My path to brain surgeon: Patients first and relentless drive to improve

How does a boy born in Lebanon become a top brain surgeon in Charlotte? For Dr. Ziad Hage, board-certified and fellowship-trained cerebrovascular and endovascular neurosurgeon at Novant Health Brain & Spine Surgery - Cotswold, it took inspiration from his father and perseverance to gain surgical training in a new country.

Here, Hage describes* his journey, why he is drawn to neurosurgery, and how he mentally prepares for the most challenging operations.

I was born in Lebanon in 1978. My father was the first medical oncologist in the country. He trained in the United States, at MD Anderson Cancer Center, and came back to Lebanon to share his knowledge. That's why he had such a busy practice. His brother was a radiation oncologist. They completed each other in treating the cancer patient.

My father had his own private clinic in Beirut. He was able to take me with him when seeing patients in the clinic or their homes, with their consent. Very early I knew I wanted to go into medicine. I learned from my dad a dedication to patients, bedside manners, and compassion.

I wanted to become a surgeon because I wanted to do more with my hands. I liked the action. In medical school at the American University of Beirut, I developed a keen interest in neurosciences, including the brain and spine. ‘Neuro’ plus surgery equals neurosurgery, and that's what led me to my discipline.

My dream of becoming a neurosurgeon in the United States was extremely difficult to achieve because of the highly competitive field I was getting into. I was competing with U.S. graduates for residency training. To increase my chances, I spent two years doing neurosurgery research at Northwestern University in Chicago.

Later I was lucky to be trained by one of the best cerebrovascular and bypass surgeons in the world, Dr. Fady Charbel, at the University of Illinois in Chicago. I learned from his excellence in surgical technique, his calm and wisdom.

I developed a love of cerebrovascular neurosurgery, the subspecialty related to diseases affecting the blood vessels of the brain. It requires a craniotomy, or removing a portion of the skull, and treating the patient through open brain surgery. It’s the most difficult subspecialty in neurosurgery because of the complexity of the disease processes and how highly technical it is.

Cerebrovascular neurosurgery deals with brain aneurysms, artery venous malformations, arteriovenous fistulas, cavernous malformations, Moyamoya disease and any other condition that would require bypass surgery in the brain. I'm one of the few surgeons in Charlotte performing brain bypass surgery, which bypasses a blocked or narrowed artery by creating a new pathway for blood to reach the brain.

I wanted to become fully rounded and offer patients a less invasive method of dealing with the blood vessels of the brain or other conditions affecting the brain or neck such as blockages, tumors or bleeding. The endovascular method treats many of the same conditions as cerebrovascular surgery, except in a minimally invasive way. You're able to introduce your instruments through a puncture in the wrist or the groin. For stroke when the blood vessels are blocked, we can guide our instruments from the wrist or groin up to the clot, pull it out, and reopen the vessel.

The downtime afterwards is 24 to 48 hours, versus four to six weeks and recovering from major brain surgery. There are guidelines to offer one procedure versus the other, but in those patients who have both options, how attractive is it that you can have your aneurysm fixed without having your head opened?

My last subspecialty is skull base neurosurgery, dealing with the most complex and difficult tumors arising from the base of the skull. All the important nerves, such as those that give you vision, smell, and hearing, are located at the base of the skull. You can only imagine how meticulous it is to try to dissect a tumor away from those structures without injuring them.

I've been with Novant Health since July 2016. One of my most memorable cases was a teenager who had a giant aneurysm. I had to stop blood flow to the brain from one of the most important blood vessels. The brain can only survive nine to 10 minutes without blood supply before a stroke happens and damages the brain irreversibly.

I had 10 minutes to stop the blood flow through that major blood vessel, cut the aneurysm open, clean out the blood clot, cut and trim it, reconstruct the blood vessel with metal clips, and reopen the vessel. We had a timer running in the operating room.

My training helps me prepare for surgery, physically and mentally. You need to be mentally tough, and that’s why neurosurgery is not for everyone. There's a pretty good amount of attrition in neurosurgery training. The worst thing you could do as a surgeon is deal with stress by panicking. You have to be the complete opposite when faced with adversity. Your “calm” level has to be tripled.

You want to be compassionate, but if you develop a strong emotional relationship with a patient, that may cloud your judgment. I’ve developed friendships with patients but that usually comes after the surgery, where I walk with them through their recovery or their fight against cancer.

It's a very important part of my career to be involved in research. I'm a principal investigator for a study assessing a groundbreaking device being developed by one of the big companies. It's similar to a mesh sphere, deployed within a brain aneurysm to treat it. Here in the U.S., we’re doing our version of the testing that was already completed in Europe. Novant Health was also one of the few centers in the country to test a device to remove deep blood clots in the brain. I was the principal investigator for that research as well.

Someday, I hope to be recognized for a breakthrough in a device. As I'm doing surgeries or endovascular procedures, I'm always thinking, ‘How can we do this better?’ I’ll write notes later or draw something about a potential new device. I might refine the idea and talk with industry manufacturing experts about it.

My father was very proud to see my career unfold. To me, being able to operate on people and save their lives as a neurosurgeon is a privilege. I am blessed to be able to have that privilege.

* As told to Andrea Cooper