The William Beecher Scoville Prize

A Journey in Neurosurgery

On Becoming a Doctor and an Explorer of the Amazing Brain, the Body's Mount Blanc

For the second time in my life, I found myself descending Mount Blanc, on the Italian Valle d'Aosta side, because the horrible weather and an unexpected snowstorm made it impossible for me to begin the final 1100 meters of an ascent from the Rifugio Quintino Sella (3700 meters above sea level) to the peak of this beautiful mountain (Figure 1). I was so frustrated that I decided, at that time, to stop to climbing mountains forever and return to the sea and sailing for natural adventure.

It was

The Basis of Knowledge

After graduation from my classical college in Italy, I successfully applied to the University of Milano Medical School. The program lasted for 6 years, with the first 3 years focusing on basic biomedical sciences and the second 3 years on clinical medical studies. Being brain-minded (pardoning the pun), during my third year I applied for an internship in neurophysiology, which gave me the opportunity to study and work with such outstanding neuroscientists as Domenico Spinelli (who had worked in

A Scientific Growing-Up

After I graduated with my M.D., I decided to apply for a position that would allow me to further specialize in brain science. I had the idea of neurosurgery in the back of my mind (again, no pun intended), but when the co-chairman of the resident program in Neurosurgery read my curriculum vitae, his suggestion was that I should work on guiding his electrode placement for tremor surgery and Parkinson disease. L-DOPA (L-3,4-dihydroxyphenylalanine) treatment was just then at its inception, and

From the Scientific to the Clinical

When I finally found myself back in Milano, it was in the position of Assistant on the medical faculty of the Department of Physiology—in the section of neurophysiology (5). At that time, I had decided that my training as basic researcher had, in effect, been complete and I was beginning to realize that I needed to enter the world of the clinic. And once again, it was Mauro Mancia who would emerge as my significant mentor and guide. I had applied to take my Boards of Specialization in Neurology

The Genesis of a Neurosurgeon

The Chairman of the Department of Neurosurgery at the Universitätsspital Zurich at that time was Professor Hugo Krayenbhul, one of the masters and founders of European Neurosurgery. Working with him at that time, were his assistants A. M. Landolt, an expert in pituitary transnasal transsphenoidal surgery; Jean Siegfried, a master in functional neurosurgery; and M. Gazi Yasargil (Figure 5B) the up-and-coming “star” of microsurgery.

Since I was already an expert at exposing the Gasserian ganglion

The Neurosurgical Independent Project

While I was away in Zurich, Giulio Morello paid a visit to Gazi Yasargil and had the opportunity to speak, at length, with J. S. and G. Y. When he returned to Milano, he asked me to create a modified, small OR that would be devoted towards the goal of creating a completely equipped stereotactic OR. At that time, CT scanning was not yet available and so the only way to estimate a basal ganglia target was by using the anterior commissure/posterior commissure complex. To overcome this limitation,

Scientific and Personal Relationships: How to Increase One's Learning

Surgical training and experience abroad was critical for my education in neurosurgery, and I always recommended it to all my collaborators. This part of my professional life brought me to some of the most advanced neurosurgical centers in Europe. The following is the list of these centers and the collaborators who helped in my work:

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  At St. Anne's in Paris, the Cathedral of stereotactic neurosurgery: Jean Talairach, Jean Bancaud, Gabor Szikla, Claudio Munari (Figure 7A), and Osvaldo Betti. The

New Neurosurgical Spaces and Interest and Building a Team

Although Basal ganglia stereotactic surgery continued to hold my interest and fascination, new interests began to emerge, particularly in the treatment of brain glial tumors. Here is a summary of this phase of my professional evolution as a neurosurgeon:

The Evolution of Functional Neurosurgery and the Influence of Angelo Franzini

The advent of CT and magnetic resonance imaging produced dramatic changes in all phases of stereotactic methodology. Similarly, the advent of virtual ventricolography would lead to the opportunity for the direct targeting of brain sites. And finally, the changes that came from externally driven internal pulse generator to internally driven ones, along with the technical evolution of hardware and the important evolution of functional magnetic resonance imaging made possible a wide number of new

The Mini-Invasive Concepts

After the Perneski lesson and the dreams that would follow, a visit by myself and Paolo Ferroli to the Barrow Neurological Institute in Phoenix, Arizona, USA (Figure 8B) led to a dramatic and exciting new entry that broadened the effectiveness of our surgical team. We were now being drawn back to the issue of vascular surgery and to the possibilities of skull base approaches via endoscopy. From 1998 on, the neuroendoscopic methodology has flourished at Besta to the point where it is now routine

The Scientific Rules and Honors

During this time I had the opportunity to be invited as visiting professor in many European, U.S., Eastern, and Far East Universities; to be part of the International Congress Faculty (Figure 9A and 9B); and become a member of different scientific societies in some of which I had the honor and duty of serving as an officer in different positions:

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  Società Italiana di Neurochirurgia (SINCh): member from 1974, Officer 1998–2002, President 2002–2004

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  European Society for Stereotactic and Functional

The Curiosity of the New Age

Years of experience with a variety of approaches in understanding and treating the human brain have led me to a number of opinions about the future of our discipline, but with of course all of the limitations and uncertainties that all such speculations about the future may hold. I see the future as a time of experimentation and validation for many new technologies, a few of which I will list here:

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  Robotics

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  Virtual reality

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  Stereotactic ultrasound-guided imagery

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  The design of malleable new

Some Advice

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  Be open and feel free to be foolish, but try, wherever possible, not to be selfish.

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  Enjoy life in the present as much as you were in the past when you were a child.

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  Celebrate this possibility with life's many “gifts”: children; grandchildren, and families; opportunities to travel, sailing (Figure 10A-C); and the many opportunities created by one's curiosity to understand new people, countries, and cultures. Sailing and climbing mountains are fantastic opportunities to have the time and the