Interview - Michael Bruneau catches up with Prof Bernard George

by Michael Bruneau, Erasme Hospital, Brussels, Belgium

 

Thank you for having accepted to participate to this interview. Many people ask a lot of questions about you, you stay in all the memories. This discussion will be an opportunity to give them some news and to share your vision of our profession and on the world.

MB- First of all, how are you doing?
BG- Hello Michaël. Apparently I am going well; in fact I have collected a lot of health problems over the last few years: I went through 3 cancers, 2 myocardial infarctions and even 2 cardiac arrests. Now I realize physically and psychologically the feelings of someone going to undergo a serious surgery. This is just the opposite of what I had been doing for more than 40 years.

MB- Since how many years have you left your position of head of the department? Were you prepared for your retirement?
BG- I left my position of head of the department 3 years ago without any difficulty because I was ready in my mind and because my wife did the same at the same time. In fact with my health problems, I have already had to slow down my activities. I must say that the more and more heavy load of the administration was also an important factor in this decision. Having chosen and being very satisfied by the choice of my successor was also a good point.

MB- Are you still involved in some neurosurgical activities? 
BG- I have kept some contacts with the department; they call me very often to ask some advices in the medical and the administrative fields. Many french and foreign neurosurgeons still send mails questioning my opinion about the diagnosis and treatment of their patients. I sometimes go and do surgery in different places but less and less. I also like to participate in courses to teach young neurosurgeons. 

MB- Is your daily time so busy than before? By which activities? You were very well organized, very punctual. Is it still the case? 
BG- Many of my friends and of my family are surprised that I don’t miss my former activities, especially surgery. In fact not at all; I am very happy to spend the time with no real commitment, no stress and no real goal but enjoying any good and simple moment of life. I don’t need to be a surgeon to be sure that I exist. In fact I like to say that since I am retired, I do nothing but I am overbooked.

MB- What is your look at current medicine?
BG- The evolution of medicine and neurosurgery over the 43 years of my career was incredible. Imagine that when I start in the early sixties there was neither CT scanner, nor MRI, in fact nor neuroradiology. As a resident, every week we had to put our names on the operative program but also on the radiological program, to do angiography, myelography, pneumoencephalography. Moreover microscope, bipolar coagulation, neurophysiology, neuronavigation did not exist. An aneurysm surgery without microscope and with very bad clips was an incredible moment; for a young resident attending the main surgeon but seeing almost nothing, with a sucker in hand in case of rupture (it almost always happened), it was a terrible experience. You must realize that mortality in aneurysm surgery was about 50%. The microscope was a real revolution and a tough challenge for the old surgeons. Some could never get used to it. This is similar with the recent development of endoscopy. We generally do not realize on working with a microscope our gaze is not directed towards the operative field and the instruments with their bayonet shapes are not in the axis of our fingers; with an endoscope, the surgeon watches a screen and adjusts his movements from a picture. This can be compared to a soccer player shooting the ball towards the goal without seeing neither his foot nor the ball nor the goal but watching a monitor.

MB- Your career as well as your legacy to the newest generations remains exceptional. You developed several surgical techniques that are used worldwide nowadays and your visionary character has significantly impacted a lot of neurosurgeons. Could you relate the main events in your professional career?
BG- I think I have been lucky all along of my career; in fact I prefer to say I had and took the good opportunities. Not missing the good opportunities is a lesson for every life. The luck is rather to have more or less good opportunities. When I start my medical studies, I even did not know that neurosurgery could exist. But I discover this specialty when I was sent to a department by a random draw. Then I did my first surgery on the Vertebral Artery (VA) when I was still a resident (in 1977) with a friend, resident also in vascular surgery. After the chiefs of our departments failed to treat an aneurysm of the VA at the C3 level, we went to the lab and work on a surgical approach to expose the cervical VA. Few months later, the same patient came back after a new embolic stroke. It sounds unbelievable but our chiefs accepted the proposal of the two residents: to perform a saphenous vein by-pass between the subclavian artery (there was no Pcom) and the VA distal to the aneurysm with a proximal clip excluding it. And we did it. Then some people told me this is a wonderful surgery but it is an orphan, meaning that there will be no other indication for a similar surgery. In fact when I retired, I had done more than 1800 cases of surgery on and around the VA. Then very early, in the late seventies, I develop approaches to the VA especially at the level of the cranio-cervical junction: the postero-lateral approach specially designed for Foramen Magnum meningiomas and the antero-lateral approach for bone tumors (chordomas and others). Later people more expert in marketing than me, described the same approaches under the names of far lateral and extreme lateral. Another application of the VA surgery was found after I was called in another institution to treat a cervical neurinoma involving the lateral aspect of the spine on 3 levels. I had the idea to drill obliquely the vertebral bodies so to get an access to the antero-lateral aspect of the cervical canal with minimal bone resection. This technique, I call it oblique corpectomy, was then applied to decompress the cervical canal in case of spondylotic myelopathy and radiculopathy. Finally being known to be the guy who can treat any VA problem, I was sent a lot of rare pathologies such as, Bow Hunter syndrome, congenital anomalies, pseudo tumors …

MB- Have you some feeling of achievement? Would you have performed some things differently retrospectively? Do you regret not having had time to develop some projects specifically?
BG- Yes I have the feeling of having achieved a nice work along my life; in fact I start to feel this achievement when I was less than 60 years, thinking already at that time that I have done so many interesting things and reached such a good position in the world of neurosurgery. One sign of this achievement is the book on VA surgery that you and me did together, Michael and which I am very proud of. Looking back I have no regret, except of some mistakes I did in my practice but I feel I have been so lucky in my professional life that I cannot imagine it could have been better.

MB- Our profession implies high responsibilities, generates a permanent stress, raises questions about life. How have you deal with this all over your career? Has your profession impacted your life and your vision of the life in general?
BG- It is very surprising how we can go through our professional life without considering the real impact it has on us. Probably most of us did not think of the significance of brain surgery on a patient and his surgeon. As the European lecturer in 2009 at the EANS meeting in Rome, I gave a lecture on this topic. I suggest brain surgery is a penetration in the most intimate part of our body and therefore should not be experienced as a rape. Moreover in any surgery we divide someone who is an individual; and this word means who cannot be divided. I have personally felt this deeply. On the other side the neurosurgeon is a person who has for a short period of time, an immense power over another person with his complete agreement. Therefore it is a very unique experience for both the surgeon and his patient. As a consequence a surgeon must be a little megalomaniac or at least very self confident. When he starts a surgery, he must think that no one else could do better. In fact nobody can be the Olympic champion every day and even the best surgeon has been a beginner. So we must combine ambition, self-confidence and sense of humanity but not forget that our life is just a short, quickly forgotten moment in the world history.

MB- What would you advise to the new generations of residents who have stars in the eyes? And something to recommend to all neurosurgeons?
BG- For the future, (young and less young) neurosurgeons must be prepared to surprising changes and never considered they have reached their final point or the summit. They must keep their mind wide open and remain ambitious but humble. These are the words one of my masters told me after a catastrophy (the patient died) he had during a pituitary surgery. Another point always very beneficial is to accept to listen and to work with others, whoever they are. Combining the knowledge of different specialists can bring big advances. There are many examples of this: the CT scanner (radiologist and computer specialist), endoscopy (ENT and neurosurgeon); personally my work on the VA could not have been possible without a vascular surgeon. The future of medicine is probably to incorporate non-medical specialties. The last point is to consider that surgery in general and neurosurgery in particular as a non-sense. To say that we are going to improve someone and starting by destroying different tissues on the way is not logical. Minimally invasive is a word invented in the eighties, which satisfies the surgeon but non-invasive would certainly be better; this should be the trend of the evolution of surgery. Other techniques or pills will replace surgery. For example there is certainly a better way to treat gliomas than surgical resection. 

MB- And a final word…
BG- And my final word would be to say that our job is the most exciting but also the most demanding and the most in evolution and never forget: vanitas vanitatum et omnia vanitas.