In most respects, the history of neurosurgery in Rhode Island followed the general pattern of the evolution of these specialties throughout the United States. Some limited "brain surgery" was done at first by general surgeons, then formally trained neurosurgeons came to the area. In addition to increasingly sophisticated neurosurgical cases, the early neurosurgeons also handled large amounts of what would now be considered medical neurology, until fully trained neurologists eventually arrived to take over their part of the work. But in Rhode Island, such things often have an interesting and unexpected twist — an individualistic difference — and so it was at the beginning of our story.

In the fall of 1937, Dr. Wilder Penfield, came to Brown to give a talk. He had just recently founded the Montreal Neurological Institute at McGill University and was already launching into his work in epilepsy surgery that made him famous. On the morning after Penfield's talk, a young man named Herbert Jasper, PhD, invited Penfield into his laboratory. Jasper, not at that time a physician, had acquired a doctorate in neurophysiology in Paris, where he had seen an early and crude EEG (electroencephalography) machine demonstrate human brain waves through scalp recordings. Jasper was skeptical, and so had constructed his own EEG machine in a basement room at Butler Hospital. 

The room was a maze of chicken wire, which served as electrical shielding, and Penfield recalled that, "Inside the maze was a young man [Jasper] moving about like a bird in an aviary." Jasper told Penfield that he had been able to use the EEG to localize the discharging foci in two epileptic patients. It was then Penfield's turn to be skeptical, but Jasper was persuasive. A few months later, Penfield operated on Jasper's Rhode Island patients in Montreal. Jasper's predictions proved accurate in both cases, and so began one of the most productive and important collaborations in twentieth-century neuroscience.

In Rhode Island and at Rhode Island Hospital, the first person to do neurosurgery on a regular basis was Dr. Wilfred Pickles, who had trained as a general surgeon. Dr. Pickles was officially appointed Chief of Neurosurgery at Rhode Island Hospital in 1944. Much of his clinical practice was trauma, and he wrote several influential papers on traumatic brain injuries (TBI) in the New England Journal of Medicine. In one of these, he points out that another Rhode Island physician, Henry E. Turner of Newport, much earlier (circa 1861) was perhaps the first to suggest that opening of the dura might be a useful mechanism to relieve pressure on the brain in the setting of head injury, a procedure that is indeed common today.

Dr. Julius ("Gus") Stoll, Jr. came to Rhode Island Hospital in 1954 and carried on the earlier work of Jasper, studying the brain’s electrical activity in both humans and animals. Stoll had received part of his training in Montreal, where he worked with Jasper, co-authoring several papers on epilepsy and neurophysiology. He came to Rhode Island after turning down an opportunity to join Maitland Baldwin's surgical epilepsy research program at the National Institutes of Health because he did not wish to limit his practice to temporal lobectomies. Here, he was among the early proponents of academic neurosurgery and neurology at Brown. 

Upon Pickles' retirement in December, 1956, Stoll became Surgeon-in-Chief of the Department of Neurological Surgery in January, 1957.  He thought he could do both community practice and research, but it proved to be impossible. In addition to performing neurosurgery and neurology at his home base, Rhode Island Hospital, he found himself consulting frequently in Attleboro and Fall River, Massachusetts. Eventually, he became the senior member of a busy three-person group, including Paul Welch and Melvin Gelch. 

Another early arrival on the neurosurgical scene in Rhode Island was Dr. Maurice Silver, who also had a background in epilepsy research. Silver was Chief of Neurosurgery at The Miriam Hospital from 1952 to 1960. He was eventually succeeded at that post in 1971 by Dr. Bertram Selverstone who, like Pickles, had trained at Montreal. 

Selverstone developed an outstanding reputation in neurosurgery as an innovator.  He invented the eponymous “Selverstone clamp” to gradually occlude the carotid artery in order to encourage the development of collateral circulation for the treatment of intracranial aneurysms.  In addition, Selverstone was an early pioneer of the idea that one could undertake intra-operative tumor localization using systemically injected compounds.  Because brain tumors may not be distinguishable from normal tissue using just the naked eye, some method to enhance visualization intra-operatively was required to improve a surgeon’s ability to precisely resect these tumors. In his case, he used injections of radioactive isotopes, such as Phosphorous-32, that he found to preferentially concentrate in brain tumors, combined with a modified radiation counter device fashioned as a modified ventricular catheter.  This approach was a precursor to a common method today, in which fluorescent compounds are injected intravenously, concentrating in tumor tissue such as to be observable through a microscope with a particular optical filter.

In his previous position as Chief of Neurosurgery at the Tufts/New England Medical Center in Boston, Dr. Selverstone had sent a rotating neurosurgery resident to Rhode Island Hospital. This practice was discontinued when the Residency Review Committee decided that the hospitals were geographically too far apart to sustain a viable affiliation. Around that time, initial efforts to start a residency program at Brown and The Miriam Hospital were unsuccessful. Meanwhile, Brown University’s six-year program in medicine was initiated in 1963, 133 years after the school's original medical course had been abolished in 1827. In 1973, the full MD program was reinstituted. The clinical departments were hospital-based and evolved slowly. 

Originally, Neurosurgery was a division in the Department of Surgery at both Brown and Rhode Island Hospital. In large part through the efforts of Dr. Stoll, a formal program in Neurosurgery was established in 1985. Dr. Mel H. Epstein came from Johns Hopkins in that year to become its first Chairman. One of Dr. Epstein’s major contributions was that he understood the value of Gamma Knife at a time when most people did not. He brought the first Gamma Knife system to New England, which was also one of the first in the U.S. The first director of the Rhode Island Hospital Gamma Knife, Christer Lindquist, had been trained by its brilliant inventor, Lars Leksell himself.  Gamma Knife radiosurgery became a signature of the neurosurgery program, with the only comparable treatment available in New England being the proton beam apparatus at Massachusetts General Hospital.  However, unlike Gamma Knife, that system could not perform highly focused treatments such as is required for many of the more precise stereotactic procedures. 

The Neurosurgery Research Laboratory was established in 1985 with the recruitment of Dr. Conrad Johanson, PhD, a senior investigator with extensive experience in cerebrospinal fluid (CSF) research.  Dr. Johanson’s work was among the earliest to recognize the importance of the blood brain barrier in the development of a variety of neurological diseases, including Alzheimer’s Disease.  This work continued with the recruitment of Dr. Petra Klinge in 2009.  Dr. Klinge would go on to establish herself as one of the world’s most sought-after experts for rare congenital disorders such as tethered cord and Chiari malformation, drawing patients from around the U.S. and from other countries. 

In 1987, the Neurosurgery Residency Program was approved; it was a seven-year residency. Six slots in that first year were filled with residents who transferred from other programs. The very first resident to go through all seven years was Dr. Deborah Benzil, one of the founders of WINS (Women in Neurosurgery) and now a prominent, nationally recognized neurosurgeon. She began the program in 1987 and graduated in 1994. The residents were accomplished, with the likes of Dr. Michael Park winning the Van Wagenen Traveling Fellowship Award from the American Association of Neurosurgeons (AANS).

In 1988, the Julius Stoll Chair of Neurosurgery was endowed to support the Neurosurgeon-in-Chief at Rhode Island Hospital. This was funded in part by a generous contribution from its namesake and in part by the many friends of Dr. Stoll, who wished to recognize his tireless efforts on behalf of the clinical neurosciences at Brown and throughout the Rhode Island medical community. 

Around that time, the programs in neurosurgery and neurology were combined into the Department of Clinical Neurosciences with Drs. Easton and Epstein, who alternated administrative responsibilities every two years, as Co-Chairmen. This combined department continued until Dr. Epstein retired in 2001, at which time Dr. John Duncan, a pediatric neurosurgeon, became the Chair of the Department of Neurosurgery.

In the 2000s, Brown Neurosurgery became a prominent center for “functional neurosurgery,” that is, brain surgery to treat disorders of function such as movement disorders, epilepsy and psychiatric disease.  Brown University was the first center in the United States to perform Gamma Knife Capsulotomy for OCD.  Under Dr. Gerhard Friehs, Rhode Island Hospital was an early adopter of deep brain stimulation (DBS) for tremor and for Parkinson’s Disease.  Furthermore, in collaboration with Brown Psychiatrists, the first implantation of a DBS system worldwide for depression was performed at Rhode Island Hospital, and the first implantation of DBS for obsessive compulsive disorder (OCD) in the U.S. was also performed here.  This led to a Brown-led multi-center trial of DBS for OCD that ultimately garnered FDA approval (under a Humanitarian Device Exemption) for this innovative treatment, the first and still only psychiatric indication for DBS.  In parallel, Brown neurosurgeon Georg Noren worked with psychiatrists to implement and demonstrate the utility of Gamma Knife capsulotomy as a treatment for intractable OCD (which, also led by Brown neurosurgeons, has more recently evolved into laser capsulotomy).

In 2010, Dr. Rees Cosgrove, a functional neurosurgeon who had established himself as a preeminent figure in the field while at the Massachusetts General Hospital, was appointed as Chair of the Department. He reorganized the Department, moving the neurosurgery offices into the hospital itself, and recruited two new faculty, Drs. Wael F. Asaad and Albert E. Telfeian.  He was instrumental for the establishment of the Norman Prince Neurosciences Institute, in honor of a decorated World War I pilot who ultimately lost his life due to brain injury suffered in an airplane accident returning from a successful mission.  The Institute was established with a $15 million gift from the Frederick Henry Prince 1932 Trust, which was created by Norman Prince’s father, Frederick Henry Prince, a Boston entrepreneur. The gift from the trust to Rhode Island Hospital was the single largest gift in the hospital’s history at that time. Rhode Island Hospital was selected for the gift by Elizabeth J.M. Prince of Newport and her children, Diana Oehrli, Guillaume de Ramel and Regis de Ramel — all three of whom have followed the family tradition as pilots and philanthropists.

In 2015, Dr. Ziya Gokaslan, world renowned for developing highly complex and innovative procedures for spine tumors while at MD Anderson Cancer Center and then at Johns Hopkins, was named Chairman of the Department of Neurosurgery. This marked an inflection point for the department of neurosurgery. What had been a small department of about half-a-dozen faculty now expanded over the next 8 years to include 19 clinical faculty and 3 PhD research faculty.  The most recent recruits include Drs. Athar Malik, Christine Lee, and Clark Chen.  This growth enabled a very high degree of subspecialization rivaling that of many of the most prominent departments in the nation.  Furthermore, a unique practice model re-aligned incentives to remove barriers against within-department referrals, ensuring that patients could be routed to the most highly capable specialists for their particular conditions, regardless of how they found their way into the system.

In conjunction with this growth, Dr. Gokaslan established an international neurosurgery referral pathway for the Department to help manage an increasing number of patients traveling long distances to see him and other faculty for highly specialized neurosurgical care.

The educational and academic programs of the department expanded as well during this time, with the residency program growing from 1 resident per year to alternating between 1 and 2 residents, and the establishment of fellowship programs in complex spine surgery, neurosurgical oncology, and functional & epilepsy surgery.  Published research work and research funding also increased dramatically during this time.  One example of this research effort is the “Intelligent Spinal Interface” (ISI) project, established between Drs. Jared Fridley (neurosurgery) and David Borton (neuro-engineering), along with other local collaborators.  This project was awarded a multi-million dollar grant from DARPA (the Defense Advanced Research Projects Agency) leading to the establishment of an advanced human mobility lab for testing device-based interventions for spinal cord injury and other mobility and movement disorders.

The Brown University Department of Neurosurgery at Rhode Island Hospital has over these years positioned itself as a premier clinical and academic program.  It has benefitted from the foundational efforts of many determined and innovative pioneers, and now the expert and thoughtful leadership of Dr. Ziya Gokaslan.  The Department continues to forge ahead with new ideas and new visions, to provide the most skilled, compassionate, and technically advanced neurosurgical treatments to patients who come from all over the U.S. and from more than 20 countries. The future of the Brown University Department of Neurosurgery at Rhode Island Hospital has never appeared brighter.