Neurosurgical Classic—XVI
1964; American Association of Neurological Surgeons; Volume: 21; Issue: 2 Linguagem: Inglês
10.3171/jns.1964.21.2.0144
ISSN1933-0693
Autores Tópico(s)Neurology and Historical Studies
ResumoC AROTID arteriography is used widely as a diagnostic procedure in modern neurosurgery. The development of this important technique primarily was the result of the efforts of one man--Antonio Caetano de Abreu Freire Egas Moniz. Egas Moniz led an unusually varied and productive life2 ,is,is His nonmedical achievements alone were impressive. As a politician, Egas Moniz created and directed the Centrist Party. He was a political prisoner at one point in his career, and at another he was almost killed by a schizophrenic assassin. During the first World War, Egas Moniz was the Portuguese Ambassador in Madrid, and later Minister of Foreign Affairs. He was also president of the Portuguese delegation to the Paris Peace Conference in 1918. In 1951 he was asked to be President of Portugal, but he refused. Egas Moniz also was active in other fields. He wrote an operetta, taught mathematics, fought a duel, became a gourmet, and still found time to write on the history of playing cards and to publish a biography of Pope John XXI. Even more outstanding were the medical achievements of Egas Moniz. After distinguishing himself as a student at the University of Coimbra, he studied neurology at La Salp~tri6re with Raymond, Pierre Marie and Dejerine, and at L'HSpital de la Piti6 with Babinski. Egas Moniz became a professor of medicine at the age of ~8, the first occupant of the chair of neurology at the University of Lisbon, and the author of over 300 medical publications. Partly in collaboration with the neurosurgeon Pedro Manuel de Almeida Lima, he developed two major neurosurgical techniques--carotid arteriography and prefrontal leucotomy. The latter work brought Egas Moniz the 1949 Nobel Prize for physiology and medicine. In developing carotid arteriography Egas Moniz persevered in the face of numerous difficulties2.16 Prior to his investigations, contrast radiography for neurological diagnosis had become known in the forms of ventriculography, encephalography, and myelography. 5,2~ Techniques of carotid injection had been described, and radiographic studies of the anatomy of various organs had been performed in cadavers by arterial injections of radiopaque materials. 6,15,19 Egas Moniz applied these ideas and techniques to his project, but the applications were not easy. 3,5 Even after a number of contrast media had been screened carefully in animals, those thought safe for human experimentation were shown to cause irritation of tissue and pain, The percutaneous injection of the internal carotid artery was tried in four patients. This proved so difficult that it was supplanted by direct injection after surgical exposure of the artery. Other problems were posed by the intravascular dilution of the contrast medium, and the inadequacies of the available radiological equipment. While a successful technique was being developed, nine patients were given intracarotid injections. Of these, six subsequently had transient neurological symptoms and one died. To the credit of Egas Moniz, he persevered and gained eventual success. Numerous papers on carotid arteriography were published by Egas Moniz and his collaborators in 19~75-9 and the ensuing years. In 1931 Egas Moniz presented his studies at the First International Neurological Congress in Bern, ~~ and published a book describing his first 180 arteriograms, n Other volumes by Egas Moniz and by Almeida Lima followed.i. 2.12-14 With later improvements in contrast material, techniques of injection, and radiological equipment, carotid arteriography became employed widely29 I t has fulfilled the expectations of Egas Moniz in the diagnosis of intracranial neoplasms. But more important, carotid arteriography
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