[Aarno Snellman, the pioneer of modern neurosurgery in Finland and the founder of the Neurosurgical Clinic of Helsinki University Hospital]. / Aarno Snellman, neurokirurgian uranuurtaja Suomessa ja Helsingin neurokirurgisen klinikan synty.

Aarno Snellman, M.D., (1893-1964) was the pioneer of modern neurosurgery in Finland and the founder of the Neurosurgical Clinic of Helsinki University Hospital. In 1932, at the initiative of Marshal Mannerheim, the Finnish Red Cross Hospital started functioning at Helsinki, with trauma as its focus of activity. From the outset, the main task of the hospital was to treat the brain injuries caused by traffic accidents in the capital and its environment. With a view to improving the prognosis of the patients, the medical staff took an active interest in the achievements of foreign neurosurgeons. Assistant Surgeon Aarno Snellman had been working at Prof. Herbert Olivecrona's Neurosurgical Clinic in Stockholm. After his return in 1935, he was the first to perform a craniotomy in Helsinki. When the war began in 1939, the development of neurosurgery was delayed by the lack of staff. On the other hand, the war provided a strong incentive for the development of independent neurosurgery. The military authorities favoured the Finnish Red Cross Hospital, all wounds to the brain, spinal cord and peripheral nervous system being referred to its wards, which were superintended by Snellman. After the conclusion of peace, these wards were gradually transformed into an independent neurosurgical clinic led by Snellman. He was appointed Personal Professor of Neurosurgery at the University of Helsinki in 1947. He retired from his post as Head of the clinic in 1961. Aarno Snellman's abundant achievements include the organization of treatment and after-care of the brain-injured war veterans in Finland.

A prospective study of patients with sciatica. A comparison between conservatively treated patients and patients who have undergone operation, Part I: Patient characteristics and differences between groups.

Based on a prospective study on 342 sciatica patients examined with rhizography, the aim was to determine which factors others than the rhizography finding and the grade and duration of symptoms were related to the selection of patients to undergo operation. Compared with surgically treated patients, conservatively treated patients who did not undergo operation and who had pathologic rhizography findings had pessimistic attitudes to possible surgery, often expressed a desire to retire, and considered their work as physically stressful. The women in this group were older and had lower pain indices than women who underwent operation. Conservatively treated patients with negative rhizography had more severe occupational handicaps, minor expectations of possible surgery, physically more strenuous jobs requiring difficult physical positions, and lower indices for pain and ADL than did the operated patients. The social and ergonomic background problems are emphasized in sciatica patients conservatively treated after rhizography.

A prospective study of patients with sciatica. A comparison between conservatively treated patients and patients who have undergone operation, Part II: Results after one year follow-up.

The prospective study included 122 sciatica patients who had not undergone operation (NOPs) and 220 sciatica patients who had undergone operation (OPs); all had been examined by rhizography. The follow-up study was done on 110 (90%) of the NOPs and 212 (96%) of the OPs. The NOPs were divided into two groups: 30 patients with pathologic rhizography (PR) and 80 patients with negative rhizography (NR). Pain-, ADL-, and occupation-handicap indices showed that after the 1 year follow-up the OP group had the best result and the NR group the lowest result. The PR group had nearly as good a result as the OP group. Thus, sciatica patients are candidates for conservative therapy, even though they have pathologic findings in rhizography, if the symptoms are mild. To improve therapeutic outcome, more accurate diagnostic tools are needed to develop specific therapy especially for those sciatica patients with negative rhizography.

Clinical, social, and psychological factors and outcome in a 5-year follow-up study of 276 patients hospitalized because of suspected lumbar disc herniation.

The study consisted of 276 patients who were hospitalized between 1980 and 1982 because of suspected lumbar disc herniation. No randomization of treatment was used. On the basis of clinical indications 179 patients were operated on and 97 had further conservative treatment. Results of physical, social, and psychological examinations performed after 1 year were related to the 5-year outcome defined by occupation handicap of the WHO system. For operated patients, subjective working incapacity, sensory deficit of leg, tightness of hamstrings, age, and pain in lumbar extension predicted a poor outcome. Predictive factors for non-operated patients were increased occurrence of occupational hazards and co-morbidity.

When Nordic neurosurgery was still in its infancy.

Olof af Acrel, the father of Swedish Surgery, operated in 1768 upon a young nobleman who had experienced an increasing swelling on the skull, due to a tumour which also turned out to be growing deep into the brain parenchyma. The patient survived the operation for 3 days. Edvard Bull in 1877, after diagnosing a ruptured internal carotid artery aneurysm in a young female who temporarily recovered after her first hemorrhage, emphasised that the risk of a second, fatal haemorrhage--which in fact occurred--was immediate. He predicted that carotid ligation might be a way to reduce the risk of repeated haemorrhage from such aneurysms. Virtually unknown to modern neurosurgeons are many remarkable Nordic pioneers who, in the 1800's and early 1900's, rendered major contributions to the birth of modern neurological surgery. Thus early neurosurgical operations were performed by Carl Daniel von Haartman in Finland and by Christopher Withusen and Gundelach Møller in Denmark. von Haartman and Withusen had both visited Sir Astley Cooper in London in 1816. Vilhelm Magnus of Oslo was a neurosurgical giant, who had been trained by Victor Horsley during visits to London in 1903 and 1904. Magnus performed his first two-stage operation for a tumour located deep in the left cerebral hemisphere in 1903. By 1921, he had operated upon 112 cases of intracranial tumour with an 8.1% surgical mortality. His results were certainly fully comparable with those of his contemporary American pioneer--Harvey Cushing. Vilhelm Magnus, who worked alone under primitive conditions in small private hospitals, published altogether 70 scientific papers. In 1925 his series comprised 189 patients operated upon for brain tumours with 7.7% surgical mortality in supratentorial, and 17.8% mortality in infratentorial tumours. Magnus was congratulated on his brilliant achievements by a Swedish colleague 20 years his junior, Herbert Olivecrona, the man who was to carry on his pioneering work in Sweden.

Rehabilitation after surgery for lumbar disc herniation: results of a randomized clinical trial.

The aim of this prospective study was to examine the one-year postoperative results in patients operated on for lumbar disc herniation randomized in two groups: one with comprehensive rehabilitation and the other taken care of by normal care facilities. A total of 212 patients without any previous spinal operations comprised the final study group. The physiatrist, the surgeon, the social worker, and the psychologist performed the handicap evaluation according to the occupation handicap scales of the WHO. The handicap was evaluated for two phases: before the onset of acute sciatica leading to operation and one year after operation. No significant differences in handicap distribution between the intervention and normal care groups were seen. The postoperative handicap correlated highly significantly with preoperative handicap for both groups. More than half (57%) of all the patients returned to work within two months of the operation. The amount of sick leaves did not differ significantly between the intervention and normal care groups. A total of 15 persons (7%) retired during the postoperative year.

Operated lumbar disc herniation: epidemiological aspects.

A total of 1011 operations for lumbar disc herniation were carried out in South-West Finland during the period 1975-1979. Of these operations 907 were first and 104 reoperations. Eleven patients had cauda equina symptoms. There were 856 operations performed on patients living in the area served by Turku University Central Hospital, an area with 455 000 inhabitants. Operations on 778 patients (342 women and 436 men, mean age 41.6 years) were first and operations on 78 patients (36 women and 42 men, mean age 42.7 years) were reoperations (9.1%). Nearly 90% of the patients were between 25 and 54 years of age. Neither heavy nor light work was more common among the first operated or reoperated patients than in the population at large. The monthly variation in the number of operations had no statistical significance. The incidence of operation for first lumbar disc herniation varied yearly from 31 to 36 per 10(5) persons living in the Turku University Central Hospital area.

Contrast enhancement around a prolapsed disk.

Five patients with herniated intervertebral disk had undergone a preoperative CT examination with intravenous contrast medium. In 2 cases, intense enhancement was seen around the prolapsed disk. In 1 case, there was an arachnoideal thickening over the herniation, but in the other case, nothing unusual was found around the prolapse at operation. The etiology of the phenomenon is discussed.

Late-onset malignant astrocytoma in a case of multiple sclerosis. Clinical, neuropathological, virological, and tissue culture studies.

An unusual case of concurrent MS and anaplastic astrocytoma is presented. MS was diagnosed in a female patient at the age of 22 years. A left side thalamotomy was performed for relief of severe intention tremor at age 28 and at age 32 she received immunosuppressive therapy for 1 year. At the age of 36 after a severe exacerbation of her symptoms a left side fronto-temporal tumor was diagnosed and a subtotal neurosurgical extirpation was performed. Histopathologically, the tumor was an anaplastic astrocytoma, which was further substantiated by electron microscopy and establishment of a permanent cell line in vitro. The cultured tumor cells were negative for measles virus by immunofluorescence. The relationship between the reactive astrocytes in MS plaques and astrocytic neoplasia is discussed.

Differentiating intracerebral neuroblastoma: report of a case and review of the literature.

A case of the rare primary intracerebral neuroblastoma is reported. The patient, a 13-year-old girl, was subjected to craniotomy because of a right frontal tumor. The removed tumor tissue was composed of immature, highly cellular areas with numerous mitotic figures, adjacent to fields with Homer-Wright rosettes, and areas consisting of neuroblasts and mature neurons. There was no evidence of a primary tumor elsewhere in the body and 25 months after the operation and postoperative irradiation, the patient is without any signs of recurrence. Determination of catecholamines and their metabolites in the urine and cerebrospinal fluid gave normal results. Dense-corded vesicles could not be detected in the tumor cells by electron microscopy. A review of previously reported cases of primary intracerebral neuroblastomas is included. The cell of origin and the possibility of transition of a differentiating intracerebral neuroblastoma to ganglioneuroma are discussed.

Antibodies against herpes simplex virus type 1 subunit antigens in patients with trigeminal neuralgia and controls.

Serum IgG antibody levels against herpes simplex virus (HSV) type 1 subunit (capsid, envelope, and excreted) antigens detected with radioimmunoassay were compared in 25 patients with trigeminal neuralgia and their age- and sex-matched controls. No significant differences were found between the patients and controls, either in the distribution of the antibody titers or in the mean titers against any of the subunit antigens tested. In 6 patients HSV antibody titers were tested before and after trigeminal root section; no significant changes were observed.