Paulo Niemeyer Soares, 1914–2004

Paulo Niemeyer Soares was born in Rio de Janeiro on April 14, 1914. He was the son of Oscar Niemeyer Soares and Delfina Almeida Niemeyer Soares. His brother, Oscar Niemeyer, is an architect of great masterpieces in Brasília. Dr. Paulo Niemeyer had six children and three foster children. In the last 40 years, Marisa Niemeyer, his third wife and mother of his two youngest children, gave him the incentive and support to pursue his medical profession with enthusiasm. Paulo Niemeyer was graduated from the Faculdade Nacional de Medicina in Rio de Janeiro in 1936 at the age of 22 years. In the beginning of his career, he specialized in general surgery and acted as monitor of Operatory Techniques and Experimental Surgery at the Faculdade Nacional de Medicina and at the Escola de Medicina e Cirurgia in Rio de Janeiro, Brazil. Later, he became Assistant Professor to these two departments. In 1939 Dr. Niemeyer was appointed Surgeon in Public Service after interning at Emergency Hospitals in Rio and Niterói and attaining first place among 270 candidates in a medical contest. Paulo Niemeyer showed great interest in many branches of surgery, yet his interest was soon focused on neurosurgery, especially the following areas. In 1949 the National Academy of Medicine awarded Dr. Niemeyer the Antonio Austregésilo Prize for a paper entitled “Cranioencephalic traumatisms, an analysis of 1000 cases.” Dr. Niemeyer became interested in the surgery of Parkinson disease by performing pallidotomias and pyramidotomias in rhesus monkeys in Manguinhos. His contribution to the thesis, “The pyramidal tract and the parkinsonian tremor,” helped Prof. Deolindo Couto succeed as Professor of Neurology at the Faculdade Nacional de Medicina. Dr. Niemeyer operated on seven of eight patients studied by Prof. Couto, by using the Putnan technique. In 1950 the National Academy of Medicine honored Dr. Niemeyer with two prizes. He received the Fernando Vaz Prize for his work, “Percutaneous cerebral angiography,” and the Antonio Austregésilo Prize for his study, “Angiography in cerebral tumors.” Dr. Niemeyer was a pioneer in the surgery of cerebral aneurysms, and in 1971, introduced the use of microscopic surgery in Brazil. In 1974 Dr. Niemeyer introduced the technique of transphenoidal microsurgery of the hypophysis, which he divulged in courses and congresses throughout Brazil. Dr. Niemeyer also was interested in the surgery of acoustic neurinomas, after operating on the first cases in 1943, and demonstrating the possibility of preserving the facial and acoustic nerves with the use of the surgical microscopy. With this theme, Dr. Niemeyer successively elaborated his thesis, “Microsurgery of acoustic neurinomas,” for which he was elected an honorary member of the National Academy of Medicine in 1981. Paulo Niemeyer's medical vocation was linked to a painful incident. His sister, Judith, lovingly known as Juju, had epilepsy. Paulo said, “When I was 8, Juju received some mail from a Hollywood studio.” It was common practice at that time for girls to write letters asking for pictures of actors and actresses. “When the letter arrived, I ran to wake her up. She hurriedly sat up in bed, but thrilled by the event, presented a seizure, the first of a series to follow. Henceforth, this sad moment imprinted on my mind, and aroused my interest in medicine, especially epilepsy.” In her teenage years, Judith was an inmate at the Casa de Saúde Dr. Eiras. After their mother's death, Paulo Niemeyer took care of his sister and operated on her brain in the early 1950s. On September 15, 1949, Abraham Ackerman and Paulo Niemeyer founded the Brazilian League Against Epilepsy at Santa Casa de Misericórdia in Rio de Janeiro. The initial years of the League were very active under Dr. Niemeyer's leadership. In 1954 he organized a course about temporal epilepsy and brought Prof. Henri Gastaut, at that time already a great authority on this theme, to Rio de Janeiro (1). The eminent epileptologist returned in 1955 for an International Electrocorticography Colloquium presided over by A. Earl Walker (U.S.A.), with the participation of Bartolomei Fuster (Uruguay), Abraham Mosovich (Argentina), Carlos Vilavicencio (Chile), and Aristides Leão (Brazil). The latter is especially remembered for his pioneer work on brain spreading depression. In 1957 Paulo Niemeyer organized the first Brazilian League Against Epilepsy meeting with the assured presence of Richard Jung. Murray Falconer, the British creator of the en bloc temporal lobectomy technique, was invited to Rio in 1959. Dr. Paulo Niemeyer dedicated himself to various aspects of the resection of the epileptogenic tissue, such as electrocorticography and electrographic exploration with implanted electrodes. This was a method of neurologic investigation practiced for the first time in our circle at the Neurosurgical Department of the Santa Casa de Misericórdia, initially in the studies of profound cerebral tumors and later in the investigation of epileptic foci. Dr. Niemeyer tried to demonstrate, as described in animal studies, the existence of cortical spreading depression in the human brain. In this regard, in 1946 he published the work “Suppression of the motor response and the electrical cortical activity in man” in the Brazilian journal ArquivosdeNeuropsiquiatria (2). Several published articles in the field of epilepsy followed. In 1953 the technique of electrocorticography was documented in a 16-mm color film entitled, “Electrocorticography in cerebral tumors.” The film was compiled by Paulo Niemeyer and Helio Bello, the prominent neurophysiologist who worked side by side with Dr. Niemeyer throughout his career. Based on Jackson's observations on the results of work done by Henri Gastaut and others, Niemeyer developed the surgical technique that he called transventricularamygdalohippocampectomy. As special guest and the only representative of South America, he participated in the Second International Colloquium about Temporal Lobe Epilepsy, sponsored by the National Institutes of Neurological Diseases and Blindness in Washington from March 21 to 25, 1957. There he discussed the theme “Surgical Series in Temporal Lobe Epilepsy” and held a conference entitled “The Transventricular Amygdala-Hippocampectomy in Temporal Lobe Epilepsy,” subsequently published in the 1958 book TemporalLobeEpilepsy (3). In this article, the technical approach was described as follows: The transventricular amygdala-hippocampectomy was employed only when the temporal cortex was grossly normal. A 2-cm incision was made on the second temporal gyrus, avoiding injury to cortical vessels. The temporal horn of the lateral ventricle is opened and the hippocampus exposed. After the electrographic study, the hippocampus is ablated in an extension of 3 cm, and the n. amygdalae and gyrus hippocampi are removed by subpial suction, until the basal arachnoid appears on the whole extension of the exposed ventricular floor. By transparency through the arachnoid, we can see the tentorium and the communicating and posterior cerebral arteries. Niemeyer's access to reach the mesial structures was modified by Yasargil and Wieser. They published their 1982 article 24 years after Niemeyer's description and have contributed to the diffusion of this surgical approach for temporal lobe epilepsy in more recent years (4). For some, the transylvian route proposed by the previously mentioned authors is more difficult than the original technique with the transventricular route (5). In postsurgical neocortical electric abnormality, Niemeyer made an original observation described in his 1958 article: “Immediately after these ablations, the abnormal cortical activity becomes surprisingly worse, but in a few days this abnormality disappears, as we can see with electrodes left in the subdural space.” In 1992, two other Brazilians, Fernando Cendes and Arthur Cukiert, carried out a research on this phenomenon at the Neurological Montreal Institute, calling it “Niemeyer's effect” (6). Paulo Niemeyer passed away on March 10, 2004, at the age of 89. He continued to work 12 hours per day until then. His hobby was studying and working, especially in the operating theater, where he instructed hundreds of residents and contributed his vast experience to the formative years of various generations of Brazilian neurosurgeons. The greater part of his time was spent at the Santa Casa de Misericórdia in Rio de Janeiro, a philanthropic entity where he developed his voluntary work and ended his days as curator. This was the highest position at the institution, and he remained there until the moment his mitral valve ruptured, surprising even him while working in his office: “It was there where I went at 17 as a medical student, without earning anything, and continued to do so without any charges. It is the spirit of mercy which motivates us to do something for the sick, to learn from them and to teach.” Yes, this was Dr. Paulo, a man from a blessed family who so fortunately received some rare genes as a gift from God. These manifested in the Niemeyer family as traits of simplicity and fraternal love, present in their daily activities; longevity, which gave us the opportunity to testify these qualities and learn from their examples, and finally, geniality, which allowed the siblings to produce masterpieces in such diverse materials, concrete and the human brain.

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