Walter Edward Dandy

Walter Edward Dandy (born April 6, 1886 in Sedalia , Missouri , † April 19, 1946 in Baltimore ) was an American neurosurgeon and neuroscientist . He is considered a co-founder of modern neurosurgery. His important innovations and inventions include the description of the cerebrospinal fluid circulation in the brain , the surgical treatment of hydrocephalus , and the discovery and introduction of pneumoencephalography of the CSF spaces in diagnosticsthe intracranial masses, first operation of an intracranial aneurysm and thus the birth of cerebrovascular neurosurgery.

life and work

Walter Edward Dandy was born on April 6, 1886, the son of a railroad engineer in Sedalia (Missouri) , USA . His parents immigrated from England . Dandy also spent his school days in Sedalia and his college days at the University of Missouri . Because of his achievements, he was awarded a Rhodes Scholarship that would have enabled him to study at Oxford University for free . Dandy did not accept the scholarship because he wanted to study medicine , which was not represented in Oxford at the time. With the help of the zoologist Curtis, in whose laboratory he had worked, Dandy went to the Johns Hopkins Medical School in Baltimore in 1907 . After passing the state examination (1910) he went to the Hunterian Laboratory for Animal Surgery .

It was here that he first came into contact with the neurosurgeon Harvey Cushing . At the suggestion of Cushing, he examined the blood supply to the pituitary gland . In 1911 he was interned and came to the surgical department, where he also remained as assistant resident and from 1916 as resident . In 1918 he established himself as a general surgeon. In the same year Dandy began working as a surgeon, later as a neurosurgeon, at Johns Hopkins Hospital (Baltimore), where he remained until his death in 1946. In 1932 he was elected a member of the Leopoldina .

Even as an “assistant resident”, Dandy turned to liquor studies; In 1913 he published his first work on hydrocephalus and the liquor circulation. Dandy was able to show that, firstly, the CSF was produced by the choroid plexus and, secondly, that the CSF was not absorbed in the cerebral ventricles. He was able to show on the corpse that in every case of idiopathic hydrocephalus a passage obstacle could be detected. He made the difference between obstructive ( "occlusus" ) and communicating ( "communicans" ) hydrocephalus. Dandy was able to remedy communicating hydrocephalus by surgical extirpation of the choroid plexus . These investigations also laid the foundations for the discovery and application of encephalography after spinal air introduction and cerebral ventriculography for the diagnosis of brain tumors , with which the great age of neurosurgery began.

The ventriculography

The introduction of ventriculography came after long research and deliberation. To contrast the cerebral ventricles , Dandy had tried various substances such as thorium , iodide , collargol , and bismutum subnitricum in many experiments ; but all of them had proven to be too irritating. He came up with the idea of ​​using air as a contrast medium after seeing a spontaneously occurring pneumoperitoneum after intestinal perforation, in which the air that had collected under the diaphragm was very clearly contrasted in the X-ray image . Ventriculography now made it possible to determine hydrocephalus and the location of a brain tumor so precisely that it had to be found during the operation. Dandy turned almost exclusively to brain surgery.

Contributions to neurosurgery

Walter E. Dandy published the first work on the treatment of brain tumors in 1921. In the same year he described his surgical method for pineal gland tumors . In 1922 he was able to report on the surgical removal of tumors in the third ventricle. In the same year his work on the surgical treatment of pituitary tumors appeared. His studies on the nerve and vascular supply of the pituitary gland from 1910 were supplemented by animal experiments.

Of the other contributions that Dandy made on neurosurgery, the following should be singled out:

• The acoustic tumors were first radically operated on by Dandy.
• In 1937 Dandy was the first to succeed in diagnosing an aneurysm in the Willisi circle and surgically eliminating it.
• Removal of infiltratively growing brain tumors ( gliomas ) through extensive resections of brain lobes , up to the removal of an entire brain hemisphere ( hemispherectomy ).
• Surgical treatment for herniated discs .
• Neurotomy (nerve division) of the sensitive root of the trigeminal nerve in trigeminal neuralgia .

Publications (selection)

• Ventriculography following the injection of air into the cerebral ventricles . In: Ann Surg 68: 5, 1918
• Localization or Elimination of Cerebral Tumors by Ventriculography . In: Surg Gyn . 30: 329, 1920
• The Treatment of Brain Tumors . In: JAMA 77: 1853, 1921
• Operation for Total Extirpation of Tumors in the Cerebello-Pontine Angle . In: Johns Hopkins Hosp Bull ., 33: 344, 1922
• Diagnosis, Localization and Removal of Tumor of the Third Ventricle . In: Johns Hopkins Hosp Bull ., 33: 188, 1922
• Mechanisms and Symptoms of Tumors of the Third Ventricle and Pineal Body . Williams & Wilkins Co., Baltimore 1929
• Surgery of the Brain . WF Prior Co. Inc., Hagerstown 1936
• Recent Advances in the Diagnosis and Treatment of Ruptured Intervertebral Discs . In: Ann Surg ., 115: 514, 1942
• Intracranial arterial aneurysm . Comstock Publ. Co., Ithaca, NY 1944
• Dandy's Selected Writings compiled by Charles E. Troland and Frank J. Otenasek. Springfield, Oxford, Toronto 1957

Corresponding eponyms

• Dandy operations :

1. Parapontine , partial or total neurotomy of the dorsal (sensory) trigeminal root in the posterior fossa in trigeminal neuralgia .

2. Ventriculo (cisterno) stomy of the III. Cerebral chamber with non-communicating internal hydrocephalus.

3. Closed coagulation of the choroid plexus of the lateral ventricle in hypersecretory hydrocephalus.

4. Intradural neurotomy of the anterior roots C1 - C3 and the spinal accessory root for torticollis spasticus .

5. Removal of a prolapsed disc sequester .

• Dandy sign : exacerbation of sciatica due to coughing, blowing your nose, sneezing as a sign of discogenic sciatica irritation.
• Dandy Walker Syndrome : Variant of the dysraphy syndrome with congenital hydrocephalus, cystic enlargement of the fourth ventricle, atresia of the foramen magendi and poor development of the cerebellar worm .

literature

• AE Walker: A History of Neurological Surgery . Williams & Wilkins Co., Baltimore 1956
• AE Walker: Walter Edward Dandy in W. Haymaker: The Founders of Neurology . Ch.C. Thomas Publ., Springfield 1953
• E. Cambell: Walter E. Dandy - Surgeon . In: Journal of Neurosurgery , VIII: 35249, 1951
• WL Fox: Dandy of Johns Hopkins . Williams & Wilkins Co., Baltimore 1984
• ME Dandy Marmaduke: Walter Dandy. The Personal Side of a Premier Neurosurgeon . Lippincott Williams% Wilkins, Philadelphia 2002

Web links

• Literature by and about Walter Edward Dandy in the catalog of the German National Library