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Brainstorm

 The most authoritative Siberian neurosurgeon in Europe is staying in Novosibirsk  05/13/2013, 11:08
Brainstorm
Photography: Roman Brygin

There are two extremely rare documents in neurosurgeon Alexey Krivoshapkin’s office. The first confirms that he passed all neurosurgery certification examinations in the United Kingdom, the second that he is a member of the Royal College of Surgeons of England. No other neurosurgeon in Russia can boast of this level of recognition. In Novosibirsk, Krivoshapkin heads two major neurosurgical centres and a department of the Medical University. Sib.fm’s correspondent discussed with him the scope of the most delicate area of modern medicine in Siberia, the healthcare business and English teachers.

How do you assess the level of neurosurgery in Novosibirsk compared to international standards?

It’s very high. We have the latest technology to help patients with very different conditions. Of course, we try to meet international standards: what’s the point of working like a village hospital?

When the Neurosurgical Centre at the Railway Clinical Hospital opened 13 years ago, it was equipped with the most modern and sophisticated equipment available at that time. We bought the best neuronavigation system, developed for NASA, which made it possible to quickly and accurately find malformations and reduce operational risks. These systems have only just started to take root in medicine. The Burdenko Institute of Neurosurgery in Moscow was the only place that had them, and even they weren’t as advanced.

Three years ago, the Angioneurology and Neurosurgery Centre was established at the Meshalkin Institute of Circulation Pathology in Novosibirsk. It offers the very highest level of treatment for cerebro-vascular diseases.

Without false modesty, I can say that I was pleased how highly our Western counterparts rated our achievements when I was lecturing at a university in Los Angeles a month ago.

Thank God, we have minimal levels of surgical mortality and disability in patients with even the most challenging neurosurgical conditions (he knocks on wood — Sib.fm comment). We don’t only match clinics in Europe, America and Japan, in some areas we’re even more successful than them.


A male brain is 100-150 grams heavier than a female’s

For example?

We can successfully treat severe conditions of the vascular system, when there is no capillary connection between veins and arteries. The disease most often affects young people, who then either pass away or become disabled. People are racking their brains over this problem all over the world.

We have very good results for patients with arterial aneurysms. An aneurysm is extremely dangerous: a vessel in the brain bulges, thins and could burst at any moment. Unfortunately, we can’t save everyone but have been able to reduce the mortality rate to 1.3%. Judging by reports from the best clinics that treat patients with this disease, we are at the forefront.

Almost all technologies for treating spinal problems are established in Novosibirsk. The Institute of Traumatology and Orthopedics is custom-made for that. The Railway Hospital has all modern treatment methods for degenerative spinal diseases. In addition, the Medical University’s department of neurosurgery is based here. They’ve introduced innovations that effectively protect post-operative patients from back problems.


Surgeons talk to patients during surgery to remove brain tumours

We have are all the technical resources to surgically treat dorsopathy, a very common disorder of the spinal column, more commonly known as osteochondrosis. Nevertheless, we concentrate more on the critically ill with abnormalities of the brain and spinal cord and congenital malformations of the central nervous system or vascular system of the brain and spinal cord.

Alongside Professor Vladimir Shabalov (leading functional neurosurgeon at the Burdenko Institute — Sib.fm comment), we introduced a new approach that it had previously been impossible to implement in Russia. It’s a technology that relieves chronic, intolerable and non-treatable pain in patients undergoing cardiac surgery and those who are truly threatened with limb amputation.

Last year, we operated on 15 of these patients, and for free at that. I was just happy to see the smiling faces of people whose suffering was over.

95% of health facilities in the UK are owned by the state

Our work has been highly rated by leading British neurosurgeon Professor David Mendelow. I recently met him in Amsterdam at a meeting of experts on the treatment of brain diseases and he told me about one of his speeches in Newcastle: «We have spent 650 million pounds on building a new hospital in Scotland and didn’t take into account a lot of the things that have been provided for in Siberia. The Siberians have combined cutting-edge medical technologies (cardiac surgery, neurosurgery, radiology and oncology) in a single centre, have a well thought out programme for training specialists and created a training centre. They have their own library, computer centre and even a museum. When we make new hospitals, it seems like we’ve forgotten which country we live in!»

Then how can you explain the desire of many Russians to be treated abroad? Just recently there was a marathon to raise funds for a girl with epilepsy to have an operation in Israel.

Today, we can offer almost all the high-tech care here that was previously only available abroad. I’m not aware of this particular case but, unfortunately, we often encounter situations where children are used for business.

In Israel?

10 years of intensive training are required for a doctor to become a certified microsurgeon

Not only there. And not only hospitals, their parents too. I know a child who was provided with high-tech treatment, but the parents requested more money for a trip to Germany. Why? I don’t understand. I often see my compatriots turn to foreign clinics, where the first thing they do is issue an invoice, then say they are ready to operate immediately. When you start to look into it, it turns out that the operation isn’t justified. I’m working on another letter now: a hopeless child with multiple birth defects; his parents were told that a clinic in Israel is prepared to do the operation. But it’s no use. The child will die and the parents will have to pay millions of roubles. There are situations in which you can help and there are situations where even modern medicine is powerless. In addition, doctors in foreign clinics don’t really bear legal responsibility for these patients.

I don’t want to make unfounded accusations about Germany, Britain or Israel. They have great surgeons, most clinics are superbly equipped, but we must remember that there’s such a thing as the medical business.

Maybe it’s just cheaper abroad?

It’s always more expensive. If you tell the Americans how much money we are given to carry out high-tech operations under government quotas, they’ll be very surprised. You need a minimum of 100,000 dollars to operate on a brain tumour in the United States. I think our quota is 157 thousand roubles ($5,000).

You work with Novosibirsk archaeologists. What are you looking for in the past?


Denisova hominin — a new species of extinct humans that split from the common tree of human evolution 400-800 thousand years ago

Scientists at the Siberian Branch of the Russian Academy of Sciences (SB RAS) Institute of Archaeology and Ethnography made a great discovery that has global significance. They found a new line of homo sapiens in the Altai Mountains — the Denisova hominin. Together with a group of Siberian archaeologists, we’re figuring out what kind of neurosurgical technology there was in Siberia thousands of years ago. Frankly, I’m amazed. We suspect that at the time of Hippocrates, these people had very astute diagnostic processes, made skilful trepanations of the skull and did fantastic brain surgery.

How do you see the further development of neurosurgery in Novosibirsk?

The main thing is that we have the opportunity to work in close collaboration with Novosibirsk’s major academic institutes, which have extremely varied specialisations. For example, the SB RAS Institute of Cytology and Genetics is a great base for experimental studies at an ultramodern level. It would be a sin not to take advantage of that. Close contacts have been established with foreign universities and clinics.

You see, there’s no such thing a small-town science or small-town medicine. There’s global science and global medicine.

Our task is to be at this level and in places maybe take the initiative. I recently discussed this issue with Olga Kravchenko, the Novosibirsk Region Minister of Health. In particular, we have problems treating acute strokes in Siberia. The region has the highest technology for treating such patients, but it is necessary to adapt the organisation of care to them before we can take serious steps forward. The minister supports me.

I can’t help but ask you about the photos that are on display alongside your diplomas. Who are you with in this picture?

7500 neurosurgical procedures Yashargil performed over 20 years

This is Professor Yashargil, the father of microneurosurgery. The professor calls it «my microneurosurgery» and no one argues with him. I attended a series of his lectures when I was in Britain and then met him in different countries. He always says he wants to visit us in Siberia. I was recently in Zurich, where Professor Yashargil worked, and even sat in his chair.

In the other picture I’m with my teacher Professor Ksenia Kharitonova, covered in blood at the operating table. Now I’d give a student like me the boot, but Ksenia Ivanovna was a first-class, very patient teacher. One look at the photo of my teacher always calms me down, now matter annoyed I am. In fact, a few teachers played a crucial role in my life.

For example, I chose my profession primarily thanks to a great English teacher.

This man instilled a love for his subject and now I am fluent in English. Even at school I engrossed myself in the books of famous Canadian neurosurgeon Wilder Penfield, a brilliant doctor and children’s author. I liked his books so much that I started to think about what I wanted to do in my adult life.

Where do you work best?

England was really good, I look back on those years with pleasure. Queen’s Medical Centre in Nottingham is one of the largest neurosurgery centres in the country. I was given very good training there, passed all the exams, got all the certificates and became a member of the Royal College of Surgeons of England. I love Britain but, as you can see, I didn’t stay there. I like living here. I’m Russian, I was born here.


Read this interview
in Russian

Besides, there are big opportunities for me in Novosibirsk. I think I’ve already managed to achieve something by creating a clinic, practising medicine and working in science.

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