L. Dade Lunsford, MD, FAANS, is the Lars Leksell Professor and Distinguished Professor at the Department of Neurological Surgery at the University of Pittsburgh. He also is director of the Center for Image-Guided Neurosurgery at the University of Pittsburgh Medical Center, and an internationally recognized authority on stereotactic surgery and minimally invasive surgery. Jason Sheehan, MD, PhD, FAANS, recently interviewed him for AANS Neurosurgeon.

Dr. Jason Sheehan (JS): What attracted you to a career in neurosurgery?

Dr. L. Dade Lunsford (LDL): During college at the University of Virginia, I had the opportunity to do a relatively unique two-year honors program in the laboratory of Dr. Phillip Best, a professor of Physiological Psychology. His lab was studying learning in rodents using the technique of cortical spreading depression. We performed stereotactic callosal sectioning in many animals to try to interrupt hemispheric transfer of information learned by one hemisphere when the contralateral cortex was “asleep” after KCL-induced temporary cortical spreading depression. The rat, as do more advanced species, has interthalamic connections to transfer some learning paradigms. This stimulated my interest in neuroscience as well as stereotactic methods.

Prior to starting medical school at Columbia, I worked with an epilepsy neurologist in New York City. We evaluated the relationship between long-term phenytoin use and the risk of lymphoma development. I was hooked on the need for both basic science and clinical research. Neurosurgery seemed to be a profession where thought, action and analysis were perfectly mixed.

JS: What advice do you wish you had when you were a young neurosurgeon?

LDL: Be prepared for the evolution of medicine. The independently acting role models of bygone eras have given way to the need to work in teams with special expertise. Find a niche that sustains your interest. Surround yourself with people smarter than you are.

JS: What neurosurgeon (living or deceased) most influenced your career, and why?

LDL: I have certainly been associated with many wonderful and amazing people in the field. The ones that I have most admired were major innovators who never lost their humanism or humility. Unquestionably, the greatest opportunity that I had — the one that influenced my career path — was my fellowship at the Karolinska Hospital, working with Dr. Lars Leksell and his major disciple, Dr. Erik Olof Backlund. Leksell was a brilliant and restless innovator. His quest for perfectionism either overwhelmed or frustrated some. In addition to my admiration for his incredible contributions — ranging from routine surgical instruments such as the Leksell rongeur to the first really intuitive stereotactic guiding devices to the Gamma knife — Leksell was a wonderful human being and raconteur with a bit of an iconoclastic trait. As a younger man, he drove motorcycles and high-speed boats to work. His restlessness and stubbornness in search of perfection were traits to emulate.

JS: What was your most fond memory from your residency?

LDL: During my one-year time of research, while working on a long-term study of the outcomes of simple anterior cervical discectomy versus fusion for radicular or myelopathic disease, I got to see my wife in daylight. By the way, I am not sure that the latest results in the heavy-metal era of spinal fusion have shown any significant improvement over what we reported in the early 1980s. In addition, in 1978-79, I worked with two brilliant people, Drs. Arthur Rosenbaum and John Perry, to develop an early generation CT-compatible, stereotactic head frame based on the N localizer now so familiar. Perry came up with the idea independently and simultaneously with Dr. Russ Brown at the University of Utah.

JS: What is the last good book you read?

LDL: Although I generally love fiction (especially non-medical), I have recently read two outstanding non-fiction books set in the 1930s and 1940s: “In the In the Garden of Beasts: Love, Terror, and an American Family in Hitler’s Berlin” by Erik Larson and “Unbroken” by Laura Hildenbrand. Both tell remarkable tales of perseverance during the prelude to and, then, during the actual Second World War.

JS: If you could not have been a neurosurgeon, what other profession would you have chosen?

LDL: If I had had sufficient talent or the aptitude, I would have preferred to be a concert pianist. Ten years of lessons could not overcome the fact that I had rather short fingers that could barely reach just above an octave. Besides I always played with rubato, which usually drove my teachers crazy. Counting was not my greatest skill.

JS: In 10 years, how do you expect the field of stereotactic radiosurgery to have changed?

LDL: Who would have thought it would have survived the first 10 years? Dr. Sean Mullan many years ago described the typical QRS complex of neurosurgical scientific development — a P-wave blip, followed by the explosive growth of a new field or technique (QRS complex). Once all the complications became obvious, interest plunged, only later to reach the T wave, where a more balanced use finally stabilized. Think of the laser.

I believe that the efforts of many centers have correctly established radiosurgery as a long-lasting field that accomplishes the original goal of adding a lower risk and effective strategy to the neurosurgical armamentarium. Imaging the target has changed dramatically, computer speeds have reduced planning times from hours to minutes, and delivery technologies have improved greatly. These technological changes will continue to evolve. Outcome data will, hopefully, continue to demonstrate value.

More neurosurgeons will get involved as the role of radiosurgery evolves. More emphasis on training and preparation will be required by the ABNS and by hospitals where we work.

JS: As you may know, Thomas Jefferson failed to list his presidency among his top three accomplishments. What would you consider to be your top three professional accomplishments?

LDL: Making the decision to take my Van Wagenen fellowship year in Sweden (like taking a sabbatical before you start your real academic job; by the way, I have never been able to take a sabbatical since), my establishment of the first dedicated stereotactic operating room suite with a CT scanner in 1982, and the introduction of the Gamma Knife in 1987.

JS: The University of Pittsburgh recently was recognized as having one of the most productive residency programs in the country. Tell me, as residency program director: What is the secret to Pittsburgh’s success?

LDL: I remember that John Jane once told me that you need to know how to pick ‘em and how to fire ‘em (if they did not meet expectations). But there is much more to it than that. In our current revenue-obsessed culture, where work relative value units (wRVUs) are the main measure of our value, pursuit of traditional academic values — teaching, research and writing — get short shrift. We write because it should be our goal to advance and to critique what we do. Do we get value from seeing our efforts pass peer-review muster and eventually reach journal pages? You bet, but it is a reward we set for ourselves.

I followed the leadership of Peter Jannetta, who turned Pittsburgh around beginning in the 1970s. I had the opportunity to help lead the department for 10 years. During that time, I tried to encourage the residents, fellows and faculty to continue the tradition of academic inquiry, speaking and writing. I followed the advice I reported above. I surrounded myself with people smarter than me and encouraged them to fly on their own. And I tried to protect them as much as possible from the conflicts that exist in today’s modern hospital and university. They could then concentrate on more important things than the grandstanding and peacockery of much of modern medicine.

JS: Thank you for taking time out of your schedule to participate in this interview for AANS Neurosurgeon.

Jason Sheehan, MD, PhD, FAANS, is the alumni professor of neurological surgery at the University of Virginia in Charlottesville, Va. The author reported no conflicts for disclosure.