by Edward R. Laws, Jr., MD
Thor Sundt as one of the major figures in the development of microsurgery of the cerebrovascular system. His contributions ranged from laboratory studies which determined the critical parameters of normal cerebral blood flow, to technical advances in the development of aneurysm clips and instrumentation, to conceptual advances in cerebral revascularization and the management of giant aneurysms.
Reflections upon the life of an individual who makes such a major impact in medical science often provide insights as to how such talent develops. Always bright and energetic, young Thor Sundt worked during high-school summers in the family construction business. He quickly learned surveying, elements of architectural planning, landscaping and practical building skills. His natural dexterity was sharpened by playing the violin, and his mental dexterity by the game of chess. He kept playing the violin intermittently, and he and I regularly played tennis and chess with a healthy competitive spirit that also characterized some of his scientific and surgical work.
Thor followed in the footsteps of two beloved uncles, and attended the US Military Academy at West Point. The undergraduate curriculum in engineering and the leadership skills developed there served him all his life. They ultimately were recognized by his designation as a Distinguished Graduate of West Point, and the Academy is his last resting place. "Duty, Honor, Country" can serve both a neurosurgeon and a warrior as principles of life and of professional endeavor.
Leadership developed further with combat experience in the Korean Conflict, where Thor was a decorated Company Commander. After the fighting, however, he became aware of other potential avenues for the development of his life's work. He left the military and was accepted to medical school at the University of Tennessee at Memphis. Early in his studies there, he focused on Neuroscience and found powerful and willing mentors in Drs. Eustace Semmes and Francis Murphey. The residency at U.T. provided enormous clinical material, the excitement of Murphey's work on carotid surgery, and a program that included a wonderful opportunity for experience in basic laboratory research. Thor did some of this research work in Memphis, where he developed and tested the clip-graft that bears his name, and some at the Mayo Clinic in the basic cerebrovascular research laboratory that he later was to direct for so many productive years at Rochester. This laboratory worked on problems in cerebral blood flow, mechanisms of stroke (embolic vs. hemodynamic), protection of the brain from stroke, cerebral vasospasm, the role of the sympathetic nervous system in cerebrovascular control, autoregulation of the blood flow of the brain, metabolism at pH, healing and repair of arteries after injury and surgical manipulation, and a variety of the related issues. In collaboration with Robert Anderson, novel instrumentation and techniques for neurosurgical investigations were developed, and are still in use.
Microsurgery was a basic principle of all Thor Sundt's work, and he helped develop both the concepts and the techniques in this field. In addition to the clip-graft, he developed the Sundt shunt for carotid surgery, and, with George Kees, a set of aneurysm clips and appliers, and microclips for AVM's. He pioneered methods of microvascular anastomosis and procedures such as the supratentorial revascularization of the arterial system after basilar thrombosis. The outcome of the bypass study was a disappointment and he continued to remain skeptical about the study and its conclusions.
Thor Sundt taught microneurosurgery to a large number of residents and fellows, and inspired many to try to emulate his skills and his dedication. Experience assisting Dr. Sundt with the surgery of vascular disease was not to be forgotten, and the dreaded "Head-Neck-Leg" procedure was part of the making of many a fine neurosurgical trainee.
Thor Sundt embodied the finest aspects of the development and evolution of microneurosurgery. His example and his many fine contributions are testimony to a great figure in the history of our specialty.