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Pierre Lasjaunias has died. It is difficult to describe the great sorrow felt by all those who knew him and the grief we shall continue to feel for a long time to come. We all cherish many memories. Pierre had been a brother to me for the past thirty years, the person with whom I shared the dreams and hard work entailed in trying to build a new branch of medicine. Ours was a deep friendship and his loss has left a wound that will never heal. But there are many of us who did not know Pierre well and it is for them that Luc Picard and Georges Rodesch have written the two tributes published here. They are the words of two other people who were very close to Pierre and they present two different yet complementary viewpoints on Lasjaunias' multifaceted life. The tributes are published with sincere thanks to both authors for having conveyed so well the feelings of all those who knew and loved Pierre.
Pierre Lasjaunias died suddenly on 1st July 2008 in between attending the working meetings of the Executive Committee of the European Society of Neuroradiology that were being held in Freiburg (Germany) along with the European Board of Neuroradiology, and the Executive Committee of the World Federation of Neuroradiological Societies which precedes the annual course of Interventional Neuroradiology organized in Zurich (Switzerland) by Professor Anton Valavanis. The news of his death caused stupor and dismay among the entire international neuroradiology community for the loss of so exceptional an individual as Pierre Lasjaunias.
Pierre Lasjaunias was born on 15th July 1948 in Paris. After his secondary studies, he attended medical school in Paris between 1968 and 1975, at the same time climbing up through the ranks of the anatomy laboratory where he was successively monitor, assistant and head of research. Appointed a specialist in radiology in 1983, Pierre was one of the first to successfully make a solid link between radiology and anatomy, the discipline he excelled in as a teacher and in which he was made professor in 1989. Even as a student, he was passionate about the nervous system, choosing to study vascular neuroradiology under the direction of Dr Jacqueline Vignaud, head of the radiology department at the Fondation Rothschild in Paris. At that time, France was an international hub in the development of a new specialty (to treat lesions that were cervicofacial, cranioencephalic as well as of spinal origin through an endovascular pathway. It was René Djindjian, who as a young neuropsychiatrist at Lariboisière Hospital, Paris pioneered the very first techniques for the embolization of these arteriovenous malformations between 1960 and 1970. Progressively, a very dynamic school grew up around him, essentially composed of young French postgraduate students fascinated by this field. It was a specialty in the process of being created by them and with them, and which eventually developed into interventional neuroradiology.
Though younger than many of his colleagues, Pierre Lasjaunias rapidly became part of this group, participating in the first meeting of the international think-tank on interventional neuroradiology which brought together fourteen of the best specialists in Santa Barbara, California in 1980. The group, which called itself the WIN (Working Group in Interventional Neuroradiology), met again the following year in Salt Lake City and subsequently before continuing every year from 1982 to date at Val d'Isère in France under my direction. An untiring and active participant in these meetings, Pierre Lasjaunias set up a teaching seminar called ABC (Anatomy, Biology and Clinical correlations) at Bicêtre Hospital in 1991 and which eventually merged with the annual WIN meeting in Val d'Isère in 1996. Thus ABC/WIN was born, bringing together an increasing number of doctors interested in a more global approach to disease that went beyond anatomical radiology to include physiopathology, biochemical issues, genetics, etc. Directing the vascular neuroradiology section at Bicêtre Hospital since 1987, Pierre was appointed Head of the Neuroradiology Department in 1998 with the retirement of his friend and mentor, Professor Dominique Doyon.
Pierre's was a true vocation. He was a dedicated doctor, clinician and therapist devoted to treating the sick, especially children - patients came from all over the world, drawn by his outstanding professional and human qualities. Progressively he acquired a unique experience in the treatment of certain rare pathologies, such as vein of Galen aneurysms or pediatric spinal AV malformations. Surrounded by his loyal collaborators, Georges Rodesch and Hortensia Alvarez, Pierre Lasjaunias created a veritable international academy: he was appointed with the distinction of his being named visiting professor in London, Berlin, New York and Toronto. This further allowed him to widen his field of experience to an ever increasing number of particularly rare diseases.
Well aware that diagnostic and interventional neuroradiology cannot exist in a vacuum, Pierre Lasjaunias was one of the rare specialists to believe that the only logical solution permitting real development of the specialty was for neuroradiology to become an integral part of the general neurosciences. This idea was behind his becoming Director of the "Head and Neck" Division of Bicêtre Hospital in 2007, a heavy responsibility and a completely new one. Part of the current French hospital reform program, his choice had been carefully prepared in advance, since, starting as early as 1992, Pierre Lasjaunias had added to his vast medical knowledge and experience by following courses on hospital management offered by the Paris hospital system.
Pierre Lasjaunias was able to realise his goal thanks to the many qualities rarely associated at one and the same time in a single individual. Gifted and brilliant, was an unquestioned leader in world neuroradiology. Throughout his life he never ceased to reconsider his ideas, elaborating new concepts based on his remarkable knowledge of embryology and anatomy, challenging other specialists to follow, always demonstrating a rare nd creative activity. He was driven by a powerful desire to fully understand that pushed him to reflection; deepening and constructing his theories and allowing for progress in not only understanding different pathologies, but improving their treatment as well. One of his last articles that appeared in Stroke was entitled "Cerebral Proliferative Angiopathy". It is the result of long years of clinical observation, , numerous personal reflections as well as discussions with colleagues, through which Pierre Lasjaunias isolated a totally new entity permitting him to differentiate between the classic forms of "Brain AVMs".
Pierre Lasjaunias did not keep his immense learning for himself, but was animated by a desire to share this knowledge with others. He really enjoyed sharing ideas. It was also what led to his many books written in collaboration with his loyal friends Alex Berenstein and Karel TerBrugge. These books now serve as a clear reference in the field, and are considered veritable "bibles". Pierre's drive to disseminate knowledge led him in 1995 to found the journal Interventional Neuroradiology in collaboration with Marco Leonardi and several friends. This journal, which since its creation he directed as Editor-in-Chief, became a reference as well.
All that he read, wrote and assimilated show that Pierre had a profound and vast knowledge which allowed him to recognize and understand particularly rare anomalies and anatomic variants. He was regularly consulted on very difficult cases and his unique, intricate understanding of embryology and microanatomic vasculature meant that many sought his advice. Given his openness Pierre found it difficult to understand why ideas that were already known were so often "re-discovered", frequently in the event of complications; a fact which is unfortunately so common in medicine. An airplane pilot, Pierre had perfectly assimilated the rigorous methods used in aviation to ensure safety, despite inevitable human errors. Armed with this knowledge, he often sought to make his medical colleagues understand that the idea of "risk management" should always follow the same exacting and identical rules and order. This "visionary" idea would soon take hold in France, where surgical procedures are now often accompanied by the "checklist" system.
Pierre profoundly loved teaching, and he left his mark on those courses in which he participated, founded, or mentored. Whether a basic first-year science course for medical students or a top-level specialist conference, Pierre Lasjaunias prepared all his presentations with equal dedication, often working through the night and up until the last minute, driven by a desire to perfect his message to the utmost. The recognition of his students is outstanding proof of this. The list of all the classes he created or contributed to with other colleagues extends far beyond the frontiers of France. The European Course in Neuroradiology, started in 1984 and radically modified in 2002, mobilized - once again - much of his energy during these last months. He wished to take on board all developments in this field, particularly in relation to teaching interventional neuroradiology for which he led many international seminars. He wanted to determine, with the precision of a watchmaker, the multiple parameters one needs to take into account to prepare and correctly "construct neurointerventionalists", fully prepared to face the most difficult situations without reserve. In 1999, he created along with the Universities of Paris Sud and Mahidol in Bangkok, the master level "International Diploma in Neurovascular Diseases" which he organized in Chiang Mai, Thailand so that Asian Rim doctors, neuroradiologists, neurosurgeons and neurologists could have the opportunity of receiving this unique training education. Such was the success of this program, that very soon the course attracted doctors from all over the world, all wishing to learn from education aimed at content and efficiency.
Pierre was well aware that the development of such a specialty required solid support from international scientific societies. For this reason in 1990 at Val d'lsère, he actively participated in the creation of the "World Federation of Interventional and Therapeutic Neuroradiology" of which he was the first General Secretary and, since 2007, President. Convinced of the need to preserve close links between diagnostic and therapeutic neuroradiology, Pierre he was also one of the founding members of the "World Federation of Neuroradiological Societies" where he led several committees, and was a member of the Executive Committee. During the last few years, he dedicated much of his time to developing relations between the different divisions of neurology, neurosurgery and radiology within the "European Union of Medical Specialists" (UEMS), in order to introduce, and finally have accepted, the specificity of neuroradiology. It is largely due to his efforts that the principle of neuroradiology as a sector within the discipline of radiology is now accepted. The official recognition of this medical event was initially planned for mid-July 2008, but has now been delayed until the beginning of September 2008 due to problems of scheduling. Without a doubt all of European neuroradiology owes him immense gratitude.
Pivotal to all the structures and scientific societies in which he participated, he insisted constantly on the need for an organized ethical reflection to ensure the highest quality of care and accessibility regardless of financial status. We frequently discussed the various ethical problems generated by the extremely technical nature of our practice, and by the indispensable relation we have with industry. Very rapidly, Pierre was appointed national expert at the French Supreme Court of Appeal: not surprisingly he took his various missions of expertise with a scrupulous and professional honesty, always determined to truly understand the reactions of all parties concerned.
Pierre Lasjaunias always looked towards the future. Several days before his death, we worked at length together to establish the structure of the new version of ABC-WIN which will continue in January 2009. When we had finished, very happy with the decisions we had - once again - taken in complete agreement, Pierre gave me an attentive look, with that very concentrated expression he had when has was speaking from the heart, and said "Luc, you see, I still have so many projects I would like to develop and I am happy that, even though I may no longer have an official mandate to do them, I still feel capable of making them succeed."
It was this mix of qualities and his untiring dynamism that allowed Pierre Lasjaunias to create, among other masterpieces, pediatric interventional neuroradiology, which has been made a reality in his own department, renowned worldwide and recently enriched with expertise in the domain of rare neurovascular diseases. He had every intention of further developing this direction of research with his young team of collaborators of which he was so proud.
Intelligence cannot flourish unless it is enriched by sensitivity. Pierre's nature was obvious to all who knew him. It was surely the source of his immense generosity and his permanent concern to share and communicate with others. This generosity was not only applied, as you might imagine, uniquely to professional concerns. During the Symposium Neuroradiologicum in Paris, whose organization he freely worked on for many years, we together chose the slogan "Nothing that is human is foreign to us". This slogan is fully Pierre Lasjaunias, and stands as a witness to his constant philosophical and cultural quests. He was, among other things, passionate about Asian art, and never ceased to widen his knowledge on the topic.
The aesthetic of Pierre Lasjaunias was an aesthetic of life. His was a deep-rooted ethic that underpinned all his actions, professional or otherwise. However it is difficult to speak of Pierre Lasjaunias without talking about those he held most dear. Never, in all the many trips we took together, no matter how distant they might be, neither his heart, nor his thoughts were ever far from those he cherished most: his wife Pascale and their three daughters Estelle, Aude and Coline, with whom we share, affectionately, our profound sadness.
International neuroradiology has lost one of its most brilliant leaders. During the memorial ceremony organized at Bicêtre Hospital, the many colleagues and true friends from throughout the world unanimously expressed, not only their deep emotion, but also their respect and affection for a great master. All those who knew Pierre Lasjaunias had the rare opportunity of knowing a human being with immense qualities, a man inspired by an incredible energy which made him the extraordinary individual that we will always continue to love and admire.
It seems inconceivable that Pierre has gone, that his boundless energy is no longer.
On 1st July 2008, however, at 59 years of age, his heart brutally stopped beating. His death caused profound emotion and disarray throughout the world: neuroradiology went into mourning, and all of the neurosciences have been afflicted. On 5th July 2008 a ceremony was held at Bicêtre Hospital in tribute to the doctor, man and friend. There were no frontiers on that day, with representatives from around the world, some just for a few hours of simple quiet presence, to share their pain, and to thank Pierre for what he was.
Pierre Lasjaunias was born on 15th July 1948 and started his medical studies in 1968. Early on he demonstrated an interest in the nervous system and he was impassioned by the study of its vascularization. He was fortunate enough to meet Doctor Jacqueline Vignaud, Head of the Department of Neuroradiology of Foundation Rothschild in Paris, who rapidly realized the potential of this young student, and allowed him to develop and nurture his intellectual capacities to the full. In 1975, he published his first article as first author on the vascularization of the orbit and its radio-anatomical correlation. This was the start of a long and impressive list of more than 280 peer-reviewed scientific publications. Writing was always Pierre's passion. It was never self-centred focusing on his personal successes, but rather writing to share his team's experience aiming at the diffusion of knowledge. Pierre's experience and knowledge was vast, supported by a thorough understanding of embryology and anatomy. The conjunction of these qualities in a single person made Pierre the one to turn to when a patient file became particularly challenging, or an anatomical variation perplexing. Pierre provided the solutions, clearly and without doubt. And if they appeared still complex to us, it was because our knowledge still lacked further basic knowledge. We then sought further solutions in the many books he wrote in collaboration with his faithful friends and colleagues, Alex Berenstein and Karel Terbrugge. How these books frightened us initially, seeming beyond our intellectual range! Pierre would then explain how to understand them as long as we were willing to make the effort to come prepared with an openness to learn a new language. Once familiar with them, we grew to love them, and the books became essential to us. With Pierre, expectations were always high, yet never unattainable. He expected us to always try to exceed our abilities.
Professor of Anatomy, Head of the Department of Neuroradiology and Coordinator of the Head and Neck Section of the Bicêtre Hospital, Co-founder of the European Course of Neuroradiology (ECNR) and of the World Federation of Interventional and Therapeutic Neuroradiology (WFTIN) of which he was President at the time of his death, Member of the Executive Committee of the World Federation of Neuroradiological Societies, Director of the International Diploma in Neurovascular Diseases in Chiang Mai, Thailand, which he developed jointly between Paris Sud and Mahidol Universities (Bangkok, Thailand), Initiator of the ABC course (Anatomy-BiologyClinical Correlations) held initially in Bicêtre, and subsequently integrated with the Working group in Interventional Neuroradiology (WIN) of Professor Luc Picard thereby creating the ABC-WIN seminars which were held annually in Val d'Isère, co-founder and Editor-in-Chief of the journal Interventional Neuroradiology, Member responsible for Neuroradiology at the European Union of Medical Specialists (EUMS), National Expert at the French Supreme Court of Appeal, Pierre, because of his dynamism, was on all frontiers of combat. Rare are those men to have engaged so much in their medical specialty, founding, nurturing and developing it to help it become an accepted and recognized discipline. He was one of the first interventional neuroradiologists to take a keen interest in pediatric vascular pathology, and to recognize its specificities. The child for him was not a small adult but a patient in his own right. Pierre therefore built a novel and accurate model that would apply to and distinguish the newborn baby, infant, child and teenager. The Department of Interventional Neuroradiology of Bicêtre established itself under his direction at international level as a centre of excellence for the treatment of pediatric vascular malformations. All pediatricians, neurosurgeons or pediatric anesthetists dealing with patients with cerebral or spinal cord arteriovenous malformations, or with the rare vascular malformations of the Vein of Galen are indebted to Pierre Lasjaunias, who understood this latter affection better than anybody else. He established the standards of care for responsible management of this disease, saving a number of otherwise doomed children.
Pierre had a passion for teaching and sharing. The many doctors who rotated through his department were marked by his great generosity and the manner he shared his vast knowledge. If it is often said that "a good school is a school that spreads itself". Without a doubt, through the international network set up around him, Pierre did create a true school of quality whose pupils feel proud to belong to.
His teachings extended beyond the strict framework of neuroradiological knowledge and took aim at the ethics of medical practice. Thus, always concerned with the training of young interventional neuroradiologists, Pierre worked within the framework of the WFITN to create a foundation of courses associating the already existing teachings into a cohesive framework so that each young doctor eager to practise this specialty could acquire the best theoretical and practical knowledge allowing him to deal, in an optimal way, with all the patients entrusted to him.
To reduce Pierre Lasjaunias to his strict stature of doctor would not do him justice. Impassioned by the South Asian countries, or by Yemen, where he had done his military service and which had influenced him so much, Pierre had developed a keen and knowledgeable interest and taste in Asian art. To accompany Pierre to seek for rare masterpieces in Thailand, China or Japan was a memorable experience visiting shops, antique dealers or markets. His enthusiasm for an art work in his hands would suddenly make it acquire a soul...
A rich and enriching personality for all those who were close to him, Pierre leaves behind his wife Pascale, and their three daughters Estelle, Aude and Coline. We are grateful to them for allowing us, often at their own cost, to share this exceptional husband and father.
We must thank Pierre Lasjaunias for what he taught us all wherever we came from. Master and mentor for many among us, friend for the luckiest, Pierre overcame the difficulties of interventional neuroradiology and changed them. He managed to transform a subject area considered difficult and arid into a fundamental cornerstone required for the good practice of our specialty. He fired us with the desire and the need to know.
Thinking about him reminds me of an old medieval story about a wayfarer who one day came across a stonebreaker. "I have a difficult life" said the man, "Exposed to the elements, my life and work is hard". A little further, the wayfarer met another stonebreaker. "It is a hard trade", said the latter. "but it is good work. I meet people, I see the world go by, and I don't complain". Carrying on his road, the wayfarer met a third stonebreaker and stopped to talk to him about his daily difficulties and hard work, and the happiness and satisfaction that his work must generate. The third stonebreaker then looked him in the eyes and said "All that you say is true. but I build cathedrals".
Yes, Pierre Lasjaunias also built cathedrals.
Mon cher Pierre, C'est bien la première fois que tu nous fais à tous du mal C'est bien la première fois que tu n'es pas là quand on a besoin de toi
