Address by the President of the Central European Neurosurgical Society (CENS): Influence of the US Democratic System on the Level of Neurosurgery in Postcommunist Countries

Zverina, Eduard MD, PhD, FCMA

doi: 10.1227/01.neu.0000430304.33208.df

Mankind’s history and social organization are marked by relentless competition, a struggle between 2 systems: totalitarianism and democracy. Throughout history, dictators have been trying to replace democracy with totalitarian, dictatorial systems and governments (tribal, religious, partisan, or finance-based oligarchic, etc) allegedly for the benefit of mankind and progress. In the early epochs of human civilization, these regimes and empires led to progress but ultimately to destruction and collapse, social decay, and arrest of progress. This is equally true of ancient, medieval, and modern-age empires of Africa, Egypt, Asia, China, India, Japan, the Near East, the Mediterranean region, South America, and Europe.

The democratic political system is most likely to have been born in ancient Athens where, in the 6th century BC, Cleisthenes helped to oust the rule of tyrants (cratos) and to install the rule of the people (demos). Much later, in 1789, the French Revolution put an end to the rule of kings and aristocracy and ushered in the people who replaced them.

Democratic systems of the New Age and the present have obviously been influenced by the kind of democracy that came into being in North America. Prominent factors of the process include the Declaration of Independence of 1776, the Constitution of the United States of 1790, and George Washington, the first president of the United States (1789-1797). The US Constitution was and still is the first and constantly valid model for all democratic countries to follow. After World War I, the United States and its democracy proved to have a major political impact, leading to the breakup of the Austro-Hungarian monarchy. Most of its people won freedom and independence. President Woodrow Wilson and T.G. Masaryk (and his American-born wife Charlotte) had an important role to play in the birth of a democratic Czechoslovakia in 1918.

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The world and the destiny of humanity came under the threat of dictatorship (Nazism, Mussolini; fascism, Hitler; Japan’s expansionism, Hirohito; Soviet dictatorship, Stalin; China, Mao Tse-tung). In 1945, after World War II, the world, Europe in particular, came to be divided into 2 opposing camps: a democratic, Western camp benefiting from the influence of US democracy (mainly through the Marshall Plan) and totalitarian, controlled by Soviet Stalinist dictatorship imposed on “liberated,” although in fact occupied, central and eastern Europe (Warsaw Pact). In those years, we welcomed every achievement and political and cultural support from the democratic world, from the United States in particular. All attempts to regain freedom and democracy were brutally suppressed by military or police means (Hungary, 1956; Prague spring events, 1968; Polish solidarity uprising, 1982). All this resulted in several waves of emigration with loss of the intelligentsia, including neurosurgeons. The Cold War came to an end in Europe in 1989 to 1990 after the Reagan-Gorbachov talks in Geneva in 1988. It took decades for democracy to win its struggle with the criminal Soviet-led communist dictatorship.

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Despite political and personal repression, it proved possible, also thanks to H. Cushing, to establish independent neurosurgery along lines similar to those in the advanced world.1 Thus, for example, the Czechoslovak Neurosurgical Society was able to join the World Federation of Neurological Societies (WFNS) in 1968.2,3 In 1971 in Prague, we managed to hold the 4th European Neurosurgical Congress and to launch the European Association of Neurosurgical Societies, despite the fact that the Soviet-led invasion of Czechoslovakia in August 1968 had ushered in a 21-year period of political repression. Hardly anyone without personal experience of living in a totalitarian system can imagine what disaster this meant for everyone and everything. For neurosurgery in eastern Europe, this amounted to a major detachment from developments elsewhere in the world. Those of us who were not members of the Communist Party were not allowed to travel abroad for > 20 years. We were not allowed to have academic degrees. For example, I had to learn the art of microneurosurgery and skull base surgery all by myself as a self-made man (Figure 2). For years, it was not permissible to publish abroad even what others thought were good or even priority results.4,5 Our 1979 monograph on nerve injury, one of the first on tension-free sutures, appeared in Czech only. For years, we lived on experience garnered in 1971 from R.M.P. Donaghy and M.G. Yasargil.6-9 We were confined to studying literary sources alone. We benefited much from US literature, from the Journal of Neurosurgery, Neurosurgery, BNI Quarterly, the Barrow Neurological Institute, later the M.S. Greenberg Handbook of Neurosurgery, and other sources. A great encouragement for neurosurgery in Europe’s isolated countries came when Professor Zdeněk Kunc and Czechoslovak neurosurgery were awarded a Medal of Honor of the WFNS in Toronto in 1985. Later, the same award went to J. Haftek of Poland. J. Vajda of Hungary won the WFNS Young Neurosurgeon Award in 1981. We were happy to hear of the success of V.V. Dolenc of Yugoslavia, who then was of the few to shake off the yoke of totalitarianism to help develop neurosurgery in the United States. He worked in Ljubljana and also, in part, at American neurosurgical centers. Despite political restriction and different measures of isolation from neurosurgery worldwide, those of us in the Central European Neurosurgical Society (CENS) countries were able, albeit with some delay, to introduce intraoperative nerve monitoring, microsurgery, and skull base surgery.10-20 We went on developing microsurgery in all directions: tension-free sutures in cases of central and peripheral nerve injury including the brachial plexus, microvascular decompression according to Jannetta, treatment for acoustic and jugular foramen neurinomas, tumors of the third ventricle, intramedullary tumors, all indications for vascular surgery, and brainstem lesions such as cavernomas. We started developing skull base surgery. In 1992, at the First International Congress in Hannover, we became, together with many US neurosurgeons, cofounders of the World Federation of Skull Base Societies.21-23

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I know of only one: balloon catheterization and occlusion of major cerebral vessels, published in the Journal of Neurosurgery by F.A. Serbinenko in 1974.24 Indeed, further development of endovascular neurosurgery and all advances in neurosurgery (eg, microsurgery, skull base surgery, navigation, imaging) can take place only in democratic countries. As for our contacts with Soviet neurosurgeons, I met A. Konovalov (head of the Burdenko Institute in Moscow) in Oxford in 1965, in Prague in 1971, and many times thereafter. Although we had a good personal relationship, the totalitarian Soviet-style communist system led to isolation and regression of neurosurgery in the central European countries. Hence, it was crucial to establish CENS after we achieved freedom.

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The WFNS is an association of national, supranational, and continental organizations worldwide. In Europe, there are national societies and 2 entirely independent supranational societies: the European Association of Neurosurgical Societies and the CENS.25-27 The latter came into being after the fall of the communist empire, thanks to efforts by rank-and-file neurosurgeons and with support from WFNS President M. Samii. The foundation CENS Symposium took place in 1998 in Bratislava, Slovakia, with J. Steno in the chair, to become a full member of WFNS in 2000.28,29 Rather than an association of national societies, it is based on individual membership of neurosurgeons from the founding countries: the Czech Republic, Poland, Hungary, Slovakia, and Slovenia, with Austria joining the group as well. The society works to uphold the standard of neurosurgery in the above-mentioned and other countries by organizing booster courses, by holding a major congress every other year, and by attending all international events of the WFNS (Table). So far, CENS has organized a total of 7 congresses: the first in 1999 in Wroclaw, Poland, with J. Wronski as president; the second in 2002 in Brno, Czech Republic, with V. Smrcka as president; the third in 2002 in Ljubljana, Slovenia, with V.V. Dolenc as president; the fourth in 2006 in Budapest, Hungary, with I. Nyary as president; the fifth in 2008 in Vienna, Austria, with K. Ungersboeck as president; and the sixth in 2010 in Pultusk, Poland, with Z. Czernicki as president. The latest CENS meeting, the seventh in 2012 in Prague, Czech Republic, was held as a joint meeting with the Congress of Neurological Surgeons (CNS) in the United States under the presidency of E. Zverina and A. Nanda (Figure 1). It was a memorable event for CENS members meeting their American counterparts and because of the presence of Yong Kwang Tu, WFNS president-elect, and 2 of his predecessors, M. Samii and J. Brotchi, as well as the legend of neurosurgery, M.G. Yasargil (Figure 3). The next congress, the eighth, planned for 2014 will take place in Bratislava, Slovakia, under the chairmanship of J. Steno. The CENS presidents are elected for a term of 2 years; they are representatives of the organizing country for the congress. As the 12-year CENS existence shows, the foundation of a second society in Europe proved to be fully justified, and the standard of neurosurgery in those countries has since been approaching that in the most advanced countries.30-34

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In Europe in 1989, we were able to regain freedom, together with all of the occupied countries, after a struggle in which the playwright and future Czech president Václav Havel and the Velvet Revolution had a key role to play. Havel’s rallying cry was that truth and love must prevail over lies and hatred. A great admirer of American democracy, Havel was friends with US presidents R.W. Reagan, G.H.V. Bush, and W.J. Clinton and former Secretary of State Madeleine Albright, herself of Czech origin. Much to our sorrow, Havel died in 2011 (Figure 4).

Since regaining freedom, we have been striving to become reintegrated in the world mainstream of neurosurgery. American neurosurgery had a most important, indeed a crucial, role to play. It is impossible to give a full list of all the internships, courses, congresses, and friendly personal contacts with American neurosurgeons over the past 22 years that helped to increase the standard of neurosurgery in the CENS member countries (Figure 5). However, I must mention, in no particular order, at least some of them: P. Jannetta, L. Sekhar, J.A. Jane (honorary member of the J.E. Purkyne Czech Neurosurgical Society), M.G. Yasargil, R.F. Spetzler, A. Nanda (honorary member of the CENS), T. Fukushima, E. Laws, P. Black, A.L. Rhoton, S. Abdulrauf, R. Heros, J. Morcos, M.L.F. Apuzzo, T. Rutka, O. Al-Mefty, G. Rosseau, and many others.

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As president of CENS and as a neurosurgeon and microsurgeon working in the field of neurosurgery at Charles University, Prague, for 51 years now, I wish to tell you the following: The future of neurosurgery depends on you, the new generation. Remember what Leonardo da Vinci said: Poor is the pupil who does not surpass his master.

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The United States and American democracy are today faced with many enemies without and within.35 As Miloš Forman, Czech and American filmmaker, wrote earlier this year: “Today US democracy, a miraculous gathering of diverse players, desperately needs unity. If all participants play fair and strive for the common good, you can achieve a harmony. If just one section or even one player is out of tune, the music will disintegrate into cacophony....noisy dissonance might become loud enough to wake another Marx, or even worse.”

CENS wishes all of the United States a strong and stable democracy, one that can guarantee the future of the United States and the world at large. For democracy is also a guarantee of the development and future of our neurosurgery, an incredible branch of medicine designed to treat the most valuable gift we have: the brain.

For related video content, please access the Supplemental Digital Content:

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The author has no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article. Photos are from the archives of author.

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