WFNS Past-Presidents Letter918 www.SCIENCThe Birth of World Neurosurgeryn Greek mythology, Athena was
born full-grown from the head ofI Zeus. Legend says that Zeus devel-oped a severe headache, and Haephes-tus split his skull with an ax to relieve
pressure (early craniotomy). Athenaemerged in armor, fully mature. She
became the goddess of Athens, the
greatest of all Greek cities. Because of her origin, she was
considered to have dominion over all things of the intellect (1).
There may be substantial parallels with the birth of WORLDNEUROSURGERY. In 2008, as the President-Elect of the WorldFederation of Neurosurgical Societies (WFNS), I wanted to
explore the idea of a journal for the Federation. I talked withseveral WFNS officers and with their blessing interviewed a fewpublishing houses. Most well-knownpublishers already had a full neurosur-
gical list. However, Elsevier was in apeculiar situation. They wished to
implement editorial and administrativechanges to an existing neurosurgical
title. Thus, they declined the proposal tolaunch a new addition to their catalogue
but offered to replace the existingneurosurgical title with a new publica-
tion. For them, the concept of an inter-national journal with the backing of the
WFNS was quite attractive.
For the WFNS, this was a remarkablepotential windfall. Normally it takes a
journal several years to get on theindexing lists and many more years to
build institutional and individual sub-scriptions and citation rating. More
important, the startup costs of such a
journal would be impossible for theFederation. The interests of the senior
management at Elsevier journal publish-
ing and the WFNS were aligned. Elsevier would provide the sub-
strate on which to build the journal and the publishing and printingexpertise; the WFNS would provide editorial review and content.
In this matter, Elsevier was not Zeus; it was Haephestus, and Iwas the axe. There was only one person who could be consid-
ered Zeus in this situationDr. Michael Apuzzo. By 2009,Michael had spent 20 years in neurosurgical editing, most
prominently as the editor of Neurosurgery. He had brought thatjournal to remarkable influence in that time. Because of changes
taking place within the Congress of Neurological Surgeons, hewas potentially available to undertake the editorship of this newEDIRECT.com WORLD NEUjournal. He and I met with Herb Niemirow of Elsevier in thespring of 2009 to discuss what might be possible. That was a
prophetic meeting. Shortly after that, Michael created a synopsis
to describe his vision for the journal.
It was then that I got the first view of Athena emerging from Dr.Apuzzos head. He knew exactly what WORLD NEUROSURGERYshould bea journal open to the entireworld and not dominated byone geographic region. The United States, Europe, Australasia,
and Japanhad their own journals in neurosurgery, but therewasnopublication that was explicitly international in its scope and repre-
sented a truly international neurosurgical organization. Also, Dr. A
(as he is affectionately called by his coworkers) felt that the journalshould have not only scientific articles but also socioeconomic,
cultural, historical, philosophical, and informative articles aboutwhere neurosurgery was going.ROSURGERY, http://dIn June 2009, we were able to convince
Dr. Jacques Brotchi, then President ofthe WFNS, that such a journal was a
good idea and acquired support of theAdministrative Council. As President and
President-Elect, Jacques and I signed thefirst contract with Elsevier, and so we
may be considered the official foundersof WORLD NEUROSURGERY. The next 9months were frantic with activity. A
backlog of articles from the existingneurosurgical title had to be published.
The first issue of the new journal WORLDNEUROSURGERY was scheduled for April2010.
It was fitting that this issue should be onAfrica, a major focus for the WFNS. Sub-
sequently, the journal has like Athenaconquered much of the territory of the
known world. It has emerged as a majorvoice for international neurosurgery. It
has gone from 20,000 downloads a year
to 400,000; its impact factor has risen to be the same range as
more established journals; and it has been chosen by major world
subscription services to be included in their electronic sub-scriptions. Each issue has had a theme, and the journal is physi-
cally stunning as well as intellectually stimulating.
It is fortunate that this journal Athena was born with her armor
because there were many challenges immediately upon her birth.Several neurosurgical organizations were concerned at the idea
that there should be another neurosurgical publication and felt thatit was unnecessary. Dr. As vision demonstrated that there was
room for at least one more journal completely international inx.doi.org/10.1016/j.wneu.2014.10.019
Pictured left to right, Charles Liu, Veronica Pagan, Michael Apuzzo, Peter Black, Lee Ida Boyd, Rod Faccio.
WFNS PAST-PRESIDENTS LETTERscope. Within the WFNS, there was a reluctance to support the
journal in a way that would allow it to flourish. Dr. A and his staff allhad taken significant salary cuts and had worked for several
months without any salary while the WORLD NEUROSURGERYcontract was being negotiated. Funds from the Rudi Schulte
Foundation and The Integra Foundation helped to keep it alive. Thebirthing difficulties were met with indifference by many of the
more senior WFNS leaders, and there was an attempt to under-mine the second 5-year contract by the highest leadership.
Despite these difficulties, the talent and extent of the enter-prise were remarkable. One look at the names on the editorial
and advisory boards of WORLD NEUROSURGERY will convincethe reader of the breadth and depth of Dr. As influence and
vision. An editor is in many ways like a salesman trying to getothers to buy into his enterprise. Dr. A carried this out with
enthusiasm and energy. He was able to enlist neurosurgicalleaders from all around the world. Within a few years, we
were able to get many societies to name WORLD NEUROSUR-GERY as their official journal. These include the Albanian Soci-ety of Neurosurgery, Algerian Society of Neurosurgery, BelgianSociety of Neurosurgery, Brazilian Society of Neurosurgery,
Chinese Neurosurgical Society, German Academy of Neuro-surgery, Hellenic Neurosurgical Society, Italian Society of
Neurosurgery, Mexican Society of Neurological Surgery, MiddleEast Neurosurgical Society, Norwegian Neurosurgical Society,
Shanghai Neurosurgical Society, and the Society of UniversityNeurosurgeons.
For Elsevier, the journal also provided some challenge becausethat publishing house simply was not used to as dedicated andWORLD NEUROSURGERY 82 : 918-919, DECEMBER 2014demanding an editor as Dr. A. The business model in which they
asked that member societies sign up their individual memberswas not a very successful one. It was only with the advent of
downloads and the increasing institutional subscriptions that thejournal became financially viable and then vibrant within 4 years.
Herb Niemirow and Josh Spieler were vocal supporters for thejournal at Elsevier during this period.
It would be a dismal exercise to consider what a less experi-
enced and resilient editor would have done with this fledglingjournal. With Rod Faccio as Managing Editor, Lee Ida Boyd as
administrator, and dedicated young people such as VeronicaPagan, Martin Lu, and Associate Editor and Continental Liaison,
Dr. Charles Liu, the journal was able to do with 3 or 4 peoplewhat Neurosurgery or the Journal Neurosurgery did with many
more. We wish Dr. Ed Benzel every success in continuing thejournal into the next period of its life.
The journal will be 5 years old in April 2015. Like Athena, it seemsto have appeared full-grown on the neurosurgical scene. It also
has dominion over many, if not all, things intellectual in neuro-surgery. Very truly, it has sprung from the head of Dr. Apuzzo. All
Elsevier, Dr. Brotchi, and I had to do was chop his head open withan ax.
Peter M. Black, President, WFNS, 2009e2013Franc D. Ingraham Professor of Neurosurgery Emeritus, Harvard Medical SchoolFounding Chair, Department of Neurosurgery, Brigham and Womens HospitalChair Emeritus, Department of Neurosurgery, Childrens Hospital Boston
1878-8750/$ - see front matter 2014 Elsevier Inc. All rights reserved.http://dx.doi.org/10.1016/j.wneu.2014.10.019www.WORLDNEUROSURGERY.org 919
The Birth of World Neurosurgery