Neurosurgery

The Neurosurgery Clinic in Timișoara is a regional centre for the treatment of spinal, tumoral, vascular, malformative and traumatic brain pathology in adults and children. It is also an important centre for functional neurosurgery. At the same time, it also serves as an undergraduate and postgraduate training centre.

“What is a neurosurgery department? A hospital where suffering reaches the limits of the bearable, a nightmare of despair, very often a ramp to eternity, a place where real personal or family dramas unfold, an interruption of life or its normal course. The unpredictable prevails over the normal course of illness – it is hard and disheartening to work in such a unit. Phrases like dedication, devotion to the patient, become banal, empty words, platitudes. Timișoara needed such a department to alleviate human suffering,” says a paper by Associate Professor Dr. Constantin Costea.

In 1955, the first neurosurgery department in Timișoara and in the western part of the country was established in the current Municipal Hospital of Timișoara, under the supervision of the Associate Professor Dr. Vasile Miclăuș. The first procedures were performed there.

At the beginning of 1974, the Neurosurgery Department was relocated to the County Clinical Hospital. The department continues to be run by the Associate Professor Dr. V. Miclăuș, counting 50 beds and two operating theatres. Obviously, the beginnings of neurosurgery in Timișoara are marked by the personality of the Associate Professor Dr. V. Miclăuș, who intended and partially succeeded in creating a school of neurosurgery. His scientific activity was rich, with more than 100 scientific papers published or presented.

He pioneered original operative procedures such as:

• frontal sinus plasty after craniocerebral trauma, involving the air cavities of the skull;
• dura mater plasty of the frontal stage of the skull base by section, with sliding of the cerebral falx;
• occlusion of the large dehiscences of the fronto-nasal meningoceles by means of a plastic plate;
• selective cervical pyramidotomy in extrapyramidal disorders.

He designed and built a medical device for maintaining a constant temperature of saline during surgery, the intraoperative oxygen dome, the protection of the bandages for restless patients by applying special gloves. The most important invention is the craniocerebral stereotaxic apparatus (model I and II). During that time he produced the first neurosurgical film in Romania entitled ” The Bulbar Tractotomy”, which was screened during the “Medical Days”.

His scientific activity was acknowledged through the following orders and medals:

1. The Medical Merit, decoration of the People’s Republic of Korea for medical work in the P.R. Korea medical mission 1953-1954;
2. Order of Labour, 3rd class, awarded by the Presidium of the Grand National Assembly, Decree No. 86 of 16 February 1957 for medical and sanitary work;
3. The Star of the Republic, 5th class, awarded by the Presidium of the Grand National Assembly, Decree No 613 of 30 December 1957;
4. Doctor Emeritus.

However, after 7 years, the board of the Faculty of Medicine and Pharmacy in Timișoara decided to discontinue the course of neurosurgery.

After the untimely death of the Associate Professor Dr. V. Miclăuș (12 December 1977), Dr. Nicolae Borzan was appointed head of the department. He maintained the high standards of the department for the next 10 years. He was awarded a Doctorate in Medical Sciences in 1975 and trained the new generation of neurosurgeons, namely: Dr. Ladislau Hess, Dr. Constantin Costea, Dr. Andrei Petru Goga, Dr. Horia Prundeanu, Dr. Aurean Băcean. During this period, Dr. Horia Pleș and Dr. Adrian Franțescu, medical specialists, join the neurosurgical team.

Since 1988, the Neurosurgery Department has been managed by Dr. Constantin Costea, a consultant at that time. He trained in Timișoara, having as mentor the Associate Professor Dr. V. Miclăuș. Taking advantage of the changing political situation in our country, Dr. Constantin Costea set out to modernize the Neurosurgery Department, insisting on improving surgical techniques and, especially, on introducing microsurgery techniques in the approach to all neurosurgical pathology. He paved the way for the development of the next generation of neurosurgeons: Dr. Mihai Cristian Nuță, Dr. Dan Negoescu, Dr. Stanca Mihaela Pleș, Dr. Adrian Sora, Dr. Daniel Costea, Dr. Marius Sorin Hanăș, Dr. Nicolae Lupa, Dr. Liviu Groza, Dr. Diana Beck, Dr. Marcel Alexandru Angelescu, Dr. Alghabaghbi Mohammad.

In 1992, Dr. Constantin Costea successfully re-established the Department of Neurosurgery at the University of Medicine and Pharmacy V.  Babeș Timișoara. Around this time he introduces several new surgical techniques: the extra-intracranial vascular microanastomosis and the carotid endarterectomy.

At the end of 2010, Dr. Horia Pleș was appointed head of department. He took over a ward with 60 beds and 3 operating theatres, albeit in a space totally unsuitable for neurosurgical activity. Dr. Horia Pleș and Dr. Adrian Franțescu were the only neurosurgeons who trained in neurosurgery for 5 years in the University Centre of Bucharest, under the guidance of Prof. Dr. Constantin Arseni. When the two neurosurgeons arrived in Timișoara, the surgical treatment of internal hydrocephalus was introduced, namely ventriculo-cardiac drainage, and later on the ventriculo-peritoneal drainage. The previous approach for cervical spine fractures, already practiced in Timișoara before 1988, became routine thanks to the contribution of the 2 doctors. The cerebral aneurysm was treated for the first time in Timișoara on April 11, 1994, a surgical technique introduced by Dr. Horia Pleș, after a training period in Holland. The first operation was performed with the help of operating magnifiers, the technical leap being achieved with the purchase of the operating microscope by the University of Medicine and Pharmacy “Victor Babeș” in Timișoara. Brain aneurysm clipping has become routine nowadays, with 80-100 operations performed in a year.

After the year 2000, there was a need to introduce instrumentation in spinal surgery. Dr. Dan Negoescu, now a primary neurosurgeon, was guided towards this subspecialty by Dr. Horia Pleș during his residency. Dr. Dan Negoescu’s practice is currently being carried out at Premiere Hospital in Timișoara since 2017. The first spinal neurosurgery intervention took place in 2004, at Casa Austria, also performed by Dr. Dan Negoescu. Currently, Dr. Cristina Mihoc and Dr. Sebastian Leuce work at Casa Austria. Since 2011, spinal surgeries are also performed in the Neurosurgery Department of the Emergency County Hospital in Timișoara, with the main surgeons being Dr. Marcel Angelescu and Dr. Sorin Hanăș.

The transsphenoidal approach to the sella turcica was an early aspiration of Dr. Horia Pleș. This was achieved at the beginning of 2012, after the purchase of all the necessary instruments and after Dr. Sorin Hanas had completed a training session in Bucharest.

A minimally invasive neurosurgical procedure, namely brain endoscopy, is performed by Dr. Daniel Costea. Since its foundation, we estimate that over 60,000 operations have been performed to date, and in recent years we have been performing 1300 operations per year.

Since the beginning, the scientific activity has been quite extensive. More than 500 papers have been published and presented. 17 books have been published, 20 book chapters written, the beginning belonging to the Associate Professor Dr. V. Miclăuș with the book entitled “Sistemul nervos în diagrame (The nervous system in diagrams)” with the subtitle “Multum in parvo”, which appeared posthumously in 1978, under the auspices of the Medical Publishing House (Editura Medicală).

In 1992 the Society of Surgical Neurology of Timișoara was founded, under the chairmanship of the Associate Professor Dr. Constantin Costea. The Society edited the Journal Neurologia Medico-chirurgicală, with the editor-in-chief Dr. Horia Pleș. The Romanian Neurosurgery Society Journal was also published in Timișoara between 2000 and 2009, with Dr. Horia Pleș as editor-in-chief, who is currently a member of the Emeritus Editorial Board of the Romanian Neurosurgery Journal. As of 2018, Dr. Horia Pleș was elected President of the Romanian Society of Neurosurgery, and was subsequently elected until 2023. The year 2020 was put on hold due to the pandemic.  

The Neurosurgery Clinic in Timișoara hosted two national conferences with international participation in 1994 and 2004, with more than 20 professors from abroad attending each conference. Between 1999 and 2007, the Neurosurgery Clinic organised annual French-speaking courses in interventional neuroradiology and neurological sciences. Each time the courses have been a success.

The activity of the Neurosurgery Clinic in Timișoara has been recognized nationally in that the Associate Professor Dr. Constantin Costea served as vice-president of the Romanian Society of Neurosurgery. The Associate Professor Dr. Constantin Costea was a member of the Neurosurgery Commission of the Ministry of Health, subsequently Dr. Horia Pleș also held these positions since 2012.

Locally, the Associate Professor Dr. Costea Constantin served as Vice President of the College of Physicians and member of the Board of Directors of the County Emergency Hospital Timișoara. Currently Dr. Horia Pleș is the President of the Disciplinary Commission of the College of Physicians Timiș, since 2011 until now.

The staff of the Neurosurgery Clinic is a member of multiple national and international scientific societies: Dr. Horia Pleș is the first neurosurgeon practicing in the country to be a member of the American Congress of Neurosurgery. The international recognition is reflected by the fact that Dr. Horia Pleș is part of the Executive Committee of the World Federation of Neurosurgery since 2009. All doctors of the Neurosurgery Section actively participate in national and international conferences and courses.

Last but not least, it is worth mentioning the international medical researches in which the team of neurosurgeons participated, namely STICH II Lobar, STITCH Trauma, CENTER-TBI, Crash 3 and TOP SAT 2. For these studies, the Neurosurgery Clinic received the diploma of the best recruiters in Europe, thus recognising the effort invested.

Conditions permitting, the Neurosurgery Clinic Timișoara will remain among the prestigious services in Romania.