Y Yaşargil先生を偲んで
森田明夫
(脳神経外科専門的な内容で、一般的ではありません。一般的雑談は写真に少し記載があります)
脳神経外科界の巨人で20世紀後半の脳神経外科の父と呼ばれていたMahmut Gazi Yaşargil先生(THE PROFESOR;先生と呼ばせていただきます)が去る2025年6月10日長年教鞭を取られたSwiss Zurichで99歳の生涯を閉じられました。私はYaşargil先生の直接指導を受けたことはないのですが、2016年以降とても目をかけていただき、実はこの7月6日に100歳の誕生日をお祝いに伺う予定としておりました。残念ながら急遽亡くなられたため、その催しはメモリアルイベントに再編成され、かなり迷いましたが、現在の私の立場上、出席をキャンセルせざるを得ませんでした。とても残念ですが、近くで見守られた人たち多くいらっしゃるので、私など伺っても何の足しにもならず、自己満足にしかならないと感じたからでもあります。以前日本医科大学在籍の時にYaşargil先生のことを少しスターウオーズのYodaに例えてブログに書かせていただきました(その時の記事はこちら)。
先生の業績の第一は、まず脳の手術に顕微鏡を導入し、脳の血管そのものをつなぐという技術を開発し定着させた第一人者であるということ。もう一つは脳内のくも膜とくも膜腔と周辺構造物との関係を明らかにしたこと。そして脳動脈瘤をしっかりと閉鎖するクリップ(Yaşargil’s clipとして世界中で使われています)を開発されたこと。だと思います。
若い頃は彼の手術室内・外はピンと空気が張り詰め、見学者が私語を話そうものなら叩き出されていたらしいです。日本からの直接の門下生としては菊池晴彦京都大学元総長をはじめ、国立循環器におられ、その後Zurich大学の教授になられた米川先生、東京大学からは亀田総合病院部長でいらした江口先生などが名高い先生方です。どの先生も血管障害、バイパス手術、日本の脳血管の手術を世界に比類ないまでに高めた先生方です。そのほかにも世界中のたくさんの先生方がZurich大学を見学に訪れました。スイスの大学を引退されたのち、先生はOssama Al Mefty教授の招きで米国Arkansas大学で若手を育てられ、その時の門下にはやはり現在脳血管手術で非常に高明なAli Krisht先生がいらっしゃいます。そして、最近の10年間はトルコ・イスタンブールのUgur Ture先生の元で最後の臨床への関わりを持たれていました。私が先生と出会ったのは、トルコの学会に日本代表として出席させていただいた時で、その時に聴かせていただいた先生の1時間の講義の内容に非常に感動したのを思えています。人と芸術の関わりから始まり、それらを理解し深める脳の神秘、宇宙に喩えた講義であった。そしてその脳の病気への治療を行う脳神経外科という領域に必要な9項目のトレーニングと脳の生理や病気に関する考え方をお話しになられました。9項目のトレーニングというのは、以下にあげた項目ですが、それぞれのタスクを3か月かけて総時間30か月をかけてじっくり解剖や動物、モデル実験によって知識として頭に、技術として手に染み込ませ訓練するというものでした。最低3年間のそのようなトレーニングの基礎の上に、手術経験や深い思考を備えてゆくというのが先生が考える脳神経外科医の育成方法とのことでした。
さてその講義の後にお話しさせていただき、日本でこの同様な講義をしていただけないかとお願いし、2016年の末に東京大学で先生の講演が実現しました。一方の日本の脳神経外科の父である佐野圭司先生の名を冠したKeiji Sano Lectureship 2016 (これが最後のlectureship)でのご講演です。その際、脳の神秘、生理、解剖の重要さ、脳の血管、腫瘍、機能性病変のそれぞれの経験を深くお話ししたいとのことで数日にわたって6時間超の講演をしたいと先生は希望されました。ただ日本でお一人の講演で6時間はあまりないし、当時91歳の先生にそこまでお願いするのは非常識と考え、3時間の講演ということでお願いすることとなりました。今思うと、ぜひ数日、6時間の講演をお聞きしたかったと思います。それでも91歳で3時間の講演を立ってほぼぶっ続けてされるというのは並大抵のエネルギーではありません。聴衆は200名ほどでしたが、皆さんその迫力に圧倒されていました。Yaşargil先生は40~50年ほど前に日本の順天堂大学でMicrosurgery Bypass(血管吻合)の講義をされて以来、何度も日本に足をお運びいただいたとのことでしたが、結局2016年が最後の訪日となりました。ただその後も私が2022年に浅草で主催した第27回日本脳腫瘍の外科学会では、ビデオで講演をしていただいています(講演はこちら:専門的内容を含みます)。コロナが完全に明けていれば日本に再度きていただくことができたかもしれません。
先生がよくおっしゃっていたのは、手術は、指の先に目がついているくらいのつもりで、とても繊細にしなければならない。マイクロスコープやバイポーラー(凝固鑷子)などよく使う道具はエルゴノミックにできていることが肝心で、軽くバランスよく、また必要十分に強度を持って作らなければいけないなど重要な道具に関する考え。特に手の感覚を非常に大切にされていました。また脳における動脈と静脈の分布の違いによる脳の脆弱さ、そして疾患特有の課題に対する解決方法。などが満載されています。一方で、Yaşargil Clip作成の時のエピソードで、手術機器を作るときに、無名では会社が全く振り向いてくれない、自分の名前を売ることも大事だというニュアンスのお話しまでされました。当時世界的シェアを持つCodmanが振り向いてくれず、当時小さい会社だったAesculap社が作るのを協力してくれたそうです。
先生のご講演はいつも神がっていて、深い考察に基づいています。一つ一つの言葉が何を意味しているのかを考え、気づきながら拝聴しないといけないので、先生の講演を聞くと非常に充実した感じと、非常に疲れた感じが残ります。もちろんその熱意と時間にもよると思いますが。やはりエネルギーに満ちた講演をお聴きするにはそれに見合うエネルギーを要するのです。
また先生の著された名著 Microneurosurgery Vol I~IVA, Bは、その中に宝石のような言葉と知恵が散りばめられています。美しいくも膜や疾患の絵が挿入されており、本当に先生が脳や脳の手術を愛されていたのだとわかります。本を著すのであれば、このような書籍を作ってみたいものです。
さて私生活では、先生はZurich時代に人生の相棒として最も長い時間を過ごされた手術の機械だし看護師であったDianneさんと結婚されていつも一緒にいられました。もちろんお酒もタバコもされず、食事は肉や贅沢なものを拒み、日本にいらしても、寿司とか美味しいビーフとかなどは一才召し上がらず、「毎日食事はフランスパンとチーズと少しの野菜や果物だけでいいのだ」とお話しされていました。99歳まで執筆活動をされ、示唆に富む指導を最上級の教授たちにできる頭と体力とエネルギーを持ち続けられたのは、そのような生活習慣によるものかもしれません。(C級美食で酒飲みの自分は反省しきりです。)
私・個人的には2016年以降数回イスタンブールに先生とその弟子のTure先生をお訪ねし、先生には私が現役時代に進めていたMicrosurgeryロボットの開発と手術手技の科学・工学的評価の研究に大変興味を持っていただき、親しくお話しをさせていただきました。実は一度イスタンブールでのマイクロの手術のトレーニングコースで教育スタッフにしていただいたのですが、その時に自分では初めて扱う人の胎盤(すごく脳の血管に似た構造をしている)を使った血管障害トレーニングのデモを先生の目の前でさせられて、ドギマギして、新人の時のように緊張したのを覚えています。でも若い頃の先生とは異なり、この10年お話しさせていただいた先生はとても優しく深い目で自分を見てくれました。
今回先生のメモリアルに出席することができず、非常に残念で、今自分が感じる先生への想いや記憶をまとめて残しておこうと思いこの文を書いています。友人が何人もメモリアルに出席するので、どんなメモリアルだったかしっかり聞いておきたいと思います。
PROFESSOR! 自分もその仲間に入れれば良いのですが、先生の育てたたくさんの弟子・生徒、先生の本や言葉で脳神経外科医を目指した者たちが、世界に溢れ、今後もどんどん増えてゆくと思います。ありがとうございました。
以下まとめ:
Yaşargil先生の手術の技に関する考え
The Art of Surgery
• The art of surgery is based upon a number of factors, such as basic knowledge, experience, judgment, and manual dexterity, as well as the qualities of courage, decisiveness, patience, and endurance of surgeons.
• Surgical skill relies on the integration and combination of an array of abilities, method, and mental attitude in order to promote proficiency and a high standard of surgical performance.
脳神経外科のトレーニングに必要な9項目
- Skin, Muscle, Vasculature, Nerves
- Cranio-Spinal bones, High-speed drilling
- Cranio-spinal meninges: Dissection-Suturing
• Dura-Arachnoidea-Pia
• Cisternal compartments
- Cranio-spinal Vasculature Dissection-Suturing
• Arteries-Veins-Venous Sinuses
- CNS Parenchyme: Dissection
• Gyri-Sulci,Cortices
• White Matter-Fiber System
• Nuclei and their connections
- Ventricular System
- Cranial, Spinal and Peripheral Nerves: Dissection-Suturing
- Adaptation to the segmental and compartmental concept
- Cranio-spinal Surgical Approaches
以下写真と動画
Yaşargil先生の講義 第27回日本脳腫瘍の外科学会
リンクは下記
27th JBTS Yasargil Lecture on Bypass Surgery
米国脳神経外科学会 AANS2025でのYaşargil先生へのAward lecture
リンクは下記
ちょっとYoda似のYasargil先生
奥様のDianneさんと中込先生、中富先生、森田
手の感覚を大事されるYasargil先生
Microneurosurgeryに掲載されたCisternの絵と指先に目
Yasargil先生、J Hernemieni先生 U Ture先生@Istanbul
Yeditepe大学(Istanbul)手術室にて
雑談写真集:
今回は一般的情報がまったくないので、当時撮りためた写真からイスタンブールを紹介します。
とても素敵な街です。比較的安全ですが、客引き(これで私も数10万円のタイルとかを、、購入したとかしないとか、カーペットや骨董も超高額なのでご注意)と 非合法タクシーは多いのでご注意
Hagia Sophia: イスタンブールがコンスタンチノーブルと呼ばれた東ローマ帝国自体の中央協会です 今はモスクとなりイスタむとキリストが共存しています(塩野七生さんの コンスタンチノーブルの陥落 の中心地)
イスタンブールの美:バザールの中は色とりどりのものがたくさんあってすごく綺麗です。カドキョイからエミノミュへの公共連絡性はアジアとヨーロッパを結ぶ船旅です。そしてトプカピ宮殿のタイルもすごいです。
English version
In memory of Prof. Yaşargil
Dr. Mahmut Gazi Yaşargil (THE PROFESOR), a giant in the world of neurosurgery and the father of neurosurgery in the late 20th century, passed away on June 10 at the age of 99 in Swiss Zurich where he taught for many years. Although I never had the pleasure of working with Dr. Yaşargil personally, he had been a great mentor to me since 2016, and I had actually planned to visit him on July 6 to celebrate his 100th birthday. Unfortunately, the event was restructured into a memorial event, and after much hesitation, I had to cancel my attendance due to my current position. I am very sorry, but there were many people who were close by who witnessed the event, and I felt that my visit would not add anything to their lives and would only be a form of self-satisfaction. When I was a student at Nippon Medical School, I wrote a blog post about Dr. Yaşargil, comparing him to Yoda from Star Wars (click here to read the post).
The first of his achievements is that he is the first person to develop a technique to connect blood vessels in the brain itself. The second is his clarification of the relationship between the arachnoid membrane, arachnoid cavity, and surrounding structures in the brain. And he developed a clip (called Yaşargil's clip, used around the world) that securely closes a cerebral aneurysm. I think it is the most important thing.
When he was young, the air inside and outside of his operating room was so tense that any visitor who spoke to him privately would be thrown out of the room. His direct students from Japan include Dr. Haruhiko Kikuchi, former president of Kyoto University, Dr. Yonekawa, who worked at the National Cardiovascular Center and later became a professor at the University of Zurich, and Dr. Eguchi, former director of Kameda General Hospital from Tokyo University, among other renowned doctors. All of these doctors have advanced vascular disorders, bypass surgery, and cerebrovascular surgery in Japan to a level unparalleled in the world. Many other doctors from all over the world visited the University of Zurich. After retiring from the University of Switzerland, Dr. Krisht was invited by Prof. Ossama Al Mefty to train young surgeons at Arkansas University in the United States, where Dr. Ali Krisht, who is now a highly respected expert in cerebrovascular surgery, is also a student. The last 10 years of his career were spent with Dr. Ugur Ture in Istanbul, Turkey, where he was involved in the last phase of his clinical practice. I met Dr. Ture when I attended a conference in Turkey as a representative of Japan, and I remember being very moved by the content of his one-hour lecture. The lecture started with the relationship between people and art, and then moved on to the mysteries of the brain, which deepens our understanding of these mysteries, and the universe. He also talked about the 9 training courses required for the field of neurosurgery, which treats diseases of the brain, and his thoughts on brain physiology and diseases. 9 training courses are the items listed below, and each task is performed over a total of 30 months through careful dissection, animal experiments, and model experiments. The training was to be conducted through dissection, animal experiments, and model experiments over a total period of 30 months, so that each task would become ingrained in the brain as knowledge and in the hands as technique. He said that his idea of training neurosurgeons is to have surgical experience and deep thinking on the basis of such training for a minimum of three years.
Well, after that lecture, I spoke with him and asked him if he could give this similar lecture in Japan, and his lecture was realized at the end of 2016 at the University of Tokyo. On the other hand, Dr. Keiji Sano, the father of neurosurgery in Japan, gave his lecture at the Keiji Sano Lectureship 2016 (this is the last lectureship) named after him. He wanted to give a 6+ hour lecture over several days to discuss in depth the mysteries of the brain, its physiology, the importance of its anatomy, and his experiences with each of the vessels, tumors, and functional lesions of the brain. However, six hours for a lecture by one person in Japan is not very long, and I thought it would be insane to ask a 91-year-old doctor to give a lecture of that length, so I asked him to give a three-hour lecture. Looking back on it now, I would have loved to have heard him give a 6-hour lecture over several days. Even so, it is no mean feat for a 91-year-old man to give a three-hour lecture standing up for almost the entire time. Dr. Yaşargil had visited Japan many times since he gave a lecture on Microsurgery Bypass (vascular anastomosis) at Juntendo University in Japan 40~50 years ago. However, 2016 was his last visit to Japan. However, after that, he gave a lecture by video at the 27th Japanese Society for Surgery of Brain Tumors, which I hosted in Asakusa in 2022 (click here for the lecture: it contains technical content). If the corona had dawned completely, we might have been able to have him come to Japan again.
The doctor often said that surgery must be done very delicately, as if he had eyes on the tips of his fingers. He also emphasized the importance of ergonomically designed tools such as microscopes and bipolar forceps, which must be light, well-balanced, and strong enough to be used. In particular, he placed great importance on the sensation in the hands. He also discussed the fragility of the brain due to differences in the distribution of arteries and veins in the brain, and solutions to disease-specific challenges. The book is full of such information. On the other hand, in the episode of creating the Yaşargil Clip, he even told us that when making surgical instruments, it is important to sell your name because if you are not well-known, no company will turn to you. Codman, which had a global market share at the time, did not turn to him, and Aesculap, which was a small company at the time, helped him to create the Yaşargil Clip.
His lectures are always godly and based on deep thought. I have to listen to his lectures while thinking and noticing what each word means, so I am left feeling very fulfilled and very tired after listening to his lectures. Of course, it depends on the enthusiasm and the time. I think it takes a lot of energy to listen to a lecture that is full of energy.
His famous book, Microneurosurgery Vol I~IVA, B, is a gem of words and wisdom. Beautiful arachnoid and disease pictures are inserted, and you can tell that he truly loved the brain and brain surgery. If I were to write a book, I would like to produce such a book.
In his personal life, he was married to Dianne, a surgeon and nurse with whom he spent most of his time as a life partner during his Zurich years, and they were always together. He never drank or smoked, refused to eat meat or any other extravagant food, and even when he came to Japan, he never ate sushi or any kind of delicious beef. Perhaps it was this lifestyle that enabled him to continue to have the mind, strength, and energy to provide thought-provoking instruction to his top professors until he was 99 years old. (As a Class C gourmet eater and drinker, I am filled with remorse.)
I personally visited him and his student, Dr. Ture, in Istanbul several times since 2016 and had a friendly conversation with him as he was very interested in my research on the development of microsurgery robotics and scientific and engineering evaluation of surgical techniques that I was working on during my working years. In fact, he was on the educational staff for a training course on microsurgery in Istanbul, and I remember that I was so nervous, just like when I was a newcomer, when he had me do a demonstration of vascular injury training using human placenta (which has a structure very similar to blood vessels in the brain), which I was handling for the first time, in front of his eyes. I remember I was nervous like when I was a newcomer. But unlike the doctor of my youth, the doctor I have talked to over the past 10 years has looked at me with very kind and deep eyes.
I am very sorry that I was not able to attend his memorial this time, and I am writing this to leave a summary of my thoughts and memories of him that I feel now. I would like to ask my friends who will be attending the memorial what kind of memorial it was.
I wish I could be one of them, but I believe that the world is full of his many students and disciples, those who aspired to become neurosurgeons through his books and words, and that there will be more and more of them in the future. Thank you very much, PROFESSOR.
The Art of Surgery
• The art of surgery is based upon a number of factors, such as basic knowledge, experience, judgment, and manual dexterity, as well as the qualities of courage, decisiveness, patience, and endurance of surgeons.
• Surgical skill relies on the integration and combination of an array of abilities, method, and mental attitude in order to promote proficiency and a high standard of surgical performance.
9 Training Sets to master Neurosurgery
- Skin, Muscle, Vasculature, Nerves
- Cranio-Spinal bones, High-speed drilling
- Cranio-spinal meninges: Dissection-Suturing
• Dura-Arachnoidea-Pia
• Cisternal compartments
- Cranio-spinal Vasculature Dissection-Suturing
• Arteries-Veins-Venous Sinuses
- CNS Parenchyme: Dissection
• Gyri-Sulci,Cortices
• White Matter-Fiber System
• Nuclei and their connections
- Ventricular System
- Cranial, Spinal and Peripheral Nerves: Dissection-Suturing
- Adaptation to the segmental and compartmental concept
- Cranio-spinal Surgical Approaches