Constants Among Change: What the History of the Congress of Neurological Surgeons Tells Us about the Next 50 Years

Issam Awad,

It has been said that there is no present or future, only history in the making.

The philosopher historian Ibn Khaldun (1332–1406) explained all historical events in the context of human motivation within groups or tribes. Hegel (1770–1831) attempted to find Reason in History laying out laws and explanations that shed light on what will unfold in future generations. As neurosurgeons, we are a tribe of sorts, and the history of the Congress of Neurological Surgeons (CNS) provides a rich collection of our contributions and lore for more than six decades. Analysis of early and more recent CNS contributions reveal amazing constants that define a historical personality of sorts, and also affirm a dynamic organization that adapts to changes in science, technology, and societal priorities. Two Annual Meeting logos from the first and most recent CNS meetings in Boston, 45 years apart, reflect the styles of the respective eras, yet show the same human figure leaning forward, embracing a challenge, with courage and prudence, a true personification of the Neurosurgeon we strive to be (Figure 1).

A systematic examination of our archives from 1951 through 2015 reveal CNS innovations in a number of areas that are likely to chart our course for the next 50 years. These are outlined as follows, with brief (by no means inclusive) examples.

A Powerhouse of Talent

The CNS founders and early leaders were industrious, talented, diligent, and creative. They came mostly from mid-America rather than the elite clubs of either coast. They incubated their founding ideas at the Interurban Society in Chicago, but were not initially among the academic leaders of that group. Yet they each ultimately made incredible contributions in their communities as well as in the discipline at large.

A big part of these early leaders’ contribution was establishing the organizational structure and processes of the CNS. This founding generation embraced the scientific elite, creating the tradition of the CNS Honored Guest and ambitious star-studded scientific programs. By the mid-1960s, the CNS Executive Committee, the organization’s leadership pipeline, began to target academic stars from elite programs as well as the best and brightest young neurosurgeons in private practice.

Beginning in the 1970s, several CNS presidents went on to become presidents of other national and world neurosurgical organizations, and eight achieved the preeminence to be selected as Honored Guest for the Annual Meeting. This brilliant amalgam has ensured incredible creativity and innovation. The ambitious meritocracy and the “young leadership” model will likely continue into the future, with a mix of veterans and novices as well as a balance of insiders and outsiders at the helm of the CNS—a sure recipe for a creative enterprise.1

A Packed Scientific Program

From the first CNS Annual Meeting in 1951, the scientific program was meant to be a serious affair. And in each subsequent year we have witnessed a dynamic “raising the bar” with an ever-more impressive showcase of the best, the latest, and the most relevant. No other activity of the CNS has contributed more to its identity and impact. In the earlier years, there were pre-meeting or post-meeting symposia, which further extended the scientific activities. In more recent years, practical courses and evening offerings have added value and options.

Embracing New and Enhanced Technology

The CNS leadership has always leveraged novel technology to help enhance educational offerings and the surgical art. It was the first neurosurgical meeting to televise a live operation to attendees in 1963, and it was the first to compile a World Directory of Neurosurgeons to better reach and connect with practitioners.

In the 1990s, the CNS was the first to implement electronic abstract submissions, and in 2002, the first to offer every meeting attendee an electronic tablet with a preprogrammed meeting calendar and information. Over the last few decades, the Exhibit Hall has grown into a feast that informs and showcases the latest surgical instruments and equipment. In recent years, the CNS embraced the Internet more broadly and deeply, adapting webinar formats and other platforms to enhance educational offerings.

Ambitious Executive Committee Agenda

From its early years, the CNS has refused to limit itself to the business of annual meeting planning. It was the first organization to tackle utilization review, and neurosurgical billing and reimbursement. It launched early taskforces to help influence medicolegal affairs and has played a major role in international outreach, educational policy, and socioeconomic agenda. This breadth of reach has increased in recent years as the CNS has further leveraged its assets on behalf of the profession.

Broad Engagement of Other Organizations

As early as the 1950s, the CNS was a leading force in the assembly of the World Federation of Neurosurgical Societies, and it later strongly supported the Foundation for International Education in Neurological Surgery. In the 1960s it motivated and hosted the first meeting of Presidents of State Neurosurgical Societies (later to evolve into the Council of State Neurosurgical Societies) and joint officers’ meetings with the American Association of Neurological Surgeons.

In the 1970s, the CNS played a major role in the founding of the Japanese Congress of Neurological Surgeons, with similar structure and bylaws. It broadened its outreach to neurosurgical societies in Europe, Asia, and Africa in the 1980s and 90s. For the past decade, international activities have been consolidated in a CNS Division with an even more ambitious and far-reaching agenda. For three decades, the CNS has shared the cost and effort of supporting the Washington office, influencing public policy on behalf of our specialty.

Helpful Tools to Members

The CNS logo has proudly embraced numerous projects and documents widely used by our members. CNS publications have found a useful place on neurosurgeons’ desks for decades, and more recently on our desktops, smart phones, and tablets. These publications have included the World Directory, Clinical Neurosurgery, Neurosurgery®, SANS, and many others. More recent CNS educational offerings have utilized novel media (video streaming, podcasts, etc.) to broaden their reach and enhance their content.

Neurosurgery will continue to change immensely in response to the unfolding revolutions in neuroscience, information, engineering, socio-politics, and economics. In all, the CNS history has been about values and value. These have been imprinted as a double helix in our collective DNA for more than six decades. They will surely maintain a lasting influence on how we tackle the changing world of neurosurgery in the next 50 years and beyond.

References
1 Guimera R, Uzzi, B, Spiro, J, Nunes Amaral, L. Team Assembly mechanisms determine
collaboration network structure and team performance. Science. 2005;308[5722]:
697-702.