Explore Magazine Volume 6 Issue 1


        Before the advent of microsurgery in the mid-1960s, neurosurgeons relied on anatomical drawings little changed from the time of Leonardo daVinci to guide them through a part of the body where even the slightest misstep can result in death or devastating debilitation for the patient.
         Into this environment came Albert Rhoton Jr., a young man only a few years removed from a rustic cabin and two-room schoolhouse in rural eastern Kentucky. Rhoton quickly realized the microscope’s potential, not only to revolutionize surgery itself but to take brain anatomy to a new level of detail.
         For the first time, the surgical microscope enabled anatomists to map the brain’s interior landscape using more than the naked eye. Magnification brought into focus previously invisible blood vessels branching off and draining from cerebral arteries and previously unknown connections among vital centers of the brain.
         "Knowledge of brain anatomy as studied under magnification remains the most crucial aspect of the vast refinements I’ve witnessed in neurosurgical practice,” says Rhoton. “As surgeons, we need to determine the most gentle and least traumatic, tissue-preserving approach we can take to reach a specific site to perform corrective surgery, and anatomical studies through the microscope have helped us do that.”
         Now in the 36th year of an illustrious career, Rhoton is regarded by brain surgeons the world over as the father of microscopic neurosurgery.
         Last fall, in recognition of his work, a textbook-sized collection of Rhoton’s updated papers and illustrations on the brain’s posterior cranial fossa region was published as part of the international journal Neurosurgery. The unique “millennium supplement” was designed to serve as a guide to surgeons operating within this critical region of the brain, containing nerves that help to control such vital functions as breathing, blood pressure, balance, consciousness, hearing and vision.
         “Anatomy to the surgeon is like the sun for our planet; it gives us the life-sustaining knowledge to traverse the intricate pathways throughout the brain,” Arizona neurosurgeon Robert Spetzler wrote in a preface to the Neurosurgery supplement. “No single neuroanatomist can lay greater claim to expanding this knowledge for neurosurgeons than Dr. Albert L. Rhoton Jr.”
         With typical humility, Rhoton expresses amazement at a career track that has taken him from a disadvantaged childhood that began with a midwife assisting his birth in exchange for a sack of corn to a position as one of the world’s preeminent neurosurgeons.
         Rhoton continues to view the mystery and wonder of the brain with awe. He also conducts his work with a sense of gratitude for the opportunity to care for patients, train future surgeons and advance knowledge in what he calls medicine’s “greatest unexplored frontier.”
         “Dr. Rhoton’s gentle, kind and humble manner made every patient, no matter how anxious or scared, feel so much better, if only for having met him,” writes Michael F. Kaschke, general manager of the medical division of microscope manufacturer Carl Zeiss, Inc. which sponsored the special Neurosurgery issue.
         Rhoton originally planned to become a chemist but found chemistry lacking the human element he craved and switched to social work. For a while, he also considered missionary service, but then — after viewing brain surgery on an animal in a physiology laboratory at Ohio State University — he found his calling. Today, the tall, imposing man with incongruously large hands for a brain surgeon says his career is “stimulating and gratifying beyond my wildest imagination.”
         In his soft, Southern drawl, Rhoton speaks eloquently of the human brain’s “amazing ability to see, feel and experience emotion and comprehend phenomena as vast as the universe more than a billion light-years across, and to conceptualize a microscopic world out of reach of our senses.”
         And he speaks practically of the fact that the brain is the most frequent site of crippling and incurable diseases, making neurosurgery a field in which the stakes are high in terms of human lives.
         In addition to honing his own skills, Rhoton has always sought to share his knowledge with others. Shortly after joining UF’s medical faculty in July 1972, he set this goal: “I’d like to reach a point of time in which every second of every day a patient somewhere in the world benefits from microneurosurgical techniques taught at the University of Florida.”
         Today, that dream seems close to reality.
         Michael L.J. Apuzzo, editor of Neurosurgery, says: “No individual who would call themselves a neurosurgeon can afford to be unfamiliar with Dr. Rhoton’s highly essential contributions to our field.”
         Neurosurgeons everywhere refer to the refined brain maps Rhoton has drafted with the help of medical illustrators Robin Barry and David Peace, and many surgeons routinely use the miniaturized instruments Rhoton has designed for operating on minute blood vessels. More than 1,000 surgeons have attended Rhoton’s hands-on microsurgical training courses at UF, and many more have heard his lectures or attended his workshops at medical schools across the nation and in two dozen foreign countries.
         “Every neurosurgeon in the world knows and appreciates Dr. Rhoton as a master of surgical anatomy,” wrote French neurosurgeon Dr. Bernard George in another preface to the Neurosurgery supplement. “Personally, I think that the incredible quality of these pictures reflects the quality of the man himself.”
         Better brain imaging — via the surgical microscope and the newer scanning techniques of computed tomography (CT) and magnetic resonance imaging (MRI) — has resulted in immense strides in neurosurgical precision and accuracy during the prime of Rhoton’s career. And, as world leaders in neurosurgery have said in many forums, Rhoton stands out among those who have brought precision and safety to operations that were life-threatening two decades ago. To cite a few examples:
         On the basis of new insights into brain anatomy, Rhoton mapped a more precise surgical procedure and designed instruments for clipping cerebral aneurysms, bubble-like sacs on arteries in the brain. Refinements in this procedure have spared the lives of many people with this serious blood vessel disorder.
         Rhoton developed a new surgical approach — entering through a nostril — to remove tumors on the pituitary gland. His improved approach shortens surgical time and hospital stays, and reduces the amount of pain experienced by most patients.
         Rhoton has contributed immensely to the development of techniques for removing acoustic neuromas, tumors on the nerve of hearing, without damaging the patient’s hearing. Rhoton and colleagues conducted one of the most comprehensive studies ever of this region.
         Rhoton has discovered and developed new and safer surgical approaches to tumors located in the fluid-filled spaces (ventricles) at the center of the brain.
         “Today, we’re on the frontier of being able to transplant certain brain cells and tissues to help eliminate symptoms of Parkinson’s disease and to help restore at least a limited degree of limb function in patients with severe spinal cord injury,” Rhoton says. “So many things have been unraveled, yet there is so much more to learn.”
         When considering the most rewarding aspects of his career, Rhoton focuses on the opportunity to care for patients who come to him in deep anxiety about a frightening diagnosis. The outcomes are not always positive, but many patients are cured and, in almost all of them, the healing is more than physical.
         One patient, a University of Florida professor who had become depressed and discouraged with life, found out he had a brain tumor, which in a series of tests appeared to be malignant. Results of the tests increased his sense of despair because the tumor involved the speech and writing centers of his brain so essential to his work.
         Rhoton was consulted to perform the necessary surgery and, much to everyone’s surprise, the tumor proved to be benign, allowing full recovery of brain function.
         The patient later told Rhoton that through the process of living for many days thinking “it was all over” and then having the threat removed, his entire perception of the value of life and his enthusiasm for his teaching and writing were improved. After his recovery, the professor finished a new textbook and dedicated it to the surgeon.
         Another patient who stands out in Rhoton’s memory is Sallye Anderson, who was diagnosed with an inoperable malignant brain-stem tumor after undergoing exploratory surgery in Atlanta. Her path to Rhoton’s office was paved by her perceptive and persistent father, who beseeched Rhoton to see his daughter. Rhoton found, through a variety of imaging tests, a very different problem — a large, but benign, tumor called an acoustic neuroma that he surgically excised.
         Grateful for life and for the surgeon who helped her through dark hours of fear, Anderson moved on with her busy life, taking on new challenges. She raised funds for a professorship in UF’s neurosurgery department, then joined and later became president of the Acoustic Neuroma Association.
         Rhoton’s passion for improving patient care is a driving force behind his latest challenge — to help make a clinical addition to UF’s McKnight Brain Institute a reality. A multistory building situated between the east end of the Shands at UF medical center and the south side of the McKnight Brain Institute would include a Neuro-Clinical Research Center with a research operating room and laboratory complex as well as an acute care unit, a brain electrical/magnetic signal monitoring lab, a cognitive research facility and an outpatient care unit.
         Perhaps the greatest legacy to Rhoton’s work occurred last year when, in celebration of 35 years in practice, hundreds of former students, colleagues and UF staff surprised him with $2 million worth of contributions to establish the Albert Rhoton M.D. Chairman’s Professorship in Neurosurgery. With state matching funds, the gifts created a $4 million endowment.

Albert L Rhoton
Professor, Department of Neurosurgery
(352) 392-4331

         If Dr. Albert Rhoton is the foremost explorer of human brain anatomy, then David Peace and Robin Barry are the cartographers.
         For much of Rhoton’s career, Peace and Barry have been at his shoulder, in the laboratory and the operating room, shooting pictures, making sketches and taking notes. Back at their drawing tables and computer workstations, they’ve taken that information and used it to draw medical illustrations that have gained them worldwide recognition among neurosurgeons and researchers.
         Peace, in his 21st year with the UF faculty, was inspired as a child by the natural science illustrations at the Smithsonian Institute, which he visited frequently while growing up in Washington, D.C. He dreamed of drawing fish, reptiles, frogs and other animals for the Smithsonian, but midway through graduate studies in medical and biological illustration at the Medical College of Georgia in Augusta, he became interested in human anatomy and surgery.
         Barry, in her 19th year at UF, graduated with honors from Yale and earned her Master’s of Art degree through the Johns Hopkins School of Medicine’s renowned medical illustration program. It was there that she became fascinated with the brain while observing surgery.
         “Before you know much about the human brain, you think about it as a gelatinous mass,” Barry says. “Then, the more you delve into it, the more you realize how much you don’t know. And gradually you realize it’s a never-ending odyssey of learning.”
         Peace says the question he hears most often from people curious about his profession is “Why do they need medical illustrators when you have cameras?”
         He responds with a list of things that can be done by skilled medical illustrators that can’t be done with cameras — like erasing blood and other elements in the surgical field that obscure the anatomy of a certain brain region.
         “We can give a three-dimensional appearance to a lot of our illustrations, and draw in something that is invisible to the camera’s eye — like a beam of radiation. We can go places conceptually that a camera cannot go,” he adds.
         New computer technology also gives illustrators unprecedented capabilities to quickly enhance pencil sketches and photos with color, highlights and complementary backgrounds, and remove distracting elements, Peace says.
         Both Barry and Peace have embraced computers to achieve their artistic goals more quickly and effectively. Barry says much of the photo/illustration refinements she used to do by hand with paint brushes, air brushes and colored pencils are now done in sophisticated illustration software.
         Her latest challenge involves using software that merges matched pairs of color slides into a single image that, when projected and viewed through stereo glasses, appears three-dimensional. The technique, used in several popular magazines to lend drama to pictures, has a more serious purpose in neurosurgery — to add visual depth to images of brain structures to be operated on.
         Peace also has ventured into the computer world as designer/manager of the World Wide Web site for UF’s Department of Neurosurgery (www.neurosurgery.ufl.edu).
         Barry and Peace also say the chance to meet and work with leading neurosurgeons from around the world who come to UF for advanced training is a great career bonus.
         “Some of the foreign surgeons have told me they have kept the reprints (of my illustrations) in the operating room while performing surgery,” said Peace. “That is especially gratifying.”