GENERAL SCIENTIFIC SESSION 3
GENERAL SCIENTIFIC SESSION 3
History and Current Status of Neurosurgery
in Turkey
Talat Kırıs‚, MD
Mehmet Osman Akçakaya,
MD
Department of Neurosurgery, Liv Hospital, Istanbul, Turkey
Correspondence:
Talat Kırıs‚, MD,
Department of Neurosurgery,
Liv Hospital Ulus,
Ahmet Adnan Saygun Ave,
Canan St, No. 5,
Besiktas, Istanbul, Turkey.
E-mail: [email protected]
Copyright © 2016 by the
Congress of Neurological Surgeons.
T
he Turkish Republic is located along the
border of Asia and Europe. The Asianinfluenced part of the country is known as
Anatolia, and the smaller, European-influenced
portion is called Thrace. Evidence of neurosurgery practice in Anatolia dates back to the Neolithic Age.1 The majority of historical evidence as
to surgical intervention and trepanation in
Turkey, however, dates back to the Iron and
Bronze ages1 (Figure 1). The civilizations of
Anatolia were followers of each other, with each
civilization connected to its predecessor. These
civilizations include the Hittites (2500-1200
BC); Ionians (1050-300 BC); Urartus (900-600
BC); Phrygians, Lydians, Carians, and Lycians
(750-300 BC); Hellenistic and Roman civilizations (333 BC-AD 395); Byzantines (AD 3301453); Seljuks (AD 1071-1300); Ottomans (AD
1299-1923); and contemporary Turkish Republic.2 Turkey is the birthplace of many famous
ancient physicians such as Galen of Pergamum
(201-131 BC), Aretaeus of Cappadocia (81-138
BC), and Şerafeddin Sabuncuo
glu of Amasya
(1385-1468), who each had a long history of
medical practice according to classic GrecoRoman and Islamic medical doctrines. Modern
medical and surgical practice was ushered into
Turkey during the first half of 19th century. In
what follows, the development of modern neurosurgery in Turkey and the current status of
neurosurgery and practice in the country are
discussed.
DEVELOPMENT OF MODERN
MEDICAL EDUCATION IN TURKEY
During the rise (1299-1453) and expansion
(1453-1556) periods of the Ottoman Empire,
medicine was practiced according to classic
Greco-Roman and Islamic doctrines. The first
university (Istanbul University) within the
empire was established in the year 1453 after
the conquest of Istanbul by Sultan Mehmet II the
Conqueror, and Fatih the Conqueror’s Mosque
Complex (1470) later became a location for
medical education and patient care for .350
years. Similarly, the Süleymaniye Mosque Com-
56 | VOLUME 63 | NUMBER 1 | AUGUST 2016
plex, founded by Sultan Süleyman I (the
Magnificent) in 1555, included a hospital for
patient care and medical education and served
people until the early 2000s.3 Other hospital
complexes included Bursa (1339), Edirne
(1488), and Manisa (1539).4 However, as
a result of changes in the Western world such
as the Renaissance, Reformation, and conquest
of the new world, the Ottoman Empire was
unable to keep up in terms of medical knowledge, and the empire entered a long period of
stagnation from 1566 to 1827. During this
period, the empire suffered a major reduction in
its military, political, economic, and scientific
powers.
At the beginning of the 19th century, attempts
were made to modernize the army to compete
with the Western world. As a result, the first
military schools were opened, which included
medical schools and military hospitals. The first
modern military medical school, Tersane Tıp
Mektebi (Naval Medicine School), was established by Sultan Selim III in 1805 as part of an
attempt to modernize the traditional army
(Janissary System).5 However, this attempt
failed; Sultan Selim III was dethroned, imprisoned, and later killed in a revolt led by the
Janissaries in 1808; and the medical school was
closed. Later, Sultan Mahmud II was able to
establish reforms and to replace the traditional
army (the Janissaries) with a modern, Westernlike army. As a result, the first medical schools
Tıbhane-i Amire (the School of Medicine) and
Cerrahhane-i Amire (the School of Surgeons)
were founded during Mahmud II’s reign in
1827.1 These 2 schools were joined in 1839,
representing the core of what is now the Istanbul
Medical Faculty of Istanbul University.1 The
language of education was French, with Dr
Charles Ambrois Bernard holding the first
position of dean of the Medical Faculty.6 The
faculty had a medical journal titled Vakayı
I_ lmiye, and first graduates of the school exited
in 1843.6 The Gülhane Military Medical Academy was founded in 1898 and included Drs
Robert Rieder and Georg Dycke, chairmen from
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HISTORY OF NEUROSURGERY IN TURKEY
FIGURE 1. An example of trepanation with placed bone flap founded in Dilkaya,
Van, in east Turkey that dates back to the Urartu Age (800 BC) (with permission of
the Turkish Journal of Neurosurgery). Erbengi A. History and development of
neurosurgery in Anatolia (part one). Turk Neurosurg 1993;3:1-5.
Germany. In 1908, these 2 medical schools were united as a part
of the university Darülfünun-ı Osmani.”6 During the 1909-1910
academic year, a Turkish surgeon, Cemil Paşa (Topuzlu), became
the chairman of the educational board of the faculty (Figure 2).
The medical faculty had undertaken an Anglo-Saxon–type
education similar to its Western counterparts, which consisted
of 5 years of theoretical, practical, and clinical education and
a 1-year internship (Figure 3).6
With the foundation of the modern Turkish Republic by
Mustafa Kemal Atatürk in October of 1923, the country entered
a whole new era. Following Atatürk’s mantra that “the most real
guidance in the life is science,” the principles of education in the
country were completely transformed. Although centers of
Western-type education, as explained above, were available for
citizens during the Ottoman Reign, public education throughout
the majority of the country remained traditional. However, with
the reforms of the Turkish Republic, all levels of public education
were made to include methodologies that were more modern. For
FIGURE 2. Cemil Topuzlu was a very important figure in the history of both surgery and neurosurgery in Turkey. He is most likely the first Turkish physician to
present a case at an international conference (International Congress of French Neurosurgical Society, Lyon, 1894) in the field of neurosciences.
CLINICAL NEUROSURGERY
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KıRıs‚ AND AKÇAKAYA
FIGURE 3. Hospital buildings used for medicine faculties in the late Ottoman period were derived from buildings designed for other purposes. The building of the Faculty of
Medicine, then called Mekteb-i Tıbbiye-i Şahane, was built in 1903 and designed by Alexandre Vallaury and Raimondo D’Aronco, famous contemporary architects of the
period, as an 80 000-m2 hospital complex. Today, it serves as the campus of Marmara University.
example, the first female students graduated from medical
school in 1927. The modern concept of a university in Turkey
was established in August 1933, along with the countrywide
drive for university reform.6 With the help of Jewish-German
scientists such as Drs Erich Frank and Rudolph Nissen, who
fled their homeland because of the rise of Nazism, the Medical
Faculty of Istanbul University grew to become an important
educational center. To this day, the center maintains its
reputation via the contributions of many Turkish scientists,
who are motivated by the philosophy of the republic. Aziz
Sancar, who won a Nobel Prize in 2015 for chemistry,
graduated from Istanbul University’s Medical Faculty in
1969. Today, there are .84 faculties of medicine in the
Turkish Republic, making the country one of the most
important in the world in terms of research productivity in
this area.7
HISTORY OF NEUROSURGERY IN TURKEY
In the second half of the 19th century, many Turkish physicians
were sent abroad for medical and surgical training. Among them,
Cemil Paşa (Topuzlu), who completed his surgical training in
France, became a pioneer in the field of surgery.1,8,9 In addition
to being considered the founder of modern surgery in Turkey,
Topuzlu also played an important role in the development of
neurosurgery in the country, performing various neurosurgical
procedures for cranial traumas, peripheral nerve injuries, Pott
disease, spinal injuries, and cerebral infections,1,9 Indeed, he is
most likely the first Turkish physician to present a case at an
international conference (the International Congress of French
Neurosurgical Society, Lyon, 1894) in the field of neuroscience.9
Topuzlu’s case concerned a patient who presented with
jacksonian epilepsy caused by an open compression fracture on
58 | VOLUME 63 | NUMBER 1 | AUGUST 2016
the motor cortex complicated by a brain abscess. The abscess was
successfully treated via drainage.10 The case is notable in that it
was presented only a few years after McEwen’s first report of
brain abscess drainage.
Neurosurgery has a relatively short history compared with other
medical and surgical disciplines in Turkey. During the late
Ottoman Period, much like Cemil Topuzlu, many general or
ear-nose-throat surgeons performed neurosurgery. Such surgeons
included Drs Alexander Kamburoglu (?-1913), Garabe Yahoub
(1865-1936), Julius Wieting (1868-1922), Kerim Sebat (18701942), Orhan Abdi (1878-1948), Mim Kemal Öke (18841955), and Murat Cankat (1886-1963).1 Among these, Dr Öke,
who was chief of the Gulhane Military Medical Academy and was
later known as Atatürk’s personal doctor, wrote the first Turkish
neurosurgical textbook, Dimag ve Cümcüme Afetleri ve Tedavileri
(Disorders of the Brain and the Skull and Their Treatment), in
1924.11 Dr Mazhar Osman Uzman (1884-1955), who finished
his training in Germany with Dr Emil Kraepelin, is considered
the founder of modern psychiatry in Turkey. Between 1916 and
1918, Uzman published the first Turkish neuroscience journal,
Emraz Akliye ve Asabiye Müsamereleri.12 Furthermore, he was
a mentor to many young medical students and surgeons,
encouraging them to train in the field of neurosurgery. Indeed,
he played a crucial role in the establishment of neurosurgery as an
independent discipline in Turkey.13 Under his influence, Dr
Abdülkadir Cahit Tuner (1892-1980), originally a neuropsychiatrist, became the first physician in Turkey with a Neurosurgical
Fellowship Certificate after working with Dr Otfrid Förster in
Breslau, Germany, for a year.1,8,9 On his return, Tuner
established the first neurosurgery department in Turkey at the
Zeynep Kamil Hospital, where he performed craniotomies for
brain tumors, laminectomies for spinal tumors, and percutaneous
treatment for trigeminal neuralgia from 1923 to 1927.1,8 After 4
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HISTORY OF NEUROSURGERY IN TURKEY
years of efficient work, however, he retired from his job as a result
of a conflict with his mentor, Dr Uzman, which resulted in the
delay of the development of neurosurgery in Turkey.
Dr Hami Dilek (1892-1980), also originally a general surgeon,
went to France in the late 1930s for neurosurgical training under
Dr Uzman. He worked with Drs Clovis Vincent and Thierry de
Martel, returning to Turkey after finishing his education in
1936.1,14 After his return, he opened an independent clinic as
a division of the General Surgery Department at Bakırköy
Hospital for Mental and Nervous System Disorders in 1947,
which was the first neurosurgery clinic in Turkey.14 However,
Dilek sought a neurosurgical center for both patient referrals and
neurosurgical training. In 1949, he was able to achieve his goal in
founding an independent clinic with 20 beds in Haydarpaşa
Numune Hospital. The Ministry of Health soon accepted
neurosurgery as an independent specialization, and Dilek’s clinic
at Haydarpaşa Numune Hospital became the first neurosurgery
department with a neurosurgical resident training program, for
which he was appointed chairman.14 Along with Dr Dilek, Drs
Cemil Şerif Baydur, Mustafa Sakarya, and Cafer Tayyar Kankat
went abroad for neurosurgical training in the 1930s. Much as Dr
Dilek did, Drs Baydur and Kankat went to France and worked
with Drs Vincent and de Martel. Dr Baydur published a Turkish
neurosurgical textbook called Nöroşirürji Bahisleri,15 and
although Dr Kankat privately practiced neurosurgery instead of
working in a university or government hospital, his contribution
to Turkish neurosurgery came in the establishment of one of the
earliest international neurosurgery journals, Modern Cerrahi ve
Nöroşirürji Mecmuası (Journal of Modern Surgery and Neurosurgery), which ran from 1936 to 1947 (Figure 4).16 Dr Sakarya
went to the United States and became a fellow of the legendary
Dr Walter E. Dandy.17
The development of neurosurgery in Turkey as an independent
specialization in the universities began in the 1950s. Dr Bülent
Tarcan (1914-1991), originally a general surgeon, traveled to the
United Kingdom in 1950 to train in the field of neurosurgery and
to work with Dr Northfield.1,14 A versatile and sophisticated
personality, Dr Tarcan was also very well known as a pioneer in
the field of Western classical music in Turkey.18 Tarcan
established the first neurosurgery clinic in a university hospital
as a division of the General Surgery Department of Istanbul
University, Istanbul Medical Faculty in 1952 on his return from
the United Kingdom. This clinic would go on to become an
independent department in 1968.19 Along with his neurosurgical
achievements, he was a composer of various Western works of
classical music, including piano suites, concertantes, chamber
FIGURE 4. Dr Cafer Tayyar Kankat’s contribution to Turkish neurosurgery was to publish one of the first international
neurosurgery journals, Modern Cerrahi ve Nöroşirürji Mecmuası (Journal of Modern Surgery and Neurosurgery), from 1936 to
1947.
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KıRıs‚ AND AKÇAKAYA
music, orchestrals, and ballets. After his retirement from the
Istanbul University as a neurosurgery professor, he served as
a professor of classical music composition at the State Conservatory of Mimar Sinan Fine Arts University (Figure 5).18 His
versatile personality helped to shape and influence the professional and personal lives of his fellows, residents, and students
and continues to influence the spirit of his department to this
day.
Dr Feyyaz Berkay (1915-1993), yet another Turkish general
surgeon, completed his neurosurgical training with Dr Roland
M. Klemme in the United States at St. Louis University between
1946 and 1951.1 He was the first Turkish neurosurgeon
certified by the American Board of Neurosurgery,20 as well as
the founder and first chairman of the Neurosurgery Department
of the Cerrahpaşa Medical Faculty. Dr Berkay also played an
important role in the establishment of the Turkish Neurosurgical Society (TNS) and the organization of the first national
congress in 1971. Dr Hüsamettin Gökay, an American board–
certified neurosurgeon, finished his residency under the
supervision of Dr Paul C. Bucy in Chicago in 1954. He
FIGURE 5. Dr Bülent Tarcan is the founder of the neurosurgery clinic at
Istanbul University, which is the first neurosurgery clinic in a university hospital
in Turkey. He is also one of Turkey’s famous classical music composers. His
biography, written by Evin I_ lyasog lu, discusses his passion for both neurosurgery
and classical music.
60 | VOLUME 63 | NUMBER 1 | AUGUST 2016
worked as an attending neurosurgeon in Chicago for another
year before coming back to Turkey in 1955 to work in the
Neurosurgery Department of Bakırköy Hospital for Mental and
Nervous System Disorders and later in the Neurosurgery
Department of Istanbul University’s medical faculty. Along
with Dr Hamit Ziya Gökalp, Gökay is one of the oldest active
members of the TNS, representing an excellent role model for
young neurosurgeons in terms of professional discipline and
dedication. Lastly, Dr Aysima Altınok finished her residency in
the Neurosurgery Department of Haydarpaşa Numune Hospital under the supervision of Dr Dilek14 and became the first
female neurosurgeon in Turkey in 1959. She is one of the
earliest female neurosurgeons worldwide. Later in her career, she
became chief of the Department of Neurosurgery at Bakırköy
Hospital for Mental and Nervous System Disorders in 1968.
She is still an active member of the TNS.
After these developments in Istanbul, new neurosurgery departments started to develop in the relatively young universities of
Turkey, beginning in Ankara, the capital and second biggest city,
in the late 1950s. The Gulhane Military Medical Academy was the
first center to have an independent neurosurgery clinic in Ankara.
After finishing his residency abroad, Dr Zinnur Rollas became the
chairman of the clinic in 1957,21 and in 1959, Dr Hamit Ziya
Gökalp became the first resident of the clinic. However, because
of the lack of a certain residency program, Dr Gökalp was sent to
the United States for residency, and on his return, practical
residency training began.22 Dr Vahdettin Türkmen, who finished
his residency under the guidance of Dr Francis Grant at the
Philadelphia Medical Center at the University of Pennsylvania,
established the Neurosurgery Department of Hacettepe University’s Medical Faculty. However, just a year later, he left Turkey.1
Nurhan Avman (1928-1988), a former resident of Dr James
Poppen at the Lahey Clinic in Boston and Dr Ernest Sachs, Jr at
Dartmouth College School of Medicine, became the chairman of
this department (Figure 6).1 In 1965, he left Hacettepe
University and established the neurosurgery department of
Ankara University. Neurosurgery departments were founded
in Izmir at Ege University by Dr Erdem Tunçbay (1930-2010)
in 1967 and in Adana at Çukurova University in 1972, which
were then followed by the establishment of other departments
countrywide.1 Dr Gazi Yaşargil also deserves mention as
a figure who offered microneurosurgical training to many
Turkish neurosurgeons from various clinics in his department
in Zurich, which helped to develop Turkish neurosurgery in
relation to the latest advances and technical standards.
Including state and private universities, government training,
and research hospitals, there are 83 neurosurgery training
programs in Turkey today, with approximately 150 residents in
training nationwide. There are currently .1500 neurosurgeons
in Turkey. At present, a neurosurgical education lasts 5 years in
Turkey, including 7 months of rotations. In terms of neurosurgical technologies and surgical techniques, Turkey is up to date
with the developed countries of the world, and concerning
research productivity, the country’s contribution to neurosurgical
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HISTORY OF NEUROSURGERY IN TURKEY
FIGURE 6. Dr Nurhan Avman is a pioneering neurosurgeon and founder of
neurosurgery clinics at the universities of Hacettepe and Ankara. He was also the
first president of the Turkish Neurosurgical Society.
literature between 1996 and 2009 put it in fifth place worldwide
in terms of general research articles, sixth place for review articles,
third place for case reports, and eighth place for clinical trials.7
THE TNS
The first neurosurgical society in Turkey was founded in
Istanbul by 11 neurosurgeons in 1968.1 This society was closed,
however, as a result of a military coup in 1982, much like every
other social organization in Turkey. In 1985, the TNS was
founded in Ankara by 9 neurosurgeons, with Dr Nurhan Avman
selected as its first president. Subsequent presidents included Drs
Aykut Erbengi, Özdemir Gürçay, Tunçalp Özgen, Yücel
Kanpolat, Osman Ekin Özcan, Ertekin Arasıl, Yamaç Taşkın,
M. Nur Altınörs, M. Kemali Baykaner, Kaya Aksoy, M.
CLINICAL NEUROSURGERY
Necmettin Pamir, Nurcan Özdemir, Ö. Selçuk Palaoglu,
Mehmet Zileli, Ethem Beşkonaklı, Murat Bavbek, Ugur Türe,
and Zeki Şekerci. There were 1400 members of the TNS as of
2015. The society mainly provides support to young neurosurgeons in terms of research and clinical education abroad, funds
scientific projects, informs the public of and raises social
awareness about issues of public health related to neurosurgery,
and defends the professional rights of its members. In 2015, the
TNS gave a total of 15 scholarships, each related to neurosurgical
education abroad. The TNS also offers prizes for scientific
research. In the current year, the prizewinners are as follows:
Hamit Ziya Gökalp, Young Neurosurgeon Prize; Nurcan
Özdamar, Best Scientific Research Prize; Erdem Tunçbay,
Neurosurgery Board Examination Success Prize; Aysima Altınok,
Best Neurosurgery Thesis Prize and TNS Best Scientific Research
Prize; and Mahir Tevruz, Scientific Research Prize.
The TNS has organized its annual congress in April at the time
of the Neurosurgery Nursing Congress for the past 11 years. In
2016, both the 30th Annual Congress and 12th Neurosurgery
Nursing Congress will be held. These congresses create environments for the scientific and social interaction of our members and
residents in training. In addition to the annual meeting, there are
monthly symposia organized by the TNS in major cities
throughout Turkey such as Istanbul, Izmir, Ankara, Malatya,
and Konya. Six different subspecialization groups exist for the
training and education of TNS members, including Stereotactic
and Functional Neurosurgery, Pediatric Neurosurgery, Neurovascular Surgery, Neuro-oncological Surgery, Spinal and Peripheral Nerves, and Surgical Neuroanatomy work groups, each of
which organizes at least 1 annual symposium in addition to many
local meetings and courses. Besides its scientific organizations, the
TNS has established various committees and boards related to
public relations, professional issues, social responsibility projects,
and the provision of consultancy for different governmental
agencies.
The TNS has 2 scientific peer-review journals, both of which
have been in continuous publication since 1989: a Turkish Journal
called Türk Nöroşirürji Dergisi and the international journal
Turkish Neurosurgery, which is currently indexed in Science
Citation Index Expanded, Index Medicus, Medline, PubMed,
and Scopus. The journal has an impact factor of 0.576, with a 5year impact factor of 0.702 according to the ISI Web of
Knowledge, Journal Citation Report in 2014 (Figure 7). The
first editor of this bimonthly journal was Dr Tunçalp Özgen,
and its first editorial board included Drs Yücel Kanpolat, M.
Nur Altınörs, M. Nuri Arda, and Kemali Baykaner. Dr Hakan
Caner’s name should be mentioned also because of his
enormous efforts and those of his editorial board during the
registration of the journal in the Science Citation Index
Expanded in 2008. Thanks to these efforts, the journal became
more internationally known each year, with only 115 of 254 of
the ahead-of-print articles now coming from Turkey. Submissions to the journal are of a great variety from all around the
world, from the United States to Iran, Germany to Pakistan,
VOLUME 63 | NUMBER 1 | AUGUST 2016 | 61
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KıRıs‚ AND AKÇAKAYA
and South Korea to the Ivory Coast. From 2007 to 2013, 714
articles were published and 1154 articles were rejected. An
online system has been used for submissions since 2006. Besides
scientific journals, the TNS publishes a bulletin each year to
inform members of various activities and events, with a printed
edition of the bulletin also sent to members. In addition to the
journals, the TNS has published several textbooks on different
aspects of neurosurgery.
The TNS has organized Basic Neurosurgery Courses since 2000
to provide a standard knowledge of neurosurgery for residents and
young neurosurgeons. The education program and its duration are
very similar to those of the European Association of Neurosurgical
Societies (EANS) training courses. A cycle can be finished in 4
years, with 3- to 4-day courses taking place on different aspects of
neurosurgery. In 2011, the TNS decided to organize an International Basic Neurosurgery Course based on other national courses.
International Basic Neurosurgery Courses aim to function
similarly to the EANS training courses and provide a standardized
education program for neurosurgeons of different countries, with
a particular focus on developing countries. Today, the course is
a true success story for the TNS, with an increasing number of
participants each year and with participants from .70 countries in
2016.
The TNS is a member of EANS and the World Federation of
Neurosurgical Societies. The TNS organizes not only courses and
national congresses but also international meetings such as the
Ninth International Cerebral Vasospasm Meeting, the Sixth Black
Sea Neurosurgical Congress, the First Middle East Neurosurgical
Symposia, the Asian-Anatolian Friendship Meeting, the Ninth
Asian Congress of Neurological Surgeons, and joint meetings with
other neurosurgical societies such as the First Korean-Turkish
Neurosurgeons Joint Meeting in 2008 and the First GermanTurkish Neurosurgical Societies Joint Meeting in 2014. The TNS
also signed an agreement with Congress of Neurological Surgeons,
with the first joint meeting in April 2015 in Turkey, followed by
another in September of the same year in New Orleans. Istanbul
was chosen as the site of the 16th World Congress of Neurosurgery, and the World Federation of Neurosurgical Societies 2017
Congress in Istanbul will represent one of the most prestigious and
important gatherings held by the TNS.
Here, we have offered a brief summary of the history and
current status of neurosurgery in Turkey, with a special
emphasis on the TNS.
Disclosure
The authors have no personal, financial, or institutional interest in any of the
drugs, materials, or devices described in this article.
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FIGURE 7. Turkish Neurosurgery is the peer-reviewed international journal of
the Turkish Neurosurgical Society, which is indexed in the Science Citation
Index Expanded and has been in publication since 1989.
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HISTORY OF NEUROSURGERY IN TURKEY
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