Pedro Lylyk’s work and achievements in the neurosurgical field have spanned several decades, and range from a momentous intracranial stent placement in 1996, to leading the first in-human study of a novel hydrocephalus treatment in 2022—with more than 10,000 brain aneurysms and arteriovenous malformations (AVMs) treated in between. Since the mid-1980s, Lylyk has dedicated his career to the development and improvement of therapeutic options in endovascular neurosurgery, as well as the training of young physicians from all over the world. He is also currently the director and CEO of ENERI (Equipo de Neurocirugía y Radiología Intervencionista) and Clínica La Sagrada Familia in Buenos Aires, Argentina, in addition to several other titles and appointments. Here, Lylyk gives NeuroNews a window into his career and discusses how the field of neurosurgery has changed in this time.
What initially attracted you to medicine, and the field of neurosurgery specifically?
I wanted to be a doctor for as long as I can remember. I knew from the very beginning that neuroscience and the brain were so interesting, and that there was a lot to understand, develop and emerge. After finishing my residence in neurosurgery, I shared with my mentors the concept of treating diseases through minimally invasive therapy—an evolving technique at that time!
Who have your mentors been and how have they impacted your career?
My mentors were Raúl Carrea, who is a paediatric neurosurgeon, and Charlie Drake, in neurosurgery, Julio Castaño, a neurologist, and Fernando Viñuela in interventional neuroradiology. I have tried to combine the best of all of these fields in this new speciality. All of them were inspiring and generous teachers, not only in neurosciences, and they also showed exemplary leadership, ethics and commitment. I have been lucky to be able to learn from my friends and colleagues from all around the world, exchanging ideas and experiences, sharing specialist seminars, proctoring, observing cases, researching and taking part at numerous meetings, symposia, discussions and conferences.
You are recognised as having placed the first intracranial stent in 1996— could you describe the procedure, and how you gained this achievement?
I was performing a very difficult case of acute posterior inferior cerebellar artery (PICA) dissection and there was no other option. Luckily, our team included interventional cardiologists, with whom we discussed the emergency case, and we decided that we would give the patient a chance by implanting a coronary stent—to which the family agreed. This was in 1996 and the patient is perfect to this day.
How did your fellowship training in North America influence you as a neurosurgeon?
I did my neurosurgery fellowship at the Western Ontario University in London, Canada and the University of California, Los Angeles (UCLA) in Los Angeles, USA. To this day, I remember Charles Drake’s advice, telling me that endovascular neurosurgery would promise a bright future!
In your experience, how do neurosurgical practice and research differ in South America compared to other parts of the world?
Our experience in Latin America is very good. We have been trained in Europe and North America and, today, we train many people from a variety of different countries in Latin America. The current state of the medical education and available opportunities in Latin America face major challenges, however, due to a lack of resources, and the fact that funding and access are quite different depending on the given health system or country.
Why did you decide to develop an endovascular neurosurgery and interventional radiology training programme at your centre, and how successful have these programmes been?
Since Fernando Viñuela, and other young and enthusiastic neuroradiologists, had founded SILAN (Sociedad Iberolatinoamericana de Neurorradiología Diagnóstica y Terapéutica), I decided we should create our own centre—the International Center of Endovascular Training (ICET). The goal was to receive and teach Ibero-Latin American physicians for a period of at least one year, together with three other universities in Buenos Aires, as the training of doctors in interventional neuroradiology in Latin America was an imperative need. Today, we also receive people from several other countries, including China, India, Japan, and places in Europe. I am very proud and grateful to all of them.
What do you feel has been the most important development in the field of neurosurgery during your career?
There have been three particularly important milestones, in my opinion:
- The Guglielmi detachable coil (GDC), which was introduced in the 1990s and drove the endovascular treatment of brain aneurysms
- After this, intracranial stents, as a treatment for stenosis of the intracranial or carotid arteries
- More recently, flow diverters and intrasaccular flow disrupters have provided a new option for treating intracranial aneurysms
Also, today, we crucially have a better understanding of brain diseases and the best way to take care of these patients.
What is the most significant unmet need in neurosurgical care right now?
The field of interventional oncology has to evolve—this will be one of the biggest challenges to overcome in the near-future.
What is your proudest achievement in neurosurgery?
The early treatment of newborn patients with vein of Galen aneurysms (a rare form of AVM in which the embryonic precursor to a vein at the base of the brain dilates, causing too much blood to rush to the heart). My team and I have performed these treatments over the course of many years, with a challenging yet improved technique, at our centre in Buenos Aires.
Besides your own work, what is the most interesting piece of neurosurgery research you have seen in the past year?
Besides endovascular neurosurgery, the most interesting outlook for the future is the development of new techniques for non-vascular diseases like hydrocephalus by endovascular means. This is a new and exciting project that I am working on today with my colleagues Adel Malek and Karl Hellman from CereVasc and Tufts University (Somerville, USA). As the principal investigator for the first-in-human ETCHES I study, I have already published a case report detailing the first treatments of communicating hydrocephalus with the eShunt system (CereVasc) in the Journal of NeuroInterventional Surgery, and the first normal-pressure hydrocephalus patient was also recently treated with the device at Clínica La Sagrada Familia.
What advice would you give to people embarking on a career in neurosurgery?
Our field has been growing up very fast, but there are still many opportunities to learn and improve. The younger generations must study hard, and take advantage of many innovations and interactions between different fields, while the study of the anatomy, physiology and pathology is also very important. The new generation has to think out of the box in order to improve the quality of life of our patients as well.
What are your interests outside of the field of medicine?
Outside of medicine, my interests are the study of history, playing tennis, and travelling with my family—my wife, Sandra Boreisink, and my three wonderful children, Ivan, Pedro Nicolás and Natalia. Since my childhood, I have been a dancer in the Ukrainian ballet in Argentina and have ended up being its director. Today, I greatly enjoy opera and watching classical ballet at the Teatro Colón in Buenos Aires. As a Ukrainian descendent, I am also proud to be the honorary consul of Ukraine in Buenos Aires, and I have chaired the Argentine Central Ukraine Representation (RCU-Representación Central Ucrania) since 2011.
- Neurosurgeon, director and CEO, ENERI (Equipo de Neurocirugía y Radiología Intervencionista) and Clínica La Sagrada Familia, Buenos Aires, Argentina
- Chair of Neurosurgery and Hemodynamics, University of Buenos Aires (UBA)
- Professor and chair, Department of Vascular Medicine, Universidad del Salvador (USAL)
- Professor and chair of Endovascular Surgery, Universidad de Ciencias Sociales y Empresariales (UCES)
- MD, Faculty of Medicine, UBA
- Residency in Paediatric Neurosurgery, Ricardo Gutiérrez Children’s Hospital
- Fellowship in Diagnostic Neuroradiology, Therapeutic and Endovascular Neurosurgery, University of Western Ontario, London, Canada and University of California Los Angeles (UCLA), Los Angeles, USA
- 2009: Master of Neurosurgery, World Federation of Neurosurgical Societies (WFNS)
- 2011: “Outstanding Personality of Science”, legislature of Buenos Aires
- 2015: First Tribute to Men and Women of Health, Health Prize, UCES
- 2018: First non-Spanish doctor distinguished as honorary member, Official College of Physicians, La Coruña, Spain
Lylyk is also co-founder of the Cerebrovascular Research and Education Foundation (CREF) educational grant, which allows young physicians, technologists and nurses from around the world to attend the World Live Neurovascular Conference (WLNC)—the most intense and educative live case discussion platform that rotates around the world from one continent to another each year.