technology available in most of them.

Population of Iraq around 40 million and And now it is one in your residence having 200, 000.

population.

So the torch was passed to our younger colleagues, younger leaders to take over and we are proud of their leadership achievements at progress.

And thank you.

If you have any comment, Dr.

Osman, Dr. Lazarov, Dr. Al-Sarov, and Dr. Ali Khansari If you don't mind, I say something to share with our other young colleagues.

When Dr. Khali Lee talked about Dr. Victor Horsley, it is in the history of the neurosurgery, the first epilepsy surgery done in 1884 by Dr. Horsley was on the 12 year old young boy who was hit on the head with a donkey and he had damaged his brain at a constant seizure.

And he operated even at that time 1884.

to remove the score and the pichine recovered.

It is written in the British Journal of the Medicine.

I saw the original one which we had it in our library at UCLA - Sir Kavil, I thought you had a very interesting presentation you had, the history is very interesting in Iraq.

And

it again supports the fact that there are bright people everywhere in the world who have created

many, many great things.

You mentioned about

experimenting with spinal cord transaction

and in dogs and so forth.

Were you able to see some forms of recovery and those experiments -

Yes indeed It was after we finished with the mice.

we proceeded with middle animals, the dog.

And then it was project for a PhD student, a vet doctor.

And she did the experiment.

I was supervising her -

She mutes -

Mutes, Mark, Mike,

Sam -

Okay So we used, and as I said, in mice, we use the sciatic nerve

for the mouse.

And we had definite histological

recovery

and hypertrophy of

the

axons coming through the gap.

But for the dogs, we use the siren nerve.

And then we had four groups of dogs, one siren nerve

minsti-graft.

We used minsti-graft sciatic nerve in both experiments, mists, nerve-graft.

So we used minsti-sural nerve-graft as a group.

group two as a control group three as minced graft with pedicle of momentum coming through subcutaneously, coming to the spine and switch over the deura and the fourth one only a mental graft and then we do with the third group that's both siren nerve, minced graft and a mental we have almost full recovery of the paraplegia and we have video for that but the video you know at the time of sanction everything was difficult and the video does not show exactly the color of before when the child the dog has complete the family pleas caraplegia and the recovery complete recovery the video pictures they don't show the same color so I was skeptical because people made out that but it is truly full recovery of the paraplegia and this group with mince

Surinar and supplemented by a mental graft.

A mental graft, we got the idea from one of our professors in South Africa, Ambassador Duktor Hamrezian-Sadi, the late Hamrezian-Sadi.

Again, he was an innovative surgeon.

He was to go for the prostate through the perinium.

So he used this a one-trig graft for treatment of elephantiasis He brings the momentum under all the

ligaments going to the thigh, and then the

elephantiasis improved significantly.

So I have

the video with me here for these dogs.

And she got her PhD with distinction, the girl.

But unfortunately, she was killed with her daughter.

And this mess, what we had in Iraq, and it was very, very sad for me personally, for Iraq in general.

That's excellent work and when was that done - It was done and

we started 2002,

extended

2005 - It's a traumatic work.

We published some articles in surgical neurology and international by Dr. Kennevaro who was doing similar work in a little with different techniques and mice and dogs and then

a monkeys in which he was experimenting

with can you restore spinal cord function after transaction and they were able to show that you can just as you did.

Were you able to publish that work that this young woman did with you - No, unfortunately, what they have the thesis with me here

Well, if we could watch, we could see the video.

If it's up to Sam or but the other thing I would suggest is, if you want, we can publish the video or even your short summary of this experiment.

I have a good question.

I published them in Surgical Neurology International.

I think it's very important for the literature to know this.

Dr. Kennevaro with his work has undergone enormous criticism because people don't believe it, but I can tell you the experiments were done in multiple laboratories around the world.

And it is outstanding work, and the work you're doing is very interesting.

There was a doctor in the United States by the name of Harry Goldstein who used momentum.

You probably know the name.

We corresponded with him, by the way.

Yes, and

he was also underwent tremendous criticism He was a general surgeon.

but he used the momentum on the spinal cord in the brain to revascularize

it because of just what you said.

It has, as in the leg, it has huge vascularity and amazing absorption powers in the tissue for proteins and fluid and so forth.

So you were ahead of your time.

And I think you could even write a, either a small short editorial or a letter to the editor with your video, we'll publish them.

And I think she will get credit.

And I'm very sad to hear that she's not alive but you will be able to give her credit for what she has done.

That's very important work - I love that, especially for her.

I had the fact the idea of using the momentum for treatment of idiopathic intracranial pressure at one time but I did not, they would do

that - It's very, very creative, very good The next thing you said.

was that you were, I thought I understood that you were, you were doing experiments with cysts in the brain.

And did you use which balloons in the brain to do that to measure their effects?

How did you do that -

We did,

that's at the beginning of the CTIS-COM fact was in 1978 or '79.

I have got a surgical look-loved, filtered with water, and then amputated the thumb to make it a smaller sack, and then one of the other fingers to have a bigger sack, and I put one in the orbit with some slices of fat in the orbit to simulate the orbital fat.

And then one sack was put in the cranium itself, and then did CTIS scan for that cranium and see the density.

Because in the orbit, there's something peculiar

It is interpreted by the CT scan as brain as tumor, a solid tumor because of the physics problem of transition from bone to fat, is that immediate transition so it will the computer will be confused.

So, many times I opened the cranium just to go to the from the roof of the orbit to get to the tumor in the orbit and then at disappointed to see just it is the sack filled with fluid

That's why I did this experimentation and then proved that orbital the cyst in the orbit has five to seven times more dense than cyst anywhere in the body

Very interesting.

Yeah, because of the location in the orbit, born all around fat inside complete discrepancy between the density of the two there's nothing in between no no soft tissue just bone and then fat.

So the computer and interpret that as a tumor.

and it was published in fact in American Journal of Competrized Radiology - And it's a very interesting observation.

We received

over the years many papers on intercranial hemorrhaging, you knew the subject well,

about people in various countries taking a group of patients with intercranial hemorrhaging, removing them

and reporting their success.

What bothered me, and you know about the randomized studies that were done in England, which have some very serious flaws but remain the major standard papers in the world.

There's some additional papers that it didn't make any different information.

And to me it was always a very reasonable idea And you could do this with a balloon tip catheter.

to put a catheter in the, say, the frontal lobe, a blow up the balloon.

And you could measure this in many different ways.

You can put contrast in the balloon, for example.

And you can see what would happen if you left a balloon for 30 minutes or 60 minutes or three hours or 24 hours and then deflated it, what would be the recovery of the animal?

And it would at least give a standard approach to testing

some of the principles in hematoma surgery, one of which is that the surgery should be sooner.

And it would prove that.

The other things that complicate an acranial hematoma, the fact that there are chemicals related to the blood in the brain itself, which causes inflammation and other things.

But there are, just like you're very creative experiment with a glove.

This is something that can be done simply anywhere in the world.

You don't need anything fancy.

And you can find a standard answer to probably one of the major health problems in the world.

And maybe some of the students around this can think about that or talk to some of the neurosurgeons.

But there are, just as shown today, there are examples of diseases we see everywhere that bright people anywhere in the world can find solutions for and you've presented them.

You see, at the time, we didn't have any equipment literally.

What we have,

they needed repair.

We don't have spare parts.

So once I was operating on acoustic neuroma and just worried about the patient, so we don't have any sense that anything to dictate, to discover where the patient nerve is.

So my colleague, neurophysiology colleague, we brought a pin, ordinary pin, and connected it to wire, thin wire, and then we use that as a probe to stimulate the nerve and find out if there is any reaction there contraction.

And it didn't work all right at that time -

I think as a student, let me say one more thing.

I think the students should listen because from your presentation and the presentation which follows you on the technology, it shows that you don't have to be think

that you cannot make great achievements because you can't do the same things as people in countries with lots of money.

It doesn't take money.

It takes brains, it takes creativity, It takes determination, none of which you can buy with money.

Absolutely, right - Actually, I would argue that the money actually inhibits innovation -

You realize - I think you're right -

It spoils people because they just throw money out it and try to solve the problem - I think you're right - All the same when you have only one set of clothes and you have to go twice with the same people, you actually articulate all the possibilities, no?

Different tie or tend tie up - You have the same, absolutely - I agree with you, As-a.

Money sometimes,

blocks the creativity, yeah - Especially the glance from the NIH -

I would like to ask a question for Dr. Achelevi just to have

the

full picture because most of the people, I think they don't know about it like, you kind of feel like you have, have,

strong career in Iraq building a department and

teaching people, treating patients.

But at the end of his Iraq time,

there is a huge event, I think, change a lot.

And yeah, this is part of the story And I would like Dr. Harid just to

inform everybody about the event, about his kidnapping and what happened, because I think this is part of the picture and part of the story.

Yeah.

But life in Iraq was difficult really for everybody before 2003 and after With the sanction and the lack of everything, the budget or

the salary of the doctor was 3 a month.

So he has to live with that.

lack of papers, we have lack of

shuns, we have lack of oxygen, many operation lists were cancelled because we don't have oxygen.

We don't have any air conditioning in the theatre, so you have the sweat you possibly use maybe two liters literally of sweat during six hours of surgery, so you have to feed yourself with lots of water.

So it was difficult time at that time, again, in

2003 I had a problem, my car

was

taken by force, by three people with two guns with each, with the hands of each one of them, and then I was going to really to be shot at that time, so they took the car from my driveway and then I went inside and they shot out the door, one bullet, but fortunately that door was thick, so nothing happened, but they took the car.

But they were more important event to happen in 2004 when I was kidnapped.

Kidnapped, I think because I created the big society in Iraq called Iraq

Rescue of Culture and Development in Culture

Rescue Society with many distinguished people, Iraqi people, from all six of the society So I was the president of that society.

I think that created lots of fuss in Iraq at that time.

So I was kidnapped then and put in the trunk of the car with handcuffs and blindfolded.

And then I was taken somewhere outside of the suburb of Baghdad locked in and then they wanted half a million ransom, half a million dollar

And then what about -

We just more than three days I was released, but they accepted 30, 000.

I was

a little upset because they realized that I'm not worth half a million.

I just worth it.

So I was released then.

At that time, I was not really in distress at all.

First maybe a few seconds, few moments I was distanced and accepted the reality and that's it.

And once the kidnapper was beside me, it asked him to take a picture for me with his phone.

So he took a picture and said, That's no good.

Put the handcuffs and blindfold and take a picture.

And then I smiled at the phone.

But of course he did not send me that picture because he would be the expose himself.

So after that I stayed in Iraq, but they asked me to leave the country and then I listened just for a few months.

And they asked me to leave the country not to stay at all.

That's why from 2004 until now, it did not go to Iraq.

I always, you may know that I was offered to be the Minister of Health, the Minister of Higher Education a few times, lately and two years ago, but I apologize because I thought I can help from here, rather than to be a Minister in Iraq.

I was here in Washington as a cultural attaché to dealing with the link of Iraqi health and

higher education with American institutions.

And you have lots of activities.

I have a big conference at the Library of Congress and the video of that conference about five hours.

You can see it at the website of the Library of Congress up to now.

I gathered about 300 Iraqi-American academics leading professors in the country with Professor Peter Agri, the Nobel Prize winners, to attend that meeting.

three days we had the big two days we had a big conference here at the National Post by National Academies of Sciences and the created project called Together for Iraq with four to three committees in each branch of life of science, 18 about in medicine and the rest in education and law and everything and linked to Iraqi committees but unfortunately that did not materialize and did not work because of the situation in Iraq so many things happened and

we are here

trying to help Iraq in whatever way we can.

Bless you, you're just so wonderful, wonderful things you're doing

and we appreciate it.

Back to Dr. Kalleli and this mostly for the students when we say 'Sist' and we look at the seas like a big, bold, balloon, blood on the

Tkatskan to operate and that it sees.

is like a disarmament atomic bomb because if the cease explodes, all the

either of these contain within the, the, the, the cease, they spread over.

No. So it's quite a technical and

surgical achievement to operate on either of the cease of the size that professors clearly show them.

And I agree with the, at the statements or that the close man said about the research as well.

No, the relevance of the research.

And the final statement is an admirable work and commitment to your country that you're going to do in Dr. Mata Kali, you know.

Thank you.

Well, Dr. Kahlilia, while Sam was getting that up, I'd

like to invite you to be on the member of the Board of Surgical Neurology International and SI Digital.

We need people with your experience and judgment and wisdom.

And

it would be a true honor for us to have that happen - It would be my honor, sir.

It would be my honor - I'll correspond with you once I get Sam here to give me your address, but you should be

praised everywhere in the world for what you've

done - Thank you so much - Yeah - And not like what you have done - As you can tell,

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