Interview with Antonio Di Ieva
Antonio Di Ieva, winner of the EANS Aesculap Prize 2010 for the Best Laboratory Entry spoke to Petra Ernestova in May 2012.
PE: Could you please introduce yourself shortly, just in one or two sentences?
ADI: My name is Antonio Di Ieva, I am 34-years-old, specialist in neurosurgery for almost 5 years now. I studied Medicine at the University of Naples, I did my practicum in Germany, then I did my residentship in Milan and, after two years in the staff, I went to Vienna where I completed a Ph.D. in Clinical Neurosciences. In January 2012 I have begun a Fellowship in Skull Base surgery in Toronto.
PE: Do you have a medical family background?
ADI: no medical geno/phenotype!
PE: What made you decide to go into medicine?
ADI: The brain! I went into Medicine to put my brain at the service of the understanding of the brain, one of the most intriguing and sublime result of natural evolution.
PE: And into neurosurgery? Had you also considered any other specialties?
ADI: Studying the brain was always my first choice. In the beginning I also considered neurology and psychiatry, as well as basic research in neurosciences. The latter was excluded because I prefer the clinical activity to the lab. I was very satisfied with neurology and a little bit less with psychiatry, for the diagnostic and research aspects, but I found quite unsatisfying the therapeutic aspects. Neurosurgery seemed to be offering a good compromise for everything, from the basic research to the clinical and surgical applications.
PE: Which area of neurosurgery did you specialise in, and why?
ADI: I started with neuroendoscopy and then specialized neurooncology. Surgery of brain tumours requires a deep knowledge of normal brain anatomy, which is an area I am fervent about, as well as a high translationality of expertise and collaborations with different disciplines. I am very interested in the biological aspect of brain tumours, being fully aware that often the most interesting part of research and the most demanding part for the surgeon and the patient begin at the end of the surgical resection.
PE: What qualities do you feel that a good neurosurgeon should have?
ADI: He should not consider neurosurgery like a job, but a hobby; a very demanding hobby, to be performed with all the passion and involvement necessary to achieve the necessary goals. Always keeping in mind that working with delight does not mean working with dilettantism. Neurosurgery entails a stressful quality of life. Passion and devotion for one’s own beloved hobby can support each neurosurgeon to spend their life this way. Moreover, to be a good neurosurgeon not only requires being a good physician and surgeon, but also a “visionary”. In neurosciences we often play with the unknown, visions and pioneer spirit are necessary to improve our knowledge of this amazing biological system which allows us to think and to be.
PE: Do you have any neurosurgical “heroes”?
ADI: Among other heroes, for sure the founder of microneurosurgery, Prof. Yasargil, because he has built his surgical excellence and school of thought on a solid pyramid of cultural knowledge, opening the doors to the present and future neurosurgical practices. In addition to his neurosurgical milestones, my daily activities are always focused on his concepts of pure lesionectomy, respect of the “unknown” shown in every patient, importance of the anatomical training, use of the combination of the senses, bookishness, etc. All these qualities are also present in another “hero” of mine, even if he is not strictly a neurosurgeon, but something more, the one who formed off springs of neurosurgeons, Prof. Manfred Tschabitscher. For 35 years his lab in Vienna has been the cradle of the anatomical background of many neurosurgeons from the whole World, the main place where modern neuroendoscopy has found its ground. He has been my main Maestro in the “Neuroworld” for 12 years and I continue to be very happy and honoured to have his support and friendship.
PE: You won the EANS Aesculap Prize last year. Could you introduce your research project shortly?
ADI: The venous system is the least studied anatomical system of the brain. My first research interest is the study of the brain angioarchitecture. I “exhumed” a Prof. Tschabitscher’s description of a very small cerebellar vein, the central vein of the dentate nucleus, looking for it in anatomical dissections on cadavers and comparing these findings with the in vivo neuroimaging analysis performed by means of 7 Tesla MRI (performing the first imaging on myself!). The combination of a recent neuroimaging technique to visualize veins (SWI) and the ultra-high fields in MRI allowed myself to detect this submillimetric vein, opening the road for future clinical applications. We had the satisfaction to see one picture of our article on the cover of the journal Neuroimage (Jan 2011). The new neuroimaging techniques and always increasing magnetic fields are revolutionizing anatomy, therefore surgery “custom-made” can ben planned on the real anatomy of the patient and no longer on the statistical anatomy studied on books and learned on cadavers.
PE: Is there any new research you are involved with or some project you would like to start in future?
ADI: The application of mathematical models, like fractal geometry to neurosciences and, above all, to the quantitative morphometric analyses of the microvessels in brain tumours, is my main field of interest in research. I consider fractal analysis as a quantitative tool aimed at the study of anatomical systems (in physiologic as well as in pathologic states), and some friends, colleagues and I founded a webpage about the application of fractals in biomedical sciences (www.fractal-lab.org). Anyway in the future I would like to proceed with my training/research in neuroanatomy (anatomical and neuroimaging labs). How the geometrical complexity of the “normal” brain can be overthrown in pathological states (tumours, hydrocephalus, trauma, etc.) and restored by means of the different therapies is my special interest on which my actual and next researches are focused.
PE: How do you think neurosurgery will develop over the next ten or twenty years?
ADI: Neurosurgery will be always less surgical and more technological, but this does not imply that neurosurgeon will operate less, it simply means that they will have to add to their manual skills a wider cultural background: medical engineer, computer science, molecular biology and genetics, maths. The capability of interacting with other professional figures in translational ways will be always more required.
PE: What do you believe to be the role of the EANS? And what do you feel should be its objectives over the next few years?
ADI: The EANS is unifying the EU in neurosurgical perspective, and this is praiseworthy, showing to the World that the old continent has something more than only history. Anyway, by travelling everywhere in Europe, I got the feeling that the concept of “school” is dying, unfortunately. There are very good neurosurgeons everywhere but always more sporadic teachers. Observing is very important in our profession, but it is not enough, and so the most motivated residents and young neurosurgeons are forced to “emigrate” to try to concretize their knowledge and to move their hands (as the etymology of the word “surgery” requires!). The problem is that they often move within the same city (doing rotations in different hospitals) or abroad only to find similar situations, with no chance to operate! It means, great economical and psychosocial privations and only frustrations at the end. The EANS should identify those schools which work like real schools, not just on the paper, making the network stronger, in order to let young neurosurgeons rotate in those temples of neurosurgery and allow them to grow up. This is important for the whole society, obviously not only for the neurosurgeons, but also, above all, for the patients. In the same way, the EANS should control in a more capillary way the universities/hospitals, which fail their didactic purposes.
PE: How do you choose to spend your spare time?
ADI: Listening and playing music; reading; writing; travelling. For time-related limits due to this job, I learned to be able to play much less than before. This was a sacrifice! But I cannot avoid travelling; the World is too much big and wonderful to not be seen! Congresses and workshops abroad have always been my best compromise during my summers in order to learn something new and to visit other countries. Clerkships and fellowships have been a good system to do full-immersions in other realities and to be citizen of the world more than tourist.
PE: Is there anything you can tell us that might surprise people reading the article?
ADI: I have been studying and playing guitar for more than 10 years. I noted that many neurosurgeons around the world are musicians, too, above all the most skilled, and that congresses are often good chances to improvise jam-sessions (I always have in mind the beautiful concerts and CD of the “Skull Base” group: the late lamented Dr. Perneczky at the guitar, Dr. Fukushima at the drums, Dr. Jannetta at the banjo, and other famous neurosurgeons). There is an evident propensity of neurosurgeons at least to play instruments, if not being expert “music listeners and lovers”. More than a clear propensity for fine movements of the hands and fingers, I think that these “elective affinities” are a propensity of neurosurgeons to play the most beautiful instrument of the nature, the brain, with the aim to “tune it up” when pathologies “disharmonize” it.