I was asked by the AANS to give a brief overview of how my academic career started and evolved and try to provide a few insights, really, to try to help other people who are trying to accomplish a similar task. My career had its own unique path and started in one place and ended somewhere else. So I kind of subtitled it, I went from being an epilepsy surgeon to a minimally invasive skull-based surgeon, just to show you how keeping an open mind is very important in developing your career. So I'm going to start in 1991 when I was a third-year medical student and talk a little bit about what was going through my mind. So a little bit about my background. My father was a Freudian psychoanalyst, so I grew up thinking about the mind more so than the brain. I majored in philosophy and English in college, again, thinking more about the mind than the brain per se. But I was interested in language and language organization and how we categorize the world. And that took me into neuroscience more through psychology and philosophy than through biology. And I went to medical school and I wasn't really sure what I wanted to do, and at one point started to become interested in thinking about neurosurgery, started to think, do I want to do research or not? And I really wasn't quite sure what I wanted to do. I actually originally was going to do infectious disease when I went to med school. Really neurosurgery wasn't even on my radar. But I was interested in language and its organization in the brain. And I read this article called The Bilingual Brain that was written by George Ogerman, who was a neurosurgeon who did awake language mapping in patients who spoke more than one language and found that you could find representation for each language in a different location in the brain. And I thought that was fascinating. And just the concept of being able to do experiments on the human brain to learn more about language really excited me. And so I decided to take a year off during med school and drove out to Seattle to spend a year with George Ogerman. And that really was transformational for me to sort of get out of my comfort zone, move across the country, be enmeshed in a first-rate neurosurgical department with a great mentor. And finding a mentor is very important. That's obviously something a lot of people talk about. And that was very important to me to find someone who could inspire me, and that was George Ogerman. Because for him, every patient that he operated on was another research subject from which he could learn something. And that's very much true of neurosurgery. You know, when we operate, every patient we operate, we don't have to be doing an experiment on them, but every operation, we see something different, we learn something different. We have to think critically about what happened and how we can improve ourselves with every operation we do. And he really taught me that. And so I spent the year there and worked on language and language organization in the brain. He was doing single-unit recording from patients awake in the operating room during different linguistic tasks, also visual-spatial tasks. And so that got me more and more interested in neurosurgery, particularly because I got to go into the operating room and watch him operate. And this is George operating with one of his residents there, and he was very calm in the operating room. I really enjoyed working with him. And, you know, that was back in the day when he did awake language mapping, he would actually show his patients slides through a slide projector, and, you know, they would see each object and name them as he was mapping it out or as he was recording electrodes, electrons, excuse me, sorry, not electrons, neurons, pardon me, with an electrode in the brain. So it was a great year, but I also got inspired to pursue basic science because while I was there, they were doing the first experiments where they were using intrinsic signal imaging, which is a way of imaging changes in reflection of light on the brain that reflect oxydeoxy hemoglobin changes. And you could see as you would stimulate the brain, this is with a bipolar electrode, you could see focal changes in reflection of light. And that sort of heralded the whole optical way of measuring activity in the brain, neurons in the brain that now, you know, is used so widely. So that inspired me during my residency to take a year off during my research time, it wasn't a year off, really, it was the enfolded research. And I worked with this guy named Rafa Justi, fantastic scientist, great neurobiologist. And we did calcium imaging in layer one of developing a rodent brain, got a publication in Neuron, first author publication. And that was, you know, during one year of research. So I really caught the basic science bug. I love being in the laboratory. I love reading papers. I love thinking about new ways to test different hypotheses. And that got me very excited. And so I decided after my residency to do more optical imaging work. And so I went to Germany and I worked with this guy Tobias Bonhoeffer at the Max Planck Institute. And there we were doing optical imaging of epilepsy in ferrets. He had no interest in epilepsy. So I brought the epilepsy to his lab, but he was a first rate neurophysiologist, neurobiologist. And I learned about optical imaging. And that then became the subject of my research. And at that point, I wanted my career really to be doing epilepsy surgery and have my own basic science lab and try to do optical imaging and map out the human brain of my patients in the operating room. Although George Ogerman had given me some great advice. He said to me when I told him, you know, I want to be like you. I want to just do research on all my patients. He said, you know, Ted, nobody is going to refer you a patient to do experiments on them. Like you have to become a great neurosurgeon and take great care of your patients. You're a clinician first, and then you can use that opportunity to do research. And that was great, great advice. And I'll come back to that. But I started my first job and I had no medical license at the time. And I had to apply for a medical license. So I couldn't operate for two or three months when I had my first neurosurgical job. And I was miserable because you train for all those years to operate. And I wasn't allowed to operate. But I took that opportunity and just started writing grants like crazy. And I had just done this basic science work. I had a publication in Nature Medicine. And I wrote a ton of grants and I got them. You know, I got quite a few grants at that time. And so I started my own lab and then I moved to Cornell and I took the lab. And, you know, I got a K08, an R01, R21. I started writing private foundation grants. And really, that was my main focus was building my lab. And I hired people who could do the work in the lab. So the lab was self-sustaining. And then the other thing that helped sustain my lab over years was collaboration. So as I got busier and busier clinically, and I'll talk about how that morphed, I started to collaborate with basic scientists in other departments, in other adjacent laboratories. And so they would infuse new ideas into my work. I would learn new techniques that I could have them apply in their lab that would complement what I was doing in my lab. Some of the burden of grant writing and paper writing could be done by the collaborators. And I would also have my own efforts and my own people in the lab doing my own work. The other thing that helped me very much was once I built a larger clinical practice was to raise money from grateful patients who are so happy. And they're happy to help support your work. And that gave some soft money that would allow us to tide ourselves over when we were applying for the hard money for grants. So if you do have that opportunity, you should certainly avail yourself of that. And it's a way to combine clinical and basic science work. So I got to Cornell. And I really was excited to do epilepsy work. I was also interested in tumors because I like doing awake language mapping and temporal lobe tumors. And the volume of epilepsy cases really was not that great where I was. And I began to become dissatisfied and frustrated with the volume. And I knew I needed to pick things up a little bit more and find new avenues of surgery for me to do. And I was always interested in tumors. And I very much benefited from the expression here, luck favors the prepared mind. Or in the field of observation, chance favors only the prepared mind, that Pasteur had said. And there was a little bit of luck and timing involved in my transition to minimally invasive skull base surgery, which really happened at the moment where the field was just starting. So the first thing was the comment I'd mentioned. George O'Driman had mentioned to me the importance of good general neurosurgery training. And I went to Columbia, did my residency there. And I got great training. And I learned how to do all different types of cases. And I did enjoy doing transfrontal operations and brain tumor operations. I got great spine training. Vascular training was phenomenal. So I had good technical skills that I could really apply in any field. And I had also done some intraventricular endoscopy with one of the attendings at Columbia, Bob Goodman. And so I knew what an endoscope was. I'd written a paper or two on that. And I really enjoyed doing endoscopy. And I loved the view that you would get with the endoscope going to the ventricles. And then this is sort of a very lucky thing, is that I happened to play bass in a band with an incredible skull base surgeon named Takafu Kishima. And he would fly me all around the country as a resident because I was part of his band. And so he wanted me to play in his band at all the skull base dissection courses. So I went to dozens of skull base dissection courses where I would just sit and listen. I would audit them. I was a resident. I learned a ton. And then I would play in the final band. He would have the band play at the end of the course. So I really learned a lot of skull base anatomy. I also learned the value of going into the cadaver lab and working in cadavers to learn that anatomy. And I would read all the books that he had written about all the different approaches, far laterals and orbital zygomatics and things like that. So I was prepared to start doing endoscopic skull base surgery, even though it wasn't what I thought I wanted to do because I had such great broad clinical training. And then I was in the right environment, right? So when I started doing some pituitary tumors at Cornell, the chair there, Phil Stieg, said, you probably should maybe think about doing these endoscopically. Some people are starting to do it. And that was very prescient of him to say, hey, if you're going to do it, do something interesting with that. Where I was, Mark Swain Dan had already paved the way. He had started an endoscopic intraventricular surgery program. So we had fought a lot of the battles that needed to be fought so that people realized that the endoscope was really a valuable tool. My partners were willing to refer me cases. I referred them cases. They were supportive of that. It was a subspecialty practice place where you can just do tumors and epilepsy, which is really all I wanted to do. And then the other incredibly important thing, we talked about mentorship, was finding a collaborator in clinical medicine. And that was Vijay Anand, who was an endoscopic brainologist who happened to be at Cornell, was a superb surgeon and was very interested in evolving his sinus practice into a skull base practice. And so when we met each other and started talking, it was clear we both very passionately wanted to do the same thing. We wanted to build this and push it as far as we could go. And at the time, it was just pituitary tumors. We had no idea what we'd end up doing. And every program at the time that built a successful program, it was built from a collaboration between ENT and neurosurgery. And so the take-home message really is just how important it is to look at other surgeons in different fields and see what they're doing and see how what they're doing can inform what you're doing and not have a closed mind and not try to do things the way that you learned how to do them, but take that as really a stepping stone. I mean, your residency training is not the end of your training. It's the very, very beginning. And I love the fact that when I do cases now, the majority of the surgeries I do were surgeries I never learned as a resident. They're completely different, different approaches, different techniques. The basic principles are the same, but I do things quite differently because I evolved over time and that's just the way our practice works. So it was kind of a perfect storm for success for me. The combination of dissatisfaction with what was going on, motivation for change and being in the right environment to get that done. And then obviously a lot of hard work to do that. So I started the job 2001. I did my first endoscopic pituitary surgery course in Bologna. I flew to Bologna before I did a case and Paolo Cappabianca was a visiting professor. I learned from Giorgio Frank there, Ernesto Pasquini. And then we did our first case endoscopically, Dr. Anand and myself, he showed me how to use the endoscope. We had the instruments and I never converted to the microscope once. The first time I put an endoscope in the nose, I never used a microscope again. For a transfrontal case, I read every paper I could possibly read by all the masters of pituitary surgery, Weiss, Laws, Caldwell. Kelly was starting to do meningiomas transfrontally, again, not using an endoscope, he would do with a microscope. And I read those papers and I started to think, you know, maybe we can do this with an endoscope. And I would then, once I started doing more cases and started publishing papers, you would get invited to be a moderator at skull-based dissection courses. And so I was being exposed to other people who were doing similar types of operations. I was exposed to the cadaver lab. So as I was teaching the courses, I was actually going in there and learning myself and pushing myself to do more and more things. So I got an incredible cadaver dissection experience because I would go from course to course to course to course as an instructor. And when people would get lost, I'd go in there, show them what to do. And then I would do a little bit more and do a little bit more and dissect a little bit more. Maybe I saw something in a lecture and I would try to do that. And that really helped me improve. And so again, you know, that sort of practicing in the cadaver lab is something that's hard to do and you really have to push yourself to do it. And I was lucky at the time to be invited to so many of the courses. And then when I started building the program at Cornell, you know, we just tried to write paper after paper after paper and just try to get the stuff out there and think about it, present it as many meetings as we could. Anytime I was invited to moderate, present, contribute, I would just say, yes, yes, yes, yes, yes. And try to go to everything and be involved in as much as I could. We wrote a book very early on. We wrote another book. We just started pushing ourselves. We started a course, accepted international fellows, and they became people who could write papers, collaborators, they would invite you to speak. At their institutions, which would increase your exposure internationally. And then eventually start an operative fellowship. And then you have, you know, great people working with you in addition to the residents who are great, who also will write papers and do dissections and push your work and push you because they're asking you questions. You have to justify why you do what you do. So, you know, this is the final take home message is that, you know, you have to work hard to become the best neurosurgeon you possibly can be. Learn as much as you can from everybody around you. You know, don't sort of think that, you know, this type of surgery, you're not interested in it. You're not really going to put the time in because something from that operation will be helpful to you in some future endeavor that you do. Collaborate both in basic science as well as clinically with as many people from other fields as you possibly can, because it helps you keep an open mind and always keep your eyes wide open. Never be satisfied with the way you're doing anything and always try to do it better. Always try to improve yourself. So I hope that there was some useful bits of information in there. If you ever want to talk, call me, email me. Any advice I could possibly give, I'd be happy to help. Thanks very much for listening.

neurosurgery

awake language mapping

basic science research

mentorship

minimally invasive skull-based surgery