Abstract

CASTANEDA LOPEZ, Gabriela  and  RODRIGUEZ DE ROMO, Ana Cecilia. María Cristina García-Sancho y Álvarez-Tostado: first female neurosurgeon in Latin America. Salud Ment [online]. 2010, vol.33, n.2, pp.111-121. ISSN 0185-3325.

Neurosurgery is one of the most complex branches of medicine. In most countries, a trained physician requires a minimum of five years of additional preparation to become a neurosurgeon. Though in modern times women have entered almost every area of medicine, the field of neurosurgery continues to be clearly male-dominated. In 2009, for example, the National Institute of Neurology and Neurosurgery, the most important institution in Mexico for the training of neurologists and neurosurgeons, had only one female physician registered to become a neurosurgeon, while in previous years the presence of women was almost null. Given this background, a study of the first woman neurosurgeon in Mexico and, in fact, all of Latin America, constitutes an attractive topic. This woman is María Cristina García-Sancho y Álvarez-Tostado, who began her brilliant career in the 1940's. García-Sancho y Álvarez-Tostado has a most dignified and pleasant demeanor, with expressive blue eyes and an appearance that belies her real age. Tall and thin, she possesses a natural beauty. Photographs show a very attractive woman. María Cristina García-Sancho y Álvarez-Tostado de Penichet (her married name) was born on May 22^nd 1919 in Guadalajara, Jalisco. Her parents were Luis García-Sancho and Ana Álvarez-Tostado Robledo. While still a young girl, her family had to move to Mexico City in search of a better future because of the difficult economic situation that reined in Guadalajara after the Mexican Revolution. The young María Cristina studied high school at the Colegio Motolinía and was then admitted to the School of Medicine at the UNAM (National Autonomous University of Mexico), where she belonged to the 1941-1947 generation of students, one made up of 85 women and 850 men. A brilliant student, her interest in neurology began almost from her first day at medical school. It was there that she began to really appreciate the wondrous nature of the human body in general and, above all, of the brain, and came to see the understanding of that organ as a true challenge. She graduated in 1947 with a thesis entitled The Effects of Cephalic-Cranial Trauma (La secuela del traumatismo encéfalo cráneano). Her thesis adviser was Mariano Vázquez, and her brilliant defense won a honorable mention. She went on to study her Master's and Ph.D. degrees in neurosurgery from 1949 to 1951, under the direction of Alfonso Asenjo Gómez, a prestigious, internationally known neurosurgeon at the Institute of Neurosurgery and Cerebral Research in Santiago de Chile (Instituto de Neurocirugía e Investigaciones Cerebrales). At that time, this institute was an obligatory reference in everything related to neuroscience, especially clinical medicine and surgery. This Chilean physician was a magnificent teacher and their academic relationship developed later into a solid friendship that lasted until his death. During her training, García-Sancho took courses on neurology, neuropathology, neuro-otology, neuro-ofthalmology, and neuroradiology. At the conclusion of her studies, she had acquired the knowledge and experience needed to perform neurosurgery. Once again, the Chilean government offered a fellowship for her to continue her studies, this time in Europe. So, she spent three months in Germany with Wilhelm Tönnis and Joachim Zülch, and visited several neurosurgery clinics, including the Hôtel-Dieu in Paris with Jacques Le Beau and Jean Tavernier, and Madrid's Institute of Neurosurgery with Sixto Obrador Alcalde. In Portugal, she visited the clinic of Egas Moniz, the inventor of angiography, at the Department of Neurology from the Coimbra University. In all, she was in Europe for over a year. After that period overseas, she returned to Mexico, where she first joined the staff of the La Raza Hospital for a few months. However, she was soon named to the position of Head of Neurosurgery Services at the National Institute of Oncology, where she attended from 1952 more than 63 000 patients and performed operations for pain control such as peripheral blocks, rhizotomies, cordotomies, topectomies and medial, radiotherapeutic and physical treatments. The maturing and consolidation of the Neurosurgery Service under her guidance soon led to publications, congresses, teaching, and the supervision of aspiring neurosurgeons, including such important figures as Mario Echegaray Naveda, Manuel Mandujano, Estela Mandujano, José Carlos Palacios Márquez, María Teresa Ramírez Ugalde, Ramón Cerón Uribe, C. Freigó, Manuel Montoya, Miguel Ángel Hernández Absalón, José Gutiérrez Cabrera, Amelia Cabrera, and Alfonso Peña Torres, the latter four at the Institute of Neurosurgery in Santiago. The experience she acquired in several surgical techniques designed to relieve pain and, more fundamentally, her interest in this topic, led García-Sancho to improve the cordotomy procedure while working in the United States with Irving Cooper, a distinguished neurosurgeon whose main interest was functional neurosurgery. Cordotomy is a procedure used in cases of intolerable pain that resist all other kinds of treatment. It involves sectioning the anterolateral cord of the medulla. Perfecting this technique was just one of García-Sancho's achievements and contributions to Mexican neurosurgery. In fact, the technique is known as «the García-Sancho One-step Bilateral Cordotomy», and she used it in more than 1600 cases at the National Institute of Oncology and at the Women's Hospital in cases of cancer. Earlier, the cordotomy was a two-step procedure, but the variant that García-Sancho introduced consisted in cutting the sensitive roots of the medulla in just one intervention: after identifying the anterior roots, a cut is made on the posterior part in the posteroanterior direction in the space between the exit of the posterior root and the emergence of the anterior root in the medulla. García-Sancho's studies of pain and her extensive experience in that field led her to write the book Pain: Diagnosis and Treatment (Dolor, diagnóstico y tratamiento; 1974), which she dedicated to her husband and daughter, and in which she explains such topics as the anatomical channels of pain, its origin, and pain in oncologic processes. In addition to this book, she has published articles in national and international journals, some of them in Neurocirugía, a journal founded by Asenjo. Though García-Sancho is known mainly for her contributions to the understanding and surgical treatment of pain, she is also well-versed and skilled in the use of arteriography, a technique she learned in Portugal at the service of its discoverer, Moniz. García-Sancho also successfully combined her professional career with family life. In April 1954, she married Manuel Penichet, an industrialist, and they had a daughter, María Cristina Penichet García-Sancho, now a practicing psychotherapist. Today, García-Sancho, a widow since 1999, also enjoys the love and achievements of her granddaughter, a lawyer, and grandson, a business administrator. Also worth mentioning is that she studied a second career: Law at the Women's University of Mexico, where she graduated in 1989 with a thesis entitled Current Laws on the Problem of Insemination and in Vitro Fertilization (Las leyes actuales frente al problema de la inseminación y fertilización in vitro). She is also a member -in some cases a founder- of several national and international scientific societies. García-Sancho was not only Mexico's first female neurosurgeon, but also the first in Latin America. She stood out in an especially complex branch of medicine, one dominated by men. Moreover, she perfected a technique that renowned neurologists like Martín, Spiller, Froeser, Asenjo and Le Beau had been performing since 1912. Though her gender made it difficult for her to aspire to certain positions, her other professional activities gave her the intellectual satisfaction and maturity that are so evident in her demeanor.

Keywords : Neurosurgery; Instituto de Neurociencias e Investigaciones Cerebrales of Chile; women in science.

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