The Surgeon in Action: Representations of Neurosurgery in Movies from the Frères Lumière to Today

The two sides of the scalpel: The polarizing image of surgery in early cinema

This paper uses extensive database research, film viewing and literature review to show how the field of surgery was staged in the early days of film history. It can be shown that-although surgical medicine was a subject in transition, and many scientific breakthroughs (anesthesia und antisepsis) made surgery less painful and more complication-free-filmmakers still frequently resorted to horror memories of the past and created a questionable, or ambivalent image of the surgeon, sometimes as extreme as the "lunatic with a scalpel" stereotype, blurring the line between genius and madness. But there were also positive staging's: The surgical intervention was often captured on the screen as a last resort for clinically hopeless cases, with the surgeon often presented as a "deus ex machina", the savior out of nowhere. Other specialties, however, such as plastic surgery, were mostly positively dramatized, which reveals a stark contrast to research about the representation of the field in the sound film era. A view at the fields of neurosurgery and (selectively) opthalmo-surgery rounds out the panorama of forty-one surgical films. In summary, it is shown that the early surgical film depicts the specialty and the surgeon in a highly ambivalent way, from savior to monster thereby reflecting one of the most significant transitions in the history of surgery and showing us what image was presented to the public-and thus to potential patients-in the movie theaters.

Is salvage surgery for large vestibular schwannomas after failed gamma knife radiosurgery more challenging?

In order to verify whether a previous gamma knife surgery (GKS) treatment could influence the oncological and functional outcome in large vestibular schwannoma (VS) surgery, we have compared group of patients operated on for large VS after failed GKS to a group of genuine VS that underwent the same functional nerve-sparing resection technique regimen in the same period. Single center retrospective cohort study of 23 consecutive GKS failure and 170 genuine VS patients operated on between April 2003 and March 2019. After resection, patients were allocated to a Wait-&-rescan or an upfront GKS policy. At last follow-up examination, the facial nerve function was good (House-Brackmann grades I or II) in 95% of the GKS failure and 84% of the genuine VS patients (p = .25). The median volume of tumor residue was .56 cc in the GKS failure group and .62 cc in the genuine VS group (p = .70). Tumor control was achieved in 91% and 83% of cases with a mean follow-up of 74 and 63 months in the GKS failure and the genuine VS populations, respectively. The 1-, 5-, and 7-year progression-free survival were 100%, 95%, and 85% respectively in the GKS failure group and 97%, 80%, and 81% in the genuine VS group (p = .27). Despite significant modifications of the microsurgical environment associated to salvage surgery after GKS failure, a functional nerve-sparing resection is an effective strategy to optimize the results on facial nerve function, with similar long-term tumor control to those observed in the genuine VS population.

Lights, camera, scalpel: a lookback at 100 years of plastic surgery on the silver screen

BACKGROUND

The presentation of medical topics in the cinema can greatly influence the public's understanding and perception of a medical field, with regard to the doctors and surgeons, medical diagnosis, and treatment and outcome expectations. This study aims to evaluate the representation of plastic surgery in commercial films that include a character with a link to plastic surgery, either as a patient or surgeon.

METHODS

The international film databases Internet Movie Database (IMDb), The American Film Institute (AFI), and British Film Institute (BFI) were searched from 1919 to 2019 to identify feature-length films with a link to plastic surgery. Movies were visualized and analyzed to identify themes, and the portrayal of plastic surgery was rated negative or positive, and realistic or unrealistic.

RESULTS

A total of 223 films were identified from 1919 to 2019, produced across 19 countries. Various genres were identified including drama (41), comedy (25), and crime (23). A total of 172 patient characters and 57 surgeon characters were identified as major roles, and a further 102 surgeons as minor roles. Disparities were noted in presentation of surgeons, both in terms of race and gender, with the vast majority of surgeons being white and male. In total only 11 female surgeons were portrayed and only one black surgeon. Thirteen themes emerged: face transplantation, crime, future society, surgeon mental status, body dysmorphic disorder, vanity, anti-aging, race, reconstructive surgery, deformity, scarring, burns, and gender transitioning. The majority of films (146/223) provide an unrealistic view of plastic surgery, painted under a negative light (80/146). Only 20 films provide a positive realistic image (24/77).

CONCLUSIONS

There exists a complicated relationship between plastic surgery and its representation on film. Surgical and aesthetic interventions are portrayed unrealistically, with surgeons and patients presented negatively, perpetuating stigma, particularly with regard to cosmetic surgery. Cinema is also characterized by lack of representation of female and non-white surgeons. Recruitment of surgeons as technical advisors would help present a more realistic, representative view, without necessarily sacrificing creativity.Level of evidence: Not ratable.

The Legacy of a Neurosurgeon: A U.S.-Based Obituary Analysis

BACKGROUND

Textual analysis of obituaries provides insight into the shared values of a profession or community. Neurosurgeon obituaries are frequently published in both the medical literature and the lay press, but the content of these works has never been analyzed.

METHODS

Using obituary pieces from Neurosurgery, Journal of Neurosurgery, and the New York Times, frequent terms were quantified through preliminary text analysis to derive the relative importance of concepts such as innovation, research, training and family. The sentiment of these obituaries was qualitatively reviewed to approximate perceptions of neurosurgical legacy within the profession and the general public.

RESULTS

Thirty relevant obituaries with full text available were identified in the Journal of Neurosurgery, 14 were identified in Neurosurgery, and 23 were identified in the New York Times. Both neurosurgical journals and lay press articles relied on linear narratives, with greater emphasis on professional leadership and residency training in neurosurgical journals and proportionally greater mention of family in the lay press.

CONCLUSIONS

Our preliminary text analysis of neurosurgeon obituaries suggest what values are shared among the professional community and general public regarding the legacy of a neurosurgeon.