noviembre 28, 2021




WFNS Foundation has established a network of “Postgraduate Training Centers”, all with world-class neurosurgical excellence. Apart from teaching, they provide support to young fellows from developing countries including food & accommodation. 

One of our young pioneers (Dr. Thitikan -Violet- Wangapakul, Thailand) spent a fellowship period in TokyoWomen Medical University, Medical Center East, Japan, under Prof. Kasuya (Director of the center) direction. See the experience of  Violet and how this stay is contributing to her neurosurgical career when back to her country.

Dr. Thitikan Wangapakul

Can you tell us about yourself and your relationship with the WFNS Foundation?

I am from Yala, the Southern-most part of Thailand. I had completed my neurosurgical training in Ramathibodi Hospital, Bangkok 2 years ago.

At the end of my training, I had a great chance to enroll in WFNS’s fellowship program at Tokyo Women Medical University, Medical Center East.

Based on the initial idea of the WFNS Foundation to create a new generation of neurosurgeons who can operate with contemporary techniques globally, the first thing I kept in mind before I enrolled in this program was to see as much as I can. Learn the different techniques apart from what is routinely done in my country. I believe that the wider we see is the better we can operate. So it was a great chance to be exposed to different centers like TWMU-CE. So, I took this advantage to study as much as possible to adapt it to patients in my country.

Dr. Thitikan Wangapakul at the hospital after surgery

What are your daily activities?

A lot of activities run daily in TWMU-CE. Every morning I woke up early to join the morning conference with a lecture for Prof. Kasuya. Do the round after the conference and attend operations as an assistant. Prof. Kasuya loves microvascular decompression surgery. Here I saw a lot of MVD operations with transposition or interposition techniques. AMR was crucial monitoring for Hemifacial spasm surgery however it was rarely done in my country. Sometimes I was called by a Spine orthopaedist to assist spinal operations. Prof. provided me a microscope to practice chicken wing anastomosis which very worked. It resembles authentic vasculature which we can dissect and handle the soft tissue.

Not only MVD surgeries but I also had a chance to practice endoscopic surgeries which meant so much to me. I learned how to do endoscopic ICH removal using Neuroport and IVH removal using a flexible endoscope which was really a new thing to me. Nowadays I still use it in my practice. Apart from routine operations, I was assigned to teach medical students, junior residents, journal appraisal and attend several conferences in Tokyo. One of the most memorable was Tokyo-Shanghai Neurosurgical Forum Meeting which they collected some interesting cases to show.

Dr. Thitikan Wangapakul during endoscopic procedure

What are the aspects of Neurosurgery you have focused on?

What I focused on was the knowledge that I never knew before and it benefits my future patients. Additionally, some practices were new or different from current practices in my country. I always try to study something new and useful. For example; Flexible endoscope, Venous preserving technique, Retractor fewer techniques.

But not only surgical techniques, I’ve learned also how to behave like an elegant neurosurgeon. How to perform a delicate surgery as Japanese surgeons were very cautious about every little thing. How to contact patients. How to write e-mails and even how to join some presidential meetings. My feelings always are like home, working with my parents who are willing to teach me everything to grow up perfectly. Well, you may think that it is not a kind of educational thing but it really works!!

Dr. Thitikan Wangapakul during a complex spinal procedure

Could you share with our readers some usefull knowledge?

Of course, when I came back to Thailand. I started my work. Every time I perform retrosigmoid surgery, I know I have to preserve every vein, use only one retractor and place it like Prof. Kasuya always did. PICA aneurysms were the very first aneurysm that I can successfully clip. Every rectosigmoid operation seemed to be easier after I recall how he performed. Moreover, I started to work with a flexible endoscope where I can go through all the ventricles. I do Trans-Magendie for a biopsy of the small lymphoma in the 4th ventricle and it really works. Small opening without any brain retraction. I began to remove the clot in the ventricle. It was difficult at first but later it improved. Given a better result. I also have to thank Dr Koseki, one of the staff there, who was the first person who taught me how to use a flexible endoscope. Nowadays I frequently operate with flexible endoscopes. It was not easy though, Thanks Prof. Feletti additionally for being my consultant.

One case I faced when I was a first-year neurosurgeon and remind me of what Prof. Kasuya taught me was a woman with parasagittal meningioma at the premotor cortex. The tumour invaded the sinus completely from the imaging. However, Prof. always told me not to believe the picture because sometimes it is compressed and after we remove it will come back. Prof. is always serious about the vein. Every cortical vein should be preserved. In this case, I drilled the bone and the tumour was removed. a lot of collateral veins were developed and I try my best to preserve them all. However, I lost one of them. Cortex is another crucial issue. After I remove this tumour and left some which blend with the SMA bilaterally, the patient developed a typical akinetic mutism syndrome and it took almost a month before it subsided and she returned to normal function. Whether it was from the venous issue of cortical injury, it was really my good lesson to be careful about both of them.

Dr. Thitikan Wangapakul at the lab with some colleagues

How was your experience as a teacher?

Chicken wing anastomosis was one of the good things I learned from there. I prefer this to other artificial vessels because of its textures which resemble an authentic vessel the most. I always practiced chicken wing anastomosis in my free time when I was there. I think it was cheap and easy to find in many markets or convenience stores. Much better than expensive artificial vessels.

So when I went to National Taipei University Hospital last year I have a chance to teach chicken wing anastomosis to the resident there and some of my junior residents in Thailand also.

Dr. Thitikan Wangapakul at the hospital

What is your future goal?

I like tumor surgery. Both microscopic and endoscopic. I plan to continue my professional in this area. Thailand has hundreds of Neurosurgeons working now, many of them are great especially my teachers and my senior’s colleges. Future aspects of Thai neurosurgeons are moving toward this spinning world. My seniors, my colleges are trying to make an excellent practice in my country. However, new knowledge is launched every day which we have to catch on the trend of this world. I may not be the best but I would try my best to study and give back a better neurosurgical practice to patients in my country. I always wish that it would be my very pleasure if my movement can contribute to the future movement of Thai neurosurgery. Even it is a very small part though.

Dr. Thitikan Wangapakul at the hospital

How do you feel about being part of the WFNS Foundation?

I would like to thanks WFNS Foundation, Prof. Miguel, Prof. Kasuya, and everyone who taught me to become a better neurosurgeon. Please keep on this project. I believe there are many young neurosurgeons over this world who need a chance to study. Thanks to my teachers who always support me for my unlimited learning. It is still a long road to go.

The more we become professional, the more it benefits our patients.

«I’ve learned how to behave like an elegant neurosurgeon. How to perform a delicate surgery as Japanese surgeons are very cautious about every little thing»