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R. Manaças etal.
Lisbon—Hospital de Egas Moniz (Cruz Maurício), Coimbra—Centro Hospitalar de
Coimbra (Faria Pais), and Porto—Hospital de Santo António (Paulo Mendo and
Almeida Pinto). This signicant leap contributed to the growing activity in hospitals, and the teaching of neuroradiology began in Central Hospitals. By 1982, there
were three centers in Lisbon, two in Coimbra, and two in Porto, all with fully staffed
neuroradiology departments comprising Heads of Service, Senior Consultants,
Hospital Assistants, and Specialty Fellows.
Between these two phases, the neuroradiologic techniques available at the time
using uoroscopy—namely angiography, pneumoencephalography, ventriculography, and myelography—were performed in Portuguese hospitals primarily by neurosurgeons (neurologists also in Oporto).
In the 1990s, neuroradiology services or units expanded to ve more hospitals in
the National Health Care System: one in the north (Braga—led by Jaime Rocha),
two on the outskirts of Porto (V.N. de Gaia—led by José Rocha Melo (1996) and
later (1997) Matosinhos—led by José Rocha Melo) and two on the outskirts of
Lisbon (Almada—led by Augusto Goulão, a former President of SPNR, and
Amadora/Sintra—led by Rui Manaças, also a former President of SPNR).
The 1990s also saw the widespread adoption of MRI in diagnosing neurological
and neurosurgical diseases. It is noteworthy that, as with CT in the 1980s, it was
private initiatives by medical enterprises that facilitated patients’ access to this thenrevolutionary imaging technology. The dedication of many professionals led to the
pioneering establishment of RM Caselas in Lisbon (Cruz Maurício, Eduardo
Medina, Augusto Goulão, among others), SMIC in Porto (Almeida Pinto, Moreira
Maia, Romeu Cruz, among others), and IMACENTRO and DIATOM in Coimbra
(Faria Pais, Sousa Fernandes, among others). At the turn of the millennium, the
Portuguese neuroradiology community had about 100 specialists; today, that number has grown to more than 250.
The rst decade of this millennium saw the consolidation of Neuroradiology,
with expanded diagnostic capabilities (most large centers now have two MRI
machines and three CT scanners) and a growing focus on Interventional
Neuroradiology.
In the North, four major hospitals have closely followed the growth of Neurology
and Neurosurgery: two in Porto (the University Hospital Center of Porto, including
the historic Hospital de Santo António, and the University Hospital Center of São
João), one in Braga (also a University Hospital), and another in Vila Nova de Gaia.
In Porto’s neuroradiology history, the key institutions are Hospital de Santo
António and Hospital de São João. The former is considered the cradle of Portuguese
Neuroradiology, where in the 1960s Paulo Mendo, one of the rst Portuguese neuroradiologists, who started as Dr. Corino de Andrade’s neurology fellow, was oriented by him to create the Neuroradiology Laboratory—the foundation of the rst
neuroradiology department in a public hospital in Portugal. Subsequent department
heads in Santo António included José de Almeida Pinto, Romeu Cruz, and currently,
João Xavier. In 2007, this hospital became part of the Porto Hospital and University
Centre, incorporating the Maria Pia Paediatric Hospital and the Júlio Dinis Maternity
15 A Brief History ofPortuguese Neuroradiology: TheLast 30Years
149
Hospital, followed by the Joaquim Urbano Psychiatric Hospital and the Dr. Jacinto
Magalhães Medical Genetics Center in 2011.
Several key milestones in neuroradiology in northern Portugal are attributed to
this group at Santo António: the installation of the rst public hospital CT scanner
in 1983, the rst digital subtraction angiography (DSA) in 1994, the rst cerebral
aneurysm treated with GDC coils in 1995, the rst intra-arterial thrombolysis in
acute stroke in 1996, and the rst mechanical thrombectomy in 2008. The 50th
anniversary of the Neuroradiology Service at Hospital de Santo António was marked
in 2016 with an international symposium, the “Oporto Neuroradiology 50th
Anniversary International Symposium,” and the publication of a commemorative
book, 50years—50 cases... and a few more from our friends. In 2018, the service
published another book, Diagnostic and Therapeutic Neuroradiology: A Case-
Based Guide to Good Practice (João Xavier, Cristina Vasconcelos, Cristina Ramos,
editors, Springer International Publishing AG, Cham, Switzerland, 2018).
At São João Hospital, neuroradiology began in the late 1960s under Joaquim
Cruz as part of the neurosurgery service. By the early 1980s, with the advent of CT
scanning, neuroradiology was separated from Neurosurgery and integrated into the
Imaging Service. After Joaquim Cruz’s retirement, the department was led by
António Salgado and is currently directed by José Fonseca.
Pedro Hispano Hospital in Matosinhos also deserves recognition for its innovative model that directly integrates primary care services with the main hospital—the
rst in Portugal. Established in 1997, the neuroradiology department, initially led
by José Rocha Melo, later by Pedro Moniz, and now by Ana Mafalda Reis, has
advanced medical care, namely with pioneering minimally invasive spine interventions. Pedro Hispano Hospital also hosted the European Course on Spine Radiology,
2nd Cycle Module 1, in Porto from March 23–26, 2022, and since then, it annually
hosts an International Spine Interventional Course (INSIC) also endorsed by the
European Society of Neuroradiology (ESNR) (Fig.15.1).
Fig. 15.1 European Course on Spine Radiology, 2nd Cycle Module 1, Porto March 23–26, 2022
150
R. Manaças etal.
In the central region, the University Hospital in Coimbra, formed from the
merger of the University Hospital of Coimbra (HUC) and Coimbra Hospital Centre
(CHC), also has a rich history in Neuroradiology. Key gures in the 1970s and
1980s included José de Sousa Fernandes (HUC) and Francisco Faria Pais (CHC),
both of whom were founders of the Portuguese Nucleus of Neuroradiology, the
precursor to the SPNR.Successive heads of neuroradiology have included Francisco
Martins, Teresa Garcia, Cristina Moura, and currently, Egídio Machado. This hospital was the rst in Portugal to offer an emergency rota of interventional neuroradiologists for Mechanical Thrombectomy, effective January 2, 2015—just one day
after the scientic evidence for its efcacy was published.
In Lisbon, three major hospitals have been central to the practice and teaching of
neuroradiology for decades. The Western Lisbon University and Hospital Center
comprises Egas Moniz Hospital, Francisco Xavier Hospital, and Santa Cruz
Hospital. Established in 2005, it coordinates clinical activities across a broad area of
Lisbon. The Neuroscience Department, including Neuroradiology, primarily operates within Egas Moniz Hospital, which has a storied history. Founded in 1902 as
Hospital Colonial de Lisboa, it initially served overseas military personnel, focusing on infectious diseases. After expansions, it was renamed Hospital do Ultramar
in 1957, and following the 1974 revolution, it became Hospital de Egas Moniz.
The public hospital has played a foundational role in Portuguese Neuroradiology,
establishing one of the rst national departments. Professor Jaime Cruz Maurício, the
founder and rst head of the neuroradiology department, was also one of the founders
of the “Núcleo Português de Neurorradiologia,” the precursor to the SPNR.Successive
department heads included Constança Jordão, Gabriel Branco, Pedro Soares, and currently, Pedro Vilela, a former SPNR President and President of the 44th ESNR
Congress. The department has been at the forefront of innovations such as endovascular neuroradiology and the introduction of CT, training many of the country’s leading
neuroradiologists. Special mention goes to Professor Augusto Goulão, the department’s rst fellow, ESNR honorary member, and former SPNR President.
Today, the Neuroscience Department at WL-ULS (HEM) is known for its excellence in clinical and research activities, housing national reference centers in
Interventional Neuroradiology, epilepsy surgery, and related areas such as cochlear
implantation (Fig.15.2).
Secondly, it is worth highlighting the role of HCL—Civilian Hospitals of Lisbon
(as it was known at the time), where neuroradiology began formally in 1980,
although informal practices date back earlier. Initially, it was conducted by neurosurgeons and neurologists who developed an afnity for the angiography room
(used for angiography and pneumoencephalography) and the operating room with
an X-ray machine (used for ventriculographies). These practitioners, led by
Fernando Costa Reis, later dedicated themselves full-time to Neuroradiology, with
Costa Reis recognized as the founder of the specialty in these hospitals.
At that time, these hospitals included Capuchos Hospital and São José Hospital,
where the Neurology and Neurosurgery Services were based, alongside Curry
Cabral Hospital (infectious diseases), Dona Estefânia Hospital (Pediatrics), and
Santa Marta Hospital (Cardiovascular). Notably, it was at Santa Marta Hospital
15 A Brief History ofPortuguese Neuroradiology: TheLast 30Years
151
Fig. 15.2 XXIV ESNR Congress, Lisbon 1998
where Egas Moniz performed the rst angiography in 1927. These institutions are
historic, some originating as old monasteries, and one even predates the devastating
earthquake and re that struck Lisbon in 1755 (Fig.15.3).
152
Fig. 15.3 45th ESNR Annual Meeting, Lisbon 2022
R. Manaças etal.
The Neuroradiology Unit was formally established in 1980, with the rst fellows, João Reis and Rui Manaças, beginning their specialization in 1982. Both
would later become Service Directors and prominent leaders of the specialty in
Portugal in the following decades. During the 1990s, these hospitals split services:
São José Hospital retained diagnostic neuroradiology (initially with only CT scans)
and launched interventional neuroradiology, under João Reis as director of service,
while Capuchos Hospital focused solely on diagnostics, bolstered in 1998 by one of
the rst MRI installations in Lisbon’s public hospitals.
São José Hospital quickly became a pioneer in several vascular intervention
techniques and spinal procedures. The rst stroke treatment took place in 1999
using mechanical thrombolysis with a Sentry microballoon in a 20-year-old patient.
In 1999 and 2000, the rst stroke treatments using intra-arterial streptokinase were
performed in the middle, anterior, and posterior cerebral arteries, both in proximal
and distal segments. Additionally, in 2000, the rst intracranial stent in Portugal was
placed, and the rst vertebroplasty was also performed. Over the subsequent years,
the hospital was at the forefront of adopting new devices for stroke treatment,
including the Stentriever Merci in 2003 and the TREVO and Solitaire devices
in 2005.
In spinal care, São José Hospital also demonstrated a pioneering spirit. Besides
the rst vertebroplasty in 2000, the hospital introduced the rst treatment for herniated discs using gelled alcohol in 2009, followed by the rst intradiscal ozone therapy in 2012. Over the past 25years, a remarkable generation of Interventional
Neuroradiologists—around 14 in total—have passed through São José Hospital,
many of whom now working in Central and Northern Portugal.
Today, at the Centro Hospitalar e Universitário de Lisboa Central (its current
name), the neuroradiology department is led by João Reis and stands as the leading
service in the country in terms of the number of specialists, fellows, and neuroradiological activities, both diagnostic and therapeutic.
In the third and largest hospital in Lisbon, Hospital de Santa Maria—now known
as Centro Hospitalar Universitário de Lisboa Norte, formed by the merger of
Hospital Santa Maria and Hospital Pulido Valente (the latter signicant in early
15 A Brief History ofPortuguese Neuroradiology: TheLast 30Years
153
twentieth-century tuberculosis treatment)—there has also been a signicant history
in Neurosciences. Built in 1954, Santa Maria has a long tradition in this eld, with
its rst Neurology Department established by Almeida Lima in 1954, later led by
prominent gures such as neurologist José Ferro, known for his research in cerebral
venous thrombosis, and neurosurgeon João Lobo Antunes, a former President of the
European Society of Neurosurgery and a leading gure in Medical Neurosciences
in Portugal and Europe. The Neurosciences Department even houses the Museum
of Egas Moniz.
Much of the impetus for neuroradiology at this hospital was the result of the
close collaboration with the neurology and neurosurgery departments, who helped
to promote interventional neuroradiology as the future key choice for many neurovascular diseases. Neuroradiology began a bit later at Santa Maria, in the mid- 1980s,
with the arrival of Jorge Guedes de Campos. Although the neuroradiology fellowship only started in 2000, this did not prevent the hospital from becoming a center
of excellence and a reference point for clinical practice, research, and teaching in
neuroradiology in Portugal.
Jorge Guedes de Campos pioneered several interventional techniques in
Portugal, including the rst aneurysm treatment with GDC coils in 1993, performed in collaboration with Pedro Lylyk. The hospital was also the rst in
Portugal to use liquid embolic agents to treat AVMs and AVFs. More recently,
with contributions from other team members, it introduced techniques such as
balloon remodeling for aneurysm treatment and was the rst to use ow diverters
for brain aneurysms in the country. The department, currently headed by Graça
Sá, hosts a large number of specialists and fellows and remains a pillar of teaching, research, and clinical care in Lisbon, its surroundings, and the southern
region of Portugal. The department is recognized as a national reference center
in Interventional Neuroradiology.
Jorge Campos also played a crucial role in organizing the 1999 WFITN congress
in Portugal, held in Vilamoura, Algarve. He was a founding member of SILAN
(Ibero-Latin American Society of Neuroradiology) in 1989, alongside pioneers like
Fernando Vinuela and Juan Taveras, among others from Spain and Latin America.
The rst SILAN Congress was held in La Coruña in June 1989, followed by the
second in Cascais, Portugal, in June 1990, with Jorge Campos serving as President.
He also served as SILAN President from 1993 to 1995.
Several SILAN Congresses have been organized in Portugal, including one in
June 1998in Porto, with Joaquim Cruz as President, another in June 2003in Estoril,
with Carlos Morgado as President, one in October 2011in Cascais, with Luísa
Biscoito as President, and one in September 2019in Porto, with Cláudia Pereira as
President. Luísa Biscoito also served as SILAN President from 2017 to 2019
(Figs.15.4 and 15.5).
One of the areas that has seen the most signicant development in the past 7years
is the treatment of acute stroke, particularly following the establishment of
Metropolitan Emergency Units in Porto and Lisbon in 2017. This initiative institutionalized reference centers for interventional neuroradiology in several locations:
Braga, three hospitals in Porto/Vila Nova de Gaia, a central hospital in Coimbra,
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R. Manaças etal.
Fig. 15.4 XV Congress of SILAN, 2003, Estoril
15 A Brief History ofPortuguese Neuroradiology: TheLast 30Years
Fig. 15.5 XXIII Congress
of SILAN, 2011, Cascais
155
and four hospitals in Greater Lisbon (three in Lisbon and Garcia de Orta Hospital in
Almada). According to recent data, Portugal ranks among the top European countries in terms of the number of thrombectomies performed annually.
Two other hospitals in the Lisbon area also deserve to be mentioned, where neuroradiology departments were established by former neuroradiology fellows from
the renowned Egas Moniz and Capuchos Hospitals. Garcia de Orta Hospital
(founded in 1992 by Augusto Goulão) is a national reference center for Interventional
Neuroradiology, co-chaired with Egas Moniz Hospital. The department has since
been led by Maria Júlia Duarte and is currently headed by Cristina Rios. Another
notable institution is Fernando Fonseca Hospital (founded in 1995 by Rui Manaças),
which serves a large population in the western outskirts of Lisbon. This hospital has
active Neurology, Ophthalmology, and Otolaryngology departments. In the late
1990s, the rst digital subtraction dacryocystography was performed here, and several stents were implanted to treat nasolacrimal duct obstructions (led by Luisa
Biscoito).
As previously mentioned, Portuguese neuroradiology currently has more than
250 doctors, distributed across approximately eleven hospitals from Braga to Faro.
The specialty is supported by two scientic societies and is bolstered by a new generation of well-prepared professionals, ready to meet the signicant challenges
ahead. These challenges include the internationalization of the specialty, the free
movement of professionals within the European space, and the growth of subspecialties such as interventional neuroradiology, head and neck imaging, and pediatric
neuroradiology.
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R. Manaças etal.
Much of the current success of Portuguese neuroradiology as an Autonomous
Medical Specialty is due to the path, let’s say original, of how training in neuroradiology is done in Portugal: since the 1980s, when it was created as a Hospital
Specialty, which has been autonomous since its inception and not as in most countries, from which it derives from Radiology (with a common trunk of at least
3years).
To conclude, quoting José Almeida Pinto, one of the founding fathers of
Portuguese Neuroradiology, (October, 2020):
It is my pleasure to note that: (a) there is a progressive continuum between the beginning
and the now; (b) the seed that the elders sowed more than 50years ago has germinated and
blossomed into the specialty we have today—indisputably beautiful, cultured, and now
respected, which it wasn’t always".
Acknowledgment
and Pedro Vilela for their contributions to the preparation of this text.
Open Access
International License (http://creativecommons.org/licenses/by/4.0/), which permits use, sharing,
adaptation, distribution and reproduction in any medium or format, as long as you give appropriate
credit to the original author(s) and the source, provide a link to the Creative Commons license and
indicate if changes were made.
The images or other third party material in this chapter are included in the chapter’s Creative
Commons license, unless indicated otherwise in a credit line to the material. If material is not
included in the chapter’s Creative Commons license and your intended use is not permitted by
statutory regulation or exceeds the permitted use, you will need to obtain permission directly from
the copyright holder.
Special thanks are extended to Jaime Pamplona, João Xavier, Egídio Machado,
This chapter is licensed under the terms of the Creative Commons Attribution 4.0
Chapter 16
SILAN Society: History andInternational
Impact 1988–2024
RamónE.Figueroa
The Sociedad Ibero Latino Americana de Neurorradiología Diagnóstica y
Terapéutica (also known as “SILAN”) is an international professional nonprot
society constituted by 560 registered Spanish and/or Portuguese-speaking members
from all countries in America, plus Spain and Portugal. From its inception in 1988
to the present, its main goal has been to advance the eld of diagnostic and interventional neuroradiology in all its member countries through educational seminars,
annual scientic meetings, and the sponsorship of international training scholarships in both diagnostic and interventional neuroradiology for young graduating
residents from Radiology, Neurology, and Neurosurgery programs.
The origins of SILAN are traced to November 13, 1988, when a group of 24
Latin-American, Spanish, and Portuguese internationally recognized leaders coordinated by Dr. Fernando Viñuela (at the time the chief of Endovascular Therapy at
UCLA) met at the XXIII Latin American Congress of Neurological Surgery in
Acapulco, Mexico. The idea of advancing neuroradiology in Latin America through
the creation of a Spanish and Portuguese-speaking neuroradiological society
coalesced at this meeting. The initial Executive Committee was constituted by the
elected President Dr. Juan M.Taveras (originally from Dominican Republic, who
at the time was Chairman Emeritus of Radiology at Harvard’s Massachusetts
General Hospital); Dr. Jesús Rodriguez Carvajal as Vice President (who was the
chief of neuroradiology at the National Institute of Neurosurgery and Neurology in
Mexico City); Dr. Jorge Guedes Campos as Secretary (who was chief of neuroradiology at Hospital Santa Maria in Lisbon, Portugal); and Dr. Fernando Viñuela as
Treasurer (originally from Uruguay, then chief of interventional neuroradiology at
UCLA, Los Angeles, USA). The logo of SILAN was created at this time (Fig.16.1),
under the inspiration and guidance of Dr. Juan M.Taveras, the rst president of
R. E. Figueroa (*)
Emeritus Professor of Neuroradiology, Medical College of Georgia at Augusta University,
Augusta, GA, USA
D. Birchall (ed.), A World History of Neuroradiology,
https://doi.org/10.1007/978-3-032-16653-1_16
157© The Author(s) 2026