Our illustrative case demonstrates that a combination of new technologies and human creativity led to a neurosurgical innovation. This was not the sort of innovation that could be tested in a laboratory. It was critical to success that this surgeon believed his innovation would create improved results for his patients as well as result in decreased costs to society if successful, even though this creates some conflict of interest by way of indirect rewards. Some method of peer review and/or oversight might have aided the surgeon to ensure that the planned change in course of surgery would carry as little risk as possible. However, concerns over such a drastic change in practice by a committee of non-neurosurgeons may have hindered progress. Importantly, the surgeon acted as ethically as possible by truly informing his patients of his proposed new approach. Furthermore, now that this innovation has worked (or failed), he is ethically obligated to share this information with his professional community.

The conservative and careful tradition of surgery and commitment to patients engenders profound trust that must be respected (McKneally 1999). An ethical and systematic approach to new innovations may be the key to maintaining such trust, keeping in mind the balance of obligations, costs, honest communication, and open collaboration.