12.1

A neurosurgical operation is a duel between the neurosurgeon and the disease. As in the boxing ring, there are three basic ways to strike at your opponent. For the boxer, they are the jab, hook, and uppercut; for the neurosurgeon, they are dissection, hemostasis, and microsurgical suturing (Fig. P1).

The answer to the question of how to become a good neurosurgeon was given by Kikuchi et al. ¹ and included three key points:

1. 
   

   Basic microsurgical skills, such as dissection, hemostasis, and anastomosis, should be mastered on plastic tubes, cadaver vessels, and laboratory animals.

   
   
2. 
   

   Good anatomical knowledge of different approaches should be obtained during cadaver dissection.

   
   
3. 
   

   Manual skills should be consolidated when assisting with and performing surgery under the supervision of an experienced neurosurgeon-teacher.

Therefore, laboratory training plays an essential part in the formation of a neurosurgeon, because it allows one to achieve the first two goals. Microsurgical skills training and learning of surgical microanatomy are the personal responsibility of the trainee, whereas the tactics of patient treatment may be discussed with colleagues on rounds and at conferences.

We would like to end this monograph with a parable about calligraphy. Being a precise and delicate art, calligraphy, like neurosurgery, requires a long training curve. Watching a master neurosurgeon perform brain surgery is like watching the brushstrokes of a master of the art of calligraphy.

One young man wished to study calligraphy and went to a famous master to ask him to be his tutor. The calligrapher accepted him as his apprentice with great cordiality. After studying under the master for several years, the apprentice decided that there was no reason to stay with the master, because he had mastered the art of calligraphy well enough. He told the master about his intention to leave. The master did not try to persuade him to stay. Instead, he gave him a box and said at parting: I don’t want anyone to have this box. Take it and bury it at the foot of the mountain. The young man took the box, said goodbye to the master, and left. The box was small but rather heavy. As he walked, the young man tried to guess what could be inside the box. Maybe there were treasures hidden inside? Finally, curiosity overpowered him. He unslung the box and put it on the ground. Fortunately, the box was sealed carelessly, and the young man opened the lid easily. He gaped in surprise, because the box held nothing but old inkwells! There were several dozen inkwells in the box. But the young man was most struck, not by the number of inkwells, but by the fact that there was a big hole worn through the bottom of each inkwell! That’s how diligently his Master was working! The young man sat and looked through each inkwell for a long time. Then he quietly closed the lid, took the box on his shoulders, and resolutely went back to the reed hut of his master. From that time on, the apprentice devoted himself entirely to the art of calligraphy, without reservation. But it was only when his hair had turned completely gray that he achieved the peak and the true mastery came to him. ²

How many inkwells have we worn through as neurosurgeons? It is no surprise that some of the techniques that we have been taught are not working well enough in our hands. There are numerous subtle nuances that we do not yet understand and which, when performed, make a difference. There are no miracles; only deliberate, persistent practice leads to the highest perfection. There is no best neurosurgeon and no best microneurosurgical technique. The way of perfection is endless.

Evgenii Belykh, MD

Phoenix, Arizona