PEER-REVIEW REPORTS
Sofia Ionescu, the First Woman Neurosurgeon in the World
Alexandru-Vlad Ciurea1, Horatiu Alexandru Moisa1, Dumitru Mohan2
LEGACY
Key words
- Dumitru Bagdasar
- First woman neurosurgeon
- Harvey Cushing
- History of neurosurgery
- Romania
- Sofia Ionescu
- WFNS
From the 1“Carol Davila” University School of
Medicine, The National Center for Excellence in
Neurosurgery, Bagdasar Arseni Teaching Hospital,
Bucharest; and 2Department of Neurosurgery, University of
Oradea, Faculty of Medicine, Oradea, Romania
To whom correspondence should be addressed:
Horatiu Alexandru Moisa, M.D.
[E mail: horatiumoisa@yahoo.com]
Citation: World Neurosurg. (2013) 80, 5:650 653.
http://dx.doi.org/10.1016/j.wneu.2013.02.031
Journal homepage: www.WORLDNEUROSURGERY.org
Available online: www.sciencedirect.com
1878 8750/$ see front matter ª 2013 Published by Elsevier
Inc.
INTRODUCTION
As time passes, the privilege of stating that
one is the very first to have achieved
something, particularly in the field of
medicine, seems to be wearing thinner and
thinner. In a time when equality of sexes
was only something to aspire toward,
Doctor Sofia Ionescu (Figure 1), born Sofia
Ogrezeanu, became the very first female
neurosurgeon, with a career spanning more
than 47 years of devoted work, between 1943
and 1990.
Her status, although continuously
debated for more than three decades, was
finally acknowledged during the 13th World
Congress of the World Federation of
Neurosurgical Societies (WFNS) in
Morocco, in 2005, crowning an evolution
that could only be praised by the hundreds
of patients who are still alive due to her
wonderfully skilled hands (8). This official
nomination as the first woman neurosur-
geon was presented by Dr. Irina Ogrezeanu
and recognized by the president of the
Women in Neurosurgery Committee of the
WFNS, Yoko Kato. At this presentation the
audience included Prof. Edward Laws as
acting president of the WFNS at the time,
650 www.SCIENCEDIRECT.com
The authors present the activity of Mrs. Sofia Ionescu, the one female surgeon
who was nominated as the first woman neurosurgeon in the world. Sofia
Ionescu worked in the field of neurosurgery for 47 years, performing all the known
neurosurgical procedures of the time. She made herself known through her
incredible surgical skill and her enormous work power. Due to her incredible
modesty and workload, she never participated at international congresses or
manifestations. The nomination as first woman neurosurgery took place in Mar-
rakech, Morocco, during the 2005 WFNS Congress. Although some claim that
Diana Beck was the first woman neurosurgeon in the world, our theory suggests
otherwise. The first documented surgical intervention performed by Diana Beck
dates to 1952. Sofia Ionescu operated for the first time on a human brain as early
as 1944. Furthermore, Diana Beck’s actions surfaced in the year 1947, long after
the war had ended and Sofia Ionescu had become a neurosurgeon.
Prof. Jacques Brotchi who was the presi- desire to better prepare for neurology,
dent-elect of the WFNS, and Prof. Jose which she studied in her fifth year of
Martin Rodriguez (8). medical school, that made her choose
Sofia IonescueOgrezeanu was born in spending her summer internship in the
Falticeni, a small city located in the north neurosurgical unit of the “Central Hospital
east of a struggling Romania (Figures 2, 3, for mental, nervous and endocrine
and 4), in the year 1920, a time that bore the diseases” in Bucharest in 1943. This event
stamp of the First World War. Although her marked her first contact with “the golden
father’s wishes were for her to become an neurosurgical team,” led by Professor
educated young woman, who would know Dimitrie Bagdasar, the founder of the
how to sing, speak several languages Romanian Neurosurgical School, alongside
fluently, and bear children, she decided that his disciples Dr. Constantin Arseni and Dr.
she wanted more from life, following the Ionel Ionescu, who would later become
example of other doctors in her family. Sofia’s husband (3).
Thus, after attending the Girls’ Gymnasium Professor Dimitrie Bagdasar (1893e1946),
in Falticeni, she transferred to Bucharest to was a neurology specialist, for several years
the “Maria Brâncoveanu” Girls’ School, from he had trained in Professor Harvey Cush-
where she could apply to study medicine ing’s clinic in Boston at the Peter Bent
in the capital city. She attended the Faculty of Brigham Hospital between 1927 and 1929.
Human Medicine of Bucharest between 1939 He had newly founded neurosurgery as an
and 1945, a time providing the opportunity independent branch of medicine in south-
to study under great figures of medicine eastern Europe (7). In a filmed interview,
such as Francisc Rainer (anatomy), George Sofia Ionescu tells of that one decisive
Emil Palade (cell biology), Oscar Sager and moment that came to shape her entire future
Arthur Kreindler (neurology), Nicolae Cajal and the lives of the many she touched after
(pathology), Daniel Danielopolu (patho- first operating. It was under the supervision
physiology), Alfred Rusescu (pediatrics), of Professor D. Bagdasar, who was unable to
and Iacob Iacobovici (surgery). operate due to a wound on one of his fingers,
Her early years in the clinic were under that she performed her first surgery, saving
the influence of the Second World War the life of an 8-year-old comatose boy
whose casualties filled the beds of every with an extradural intracranial hematoma—
hospital and required all available hands. when no one else would even dare operate.
The war found her attending patients in the Professor Bagdasar had just discovered a
hospitals of her native town. It was her “diamond in the rough” and a great surgeon.
WORLD NEUROSURGERY, http://dx.doi.org/10.1016/j.wneu.2013.02.031
 PEER-REVIEW REPORTS
ALEXANDRU VLAD CIUREA ET AL. SOFIA IONESCU

specialist neurosurgeon, a statement in

the ongoing war with disease and death
that would toward the end of her life
culminate as chief of ward (2).
In her 25 years as chief of the Cerebral
Tumor Department and the 22 years that

LEGACY
followed as chief of the Spinal Pathology
Department, Dr. Sofia Ionescu found the
time to teach while always coming up with
creative solutions to the ongoing challenges
(4). One such account tells of an intervention
to release the pressure caused by a blockage
in the ventricular system (Figure 5). Having
read about a drainage system imagined by
a Norwegian scientist, she decided that she
had to take the risk and perform a premiere
surgery to save the life that lay in her hands.
As the nurse walked by with a tray of Foley
catheters, she felt that spark that encouraged
her to try. She carved a groove in the bone,
fixing the catheter between the cerebral
hemispheres and the meningeal sheath (5).
The patient lived.
The year 1970 found Dr. Sofia Ionescu
facing yet another interesting challenge, as
she was obligated to confirm the fact that she
truly was a neurosurgeon. Accompanying
one of her patients, a member of the French
Embassy in Bucharest, to Paris and Lyon, she
met a team of French doctors who were
astonished to discover that the woman in
front of them truly was a surgeon operating
on the human nervous system. Undergoing
the “gouge forceps test,” her hands
undoubtedly stated what their true mission
was, the callosity on her ring finger proved
Figure 1. Portrait of Sofia Ionescu.
once more that she was the only woman to

He asked the young student to remain on his

team.
Graduating in 1945, she married Dr.
Ionel Ionescu around the same period.
Her newlywed life had a strong connection
to the profession, bearing the marks of
self-sacrifice and devotion as one can
rarely observe. The young couple lived for
7 years in the hospital, ensuring perma-
nent watch in the emergency room. She
had no rest leave for more than 15 years,
and only 1 month maternity leave after her
second daughter was born. She herself
states that she had operated the day before
giving birth to her first child. “My children
had no mother. I was almost always tired,
I worked extra hours in the pediatric clinic
to supplement the family’s income” (9). Figure 2. Sofia Ionescu’s house in Falticeni.
The year 1954 marks her becoming a

WORLD NEUROSURGERY 80 [5]: 650 653, NOVEMBER 2013 www.WORLDNEUROSURGERY.org 651


ALEXANDRU VLAD CIUREA ET AL.
LEGACY
Figure 3. Sofia Ionescu’s bust in Falticeni.
operate on the human brain. Another
confirmation of this fact came in the form of
a request sent out by the Sheik Zayed bin
Sultan al Nahyan, from Abu Dhabi, who had
requested the urgent presence of a female
neurosurgeon for one of his wives due to
religious constraints that prevent male
physicians from consulting muslim women
(Figure 6) (9).
In between brain surgery in the morning,
operating on the spine in the afternoon,
being a wife and mother of two, Dr. Sofia
Ionescu found the time for research and
publishing, which was, as she amusingly
stated, done under a strict schedule,
between two and four AM “The fight I strove
against death, the final struggle of my
patients helped a great deal in strength-
ening my character.” As soon as 3 years after
obtaining her primary physician diploma,
she started writing at a rate of two or three
Figure 4. The Ogrezeanu House in Falticeni.
652 www.SCIENCEDIRECT.com
Figure 5. Dr. Sofia Ionescu during surgery.
articles per year, published both in her
country and abroad. Even after her retire-
ment, she continued with her writing, with
articles in Romanian medical journals.
Although many claim that the first woman
neurosurgeon in the world was Diana Beck,
Sofia Ionescu performed her first successful
surgery on a living human being in the year
1944 (1-5, 8, 9). Diana Beck’s activities
gained momentum only in 1947 when she
set up the neurosurgical unit at Frenchay
Hospital in Bristol before becoming
a consultant at The Middlesex Hospital in
London (6). All literature confirms that Sofia
Ionescu’s first documented surgery dates at
1944 while Diana Beck’s first documented
surgery dates at 1952 (6), secondly.
The interest in interacademic cooperation
resulted in numerous memberships—The
Romanian Academy of Medical Sciences,
Honorary Membership of The Romanian
Society of Neurosurgery, The Romanian
WORLD NEUROSURGERY, http://dx.doi.org/10.1016/j.wneu.2013.02.031
PEER-REVIEW REPORTS
SOFIA IONESCU
Society for History of Medicine. The prestige
surrounding her career could only be
acknowledged by a number of honorific
titles and diplomas, culminating with her
Decoration with the Star of the Republic
and her becoming a knight—this is the
highest distinction that could be granted to
a Romanian citizen. International approval
following the title of the first female neuro-
surgeon came only 1 year after, when the
World Health Organization declared her as
well as 65 other doctors as heroes who have
dedicated their lives to the profession.
But perhaps a greater role in the encour-
agement and moral support of this first lady
of neurosurgery was the appreciation of her
patients and those that knew her both as
a physician and as an individual. In 1946, the
last words of Professor Dimitrie Bagdasar to
his fellow neurosurgeons were not to let this
specialty die, but to continue to develop it in
the same spirit, united, in the same rhythm,

ALEXANDRU VLAD CIUREA ET AL.
Figure 6. Sofia Ionescu in Lebanon (en route for Abu Dhabi).
with the same passion and with the highest
of moral sense. Bearing such a heavy task,
Dr. Sofia Ionescu performed masterly, as
the words of Dr. Constantin Arseni (Figure 7)
stated in his first volume in collaboration,
Neurosurgical Diagnostic Elements, written in
1958: “To the distinguished surgeon, Mrs.
Dr. Sofia Ionescu-Ogrezeanu, with the
highest consideration.”
Guided by true and solid coordinates,
such as modesty, respect, and devotion, the
life of Dr. Sofia Ionescu is one great
achievement after another, something that is
rare to stumble on nowadays. Her deepest
regret, as she herself states, was not writing
her memoirs, for she had much to teach even
in her final years, her thoughts going out to
young neurosurgeons looking for more than
just technique and scientific details.
Sofia Ionescu, the first woman neuro-
Figure 7. Sofia Ionescu (right) and Prof. C.
surgeon in the world, passed away at 88
Arseni (center).
years in the spring of 2008, leaving behind
WORLD NEUROSURGERY 80 [5]: 650 653, NOVEMBER 2013
PEER-REVIEW REPORTS
SOFIA IONESCU
her the legacy of an exceptional destiny for
the history of modern neurosurgery.
We salute you Dr. Ionescu!
LEGACY
REFERENCES
1. Aldea H: Famous neurosurgeons [in Romanian].
Bucharest: Glasul Bucovinei Publishing House; 1993.
2. Arseni C, Aldea H: Milestones in the history of
Romanian neurosurgery [in Romanian]. Bucharest:
Romanian Academy Publishing House; 1988.
3. Arseni C, Ciurea AV: The history of Romanian
neurosurgery. Bucharest: Medical Publishing
House; 1981.
4. Ciurea AV: History of Romanian neurosurgery [in
Romanian]. Bucharest: Viata medicala romaneasca
publishing house; 1995.
5. Ciurea AV. Textbook of neurosurgery, vol. 1.
Bucharest: Romanian Medical Publishing House;
2010.
6. Glikes CE: An account of the life and achievements
of Miss Diana Beck, neurosurgeon (1902 1956).
Neurosurgery 3:738-742, 2008.
7. Greenblatt SH, Dagi TF, Epstein MD: A history of
neurosurgery. New York: Thieme Publishing; 1997.
8. Ogrezeanu I: Women in neurosurgery. Romania.
The 13th WFNS Congress, Marrakech, Morocco,
June 19 24, 2005. Oral presentation mentioned in
the abstract book of the Congress.
9. Simionescu R: Neodihna binelui. Neurochirurg
Sofia Ionescu. Bucharest: Atlas Publishing; 1998.
Conflict of interest statement: The authors declare that the
article content was composed in the absence of any
commercial or financial relationships that could be construed
as a potential conflict of interest.
Received 19 November 2012; accepted 5 February 2013;
published online 22 March 2013
Citation: World Neurosurg. (2013) 80, 5:650 653.
http://dx.doi.org/10.1016/j.wneu.2013.02.031
Journal homepage: www.WORLDNEUROSURGERY.org
Available online: www.sciencedirect.com
1878 8750/$ see front matter ª 2013 Published by Elsevier
Inc.
www.WORLDNEUROSURGERY.org 653