In This Issue:
- Message from The President
- Message from The Secretary Treasurer
- Message from The Newsletter Editor
- Historical Vignettes IV: ibn al Haytham and his modern theory of vision
- Our Honorary Presidents IV: Charles A. Fager, MD
- Minutes of the New Orleans Reunion
- Upcoming meetings
- WALN: a Historical Note
- Member News
- In the Next Issue


Message from the President

The reflections and responses that I have received regarding the last Congress of Lebanese Neurosurgery in Lebanon were all positive and full of enthusiasm. I am very happy and elated with the positive remarks and attitudes that I have received from many neurosurgeons. Now is the time to start working to prepare the next Congress to be held most likely in June of 1999 in Beirut, Lebanon. We are in the process of arranging and organizing this meeting which I hope will encompass a wide array of educational and scientific topics. In addition, it will be complimented with a beautiful social program.

Since my last message, I promised you that we are going to be working on several issues to get this organization stronger and to spread the message of the WALN across the globe. Regarding the association itself and its basic mechanisms, I have requested from an attorney here in Michigan to register us as an organized association and follow that with a request for a tax exempt status. He is working on this application and I hope that by the time we meet in Philadelphia during the American Association of Neurosurgery meeting, I will have a definite answer as to the status and possibly by this time, we will have these issues resolved.

Regarding the newsletter, Dr. Bejjani has been doing a magnificent job and we would like to continue to thrive and ask fellow members to submit articles of interest to improve the quality of the newsletter and make it wider and hopefully get it to all of the members in due time. In the last circulation we had a problem with the mail to Lebanon. All of the newsletters that were mailed to Lebanon were sent back to me and I had to remail them to Dr. Haddad through the New York office and I am very grateful for his help in redistributing those. However, as all of you know, the letter is on the Internet and can be accessed easily and reviewed even before the printed Newsletter is out.

We do need all your support and your full participation. We do need all of the help that we can get from every single member to make this organization stronger. I would like to emphasize solidarity and cohesiveness. These are crucial to the success of WALN.

In our last meeting in New Orleans, we had a long business meeting in which we discussed several issues. Other than the Executive Committee and the Members of the Board, we solicited other active members present in the meeting and they gracefully accepted to help us in various issues, from working on the meeting in Lebanon, to the newsletter, to publications, to the directory, etc. I do not want to name these people, they know who they are, and I am very grateful to each of them for their continued support and help. Throughout this month, I stayed in touch with Dr. Bejjani and Dr. Muakkassa to iron out all of the small details. I have tried to reach our contingency in Brazil and I hope that they well get in touch with us if they wish. Regarding Lebanon, I have always been in contact with the Lebanese group and in particular to George Haddad who is doing a superb job in helping us out and I am always in contact with him either by phone or E-mail. One of the important messages and goals I would like to achieve is to see the WALN members support and help each other and act as one unit. If we can achieve this support of each other, our strength will be insurmountable. I would urge each member to thrive and work as hard as possible to attain this goal. I am very confident that all of you would wish to see the WALN very strong and glorious. We in turn depend on each one of you to think this way.

We appreciate your support and are looking forward to seeing you all, or as many as possible, in the next meeting in Philadelphia during the American Association of Neurosurgery meeting. The date and time are posted separately in the Newsletter.

Sincerely yours,

MOKBEL K. CHEDID, M.D.
President, WALN
Section Chief of Neurosurgery- Genesys Health Systems


Message of the Secretary Treasurer

Dear Friends

I hope this Newsletter will find you all in the best of health. This our eighth issue and WALN entered its fifth year. We are growing bigger with the latest census averaging 227 members from all four corners of the world.

Although I was not present at the New Orleans meeting, I have nonetheless evaluated its resolutions. I think the future is bright for WALN with our new leadership and the young blood infused into the Association. The newly formed subcommittees will be dealing with some important issues like the WALN traveling fellowship, the Second WALN Homecoming meeting, and the Associate member category. Our New president is pursuing the issue of the not for profit status of WALN. The Newsletter is taking a new and rejuvenating look.

More and more members are paying their annual dues. Hopefully we should be able to get even more member to pay the dues, although the main issue is not money, rather it is the sense of solidarity and belonging of all neurosurgeons with a Lebanese link. It is only with Solidarity that we can achieve our goals.

You are all invited to contribute to WALN. Write us, send us your news and views, your vignettes, your suggestions on how to make WALN a better organization, an organization that represents what you are and what you want to be. Openness is one of the most cherished principles of WALN. I am receiving more communications from our members worldwide, and this makes me more confident in the present and future of WALN.

I hope to see you all in Philadelphia.

Kamel Muakkassa, MD


Message of The Newsletter Editor

Dear Members

I hope that our Newsletter will reach you all, eligible, active, associate or resident members. It is important that we all understand our common goal, be conscious of our means so we have a better grasp of the path we have to follow to make from these goals a reality.

Our Goal is to enhance Lebanese Neurosurgery worldwide and in all its aspects, whether in education, research or clinical practice. This is our ultimate Goal.

Our Means, resources and potential are enormous. Our Neurosurgical heritage is rich. Lebanon was the cradle of Neurosurgery in the Middle East. Our Honorary Presidents were neurosurgical leaders whether in Lebanon or abroad. In the USA alone, our members form more than 1% of practicing American neurosurgeons, and a significant proportion of them belongs to the academic elite and are world renown. Other members in other countries have achieved a similar stature. Our young members have enough enthusiasm and energy to make from dreams realities.

Now the Path. It is already traced thanks to the early Board of Officers, especially our founding President, Issam Awad. The WALN Homecoming Congress was an early, and very successful milestone. Other smaller steps were our Newsletter, our constantly attended regular reunions, our website, our expanding database with constantly updated information on over 227 members worldwide.

Future steps are already planned and their execution is imminent: Our Directory will be ready in April 1998, our Not For Profit Status will be established within the next few months, our Scientific Panel on the web, the expansion of the Associate member category etc. The next major milestone will be the WALN Traveling Fellowship, which will be closer to reality once our Not For Profit status established.

I would like to emphasize in this message the theme of Solidarity. All our resources are useless if not focused on executing the steps that will lead us to achieve our Goal. Our Solidarity and commitment will make us effective in promoting excellence in Lebanese Neurosurgery.

As our Past President has previously alluded, Neurosurgery in Lebanon needs us. We should overcome our personal, linguistic or philosophical differences. Our goal is not to compete with each other, but to make from Lebanese Neurosurgery a first class neurosurgery. And what better way than WALN to achieve that goal.

We want all interested neurosurgical Lebanese currents and schools to be part of WALN. "There shall be no discrimination related to ... country or type of training or practice, or to the scope of neurosurgical background or activities". It is in our Principles. The WALN Newsletter is your voice. It is not My Newsletter. It is not Mike Chedid's or Kamel Muakkassa's Newsletter. It is Your Newsletter, proud members of WALN. I only type it, print it, and distribute it. Contribute to the WALN Newsletter with suggestions or articles. Any news or views are welcome, from all members. Minimal if any editing is performed and no censorship is exerted. WALN in an "open association" relying on its " membership's input".

We have always strived to democratic bylaws and tightly adhered to them. We will keep on following them, rising above compromise and politics.

To our common Goal my friends.

See you in Philadelphia.

Ghassan K. Bejjani, MD


Historical Vignettes: ibn al haytham [Alhazen] (c 965-1039 AD) and his modern theory of vision

By Farid Haddad

ibn al haytham was undoubtedly the most significant figure in the history of optics between antiquity and the 17th century. He was the one who vehemently and persuasively refuted the old theory of vision of Lucrecius and Aristotle which maintained that vision occurs when light goes out of the eyes to the object, and substituted the modern theory of vision which says that vision occurs when light comes from the object into the eye.

ibn al haytham's achievement was to submit the visible object to punctiform analysis and to integrate into a single and highly successful theory the mathematical, anatomical and physical approaches to sight. Today , we all are ibn al haytham's intellectual progeny.

Born in BaSra6, alhasan [ which in Europe became Alhazen] ibn al haytham lived for the most part in Cairo where he died at the age of 74. He was born 15 years before Avicenna (980-1037 AD), and died at the age of 74, 30 years before alzahraAwiy (d 1009 AD). He was called to Cairo from BaSra6 by the faAtimiy khalifa6 alHakim (996-1021) who had heard of Alhazen's great learning and of his boast that he knew how to regulate the flow of the Nile. When he realized that his project was unworkable, he, in order to be free of his patron, feigned madness, but continued nevertheless to be patronized by alHakiym until 1012 when the latter died.

Alhazen was a prolific writer. With an impressive and remarkable scope he wrote several books (90-200) on all aspects of science (mathematics, physics, astronomy, optics, meteorlogy, metaphysics and medicine), the most famous of which is "almanaAdir". It was translated into Latin, Italian, German and English.

The Latin version of "almanaAdir" begins with an account of the pain and injury experienced by a person looking at bright lights like the sun. The resultant injury means that the eye has been the recipient of an external action. The phenomenon of the afterimage is again a proof that light produces some effect on the eye and that it is the nature of the eye to be affected by light.

He refuted the theories of Euclid and Galen, and based his theory on alkindiy's idea that each point or small region on the surface of a body radiates in all directions. The final perception and integration of visual impressions are achieved in the brain.

Alhazen's theory was influential and inspired every optician from the 13th to the 17th century when Kepler based his theory on the fundamental concepts of Alhazen including the concept of the one-to-one correspondence between points on the objects and points in the eye.

The precursors of Alhazen include:

a) alkindiy (d 866) the son of the Governor of kuwfa6 was the first arab to undertake serious optical studies. He left 260 books.

b) Hunayn (809-873 AD) was a very inquisitive student; one day he irritated his teacher, yuwHannaA maAsawayh, so much that the latter burst into a rage and told him that he was not worthy of the medical profession but that he better follow his father's trade (usury); young Hunayn left Baghdad vowing that he would not return until he became a famous physician. He traveled to Byzantium and Alexandria in pursuit of knowledge, mastered the Greek language, and returned to Baghdad, and reconciled himself with his old teacher [ H 35 & 51}. He became the famous translator of Greek medical books (39). It is said that alma'umuwn used to pay him for his books with their weight in gold [H 24]. He wrote the "Ten treatises on the eye" the earliest existing systematic text-book of ophthalmology [H 38]. A manuscript copy was presented by patriarch Gregorius Haddad to the Tsar of Russia in 1911 (now in the Leningrad Public Library) [H 52]. The book has been printed with an English translation in Cairo in 1928 [H 133].

c)- `aliy ibn `iysaY (c 1050, AD) was the first to describe temporal arteritis. His book on ophthalmology was translated into Latin twice.

References
- Haddad Sami I: History of Arab Medicine. Beirut: Bouheiry brothers, 1975.
- Lindberg DC: The theories of vision from al-kindi to Kepler. Chicago: The University of Chicago Press, 1976.
- Sa`di Lutfi M: Ibn-al-Haitham (Alhazen). Medieval Scientist. Univ. Mich. Med. Bull., 22: 249-257, 1956.

Figure Legend
From alhazen's almanaAdir. MS in FatiH 3212 vol 1 f 81b Suleymaniye.


Our Honorary Presidents Part III: Charles A. Fager, MD

Dr. Charles Fager was born in Nassau, in the Bahamas of the British West Indies on January 16, 1924. Both of his grand-parents had emigrated from Lebanon two decades earlier. His maternal grand parents, from the Amoury family of Hasroun came originally to New York and then emigrated south to Nassau where they settled around 1892-1893. His mother was born en route, in Virginia. Once in Nassau the family opened a shop, that supported the rapidly growing family (ten children). His paternal grand parents, from the Fakhr family of Beirut emigrated in 1892-93 also to New York where they settled. It is there that his father was born and raised. The Fakhr name became Fager. His parents ultimately met in New York, when his mother accompanied her brothers to New York, where they were seeking higher education. After their marriage, his parents went back to Nassau for a short period, during which Charles was born. At the age of seven months, Charles and his parents returned to New York, where he was raised, in the cosmopolitan Brooklyn.

His maternal uncle, Emmanuel Amoury, was a role model for him. The latter went to Fordham Medical School in New York. He practiced as a general practitioner in New York. Charles went to Wagner College for undergraduate studies. He left the college in 1943, shortly after the USA became involved in W.W.II. He joined the army where he did his medical studies, through the New York State University Medical School in Brooklyn. He finally graduated in 1946. Originally, during his surgical internship in Syracuse University, New York, he was thinking of a career in General Surgery. However, he became quickly bored of general surgery and became fascinated by the new and rapidly growing field of Neurosurgery.

From 1948-1950, he returned to the United States Air Force as a flight surgeon. Afterwards, he started his neurosurgical residency: he spent the first two years (1950-1952) at the Cushing Veteran Administration Hospital in Boston where trained with John Drew. He spent the third year (1952-53) at the Lahey Clinic, with Horrax and Poppen. Dr. James Poppen was a great inspiration to Fager. After finishing residency, he was asked by Dr. Poppen to join the Lahey Clinic, where he has been practicing for the past 45 years. He eventually became Chairman of the Department between 1963 and 1984, when he became Chairman Emeritus.

Dr. Fager's original interest was mainly in intracranial surgery primarily aneurysms. At that time this was the exciting area of neurosurgery. Many cases were done and much was learned about the treatment of aneurysms. Dr. James Poppen, his mentor, had made major contributions to operative techniques in aneurysm and tumor surgery. Dr. Fager was also interested in stereotactic surgery. At that time (1957) there were no effective drugs for the control of Parkinson disease and intention tremor. He even developed his own stereotactic apparatus, now in display at the neurosurgical museum of the AANS in Chicago. He was also actively engaged in prefrontal leukotomy during these times when little could be done for patients with chronic depression, obsessive compulsive neuroses and severe chronic anxiety. Surgery for glioma was radical and very aggressive. It took some time before it was realized that this had no value, and more limited resections with adjuvant radiation therapy became more used. Intracranial radiosurgery for pituitary lesions and pituitary ablation were among his interests at the time. This was largely due to the fact that Gilbert Horrax, the first Chief of Neurosurgery came to Lahey Clinic in 1933 after having been with Dr. Harvey Cushing for 19 years and one of his interests was the pituitary gland and its disorders.

Dr. Fager was later appointed to the certifying Board of Neurological Surgery for 6 years. He was appalled by the lack of knowledge in spine disease of the candidates. This made him more involved in spine surgery, where he started lecturing and writing about spine surgery, to promote this important part of neurosurgery. He became a prominent figure in the field of spine surgery among neurosurgeons, and his efforts culminated in his popular book Atlas of Spine Surgery published in 1989. Dr. Fager has also over 118 contributions to the neurosurgical literature.

He also assumed other important positions at the Lahey Clinic during a fruitful career: Vice Chairman of the Board of Governors for 20 years (1973-1993), Trustee for 20 years also (1973-1993), Chairman of Surgery (1982-84), Chairman of the Medical Practice Council for 13 years (1980-1993), Chairman of the Council of Department Chairmen for 9 years.

Dr. Fager got married in 1947 to Margaret Bulkley, a medical technologist at the time. They had four children: Christopher, a lawyer , who is a founder and executive vice president of the E entertainment cable TV in Los Angeles, Gregory, who has a Ph.D. in Economics at the Institute of International Finance in Washington, DC, Mary Louise who graduated from the Julliard school of arts in New York, and Jeffrey who is the executive producer of the CBS evening news.


New Orleans reunion minutes

The last WALN official reunion was held on September 30th, 1997, in the restaurant Mulate in New Orleans, in parallel with the CNS meeting. Were present during this meeting: Mokbel Chedid, (WALN President) Ghassan K. Bejjani (WALN Newsletter Editor), Issam A. Awad (WALN Past President), Fady Charbel, Ali Krisht, Jacques Morcos, Benny Iskandar, Moe Ajam, Chris Abood, and Adnan Abla.

Dr. Awad started with an opening statement, commenting on the success achieved by the WALN homecoming reunion and discussing the plans to start fundraising for a WALN traveling fellowship. He will be heading a WALN fellowship Advisory Board (to be nominated) in charge of the fellowship. All Honorary and Past Presidents will be included in this Board.

Then a fax sent by Dr. Muakassa was read. Dr. Muakassa could not personally attend the meeting due to professional obligations in Akron, Ohio. Dr. Muakassa commented also on the success of the WALN homecoming meeting.

The Bylaws were officially modified and different categories of membership were defined:
- Eligible members
- Active members
- Associate members
- Resident member

The issue of the Associate members was discussed. It was decided to start recruiting actively associate members and Dr. Ali Krisht was entrusted with this task.

The plans for the next WALN Congress were also discussed. Plans for a meeting in 1999 were made and Dr. Fady Charbel was put in charge of the scientific program.

The not for profit status was next in line. After ample discussion it was decided to register WALN in the state of Michigan. Dr. Chedid will be in charge of registering WALN. Once WALN is registered, then an application for not for profit status will be filed.

The issue of the Lebanese representative was discussed. It was decided to solicit nominations and proxy votes. The final election will be held in Philadelphia in April. Nominations and proxy votes can be either emailed or faxed to any officer.

The issue of the scientific panel on the web was also discussed. It was decided to defer any decisions until the Philadelphia meeting to give Dr. Chedid more time for contacts with potential members.


Upcoming meetings

- An International Cerebrovascular Conference will be held at New York University on May 7-8 in New York. Topics to be covered are: updates in the treatment of stroke, cerebral aneurysms, and arteriovenous malformations. Any body interested in atending should contact Dr. Jafar J. Jafar at:
NYU Medical center
530 1st Avenue
New York, NY 10016
Tel: 212-263-6312
Fax: 212-263-6992
email:jafar.jafar@mcfpo.med.nyu.edu

- The upcoming meeting of the AANS will be held in Philadelphia, Pennsylvania on April 25-30, 1998. The parallel WALN dinner will be held at Cedars on Tuesday April 28 , 1998 at 8 PM. The business reunion will follow. The Restaurant is located on 616 South Second street and the phone number is (215) 925-4950.


WALN: A Historical Note

The idea of a WALN was first conceived in 1971, by Dr. Fuad Haddad. It was during the meeting of the World Lebanese Union Congress held in Beirut in August 1971, that the idea to gather all neurosurgeons of Lebanese origin and to hold a meeting in Beirut. The meeting was supposed to be held in Beirut, in July 1973, immediately before the International Congress in Japan. The attendees were supposed to fly en group to Japan after the meeting. Needless to say that it took 24 years to realize that dream: 1997 and the WALN homecoming congress... This period witnessed the birth of WALN.

In 1990 Dr. Awad received a letter from Dr. Haddad with 35 names and the idea of WALN. In 1991, Dr. Mohasseb, who was visiting the Cleveland Clinic, revisited the subject with Dr. Awad and added new names. In 1991, Dr. Awad mailed a survey to all potential members (neurosurgeons whose names in the world directory had a possible Lebanese consonance): the result of that mailing was the original database of WALN. But it was during the meeting of the Middle East Neurosurgical Society in Beirut in May of 1992 that both men entrusted Dr. Issam Awad to start the WALN: it is then that Dr. Awad was introduced as President of WALN. The founding meeting was held in Acapulco in October 1993. A small preparatory meeting was previously held in Vancouver during the same month along with the CNS meeting. But it was in Acapulco ( in conjunction with the World Federation of Neurosurgical Societies meeting) that the first elections were held and the officers were empowered to write the Bylaws. In February of 1994, a draft of the Bylaws was circulated for suggestions and recommendations. Dr. Kamel Muakkassa designed the logo, and, before the San Diego meeting, he discussed with Dr. Awad the name of the new organization. World Association of Lebanese Neurosurgeons (WALN) was the final result. During the AANS meeting in San Diego in 1994, the logo, the name and Bylaws were approved. The bylaws were then published in the second issue of the WALN Newsletter.

In 1997, a landmark event occurred in the history of WALN and Lebanese neurosurgery: the WALN homecoming congress. During that meeting new elections were held and a new president was elected, Dr. Mokbel Chedid. The first period of WALN was a period of consolidation culminating with the success achieved during the WALN homecoming meeting. The current period of WALN promises to be a period of expansion of WALN with execution of major WALN plans : more meetings in Lebanon, a Lebanese traveling fellowship, expansion of the Newsletter, expansion of the Associate member section etc..


Member News

- We are still seeking nominations and proxy votes for the Lebanese Regional Representative position. The elections will be held in Philadelphia on April 28, 1998. Please email, fax or mail all proxy votes and nominations to any of the officers.

- We would like to welcome our newest members: Dr Douglas Kondziolka from Pittsburgh, Dr Philip Yazback from the Neuroscience Group in Wisconsin, and Dr Chatila from Sweden.

- Dr Charles J. Azzam has been elected President of the Washington Neurosurgical Academy.

- Dr Ali Krisht has succesfully directed two courses. The first was on " Recent advances in Approaches to sellar and parasellar pituitary tumors and was held at the practical anatomy and surgical technique workshop of Saint Louis on October 31-November 1, 1997. The second on "Pituitary Tumors: Recent Advances" was held at the Ritz Carlton in Saint Louis Missouri on November 2-4, 1997.

- At the Hotel Dieu De France in Beirut, a neuropediatrics service has been started with Dr Tony Rizk (Pediatric neurosurgery) and Dr Rima Nabout (Pediatric neurology). Dr Fisher also has also recently given lectures at the Hotel Dieu De France on Surgical Approaches to Acoustic Neuromas, and on Spinal Intramedullary Tumors. These are part of the Neurosurgical Journeys held at the Hotel Dieu De France in Beirut three times per year.

- Beirut is nominated as a possible site for the Congres of the "Societe de Neurochirurgie de Langue Francaise" in the year 2001.

- Dr Mokbel Chedid has been nominated to the position of Chief of Surgery and Chief of Medical Affairs at Genesys Health Systems. Good Luck!! His department was also enrolled in a multicenter study on the use on anterior endoscopic interbody fusion using conical threaded titanium cages.

- Dr Awad is the New President-Elect of the Joint Section on Cerebrovascular Surgery of the AANS/CNS. The elections were held at a recent meeting of the section in Orlando, Florida. He was also elected as Governor of the American College of Surgeons and he was asked to serve on the Executive Committee of the Stroke Council of the American Heart Association.

- Our associate member, Dr Mawad was the Chairman of the Scientific Program Committee of the first Joint Meeting of the ASITN and the AANS/CNS Cerevbrovascular Section Held in Orlando, February 1-4, 1998. The meeting proved very successful.


In the Next Issue

- Our Honorary Presidents IV: Joe Maroon, MD
- History of the Pituitary Gland
- And more vignettes

For More Information Contact:
World Association of Lebanese Neurosurgeons
Tristate Neurosurgical Associates, 200 Lothrop Street, Suite 5C
Pittsburgh, PA 15213
Tel: 412-647-3604
FAX: 412-647-3605
Internet: bejjanigk@msx.upmc.edu


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