The IANS International Lifetime Recognition Award recognizes an international figure for his or her lifetime of contributions to advancing the field of neurosurgery in a country outside the United States or Canada. This year's recipient is Dr. Jeffrey Rosenfeld of Melbourne, Australia. Dr. Rosenfeld received his medical education and his neurosurgical training in Melbourne followed by further study at Oxford and at the Cleveland Clinic. He's held numerous administrative and leadership positions within Monash University and the Alfred Hospital, including surgery and neurosurgery department head and pro-vice chancellor for advancements. He's a prolific researcher with more than 280 peer-reviewed articles, 46 book chapters and two books. His work has had 11,000 citations and he has an H-index of 52 and an I-10 index of 164. Over his career, he has received over $22 million in competitive grant funding. He was co-principal investigator on a landmark decompressive craniotomy, or DECRA, trial in patients with traumatic brain injury. He's a principal investigator within the Monash Bionic Vision Group. He's had a very active military career. He served on eight deployments, including to Rwanda, East Timor, the Solomon Islands, and Iraq. He's a recipient of the Michael E. DeBakey International Award for Excellence in Military Surgery and he was awarded the U.S. Air Force Commendation Model in 2007 and U.S. Army Meritorious Service Medal in 2017 for service in Iraq. He is a major general in the Australian Defense Forces and is a former Surgeon General of the ADF Reserves. Dr. Rosenfeld has developed a keen interest in developing specialist medical services, particularly neurosurgery, in the developing world. He's visited Papua New Guinea, Fiji, and the Solomon Islands multiple times for the AusAid-funded Pacific Islands Project to perform neurosurgery and teach. Among his many titles, founding director of the Monash Institute of Mechanical Engineering, professor of surgery at Monash University, senior neurosurgeon at the Alfred Hospital, an adjunct professor in surgery at the F. Edward Hebert School of Medicine at the Uniformed Services University of the Health Sciences in Bethesda, honorary professor of surgery at the University of Papua New Guinea, an honorary consultant neurosurgeon at Longgang Central Hospital in Shenzhen in the People's Republic of China. Dr. Rosenfeld has recently received the highest civilian honor in Australia, the Companion of the Order of Australia. In addition, he is a Knight of Grace in the Order of St. John and an officer of the Order of the British Empire, or OBE. On top of all this, he's an accomplished classical and jazz clarinetist. It's with great pleasure that the AANS presents the 2018 International Lifetime Recognition Award to Dr. and General Jeffrey Rosenfeld. Thank you. Well, thank you for the standing ovation, everyone, and thank you, Dr. Valetka and the Board of the AANS. It is a great honor to receive the International Lifetime Service Award of the AANS, and I'm very proud to receive it, very humbled. It is the pinnacle of my neurosurgery career thus far to be honored in this way. It is indeed a privilege to practice neurosurgery and to be able to help people with life-threatening and life-changing illness and disabilities. I'm sure it is for all of you. Now, I work at the Alfred Hospital in Melbourne, which is right down the south of Australia. I hope you'll get to visit it sometime. It's a beautiful city, and I trained in neurosurgery at the Royal Melbourne Hospital, in general surgery first and then neurosurgery. Here are some of the neurosurgeons who trained me, and you'll notice Dr. Andrew Kay there, who's well-known to this audience, who also received this award back in 2015. It is interesting to contemplate one's neurosurgery pedigree in relation to Dr. Harvey Cushing. I am a third-generation neurosurgeon, having been trained by Mr. Curtis, Mr. Simpson of the Simpson Grading of Meningiomas, and Mr. Keith Henderson, who were trained, indeed, by Sir Hugh Cairns, who was in turn trained by Dr. Harvey Cushing in the U.S. I also trained in neurosurgery at the Radcliffe Infirmary in Oxford, which was founded by Sir Hugh Cairns in 1926. It was the first hospital in the world to actually have penicillin administered to its patients. The brilliant teacher and neurosurgeon, Mr. Chris Adams, was head of the unit when I was a registrar there. In my experience, the best neurosurgeons are knowledgeable and familiar with the evidence base. They're compassionate, kind, courteous, honest, and caring. They're excellent clinicians. They put the patient first. They have attention to detail, skilled hands, consummate judgment. They lead change by doing research, and they're fine teachers and mentors. I was fortunate to train at the Cleveland Clinic, where many of these best doctors are. There was Dr. Little, who was chair of the department at the time. Dr. Awad, Dr. Barnett, Dr. Hahn were some of the best neurosurgery teachers that I've had. Dr. Kalfus, you see there, was my co-chief resident, who is now one of the leading spine surgeons in the world. Many very fine neurosurgeons have inspired me, taught me, and shown me kindness over the years. Here are just a few of them. Dr. Roton, Dr. Pazzo, Dr. Black, Dr. Heilbrunn, Dr. Sundt, and I particularly thank Dr. Laws and Dr. Spetzler. Dr. Konziolka, Dr. Rutka, Dr. Kee Park, Dr. Constantini from Israel, Dr. Anil Nanda, and Dr. Michael Lawton. I thank you all. Some of the work that I've done over the years, very briefly, I developed an interest in hypothalamic hematomas, which cause severe intractable, gelastic, and mixed seizures in children. I developed a new operative approach to resect these lesions, which Dr. Roton himself called the Rosenfeld Approach. The anterior interhemispheric transcollosal transeptal interfornoscele route to these tumors are reported in Neurosurgery in 2005. The results were indeed superior to other methods at the time, and I had the largest series accumulated. This work was taken up by Dr. Spetzler and Dr. Rekate at the Barrow Neurological Institute, who then overtook me and developed the largest series in the world using this technique and other endoscopic techniques. Now there are newer techniques to remove these or irradiate them or heat them, but this is one that I removed surgically, and you can see the exquisite approach using this can remove very small lesions like this with excellent results. I have now developed an interest in the collaboration between engineers and physicians to develop new medical technologies and spearhead the development of the Monash Institute of Medical Engineering. The device I am working on at present is the bionic vision prosthesis, which aims to restore some vision to blind individuals or acquired blindness. We have developed a wireless multi-electrode implant which has 10mm arrays, which are platinum iridium electrodes, which pierce the visual cortex 2.5mm and stimulate the neurons in the primary visual cortex. Images from a digital camera are processed in this to simplified pixelated images by this pocket processor then transmitted wirelessly into the brain. We aim to go to the first in human trial within the next 6 to 12 months, hopefully 6 months. I have had a longstanding interest in traumatic brain injury and was a co-chief investigator on this DECRA study. Despite heated controversy on this paper, including at this very meeting when I presented it, this paper and subsequent rescue ICP trial have had a significant impact on the selection of patients for decompressive craniectomy and the management of patients with severe traumatic brain injury. I have served in the Australian Defence Force, the Army, since 1984 and have been a former Surgeon General of our Defence Force and a Major General. I served with the United States Air Force in Balad, Iraq during the Fallujah assault in 2005-06 and treated many severely injured US Marines. I got a lot of experience with mass casualty management and I got a lot of experience doing large craniectomies for blast and penetrating injury to the brain and strongly advocate this technique for these types of injuries. The management of severe blast polytrauma I also experienced. I was also honoured to be embedded in the US Army 21st Combat Support Hospital. They come from Fort Hood in Texas during the battle for Mosul last year. It has been one of the greatest privileges of my career to work with my US military friends and colleagues and to look after injured US and allied personnel who put themselves in harm's way for us. I am honoured to be an Adjunct Professor in the Department of Surgery at Uniformed Services University in Walter Reed where Captain Eric Elster, seen there, is the Chair of the Department of Surgery, a brilliant Academic General Surgeon. I have been privileged to work with US military neurosurgeons including, in that slide, Dr. Rocco Armanda who is speaking at this meeting and Dr. Randy Bell from Walter Reed. I am also concerned about inequity in global neurosurgery so I have been going to Papua New Guinea and other Pacific Islands as a volunteer since the early 1980s. This is a country of 7 million people without a single neurosurgeon. It is estimated in a recent journal neurosurgery paper by Dewan et al., just coming out now, have a look at it, approximately 23,300 additional neurosurgeons are needed worldwide to address more than 5 million essential neurosurgery cases. We have got to start somewhere. Craniotomies are done with the Hudson brace and the Jigley saw. There are no power tools, there is hardly a CT scan, certainly no MRI, pathology is often advanced. I teach the local surgeons how to do simple neurosurgery procedures with limited resources. I wrote this book to enable non-neurosurgeons and neurosurgeons in developing countries to do neurosurgery to build capacity and expertise where it is sorely needed. We will try and get this book into a second edition because it is now out of print. To finish with, it is important to have interests outside neurosurgery. Mine is music, my passion, apart from neurosurgery. I am a serious clarinetist and this is our doctor's orchestra back home. Those players there are on bassoon and intensivist, a pediatrician, myself, and an oncologist on clarinet. Many doctors have musical talents, but I will tell you what my greatest achievement is in life and that is getting married to my lovely wife Debbie and having three wonderful children. Thank you very much.

Dr. Jeffrey Rosenfeld

Australian neurosurgeon

IANS International Lifetime Recognition Award

decompressive craniotomy

Monash Bionic Vision Group