History

History of Neurosurgery at the University of Toronto

h_picture01Neurosurgery in Canada was first officially recognized as a specialty in 1923 when the University of Toronto and the Toronto General Hospital sponsored Kenneth George McKenzie to train under Harvey Cushing in Boston. K.G. McKenzie became Canada's first neurosurgeon. When he returned to Toronto in 1924, he limited his practice to operations on the nervous system and soon established a reputation as one of the world leaders in the new specialty. The University of Toronto Division of Neurosurgery thus became the first neurosurgical program in Canada. McKenzie was a brilliant technical neurosurgeon who made significant contributions to operative procedures for spasmodic torticollis, glioblastoma multiforme, acoustic neuroma, and chronic pain. McKenzie served as the President of the Harvey Cushing Society in 1936-37, and was President of the Society of Neurological Surgeons in 1948-49. He was a member of the founding Editorial Board for the Journal of Neurosurgery, and served as editor from 1943-1950.

h_picture02The Canadian Neurosurgical Society honoured his name with the creation, in 1973, of the annual McKenzie Prize, awarded for the best paper given by a neurosurgical resident at the annual Canadian Congress of Neurological Sciences Meeting.

The next neurosurgeon in sequence was William S. Keith who spent a year at the University of Chicago including time under Percival Bailey before returning to Toronto in 1930 to become McKenzie’s first full-year neurosurgical resident. h_picture03The appointment in 1933 of Dr. Keith as neurosurgeon to the Hospital for Sick Children in Toronto marked the recognition of the subspecialty of Paediatric Neurosurgery in Canada. Energetic, stimulating, and kind, Bill Keith became one of Canada’s most beloved neurosurgeons. In 1976, in honour of this early pioneer in the annals of Toronto Neurosurgery, the Division of Neurosurgery at the University of Toronto established the annual William S. Keith Visiting professorship in Neurosurgery.

h_picture04The third and final appointment to the Neurosurgical Faculty at the University of Toronto before World War II was E. Harry Botterell. Dr. Botterell had trained under Professor W.E. Gallie in the Department of Surgery at the University of Toronto in 1934. In 1936, Botterell became a trainee in neurosurgery under McKenzie. During World War II, Botterell enlisted in the Royal Canadian Army Medical Corps and went overseas in 1940. Upon his return in 1945, Botterell established the first Canadian rehabilitation centre for spinal cord injured patients in North America at the Lyndhurst Lodge. In 1952, Botterell succeeded McKenzie, then age 60, as Head of the Division of Neurosurgery. One of Dr. Botterell’s greatest contributions was the establishment of a grading system, the so-called "Botterell-scale", for patients with subarachnoid hemorrhage. A superb administrator and organizer, Dr. Botterell left active neurosurgical practice in 1962 to become Dean of the Medical School at Queen’s University. In 1982, The Division of Neurosurgery at the University of Toronto established the annual E. Harry Botterell Visiting Professorship in Neurosurgery.

h_horseyDr. William J. Horsey became the first of eight chief residents under Botterell. In the years that followed, Dr. Horsey established the first neurosurgery service at St. Michael’s Hospital in Toronto, a service that has become one of Canada’s leading neurosurgical centres. Having retired from active neurosurgical service in 1989, Dr. Horsey has been recognized for his major contributions to clinical research with the establishment of the Horsey Prize for best resident research presentation given annually at the Botterell lectureship.

h_picture05Botterell’s second resident was Dr. William Lougheed who trained in the laboratory of Dr. William Sweet in Boston in 1952. Upon his return to Toronto in 1954, Dr. Lougheed established a method of hypothermia and temporary circulatory arrest for aneurysm surgery. Another one of Dr. Lougheed’s numerous contributions to modern-day neurosurgery was his popularization of the operating microscope for intracranial neurosurgical procedures. Since 1980, the Division of Neurosurgery has recognized Dr. Lougheed’s seminal contributions in operative microneurosurgery with the establishment of the William M. Lougheed Microneurosurgical Teaching Laboratory and Bi-Annual Lougheed Microvascular Neurosurgery Course.

Following Horsey and Lougheed, the next Botterell resident was E. Bruce Hendrick who, upon completion of his residency at the University of Toronto, trained in pediatric neurosurgery in Boston in 1953 with Drs Franc Ingraham and Donald Matson. In 1964, Dr. Hendrick became the first full-time pediatric neurosurgeon in the world and helped to establish what has become a major neurosurgical institution dedicated to the care of the child with neurosurgical disease. Following his retirement from active neurosurgical practice in 1990, the Division of Neurosurgery established the annual E. Bruce Hendrick Lectureship in Pediatric Neurosurgery in 1986.

Dr. Ross Fleming finished his neurosurgical residency under Botterell in 1956 having received additional training in neuroanatomy and neurosurgery at the University of Michigan in Ann Arbor. Dr. Fleming joined the neurosurgical staff at the Toronto Western Hospital in 1956 and became head of the Division there in 1965. One of Dr. Fleming’s major contributions in neurosurgery has been to neurosurgical education. In this matter, he has been recognized by the creation of the Ross Fleming Surgical Educator Award presented annually for excellence in undergraduate or postgraduate teaching at the University of Toronto.

Dr. Ron Tasker completed his neurosurgical training in 1959 following which he undertook training on a McLaughlin Travelling Fellowship to visit the major European Neurosurgical centres in stereotactic neurosurgery. Having trained with Professor Lars Leksell in Stockholm, Dr. Tasker moved to the laboratory of Dr. Clinton Woolsey to learn the technique of microelectrode recording. On his return to Toronto in 1961, Dr. Tasker joined the neurosurgical staff at the Toronto General Hospital. In a 40 year career time span, Dr. Tasker has led the field in stereotactic and functional neurosurgery with his mapping of the human thalamus and brainstem. His major contributions to neurosurgery have recently been recognized in the establishment of the Ron Tasker Chair in Stereotactic and Functional Neurosurgery at the Toronto Western Hospital.

h_hoffman2The final neurosurgery resident to train under Botterell was Dr. Harold J. Hoffman. Upon completing his residency, Dr. Hoffman went to Europe on a McLaughlin Fellowship before joining the neurosurgical staff at The Hospital for Sick Children in 1964. Throughout his career, Dr. Hoffman pioneered several new surgical approaches to children with craniofacial disorders, epilepsy, tethered spinal cord, and brain tumors. Upon his retirement from active neurosurgical practice in 1997, the Harold Hoffman/Shoppers Drug Mart Chair in Pediatric Neurosurgery was established at The Hospital for Sick Children.

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Historic photo depicting, from left to right: Sir Geoffrey Jefferson, KG McKenzie, Harry Botterell, Tom Morley, and William Lougheed on the occasion of the opening of the Neurosurgery Unit at the Toronto General Hospital, 1958.

In 1962, Dr. Thomas P. Morley succeeded Dr. Botterell as Head of the Division of Neurosurgery at the Toronto General Hospital, and in 1964 he was named Chairman of Neurosurgery at the University of Toronto. Dr. Morley came to Toronto in 1952 having trained in neurosurgery in Manchester with Sir Geoffrey Jefferson. One of Dr. Morley’s accomplishments as Chairman was expanding the training program to include more residents trained each year, and to develop neurosurgery at other major Toronto Hospitals such as the Sunnybrook Medical Centre and the Wellesley Hospital. A total of 50 neurosurgeons finished either all or a significant part of their neurosurgical training while Dr. Morley was Chairman. Following his retirement from active neurosurgical practice in 1986, the Morley Neurosurgical Prize was established for the best research paper given by a neurosurgical resident at the annual Keith Lectureship.

Dr. Alan Hudson became Chairman of the Division of Neurosurgery in 1979. A consummate surgical anatomist and skilled neurosurgeon who subspecialized in peripheral nerve surgery, Dr. Hudson placed Toronto on the map for world neurosurgery by bringing the World Federation, AANS, CNS, and Society of Neurological Surgeons Annual Meetings to Toronto during his tenure as Chairman. Dr. Hudson will also be remembered for training a generation of residents as surgeon:scientists, many of whom have assumed faculty positions in Neurosurgery at The University of Toronto. Following completion of his term as Chairman in 1989, Dr. Hudson became Surgeon-in-Chief of the Toronto Hospital, and then was appointed as President and Chief Executive Officer of the same institution. The institution grew in stature during his tenure to include the Toronto Western and Princess Margaret Hospitals and to become known as the University Health Network. In his name, the Alan and Susan Hudson Chair in Neuro-Oncology has been established at the University Health Network, as has the Hudson Teaching award given annually at the Hendrick Lectureship for the best resident and faculty teacher in the Division of Neurosurgery.

Dr. Charles Tator followed Dr. Hudson as Chairman in 1989. As the first MD-Ph.D. to complete the neurosurgery residency program at the University of Toronto, Dr. Tator’s legacy remains his ability to encourage virtually all neurosurgical trainees during his tenure to undertake formal research programs as part of their training in neurosurgery. Many of the residents who trained under Dr. Tator have obtained their M.Sc.'s or Ph.D.'s, garnered numerous resident research awards, and have established themselves as neurosurgeon:scientists in academic neurosurgery in Toronto and throughout North America. In 1994, The Dan Family Chair in Neurosurgery was officially inaugurated with Dr. Charles H. Tator as the first Chair. This Chair was made possible following the generous donation of Leslie Dan to the Division of Neurosurgery. The Dan Family Chair fosters the academic enrichment of the research and teaching programs in the Division of Neurosurgery at the University of Toronto. In Dr. Tator’s name, the Charles Tator Endowment Fund in Spinal Cord Injury Research has been established at the University Health Network.

Today, there are four teaching neurosurgical units in the University including the Toronto Western Hospital of the University Health Network, the Hospital for Sick Children, St. Michael's and Wellesley Hospital, and Sunnybrook and Women’s College Health Sciences Centre. Neurosurgery, like all of medicine, diversifies and expands as the years pass, and no single hospital can now provide a complete, modern training. Each hospital unit has cultivated its own special neurosurgical interests and each resident, during his or her rotations will rotate to all of these units.

Although the University sets its own standards of training, the interdependence of the Royal College of Physicians and Surgeons of Canada and Medical Schools across the country, binds these institutions tightly together. The Royal College sets minimum training requirements for candidates for the specialty certificates, including Neurosurgery. The University of Toronto offers training and experience beyond the minimum stipulated by the Royal College to those residents who request or require it. The training program also prepares residents for the examinations of the American Board of Neurological Surgery.

References:

1. Eben Alexander, Jr., "Kenneth George McKenzie, Canada's first neurosurgeon", J. Neurosurg. (July, 1974), 41:1-9
2. Findlay J M, Neurosurgery at the Toronto General Hospital, 1924-1990: Part 1. Can J Neurol Sci 21: 146-158, 1994
3. Findlay JM, Neurosurgery at the Toronto General Hospital, 1924-1990: Part 2. Can J Neurol Sci 21: 278-284, 1994
4. Morley TM, A biographical sketch of Kenneth G. McKenzie (1892-1964). J Neurosurg 93:518-525, 2000