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ForumThVoTHSdriemamplaperTepocan100cortectigperabonetcongocanmeBeWiplaThe crowning achievement in soccerthat is, football, asknown everywhere outside the United Statesculminates every 4years when 32 countries come together to play in the FootballWorld Cup. To gain the privilege of competing in the World Cup,thegio2 ya nWoranplasinINFThenclingoerlthathebigCeWeBeEuterthitheweSfashioned nationalism, which can be admirable, but which alsocan become extreme. In 1969, after El Salvador played Honduras,the war known as the Soccer War broke out between the twonations and left more than 4000 dead. When Algeria beat EgyptAbbWFTo w[E-m23nal 32 teams rst competed against other countries in re- 1-0 in a hotly contested playoff game to determine who would goreviations and AcronymsNS: World Federation of Neurological SocietiesFrom the Division of Neurological Surgery, St. Josephs Hospital andMedical Center, Barrow Neurological Institute, Phoenix, Arizona, USAhom correspondence should be addressed: Volker K. H. Sonntag, M.D.ail:]Citation: World Neurosurg. (2010) 74, 2/3:234-238.DOI: 10.1016/j.wneu.2010.08.019Journal homepage: www.WORLDNEUROSURGERY.orgAvailable online: www.sciencedirect.com1878-8750/$ - see front matter 2010 Elsevier Inc. All rights reserved.4 WORLD NEUROSURGERY, DOI:10.1016/j.wneu.2010.08.019e World Cup and WORLD NEUROSURGERYlker K. H. SonntagE TABULA RASA OF SPORTSoccer is called the beautiful game for the elegant way itcan be played, the beauty of precise passing, and the daz-zle created by the phenomenal control players have whenbbling or receiving a ball. It is also a beautiful game because itphasizes the team as much as the individual. It creates a bondong its players that is close to brotherhood. It is the mostyed and watched game in the world followed by nearly everyson, every country, and every continent.he real beauty of soccer, however, is that it levels the playingld. It is the tabula rasa of sports. It is played by the rich and theor, by the elite and the nonelite, by capitalists and socialists. Itbe played on a well-mown lawn in a stadium that seats,000 people, or it can be played on a sandlot, a beach, a streetner, or a patch of grass. It can be played with an expensive,hnologically advanced ball or not with a ball at all. An old shirthtened in a ball-like shape will do, or a soda can, or a newspa-tied into a ballanything close enough to round to kickut. The goals can be expensive, made of posts, crossbars, ands as seen on manicured elds in many stadiums, but two eldes, a couple of large rocks, or two shoes can also serve as aal. Most importantly, the beauty of the beautiful game is that itbe played by everyone with two feet. Height is not a require-nt or even an advantage except maybe for heading the large or heavy or having a wide arm span is two feet and an object to kick, the beautiful game can beyed.Volker K. H. Sonntag, M.D.Vice Chairman, Division of Neurological SurgeryChief, Spine SectionDirector of Neurosurgery Residency Program and Spine FellowshipBarrow Neurological Institutenal play. Almost every country in the world participates. Afterears of elimination play, the 32 teams converge for 1 month ination that also has competed for the honor of hosting therld Cup. The 32 teams are divided into 8 groups based on theirking and by lottery. Each group is made up of four teams thaty each other, with the top two teams advancing to play ingle-elimination games until a champion is crowned.LUENCE OF THE WORLD CUPe performance of a team in the World Cup tournament inu-es the cultural and social makeup of countries and is alsoked to politics. When Brazil failed to win a World Cup, thevernment launched an investigation. The failure of the Neth-ands to win the cup in 1974 and 2010 were dening moments int nations modern history. In his study entitled Brilliant Orange,Dutch doctor, David Winer, wrote, The defeat in 1974 is thegest trauma that happened to the Netherlands in the 20thntury apart from its oods of 1953 and World War II. Whenst Germany upset Hungary in the 1954 nal, David Cohn-nedict, the former French radical and now member of theropean Parliament, told the New York Times the following: Af-1945 the Germany identity was broken, and there were twongs that rebuilt it: one was economic growth and the other was1954 football championship. For the rst time the Germansre recognized in the world for a nonaggressive achievement.occer is passionate, political, and patriotic. It fosters old-to South Africa, rioting commenced in Cairo and ambassadorswere recalled.TItaWomiingcouneszilmooccprolardohel$2OWowaDugamforfriecommaNEAtmayeato pareoucondeedeponresonFareshoorsimthetrasconeusurWONESim(Wcommunity together. The WFNS fosters friendship, relationships,and an exchange of knowledge and ideas. As in soccer, there alsois atheyeaandacarakSeoTthecongerestteccomanNEsurparingcoulioforincturtheunThcalcatWsurdohaexpforcoutoimexcWneuplachaWOoveofgescomanTHThvethoFORUMVOLKER K. H. SONNTAG WORLD CUP AND WORLD NEUROSURGERYWOhere are numerous other examples of World Cup fever. Whenlian auto workers were told that they could not watch therld Cup on the job, they went on strikeconveniently 30nutes before game time. German companies set up ofce view-areas to keep employees from defecting on game days. As antry, Brazil shuts down when their team plays; with busi-ses and schools closed and elective surgeries delayed, so Bra-ians can watch the game on TV. The World Cup is the worldsst watched sporting event, and it is probably fortunate that iturs only once every 4 years considering its negative effect onductivity. It is estimated that the German economy (Europesgest) loses about $8 billionor about 0.27% of the grossmestic productduring the 1 month that the tournament isd. Surveys in Britain predicted output losses of $1.5 billion to.3 billion during the month of the tournament.ther countries have acknowledged the popularity of therld Cup. In the Netherlands, the entire countrys quitting times moved unofcially forward to 1 PM on a Friday when thetch knocked Brazil out of the quarter nals in 2010. World Cupes are entertaining, important, and emotionalespeciallypeople who have played and loved this game and for the manyndships it has helped create. The World Cup brings the globalmunity together as no other sport or nonsport event exceptybe the Olympics.UROSURGERY AND SOCCERcasual glance, the parallels between soccer and neurosurgeryy not be obvious, yet they are there. Both endeavors requirers of training and dedication to develop the appropriate skillserform successfully. In both elds, a prepared mind and bodyneeded, often combined with luck, to obtain a favorabletcome. Success in both elds requires a certain amount ofdence, a can-do attitude, and endurance. Both endeavorsply rely on a team approach. The neurosurgeons successends not only on his or her individual surgical skills but alsothe skills of nurses, anesthesiologists, radiologists, fellows,idents, and colleagues. Likewise, in soccer, success dependsthe skills of each individual playing in concert as a team.ailuresa loss in a game or a postoperative complicationalso experienced by practitioners in both elds. These failuresuld be used as a platform for improvement, however. The lossthe complication should be analyzed and studied to prevent ailar occurrence. Both elds also offer the thrill of victoryoneld or in the operating roomthe reward for many years ofining, preparation, and discipline. The rush and excitement ofring a goal parallel the satisfaction of performing a successfulrosurgical operation in a patient with a complex, challenginggical condition.RLD FEDERATION OF NEUROSURGERY AND WORLDUROSURGERYilar to the World Cup, the World Federation of NeurosurgeryFNS) also meets every 4 years, bringing the global neurosurgeryRLD NEUROSURGERY 74 [2/3]: 234-238, AUGUST/SEPTEMBER 2certain sense of competition. As for the World Cup, the site ofWFNS meeting is chosen from many competitive bids severalrs before the actual event. The site is chosen for its local hostattractions and for what it can do to enhance neurosurgicaldemics and collegiality. Past sites have included Boston, Mar-ech, Sydney, and Amsterdam. The next meeting will be inul.he ofcial journal of WFNS is WORLD NEUROSURGERY. AsWorld Cup brings together the best soccer teams from sixtinents, WORLD NEUROSURGERY is the forum for neurosur-y across the six continents. The mission of the journal is toablish an exchange of neurosurgical knowledge, practice, andhnology through contemporary and innovative journalisticmunication for the global community. The World Cup acts asinspiration and catalyst for soccer players and fans. WORLDUROSURGERY is an intellectual catalyst for the eld of neuro-gery. The World Cup brings together not only 32 countriesticipating in the event but the entire global community watch-the beautiful game. The 2006 World Cup was seen in 214ntries and territories with a cumulative viewership of 26 bil-n people. Similarly, WORLD NEUROSURGERY acts as a forumglobal communication for the specialty of neurosurgery byluding scientic, clinical, educational, social, economics, cul-al, and political contributions. Soccer is the closest thing thatre is to a global language and currency. Certainly, it is aifying forceprobably the largest unifying force in the world.e WFNS meeting every 4 years unies the worlds neurosurgi-community, andWORLD NEUROSURGERY is the platform, thealyst of that society.ORLD NEUROSURGERY is striving to be the voice of neuro-gical professionalism around the globe. This voice will not beminated by neurosurgeons from developed countries but willve contributions from all countries; that is, it will be the sharederience and international dialogue that move the disciplineward. Neurosurgeons will learn from each other. Similarly, allntries in the world participate in or, at the very least, attemptqualify for the World Cup. The game of soccer is constantlyproved by learning from other players and other teams, anhange that improves the discipline overall.ORLD NEUROSURGERY will communicate the excitement ofrosurgery not only by its scientic content but also by being atform to list training opportunities, advancements, socialllenges, nancial challenges, and research accomplishment.RLD NEUROSURGERY can help show neurosurgeons how torcome nancial challenges, obstacles to learning, and a lacktechnology through the exchange of ideas, thoughts, and sug-tions among its global neurosurgical readership. Such globalmunication also occurs during the 2 years of elimination playd during the months of the World Cup.E WORLD CUP IN SOUTH AFRICAe 2010 World Cup took place in South Africa. South Africa builtnew stadiums from scratch and refurbished ve others, evenugh several will have no tenant after the tournament is over. It010 235is fgivdepthapreimduSoenjsocmaperthasymSoTnaprozenesphawomyFSoblaalwoutheUncoudushatreFOI hrsColombia game in the Rose Bowl. U.S.A. won 2-1. That game wasmy rst World Cup game, and the experience was electric. IremusethewabacowThsufa gwoteagamBoThthethesamtheMgicconGeseapatBWofrieU.Sthrto(fajumfulantheingTFiSFiwFORUMVOLKER K. H. SONNTAG WORLD CUP AND WORLD NEUROSURGERY23air to ask whether the $5.6 billion expenditure can be justieden all the pressing problems that beset South Africa, includingression-level unemployment of 27% and other deprivationst are the legacy of Apartheid. Of course it can be. The formersident, Nelson Mandela, was asked why he placed such anportance in rallying his nation behind the national rugby teamring that sports World Cup in 1995, which was also hosted byuth Africa and portrayed in the 2009 movie, Invictus. Rugby wasoyed almost exclusively by whites in South Africa, whereascer was played primarily by blacks. The countrys oppressedjority had just come to power with a long list of needs andsistent hatred of their former rulers. Mandelas answer wast he saw a nation united behind a Rugby team as an importantbol of social reconciliation. This was so, especially when theuth African team won the cup for a jubilant biracial crowd.his years World Cup in soccer is also symbolic of how far thetion of South Africa has progressed. Despite its persistentblems, South Africa is a vibrant modern democracy. Its citi-s are newly energized by the success of getting the country,ecially the stadiums, ready for the World Cup. The World Cups opened up Africa, and especially South Africa, to the wholerld, allowing the global community to witness its beauty andstery and the friendliness and hospitality of its people.or 2 weeks, my son Stephen and I attended the World Cup inuth Africa. We experienced the friendliness and sincerity ofck and white South Africans. We always felt safe; there wasays a smile for us. The attitude of we hope youre enjoyingr country was pervasive. The two stadiums where we watchedgames were spectacular, rivaling any football stadium in theited States. Hosting the World Cup seems to have brought thentry together. It was a cause of celebration, a 4-week periodring which fans from 32 countries rejoiced or did not rejoice,red, learned, or were proud of their nation. South Africa did amendous job of hosting the worlds biggest sporting event.UR WORLD CUPSave had the pleasure of attending four World Cup games. Thet was in 1994. My son Christopher and I watched the U.S.A. vsgure 1. My wife Lynne at the Rose Bowl before the 1994 Brazil vsweden game. (Used with permission from Volker K. H. Sonntag.)6 WORember the fans from Colombia dancing in the golf coursed for a parking lot outside the stadium. Many were dressed inir native dress. Excitement and hope were in the air. The games won by the U.S.A. largely because Andreas Escobar, a centerk for team Colombia, inadvertently scored a goal against hisn team. Escobar was shot after returning home to Medelln.e reason for his murder is unknown, but gambling lossesfered by drug barons were probably involved. His murder castrim shadow over the nal match between Italy and Brazil, whon when Roberto Baggio, the celebrated star from the Italianm, missed the penalty kick during the shoot out. The nexte, which I attended with my wife, also was played in the Rosewl (Figure 1). It was the seminals between Brazil and Sweden.e festivities before the game were spectacular. The Swedes inir Viking outts were singing and dancing; the Brazilians inir usual high-octane celebratory mood were dancing theba and singing, eating, and laughing; they were proud ofir team. Brazil won 1-0 on a header by Romero.y next World Cup experience was in 1998 during a neurosur-al meeting in Germany. I was able to sneak away from theference to see the group game between the United States andrmany. I went with my cousin from Germany. We had greatts. The U.S.A. was outplayed and lost 2-0. The excitement andriotism exhibited by both sides were fantastic.ecause of these great experiences, I wanted a more extensiverld Cup experience. Consequently, in 2006 my wife and I withnds from San Diego went to Germany for 2 weeks to see three.A. games. What a beautiful 2 weeks it was. The host countryew a party the entire month of the World Cup. If we did not gothe games, we were able to watch them in the ofcial areasnfest). Usually the town center or square was set up withbo TVs for showing the games. Food and drink were plenti-, and excitement permeated the atmosphere before, during,d after the games. Areas were set up in smaller towns to showgames, and friends were made while celebrating and watch-the games.he celebratory mood was ubiquitous throughout the coun-gure 2. Fans before the 2006 U.S.A. vs Czechoslovakia game. (Usedith permission from Volker K. H. Sonntag.)LD NEUROSURGERY, DOI:10.1016/j.wneu.2010.08.019tryhartheawoveHomawoSomWrstraantlosWeU.SThtioteaattU.SthetheWoofhoAWofrieulaJohhounouthesecplascotheThyetU.STplaandcelThtouteDoablDoU.SleaforthewhCOInCumenattenwabeaTbecthesciFigFiwFORUMVOLKER K. H. SONNTAG WORLD CUP AND WORLD NEUROSURGERYWOthe Germans, their visitors, and guests were rejoicing. Thed days of the early postwar years, the days of the Cold War, anddays of the sometimes painful yet appropriate and long-aited union of the once-divided country (Die Wende) werer. It was good to y the German ag and be proud of doing so.sting the World Cup was great for the sport of soccer butybe even better for the spirit and soul of Germany. It was anderful 4 weeks. It is now known in Germany as the Maerchenmer (the summer of fairy tales).e attended three games. Czechoslovakia vs. U.S.A. was thet. The celebrations started early in the day (Figure 2). On thein to the stadium, the Americans belted out their nationalhem, only to be outdone by the Czechoslovakians. The U.S.A.t that game 3-0 and rightfully so; they did not play very well.saw the next game, U.S.A. vs. Italy, in Kaiserslautern. The.A. played great with a gutsy performance and tied Italy 1-1.e last game was U.S.A. vs. Ghana. There was a huge celebra-n before, during, and after the game. Both the U.S.A. and them from Ghana played well. A bad call, as admitted by all inendance and later on, led to a penalty kick for Ghana and the.A. lost 2-1. They were out of the nals and went home, butfestivities and the joy of the World Cup continued. Italy woncup that year by beating France in the nal match. A greatrld Cup celebrating the beautiful game by the teams and fansall 32 countries showcased the German people and Germanspitality.s I mentioned, I also had the opportunity to attend the 2010rld Cup in South Africa. I went with my son, Stephen, and and from San Diego. The 2 weeks we spent there were spectac-r. The rst game we attended was in the Ellis Stadium inannesburg. The U.S.A. played Slovenia. We arrived severalurs early to show off our replicas of the U.S. soccer teamiforms and to talk to people, primarily other Americans, aboutr chances of winning (Figure 3). The game did not start well forU.S.A., and the team was down 2-0 at halftime. During theond half, it appeared as if a different team had shown up togure 3. My son Stephen and I before the 2010 U.S.A. vs Sloveniaame. (Used with permission from Volker K. H. Sonntag.)RLD NEUROSURGERY 74 [2/3]: 234-238, AUGUST/SEPTEMBER 2y for the U.S.A. and tied the game 2-2. Another goal wasred several minutes before the end of the game. I thought thatU.S.A. had won 3-2, and we had already started to celebrate.e referee discounted that goal, however, for reasons he has notexplained even many weeks after the game. Consequently, the.A. tied with Slovenia 2-2.he next game we attended was even more dramatic. U.S.A.yed Algeria in Pretoria. It was a beautiful day. American fansAlgerian fans roamed the streets hours before the game,ebrating and shouting their support for their respective teams.e game was very exciting with multiple close-goal attempts, allno avail. The game ended in regulation time 0-0. Three min-s of extra time were played. During the second minute, Landonnovan, forward for the U.S.A., made a goal. It was an unbeliev-e experience being in that stadium 30-40 yards away fromnovan when he made that goal. The game ended with the.A. winning 1-0. Neither the fans nor the players wanted tove the stadium (Figure 4). Hardly able to believe their goodtune, the U.S.A. went from exiting the World Cup to winninggroup with that one goal. They moved on to the quarter nals,ich they then lost to Ghana 2-1.NCLUSIONterms of excitement, patriotism, and enjoyment, the Worldp is an unparalleled experience. It evokes passion, commit-nt, and skill. Although the game can sometimes spur fans toionalistic hatred and violence, it nevertheless overcomes thatdency by the joy and wonder that it creates. It is played andtched by every country in the world. It is global; it is theutiful game.he goal of WORLD NEUROSURGERY also is to be globaltoome the forum for neurosurgeons of all countries to shareir passion, skill, and commitment for the beautiful art andence of neurosurgery.gure 4. My son Stephen after the 2010 U.S.A. vs Algeria game. (Usedith permission from Volker K. H. Sonntag.)010 237SUGGESTED READINGS1. C22. FH3. Hn4. Ofcial Match Programme: 2010 World Cup. SouthAfrica: Touchline Media; 2010.Citation: World Neurosurg. (2010) 74, 2/3:234-238.DOI: 10.1016/j.wneu.2010.08.019FORUMVOLKER K. H. SONNTAG WORLD CUP AND WORLD NEUROSURGERY238 WORLD NEUROSURGERarlin J: The World Cup 2010. Time 175:59-71,010.oer F: How Soccer Explains the World. New York:arper Collins; 2004.irshey D, Bennett R: The World Cup as big busi-ess. Time 175:72-4, 2010.5. Perry A: Playing the rebel game. Time 175:88-94,2010.6. Saporito B: Yes, soccer is Americas game. Time 175:82-6, 2010.7. Stark SD, Stark H: World Cup 2010: The Indispens-able Guide to Soccer and Geopolitics. Indianapolis,IN: Blue River Press; 2010.Journal homepage: www.WORLDNEUROSURGERY.orgAvailable online: www.sciencedirect.com1878-8750/$ - see front matter 2010 Elsevier Inc.All rights reserved.Y, DOI:10.1016/j.wneu.2010.08.019The World Cup and WORLD NEUROSURGERYTHE TABULA RASA OF SPORTSINFLUENCE OF THE WORLD CUPNEUROSURGERY AND SOCCERWORLD FEDERATION OF NEUROSURGERY AND WORLD NEUROSURGERYTHE WORLD CUP IN SOUTH AFRICAFOUR WORLD CUPSCONCLUSION