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Robert F. Spetzler
Robert F. Spetzler
Robert F. Spetzler
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Robert F. Spetzler (born 1944) is a neurosurgeon and the J.N. Harber Chairman Emeritus of Neurological Surgery and director emeritus of the Barrow Neurological Institute in Phoenix, Arizona.[1] He retired as an active neurosurgeon in July 2017.[2] He is also Professor of Surgery, Section of Neurosurgery, at the University of Arizona College of Medicine in Tucson, Arizona.

Key Information

Spetzler specialized in cerebrovascular disease and skull base tumors. Extremely prolific, he has published more than 580 articles and 180 book chapters and has co-edited multiple neurosurgical textbooks, including The Color Atlas of Microneurosurgery (2000). He retired from surgery in July 2019.

Biography

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Spetzler can be seen standing in the middle.

Spetzler was born in Stierhöfstetten (Oberscheinfeld, near Würzburg) in Germany to where his parents had been evacuated due to the Second World War. When he was 11, he moved to the United States with his parents. He performed spectacularly in the American school system, despite the fact his first language was German.[citation needed]

Spetzler received his Bachelor of Science degree in 1967 from Knox College in Galesburg, Illinois after attending a year of community college in Illinois. He spent a year at the Free University of Berlin, and then entered medical school at the Northwestern Medical School in Chicago in 1967, receiving his M.D. in 1971. He completed post-graduate training at Wesley Memorial Hospital–Northwestern and a residency in neurosurgery at the University of California, San Francisco,[1] training under Charles B. Wilson.[3] In 1983, Spetzler was named Chair of the Division of Neurological Surgery at Barrow Neurological Institute. He was named director in 1986.[citation needed]

Spetzler played a dominant role in the use of the standstill operation in treating large or dangerous cerebral aneurysms.[4] One notable application of this method occurred in 1991 when Spetzler successfully removed a large aneurysm in a 35-year-old American woman named Pam Reynolds. Prior to the operation proceeding, Reynolds was placed under general anesthesia, then had her eyes taped shut and a monitoring device placed in both of her ears. She was later induced into clinical death by Spetzler and his team, which was necessary for the operation to take place. Despite being clinically dead and under intense monitoring and medical observation whilst the procedure was ongoing, Reynolds claimed to have had a profound near-death experience in which she was able to accurately recall the sequence of events within the operating theater, the surgical instruments used, and the conversations that had taken place. In an interview that took place for a BBC documentary in 2002, Spetzler affirmed many of the observations that Pam had made, and later admitted that he had no explanation for them.[5] In February 2007, Spetzler performed his 5,000th aneurysm procedure.[4] He travels and lectures frequently on the most recent advances in neurosurgery. After 30 years at the Barrow, Spetzler retired in July 2019, with Michael T. Lawton as his successor.[2]

Awards

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Selected publications

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Scholia has a profile for Robert F. Spetzler (Q7344217).

Spetzler has written more than 300 articles and 180 book chapters, as well as co-editing multiple neurosurgical textbooks. A partial list is below:

Books

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  • Surgery of the Cerebellopontine Angle. Nicholas C. Bambakidis (Author), Cliff A. Megerian (Author), Robert F. Spetzler (Author). Pmph USA; 2009. ISBN 1-60795-001-4
  • Medicine, Miracles, and Manifestations: A Doctor's Journey Through the Worlds of Divine Intervention, Near-Death Experiences, and Universal Energy. John L. Turner (Author), Robert F. Spetzler (Foreword). Career Press; 2009. ISBN 1-60163-060-3
  • The Color Atlas of Microneurosurgery W. Koos (Author), Robert Spetzler (Author), Johannes Lang (Author), J. Zabramski (Author), Robert F. Spetzler (Author), Joseph M. Zabramski (Author). Thieme; 2000. ISBN 0-86577-780-2.
  • Pediatric Neurovascular Disease: Surgical, Endovascular and Medical Management. Michael Alexander (Editor), Robert Spetzler (Editor). Thieme; 2005. ISBN 1-58890-368-0

Articles

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  • Contralateral (July 2014). "surgical considerations and clinical outcomes in 31 consecutive cases. Zaidi HA, Chowdhry SA, Nakaji P, Abla AA, Spetzler RF". Neurosurgery. 75 (1): 80–6. doi:10.1227/NEU.0000000000000339. PMID 24618803.
  • Cavalcanti, DD; Albuquerque, FC; Silva, BF; Spetzler, RF; Preul, MC (March 2010). "The anatomy of the callosomarginal artery: applications to microsurgery and endovascular surgery". Neurosurgery. 66: 602–10. doi:10.1227/01.NEU.0000365003.25338.62. PMID 20124934.
  • Wait, SD; Abla, AA; Killory, BD; Starke, RM; Spetzler, RF; Nakaji, P (October 2010). "Safety of carotid endarterectomy while on clopidogrel (Plavix). Clinical article". J. Neurosurg. 113: 908–12. doi:10.3171/2009.12.JNS09707. PMID 20113164.
  • Sankar, T; Delaney, PM; Ryan, RW; et al. (February 2010). "Miniaturized handheld confocal microscopy for neurosurgery: results in an experimental glioblastoma model". Neurosurgery. 66: 410–7, discussion 417–8. doi:10.1227/01.NEU.0000365772.66324.6F. PMID 20087141.
  • Rigamonti, D; Hadley, MN; Drayer, BP; et al. (August 1988). "Cerebral cavernous malformations. Incidence and familial occurrence". N. Engl. J. Med. 319: 343–7. doi:10.1056/NEJM198808113190605. PMID 3393196.
  • Bruneau, M; Sauvageau, E; Nakaji, P; et al. (February 2010). "Preliminary personal experiences with the application of near-infrared indocyanine green videoangiography in extracranial vertebral artery surgery". Neurosurgery. 66: 305–11, discussion 311. doi:10.1227/01.NEU.0000363596.52283.65. PMID 20087130.
  • Pfisterer, WK; Nieman, RA; Scheck, AC; Coons, SW; Spetzler, RF; Preul, MC (January 2010). "Using ex vivo proton magnetic resonance spectroscopy to reveal associations between biochemical and biological features of meningiomas". Neurosurg Focus. 28: E12. doi:10.3171/2009.11.FOCUS09216. PMID 20043716.
  • Supracerebellar (February 2010). "surgical variants and clinical experience with 45 patients. de Oliveira JG, Lekovic GP, Safavi-Abbasi S, Reis CV, Hanel RA, Porter RW, Preul MC, Spetzler RF". Neurosurgery. 66 (2): 389–99. doi:10.1227/01.NEU.0000363702.67016.5D. PMID 20042987.

References

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Robert F. Spetzler

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Robert F. Spetzler is an American neurosurgeon renowned for his pioneering contributions to cerebrovascular , including the development of the Spetzler-Martin grading system for arteriovenous malformations (AVMs) and the hypothermic cardiac standstill technique for treating complex brain aneurysms. He served as President and CEO of (BNI) in , from 1986 until his retirement in July 2017, during which time he transformed the institution into a globally recognized center for neurological research and treatment, performing over 6,000 aneurysm surgeries and authoring more than 600 peer-reviewed articles and 200 book chapters. Born in 1944, Spetzler earned a B.S. in Biology and Chemistry cum laude from Knox College in , in 1967, followed by an M.D. from in 1971. He completed his residency at the , under Charles B. Wilson from 1972 to 1977, and received board certification from the American Board of Neurological Surgery in 1979. Early in his career, he held academic positions at as Assistant Professor from 1977 and Associate Professor from 1981 to 1983, before joining BNI in 1983 as the J.N. Harber Chair of Neurological Surgery. There, he became Director in 1985 and later expanded his leadership role, fostering interdisciplinary advancements in treating skull base tumors and vascular disorders. Spetzler's innovations have profoundly influenced neurosurgical practice, particularly in managing high-risk vascular lesions. The Spetzler-Martin scale, introduced in 1986, assesses AVM risk based on size, venous drainage pattern, and eloquent brain involvement, aiding surgical decision-making and predicting outcomes. His hypothermic cardiac standstill method, which induces profound cooling and temporary heart arrest to facilitate clipping, has enabled safer interventions for giant posterior circulation aneurysms that were previously inoperable. Among his numerous honors, he was the youngest Honored Guest of the Congress of Neurological Surgeons in 1994 at age 49 and the only two-time recipient when honored again in 2022, and received the Ralph Cloward Award in 2019 for lifetime achievement. Post-retirement, Spetzler holds emeritus positions at BNI and the College of Medicine, continuing to mentor and contribute to the field.

Early Life and Education

Childhood and Immigration

Robert F. Spetzler was born in 1944 in Stierhoefstetten, a small village in , amid the final months of . His early childhood was marked by the hardships of postwar Europe, including a near-fatal incident at age five when he contracted from a rusty nail during play. Rushed to a nearby university hospital by his parents, Spetzler received pioneering treatment with penicillin, an experience that profoundly shaped his worldview and ignited his fascination with . In 1953, at the age of nine, Spetzler's family immigrated to the , seeking better opportunities in the postwar era. They settled in , where young Spetzler faced the typical adjustments of an immigrant child, including learning English and navigating a new cultural landscape far removed from his rural German roots. These early challenges, though not extensively documented, underscored the resilience required to adapt to American life, laying a foundation for his future achievements. He became a naturalized U.S. citizen on July 16, 1965. Spetzler's family played a pivotal role in nurturing his budding interest in science and , particularly through their supportive response during his childhood illness. His father's to keep him alert during the harrowing car ride to the hospital and his mother's comforting presence amid painful episodes highlighted the human side of caregiving, influencing Spetzler's later emphasis on compassionate patient care. This personal encounter with healthcare, combined with the stability provided by his family after , steered him toward a scientific path without direct involvement from medical relatives.

Academic Training

Robert F. Spetzler attended Knox College in , from 1963 to 1967, majoring in biology and chemistry. During his undergraduate years, he earned honors in biology and received a to study for one year at the from 1965 to 1966, an experience that broadened his exposure to scientific inquiry. These pursuits in the life sciences, including coursework and independent study in biological principles, highlighted his early interest in mechanisms of health and disease, foreshadowing his eventual path into . In 1967, Spetzler graduated cum laude with a degree in and Chemistry, recognizing his strong academic performance across both disciplines. His family's emphasis on education and scientific curiosity further supported his commitment to these fields during this formative period.

Professional Training and Early Career

Medical School and Residency

Spetzler earned his degree from Knox College in 1967 before enrolling at School of Medicine (now the ), where he completed his medical education from 1967 to 1971 and received his degree. Following medical school, Spetzler undertook a surgical internship at Wesley Memorial Hospital, affiliated with in , from 1971 to 1972. Spetzler then pursued his neurosurgery residency at the (UCSF) from 1972 to 1977, training under the renowned Charles B. Wilson, who was then Professor and Chairman of the Department of Neurological Surgery. During the final year of his residency, he received a Trauma Fellowship from the , focusing on advanced management of traumatic injuries. In recognition of his clinical and academic excellence, Spetzler was awarded the Annual Resident Award at the 27th Annual Meeting of the Congress of Neurological Surgeons in 1977.

Initial Appointments

Following the completion of his neurosurgery residency at the in 1977, Robert F. Spetzler joined the Department of at School of Medicine in , , as an . In this role, which he held from 1977 to 1981, Spetzler began establishing his clinical and academic expertise in neurosurgery, contributing to patient care and while advancing his interest in complex vascular cases. In September 1979, Spetzler received board certification from the American Board of Neurological Surgery. In 1981, Spetzler was promoted to at , a position he maintained until 1983. During this period, he intensified his focus on cerebrovascular disorders, including the management of intracranial aneurysms, which became a cornerstone of his early scholarly work. His research emphasized surgical techniques for challenging vascular pathologies, reflecting the growing emphasis on microsurgical precision in at the time. Spetzler's initial publications during these appointments highlighted his emerging expertise in vascular . These contributions, often co-authored with colleagues, laid the groundwork for his later innovations and underscored his commitment to improving surgical approaches for aneurysmal .

Career and Leadership

Roles at Barrow Neurological Institute

In 1983, Robert F. Spetzler was recruited to the in , where he assumed the role of Chair of Neurological Surgery and the inaugural J.N. Harber Chair of Neurological Surgery. This appointment marked a pivotal step in his career, building on his prior academic position at . Spetzler's leadership trajectory at Barrow advanced rapidly. In 1986, he succeeded Dr. John R. Green as Director of the Barrow Neurological Institute, a position that encompassed oversight of its neurosurgical division and broader operations; he later expanded this to President and CEO, roles he maintained until 2017. Under Spetzler's direction, the institute underwent substantial expansion, including increases in clinical staff, research facilities, and specialized programs, transforming it from a regional facility into a globally recognized center for neurological care by the . This growth solidified Barrow's reputation for excellence in cerebrovascular and neurosurgical treatments, attracting international collaborations and patients.

Administrative Achievements

Under Spetzler's leadership as director starting in 1986, underwent a profound transformation from a regional facility into a globally recognized leader in , particularly through the expansion of its cerebrovascular programs in the . He prioritized clinical excellence and innovation, attracting top talent and patients worldwide, which elevated the institute's reputation for treating complex vascular disorders like aneurysms and arteriovenous malformations (AVMs). This growth positioned Barrow as a premier destination for neurological care, education, and research by the 1990s. A cornerstone of Spetzler's administrative impact was his commitment to , training over 200 neurosurgical residents and fellows who now lead programs at academic centers globally. This extensive talent pipeline strengthened the field by fostering expertise in advanced techniques and multidisciplinary approaches, with many protégés crediting his guidance for their professional success. His emphasis on rigorous expanded Barrow's residency program into the largest in the United States, ensuring a steady output of skilled neurosurgeons. Spetzler also drove significant fundraising and infrastructure initiatives that bolstered Barrow's capabilities. He oversaw the development of key facilities, including the $40 million in 1997, which advanced studies in neurobiology and related fields, and the 430,300-square-foot Robert F. Spetzler in 2006, the nation's largest dedicated . These efforts culminated in the establishment of specialized units like the Barrow and , dedicated to exploring the genetics and treatment of vascular malformations.

Scientific Contributions

Innovations in Cerebrovascular Surgery

Robert F. Spetzler played a pivotal role in advancing cerebrovascular surgery through the development and refinement of hypothermic circulatory arrest, also known as the standstill operation, during the 1980s. This technique involves inducing deep , complete circulatory arrest, and cerebral protection to provide a bloodless, motionless surgical field, enabling safer access to complex deep-seated lesions such as giant cerebral aneurysms and arteriovenous malformations (AVMs). Spetzler first applied this method in treating aneurysms, reporting successful outcomes in selected cases where conventional approaches were infeasible, with the procedure allowing precise clipping without excessive blood loss or brain swelling. Over subsequent years, he refined the protocol at , integrating it into routine practice for high-risk posterior circulation aneurysms and large AVMs, significantly reducing operative risks for lesions previously considered inoperable. Spetzler's surgical expertise is exemplified by his performance of over 6,000 clippings throughout his career, a volume unmatched by most neurosurgeons and reflective of ongoing refinements in microsurgical techniques. He reached his 5,000th clipping in 2007, marking a milestone in the evolution of management where hypothermic arrest was often employed for complex cases to enhance visibility and precision. These procedures incorporated advancements like skull-base approaches and temporary vessel occlusion, allowing for durable occlusion while preserving neurological function in patients with challenging anatomies. A landmark application of Spetzler's hypothermic circulatory arrest technique occurred in the 1991 surgery on patient Pam Reynolds, who underwent clipping of a giant under total metabolic standstill, with her body temperature lowered to 60°F (15.6°C) and activity halted to facilitate the procedure. This case, performed at , demonstrated the technique's utility in extreme scenarios and has since been referenced in discussions of near-death experiences due to Reynolds' reported veridical perceptions during the arrest phase.

Development of Assessment Tools

One of Robert F. Spetzler's most influential contributions to was the co-development of the Spetzler-Martin grading system in 1986, designed to predict the morbidity and mortality risks associated with surgical resection of intracranial arteriovenous malformations (AVMs). This scale evaluates three primary angiographic features: the size of the AVM nidus (scoring 1 point for lesions smaller than 3 cm, 2 points for 3–6 cm, and 3 points for larger than 6 cm), the eloquence of the brain location adjacent to the malformation (0 points for non-eloquent areas and 1 point for eloquent regions such as sensorimotor, visual, or language cortices), and the venous drainage pattern (0 points for superficial drainage only and 1 point for deep drainage involving the basal veins of Rosenthal or periventricular veins). The total score ranges from 1 to 5, with grades 1–2 indicating low risk, 3 intermediate, and 4–5 high risk, enabling surgeons to stratify cases and guide treatment decisions between observation, , , or open . Developed during his tenure at , the system emphasized simplicity and broad applicability to improve patient selection for high-risk procedures. Building on this framework, Spetzler extended assessment principles to spinal vascular malformations in the , contributing to early classifications that adapted cerebral criteria to the unique anatomy of spinal AVMs, which are rarer and often involve intradural or extradural components. In a 1995 chapter co-authored in Neurovascular Surgery, he outlined surgical treatment strategies for spinal AVMs, incorporating factors like lesion location (e.g., intramedullary versus extramedullary), feeding origins, and venous drainage to assess resectability and risks, laying groundwork for standardized of these less common entities. This work influenced subsequent refinements, such as the 2002 modified classification system for vascular lesions, which Spetzler co-proposed to categorize AVMs into extradural-intradural and intradural subtypes (further divided into intramedullary, intramedullary-extramedullary, and categories) based on , imaging, and intraoperative findings, facilitating risk stratification similar to the cerebral scale. The utility of these tools was validated through extensive clinical studies at , where Spetzler applied them in thousands of cases, demonstrating strong correlations between predicted and observed surgical outcomes, such as lower morbidity rates in low-grade AVMs (under 5% for grades 1–2) compared to high-grade lesions (over 20% for grades 4–5). Multicenter validations have confirmed the Spetzler-Martin scale's predictive power for neurological deficits. These assessments have profoundly shaped treatment paradigms, prioritizing multidisciplinary approaches for complex malformations while enhancing safety in Spetzler's own surgical series.

Research Output

Key Publications

Robert F. Spetzler has an extensive publication record, with more than 800 works to his name, including over 600 peer-reviewed articles in and related fields. His contributions emphasize cerebrovascular surgery, microsurgical techniques, and assessment methodologies for complex intracranial lesions. Among his most influential outputs are seminal articles that have shaped clinical practice and authoritative books that serve as visual and procedural references for neurosurgeons worldwide. One of Spetzler's landmark publications is the 1986 article "A proposed grading system for arteriovenous malformations," co-authored with Neil A. Martin and published in the Journal of Neurosurgery. This paper introduced the Spetzler-Martin grading scale, a tool that assesses the surgical risk of brain arteriovenous malformations (AVMs) based on three factors: size, pattern of venous drainage, and eloquence of adjacent tissue. The scale categorizes AVMs into grades I through V, with higher grades indicating greater operative risk, and has become the standard for preoperative planning and multidisciplinary decision-making in AVM management, cited over 4,000 times. Spetzler co-authored the Color Atlas of Microneurosurgery series (Thieme, 2000), a multi-volume work that provides a comprehensive visual guide to microsurgical techniques for intracranial vascular and tumor pathologies. Featuring over 2,000 high-resolution illustrations and intraoperative photographs, the atlas details anatomical microdissections, surgical approaches, and step-by-step procedures for and tumor resection, making it an essential resource for training and reference in microneurosurgery. Its emphasis on precision and innovation has influenced surgical education globally. In 2009, Spetzler served as co-editor of Surgery of the Cerebellopontine Angle (BC Decker), a definitive text on managing lesions in the posterior fossa, such as acoustic neuromas and meningiomas. The book integrates surgical atlases with clinical case studies, outlining translabyrinthine, retrosigmoid, and combined approaches while addressing complications like facial nerve preservation and cerebrospinal fluid leaks. It remains a gold standard for skull base surgeons due to its practical integration of neuro-otology and neurosurgery perspectives.

Editorial and Collaborative Works

Robert F. Spetzler has contributed extensively to neurosurgical literature through authorship of over 200 book chapters and co-editing of multiple textbooks, with particular emphasis on vascular neurosurgery. His chapters often address complex cerebrovascular conditions, providing detailed insights into surgical techniques and management strategies. Notably, Spetzler authored sections on vascular topics in various editions of Youmans and Winn Neurological Surgery, enhancing the comprehensive coverage of neurovascular disorders in this authoritative reference. In addition to his writing, Spetzler has held significant editorial leadership roles in prominent neurosurgical journals. He served on the editorial board of from 1986 onward, where he reviewed submissions on cerebrovascular topics, influencing the peer-review process and standards for publications in the field. He also acted as of Operative Techniques in Neurosurgery starting in 1998, guiding the journal's focus on practical surgical methodologies. Spetzler's collaborative efforts extended to international projects aimed at standardizing AVM management during the 2000s. Furthermore, as topic leader for cerebrovascular discussions at the World Federation of Neurosurgical Societies (WFNS) forums, he facilitated global consensus on AVM evaluation and intervention strategies. These initiatives built on his key publications by promoting unified approaches among international neurosurgical societies.

Awards and Recognition

Professional Honors

Robert F. Spetzler received the Annual Resident Award at the 27th Annual Meeting of the Congress of Neurological Surgeons in 1977, recognizing his outstanding contributions during his neurosurgical training. In 1994, Spetzler was selected as the Honored Guest of the Congress of Neurological Surgeons, becoming the youngest recipient of this prestigious honor at age 49, which acknowledged his emerging leadership and innovations in neurosurgery. He repeated this distinction in 2022, making him the only two-time Honored Guest in the organization's history and further highlighting his enduring impact on clinical excellence and research in cerebrovascular surgery. In 2019, Spetzler received the Ralph Cloward Award from the Western Neurosurgical Society for lifetime achievement in neurosurgery. Spetzler's technical prowess was celebrated with the 2021 AANS Cushing Award for Technical Excellence and Innovation in Neurosurgery, awarded by the American Association of Neurological Surgeons for his groundbreaking advancements in surgical techniques.

Institutional and Academic Awards

Robert F. Spetzler received an honorary degree from Knox College, his undergraduate , in 1994, recognizing his groundbreaking contributions to and medical science. This academic honor underscored his transition from student to a globally influential figure in cerebrovascular surgery, highlighting the institution's pride in his achievements since graduating cum laude in 1967. During his medical training, Spetzler was inducted into the Honor Medical Society, an elite academic recognition for excellence in medical scholarship, leadership, and professionalism, typically awarded to the top 10% of medical students. This distinction, earned at Medical School where he received his MD in 1971, marked his early promise in academic medicine and set the foundation for his subsequent research and clinical innovations. Spetzler also garnered institutional awards during his residency at the . That same year, during his final residency year, he was selected for a prestigious Trauma Fellowship funded by the , enabling advanced study in neurosurgical trauma management. Additionally, his research efforts earned First Prize in the American College of Surgeons Resident Essay Contest in 1983, affirming his contributions to surgical literature and technique. These academic and institutional accolades reflect Spetzler's rigorous scholarly path and the high regard in which his early work was held by leading medical bodies, paving the way for his leadership at .

References

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  2. https://www.barrowneuro.org/person/robert-spetzler-md/
  3. https://www.barrowneuro.org/about/news-and-articles/press-releases/dr-michael-lawton-to-succeed-dr-robert-spetzler-as-head-of-barrow/
  4. https://westnsurg.org/robert-spetzler/
  5. https://www.cns.org/meetings/past-honored-guests-detail/robert-f-spetzler
  6. https://pubmed.ncbi.nlm.nih.gov/3760956/
  7. https://www.barrowneuro.org/about/news-and-articles/doctors/dr-robert-f-spetzler-makes-neurosurgery-history-as-two-time-cns-honored-guest/
  8. https://www.ivybraintumorcenter.org/blog/its-personal-dr-robert-f-spetzler/
  9. https://eanscongress.org/robert-f-spetzler-md/
  10. https://cdn-links.lww.com/permalink/neu/d/neu_2023_01_12_striley_neu-d-23-00020_sdc1.pdf
  11. https://www.barrowneuro.org/about/history-of-the-barrow-neurological-institute/
  12. https://www.sciencedirect.com/science/article/abs/pii/S1878875010003621
  13. https://www.barrowneuro.org/for-physicians-researchers/research/research-programs-labs/cerebrovascular-and-stroke/barrow-aneurysm-and-avm-research-center/
  14. https://pubmed.ncbi.nlm.nih.gov/3373282/
  15. https://pubmed.ncbi.nlm.nih.gov/18695549/
  16. https://www.npr.org/2009/05/22/104397005/decoding-the-mystery-of-near-death-experiences
  17. https://www.equip.org/articles/did-pam-reynolds-have-a-near-death-experience/
  18. https://radiopaedia.org/articles/spetzler-martin-arteriovenous-malformation-grading-system-2?lang=us
  19. https://pubmed.ncbi.nlm.nih.gov/12450276/
  20. https://pubmed.ncbi.nlm.nih.gov/25251197/
  21. https://books.google.com/books?id=VFGnMIy9I-8C
  22. https://archive.org/details/youmansneurologi0000unse
  23. https://www.aans.org/annual-meeting/award-recipients/
  24. https://www.knox.edu/about-knox/our-history/honorary-degrees/honorary-degrees-1900-1999
  25. https://www.cns.org/Assets/a316bb35-e0c4-4535-9c95-154b19e1e3c0/636987989777670000/introduction58-pdf
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