Ayub's Mentor
Joe Pennybacker was one of the earliest doctors in Great Britain to recognize Mixter and Barr's studies on lumbar disc protrusions as the cause of sciatica and to challenge the diagnosis of sciatic neuritis. He also wrote extensively on the treatment of brain abscesses. His contributions to neurosurgery are best known for the training he provided and not for original research. He was noted for his diagnostic skills and ability to operate with an economy of movements, unhurried speed, and excellent results. Indeed, neurosurgery no longer needed the deliberately slow tempo of Cushing or Cairns to achieve good results. It is perhaps Pennybacker's style of surgery that became the hallmark of the Oxford trainee.
Many neurosurgeons in Great Britain and abroad who trained under Cairns and Pennybacker became prominent in their own right. The trainees included John Curtis, Murray Falconer, Keith Henderson, Douglas Miller, Frank Morgan, Edward Hitchcock, Brian Jennett, Anthony Jefferson, Hugo Krayenbuhl, Sixto Obrador, Ayub Khan Ommaya, Huw Griffith, and Sydney Watkins.
45 minutes of death
The celebrated 18-hour operation that Ommaya performed – which became the subject of a long write-up in Reader's Digest titled "45 Minutes of Death" - involved a lethal mass on the spinal cord of 36-year old teacher Donald Hauck from Rochester, New York, that grew and grew until an operation became imperative; but for the surgery to succeed, the patient's heart and brain, it was clear, would have to be shut down, making him a "living corpse.” The operation was performed at the George Washington University hospital in Washington, DC by Ommaya.The problem was that the patient's cluster was disturbingly close to one of the body's life centers, the respiration-controlling medulla. If the medulla was to be found to be deeply embedded, Ommaya would have to cut into blood-carrying vessels and hemorrhages would obscure his vision. He would not be able to use a suction tube in critical areas next to the medulla and the high spinal cord as that might vacuum up the patient's nerve cells. Ommaya decided to drain the body of blood, put the patient on a heart-lung machine, perform the operation, reheat the blood, return it to the body, restore circulation and revive regular functions. The question was whether he would be able to revive the man's brain. Ommaya's successful operation has become a neurosurgical classic.
Ayub also appeared in Lorenzo's Oil with Nick Nolte and Susan Sarandon (1992).
Background
Ayub's father died when he was 13. His older brother Jan joined the military to help support the family. Jan became a general in the pakistan army and also was the mayor of Islamabad. When Ayub was a young student, he was unsatisfied that the school library would only let students take out 3 books every two weeks. Ayub found a way to sneak books from the bottom shelf of the library, the only shelf you could access through the locked gate. In short time Ayub had read all these books, included encyclopedia's and other reference books. Ayub always excelled at his studies, which was helpful because the family did not have many resources during this time. When he received the Rhodes Scholarship and left to Oxford, Ayub had few funds. He took several jobs during his studies and lived frugally.
Ayub was a single parent for many years caring for his 3 older children David, Alex and Shana. Ayub made all the meals, spent time with his children, and was an excellent father In addition he juggled work in the lab and as a neurosurgeon. During this time he saved many lives with advanced surgical techniques and new chemotherapy. He also made important scientific achievements that continue to benefit patients and public health. Ayub was always a hard worker throughout his life, he always woke early and worked late. He spent his life caring for others and his family. He later married Ghazali who is the mother of his 3 younger children, Aisha, Iman, and Sinan. He always spent time with people who needed his help, and he never stopped learning. He was an avid reader, and spent any free time he had reading philosophy, politics, history, and religion.
Spinal Vascular Malformations
The remarkable strides that occurred in neuroimaging and in surgical technique resulted in a better understanding of the angioarchitecture and pathology of the lesions, which likewise enhanced clarity in classification of these entities. From the 1960s through the 1980s, major new and clinically useful insights emerged; these were largely the product of a collaborative effort among neuroradiologists and neurosurgeons in England, France, and the US. In the US, the key center of spinal vascular activity was at the NIH in Bethesda, Maryland, where neuroradiologist John Doppman was a leading member of the NIH team, along with radiologist Giovanni Di Chiro, and neurosurgeon Ayub Ommaya. Although the three centers worked independently of each other, there was considerable intellectual interaction at the personal level as well as through their respective publications.
Spinal angiography was pioneered by Doppman, Di Chiro and Ommaya.The visualization of feeding arteries and veins allowed for better understanding of the pathophysiology of spinal AVMs and modern classification of lesions.
Ommaya Grading System for Concussion
Grade 1 Confusion without amnesia (stunned)
Grade 2 Amnesia without coma
Grade 3 Coma lasting less than 6 hours (includes classic cerebral concussion, minor and moderate head injuries)
Grade 4 Coma lasting 6 to 24 hours (severe head injuries)
Grade 5 Coma lasting more than 24 hours (severe head injuries)
Grade 6 Coma, death within 24 hours (fatal head injuries)
Ommaya AK. Biomechanics of head injury: experimental aspects. In: Nahum AM, Melvin J, eds. Biomechanics of Trauma. Norwalk, CT: Appleton & Lange; 1985:245–269.
Ommaya Reservoir
An improvement over simple injections through a catheter is the use of the Ommaya reservoir, which can deliver intermittent bolus injections of chemotherapy to the tumor bed. The reservoir is implanted subcutaneously in the scalp and connected to an outlet catheter within the tumor bed. Agents can be injected percutaneously into the reservoir at various times and then delivered to the tumor by manual compression of the reservoir through the scalp. Thus, compared with an open catheter, the Ommaya reservoir reduces the risk of infection, although it does not allow for truly continuous drug delivery. The Ommaya reservoir has been extensively used for intratumoral therapy. Initial clinical trials with MTX as an intratumoral agent were performed in the late 1960s and early 1970s using either an intratumoral catheter or an Ommaya reservoir
ct scanner ref
Computerized axial tomography of the head: the EMI-scanner, a new device for direct examination of the brain "in vivo". Special article.
Surg Neurol. 1973 Jul;1(4):217-22.