Gerard Guiot (1912-1998)Kamal R.M. Woods, MDDepartment of Neurological SurgeryLoma Linda University

Gerard Guiot: The ManFrench NeurosurgeonBorn January 19, 1912Raised in Fourmies, Northern FranceStrong musical inclinationMarried Elsie Bouettery on March 6, 1937Had 4 daughters

Gerard Guiot: His TrainingMedical School of Paris1937: Graduated with Laurette distinction and Silver MedalNeurosurgical training under Professor R. Garcin, Paris

Gerard Guiot: His MentorsProfessor Clovis VincentGuiot: spiritual grandson of Harvey CushingProfessor D. Petit-Dutaillis, lHopital La PitieProfessor Norman Dott of Edinburgh

Clovis VincentPercival Bailey

Gerard Guiot: His Work1944-1956: Corneo-pterygoidal Reflex1947: Surgical subtemporal approach -mesencephalic tractotomy (pain) -peduncular tractotomy (Parkinsonian tremor) Parasagittal approach to basal ganglia1950s: Use of ganglioplegic drugs in NeurosxTreatment of paraplegia in xyphoscoliosis

Gerard Guiot: His WorkStereotactic functional techniques, stereotactic frame 1958: electro-physiological exploration of sub-cortical structures with stimulation of IC1961: microelectrode recording of cell units with Madame D. Albe-FessardLacalization and delineation of various thalamic nuclei within 0.5 mm

Gerard Guiot (left) and Jules Hardy (right)

Gerard Guiot: His Work1960: First neurosx procedure under complete cardiac and circulatory arrest1963: Repair of malformations of the skullApproaches to thoraco-cervical spine1962: Devised new ventriculoscope

Gerard Guiot: His WorkTrans-sphenoidal approach1910: first procedure doneHarvey Cushing and Oscar Hirsch (ENT)1929: universally abandonedResurrected by Dott/Guiot1950s: Guiot refined technique -radiofluoroscopy

Norman Dott

Gerard Guiot: His PublicationsOver 300 scientific publications -The Clinical Evolution of Spinal Cord CompressionInspired over 30 doctorate theses by others

Gerard Guiot: His InfluenceClovis Vincent: If you want to learn and do neurosurgery, stay with me and watch me!Master of neurosurgical teaching in FranceMember of the American, Belgian, British, German, Italian, Luco-Spanish, Latino-American, Russian, Yugoslavian societies of NeurosurgeryJuly 1968: Charlie Wilson (trans-sphenoidals)

Charlie Wilson

Guiot Gerard: His Accolades1940: Croix de Guerre avec Palme and Chevalier de la Legion dHonneur a titre militaire1956: Neurosurgeon of the Hopitaux de Paris1956: Chief of Neurosx service founded at lHopital Foch in Suresnes, a suburb of Paris1966: Officier dans lOrdre Natinal de Merite1968: Elected to the SNS1979: Neurosurgeon of the Year

Gerard Guiot: His Passions400 major operations a year (1500 pit. adenomas)Coronary occlusion in mid 1970s1976 still did a little over 200 cases aloneRetired Jan 1, 1987Gardening, old farm village Les MolieresBiblical studies Music -Sacred music is the most immaterial with which one can reach God (Guiot)

Things to RememberGuiot, French Neurosurgeon (1912-1998)Linked to Harvey Cushing by Vincent and DottCorneal ReflexSubtemporal approachStereotactic functional techniquesLocalization and delineation of thalamic nucleiTrans-sphenoidal pituitary surgeryMusician by inheritance, Catholic by conviction, and Neurosurgeon by passion

ReferencesNeurosurgeon of the Year. Gerard Guiot. Surg Neurol. 1979 Jan;11(1):1-2 http://www.gladwell.com/1999/1999_08_02_a_genius.htmhttp://www.emergemd.com/bniq2/article.asp?article_ref_id=18-3-1http://www.societyns.org/society/bio.aspx?MemberID=14599

http://skyline.linksky60.com/~skullman/papers/surgical_management_ pituitary_tumors.htm

http://www.neurosurgery.org/Cybermuseum/stereotactichall/images/Stereo_820g.JPG

So, what is Guiot know for as far as his work?While at lHopital La Pitie in Paris, Guiot described the corneo-pterygoidal reflex, or the corneal reflex as its commonly known. No doubt this has become a truly significant this clinical sign in relation to prognosis of brain stem lesions. In 1947, Guiot described the surgical subtemporal approach to the brain stem, which he later applied to the treatment of pain by mesencephalic tractotomy and to the alleviation of Parkinsonian tremor by peduncular tractotomy.He also described the parasagittal approach to the basal ganglia.In the ealry 1950s, Guiot pioneered the used of ganglioplegic drugs (block neurotransmission at nicotinic receptors in postganglionic autonomic--sympath and parasympath-- neurons) in neurosurgery. These drugs were used primarily for induction of hypotension.Guiot also contributed descriptions of a new surgical approach for the treatment of paraplegia in xyphoscholiotic patients.

During his tenure at Hopital Foch, he introduced new techniques. Amongst them was Guiots original stereotactic frame. In 1958, Guiot was the first to introduce the electro-physiological exploration of deep cerebral structures with the stimulation of the internal capsule.The major advance in stereotaxic functional surgery occurred when in 1961 in collaboration with a renowned neurophysiologist, Madame D. Albe-Fessard, they applied to the exploration of the human brain the microelectrode recording of cell units.With this method, he described the somesthetic representation in the ventral posterior nucleus of the thalamus and single cells rhythmic activities synchronous with tremor of the contra-lateral limb. A more precise localization and delineation of the various thalamic nuclei within 0.5 mm was thus achieved which permitted the optimum localization of a lesion for the treatment of various abnormal disorders of movement....performing a functional procedure during Hardys stay in Paris.In January 1960, Guiot performed the first operation of the brain under complete cardiac and circulatory arrest with profound hypothermia. This practice later became increasingly popular especially in the treatment of ruptured intracranial aneurysms.In 1962, He devised a new ventriculoscope wtih optic fibers for endoscopic intracranial exploration and he described a new method for third ventriculocysternotomy with a wire leucotome as applied to the treatment of obstructive hydrocephaly.In 1963, with the collaboration of a plastic surgeon, P. Tessier, he opened a new chapter in the surgical repair of malformations of the skull like hypertelorism of Crouzons disease. These procedures were further developed and applied to the complete reconstruction of orbito-facial dysostosis and to the removal of tumors of the base of the skull, correction of dysplasia as well as the total removal of sphenoid wing meningiomas en plaques.As mentioned previously, Guiot was not limited to surgery of the brain. He did extensive work in treatment of scoliosos and devised new approaches to the thoraco-cervical spine.Interestingly, first trans-sphenoidal surgery was done around 1910 independently by Harvey Cushing and ENT surgeon Oscar Hirsch in Vienna.By around 1920 the procedure was universally abandoned (including Cushing who would switch to developing the trans-cranial approach) b/c of high morbidity related in a large part to limited imaging of the sella and poor preop planning. Often encoundered unexpected meningiomas, chordomas, aneurysms.Conceivably, the transsphenoidal procedure would have largely been forgotten if not for the persistence and vision of Norman Dott, a neurosurgeon from Edinburgh, Scotland. Dott spent a fruitful year as a Rockafeller Fellow at the Peter Bent Brigham Hospital under Harvey Cushing and was impressed by Cushings transsphenoidal approach. Once back in Edinburgh, Dott continued to use the procedure with excellent results. To overcome some of the difficulties associated with performing such a challenging procedure without proper illumination, Dott devised a special speculum with lights attached to it. The device became widely known as Dotts speculum.Under Professor Dotts influence, Guiot carried on with the transsphenoidal approach to tumors of the pituitary gland, modifying and improving the technique. Guiot's adaptation of the procedure is especially noteworthy in its correlation with the introduction of intraoperative radiofluoroscopic imaging.

This is a photograph of Cushings team during Dotts stay in Boston. Cushing is seated in the front fow, center; Dott is standing in the back row, last person on the right.Gerard Guiot is said to have authored work spanning over some 300 scientific publication. One of the most well recognized of these was his doctorate thesis: The clinical evolution of spinal cord compression, for which he was awarded with Silver Medal.How about his influence on others?Clovis Vincent once said to Gerard Guiot: If you want to learn and do neurosurgery, stay with me and watch me! Guiot took this to heart and became a devout student of Vincent.Guiot himself would later become a master teacher of neurosurgery in France to the extend that he earned disciple around the globe.This wide influence would in part be responsible for Guiots election to the American....societies of Neurosurgery.When Charlie Wilson came to U.C. San Francisco, in July of 1968, his first case concerned a woman who had just had a pituitary operation. The previous surgeon had done the one thing that surgeons are not supposed to do in pituitary surgery--tear one of the carotid arteries. Wilson was so dismayed by the outcome that he resolved he would teach himself how to do the transsphenoidal, which was then a relatively uncommon procedure. He carefully read the medical literature. He practiced on a few cadavers. He called a friend in Los Angeles who was an expert at the procedure, and had him come to San Francisco and perform two operations while Wilson watched. He flew to Paris to observe Gerard Guiot, who was one of the great transsphenoidal surgeons at the time. Then he flew home. It was the equivalent of someone preparing for a major-league tryout by watching the Yankees on television and hitting balls in an amusement-arcade batting cage. This of course is a photo of Charlie Wilson.His courage and devoted efforts during the war as military doctor (WWII) resulted in his being awarded the Croix de Guerre avec Palme and the title of Chevalier de la Legion dHonneur a titre militaire.In 1956, he was appointed Neurosurgeon of the Hopitaux de Paris. That same year he became chief of the Neurosurgery service founded at lHopital Foch in Suresnes, a suburb of Paris.He was further acknowledged by the French government who nominated him in 1966 Officier dans lOrdre National de Merite.He became a member of the Society of Neurological Surgery in 1968.And in 1979 was name Neurosurgeon of the Year by the Journal of Surgical Neurology.Finally, I will end this talk with an insight into the passion of this outstanding neurosurgeon. For often we learn more about a person NOT from his upbringing, or where he was schooled, or his contributions to his field of endeavour, but from his passions!Gerard Guiot was a passionate surgeon who, at the prime of his surgical career, did over 400 major operations a year. he has operated and analyzed 1500 pituitary adenomas. In the mid 1970s he as a heart attack and was confined to rest for 3 months. He was admitted to the hospital and advised to show down his activities when he returned to work. When asked if he did so, he said: Oh! Yes! In the past, I used to work like four neurosurgeons; now, I only work like two.Always lived modestly in an old farm in a village called Les Molieres outside of Paris.He was a devoted Catholic and when he retired in 1987, he dedicated much of his time to Biblical studies and sacred music.Guiot during this time rebuilt an old 18th century pipe wind organ in the back room of his barn, a gift from his wife. There he relaxed with meditation, prayer, and sacred music, and art he said is the most immaterial with which one can reach God.