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Victor Shcheglov, the celebrated Ukrainian neurosurgeon: “I Want the World to Applaud Ukraine!”
“The brain is a divine structure” but is susceptible to disease, and Natalya Poznyak, a freelance journalist for the Welcome to Ukraine magazine, looks into how some of these diseases can be treated without craniotomy (trepanation), and talks to Professor Shcheglov, a Ukrainian magician of neurosurgery.
Some time ago, when I was aboard a plane flying from Kyiv to Toronto, I inadvertently overheard a conversation of two Americans whose seats were close to mine. At first, I tried to ignore their conversation, but when one of them began describing his visit to a Kyiv doctor, I put my book aside and cocked an ear at his story. He had a bad case of quinsy and had to turn to an otolaryngologist for help. The way he described the round mirror with a round hole in the centre on the doctor’s forehead to send the light down the patient’s throat, caused both of them to convulse in laughter. In fact, I could not help laughing too, though sinking as deep into my seat as I could to avoid detection. But when the mirth subsided, and I began reflecting on the state of medical care in Ukraine, I realized that, yes, in many respects Ukrainian medicine was grossly outdated and in a dismal state, but on the other hand, there were achievements that put it at the cutting edge of modern medical science and practice. What follows is a story about one of such achievements.
Thirty years ago a breakthrough was achieved in medicine — operations on the vessels of the brain became possible without craniotomy. Basically, the procedure is like this: a special catheter (a very thin flexible tube) is introduced into the right vessel and the blood flow delivers it to the place to be treated; the movement of the catheter and further manipulations are controlled by the surgeon who looks at the screen of a monitor, on which the position of the catheter is graphically shown. What used to be an exceedingly complicated operation became almost a routine procedure, involving no craniotomy and no damage to the cereblal tissues. A similar method was later used for treatment of certain heart conditions and dealing with problems of internal organs — also, without having to surgically open the chest or abdomen.
Ukrainian physicians were the first to start using an advanced method, in which a miniature container fixed to the penetrating tip of the catheter would be detached from the catheter and the blood flow would deliver it to the right place — to dissolve a clot of blood in a vessel, for example.
Professor Victor Shcheglov, head of the Centre for Endovascular Neuroradiosurgery (interventional neuroradiology), has perfected the treatment of various vessel pathologies by means of balloon catheters (balloons — detachable miniature containers affixed to catheters). Over four thousand cases have already been treated at the Centre. When a clot in a brain vessel was dissolved for the first time, and the patient, who had been paralyzed, regained the ability to control his body and several hours after the operation got up from his bed and walked about, Professor Shcheglov was called “a magician.” He successfully treated hundreds of patients who suffered from the post-stroke syndromes and brought them back to a fully normal life. When a group of neurosurgeons experts from Great Britain visited the Centre they were very much impressed with what they saw, and said that Professor Shcheglov turned what used to be the extremely complicated operation into a series of rather simple manipulations.
“The brain is a divine structure, and our attitude to it should be correspondingly pious,” says Professor Shcheglov. Endovascular therapy has a great future and the number of diseases that can be treated with its techniques and methods is constantly growing. Patients suffering from the most complicated cases of vascular pathologies, epilepsy and ischemic strokes are successfully treated so that they can return to normal lives again. Cancer metastases in the brain are also treated with the endovascular neuroradiosurgery techniques — in the chemotherapy treatment tiny containers deliver the medication to the right spots thus minimizing the possible negative effects on the whole organism. “Today we can reach any part of the brain without doing any damage to the brain itself. We were the first to start doing operations of this sort when we wanted to reach a spot with great precision and without fail, and now endovascular therapy is our first priority.”
Victor Shcheglov was one of the disciples of Professor Serbinenko who, in 1972, was the first to use the endovascular method in the localization of the aneurysm of the carotid-cavernous fistula of the brain. But it was only the first step, and Victor Shcheglov set down to work out a new approach whereby the risk would be minimized and the desirable results would be achieved. He made the tiny containers (balloons) and studied their behaviour in a replica of blood vessels that he made using rubber tubes. It took thousands of tests and experiments to make sure the new method worked properly. Professor Shcheglov continues to make the containers himself, for each individual patient to be treated, taking into account the specificity of each individual case, which determines the size of the container and its shape.
Professor Shcheglov’s work re-established the validity of the endovascular therapy after the American physicians had reported that the containers damaged the vessels and not always reached the right spots. It cast doubts on the endovascular therapy in general, but Professor Shcheglov convincingly demonstrated that the failures of the Americans were caused by their using standardized containers supplied by pharmaceutical companies.
In fact, Professor Shcheglov is considered to be the founder of the endovascular neuroradiosurgery the way it is practised now. Back in 1974, the effectiveness of endovascular therapy was demonstrated at an international congress in Japan — over a hundred successful operations had been performed in Ukraine by that time in treating large aneurysms of the arteries in the brain.
“In order to achieve a success in the field you have chosen to work in, you have to devote part — nay, the whole of your life to it,” and for Professor Shcheglov it is more than just a motto — it is his life. As a teenager, a student of the secondary school in the village of Novohryhorivka in the land of Khersonshchyna, he wrote an essay about his ambition and choice of occupation. The essay contained only a few words: “ I want to be a surgeon. And a great one at that!”
It took Victor Shcheglov years of study and practice, years of experimenting and reading (his wife helped him in procuring information from foreign publications) to become a top expert in his field. Incidentally, Professor Shcheglov’s son Dmytro is a neurosurgeon too — his father taught him to make detachable miniature containers and watch on the screen of the monitor how they deliver the medicine to the right spot and thus save the patient’s life.
The Endovascular Neuroradiosurgery Centre was founded six years ago with the support from Ukraine’s president and from the Presidium of the Academy of Medical Sciences. Since its foundation, many neurosurgeons from the USA, Canada, Germany, Great Britain and other countries of the world have come to be trained at the Centre (J. Spellman and A. Berenstein from the USA; G. Hieshima, J. Moret, Ch. Drake and A. Fox from Canada; D. Sieman from Great Britain; P. Lasjuanias, H. Zeumer and W. Hook from Germany; O. Yakira from Japan, to name but a few).
There are 75 endovascular hospitals in the world, out of which 8 are in Ukraine. In 1998, the American Biographical Institute proclaimed Professor Shcheglov “The Person of the Year,” and in 1999 he was nominated for “The Person of the Year” at the All-Ukrainian contest. He is a recipient of several awards and titles. “I don’t want the honours for myself — I want the world to recognize the Ukrainian achievements and applaud them,” says Professor Shcheglov.
A number of his disciples ( Ye. Annin, S. Hudak, Ye. Butsko, O. Honcharov, N. Chabanovych and others) have come to work alongside him at the Centre and it means that there will be an interrupted continuity in passing knowledge and skills from one generation of neurosurgeon to the next one. “Unfortunately, some of the most talented of my disciples leave Ukraine and go abroad to work there — and be paid so much more than they could be paid here in Ukraine. One of them is working in America, another in Hungary, a third one in Germany. It is too bad that Ukraine is losing specialists of such a high level but how can we blame them for leaving in search of a place where their work will be appreciated and paid for in accordance with their great skills?” says Professor Shcheglov.
The most complicated operations can be performed at the Centre but to ensure they are successful new, state-of-the-art equipment is badly needed. Each operation costs a lot; plus the medication which is also expensive. In order to help solve these problems a charity fund was to set up and it was named after Victor Shcheglov.
This year, the Centre has brought down the post-operation death rate to a mere 0.3 percent, and at the same time doubled the number of those patients who, thanks to treatment, have been able to return to normal life. Ukraine retains its leading position as a major centre of endovascular neuroradiosurgery in spite of the fact that endovascular therapy has been actively developing in the USA, Canada, France, Japan, China, Great Britain, Italy, Portugal, Germany, Russia and other countries.
“It’d be so good if a leading position of a country in the world were determined in the twenty first century by this country’s special achievements in this or that field of human endeavour. Endovascular neuroradiosurgery is one of such achievements, and Ukraine being a pioneer and leader in this sphere of medicine does deserve a worthy place among the leading nations,” says Professor Shcheglov.