On a recent spring day, a 29-year-old patient with double vision lay before Joshua Bederson, MD, the Leonard I. Malis, MD/Corinne and Joseph Graber Professor of Neurosurgery and Chair of Neurosurgery at Mount Sinai Health System in New York City. The cause of the patient’s vision problems was a tumor behind the bones at the base of the skull. As it grew, the tumor pressed into the part of the brainstem supplied by microscopic blood vessels that feed the tiny, fragile—and critical—brain cell nuclei and nerves that control movement in the eyes, the face and the limbs.
With a steady hand and years of experience, Dr. Bederson slowly and carefully untangled the tumor from those essential structures. “During the operation, I tried to peel the tumor away from those fragile brainstem structures to restore nature’s beautiful anatomy,” he said.
Building a Top Neurosurgery Program
To Dr. Bederson, brain surgery is a form of art. And he should know. He is also an accomplished sculptor. When he is not in the operating room, he’s almost always to be found in his home workshop and studio, forming graceful pieces in welded steel and copper, cast bronze, hammered stone and fused glass.
“To me, art and surgery are almost inseparable and indistinguishable,” he said. “One of my jobs is to remove what doesn’t need to be there, such as a tumor, to reveal the beautiful structure inside.”
Dr. Bederson applies that same discerning eye to all his work at Mount Sinai, inside and outside the operating room. As system chair since 2008, he has implemented changes that have helped the Neurosurgery Department at the Icahn School of Medicine at Mount Sinai grow into one of the most respected in the country. In 2022, The Mount Sinai Hospital was ranked number nine in the nation’s top 10 in Neurosurgery and Neurology by U.S. News & World Report and number 8 globally in Neurosurgery by Newsweek. Creative thinking at Mount Sinai has also led to the development of new medical devices and technologies that are accelerating the field. “I really love medicine, and I feel a deep sense of gratitude and privilege that Mount Sinai allows me to continue my work to improve patients’ lives,” Dr. Bederson said.
Art, Athletics, and Brain Surgery
Dr. Bederson’s roots at Mount Sinai run deep. In fact, he was born at The Mount Sinai Hospital. However, medicine wasn’t on his radar during his early academic years. An accomplished athlete, he went to Cornell University to join the gymnastics team. There, he became a three-time Ivy League Gymnastics All-Around Champion.
At Cornell, he majored in psychology and soon became interested in the neural mechanisms of memory. “I wanted to know why people forget things,” he said. “During my first year, the questions I posed to my professors were answered in scientific and neurobiological terms.” His professor steered him toward neuroscience, which Dr. Bederson eventually adopted as his major. But because he had attended an alternative high school that didn’t give grades, he realized he had to catch up academically if he wanted to pursue a career in medicine. With the same hard work and determination that made him a champion gymnast, he enrolled in summer school and threw himself into his studies.
The work paid off. After Cornell, he completed his medical degree and a residency in neurosurgery at the University of California in San Francisco. During medical school, he took a year off to study sculpture at New York University. The idea had come to him on a whim while studying for his medical board exams, and it took some effort to convince the medical school to sign off on the plan. His advisor agreed to the leave only after Dr. Bederson suggested he could also write some medical research articles during his year at art school. The plan worked better than he could have expected. He deepened his knowledge of sculpture, and the paper he published as a medical student, on neurological exams in rats, remains the fifth most-cited journal article in all of neurosurgery literature.
After a year at NYU, he finished medical school and completed advanced training in neurosurgery, followed by fellowships in the United States and Europe. He joined the faculty at Mount Sinai in 1992. Since then, he has performed nearly 5,500 brain surgeries, making a name for himself as an expert in removing skull base tumors—a challenging surgery due to the many critical nerves and blood vessels that crisscross the area. He also performs surgeries to treat vascular problems such as aneurysms and malformed blood vessels in the brain.
Neurosurgery Specialization and Skill
As Dr. Bederson focused his attention on skull-base surgery and other complex operations, he encouraged other neurosurgeons in the department to hone their specialties. “Previously, a well-trained neurosurgeon was expected to do almost every type of case. Since I became chair, I’ve made a point to develop each of our subspecialties,” he said.
He recruited leading experts in vascular surgery, pituitary surgeries, pediatrics, spine disorders and many other fields of neurosurgery. Some focus on treating stroke patients, for example, while others specialize in deep brain stimulation for Parkinson’s disease and epilepsy. By becoming hyperspecialized, a neurosurgeon can treat more patients with a given condition and gain more expertise and experience.
Across Mount Sinai’s hospitals, surgeons and patients have benefited from the department’s commitment to this type of specialization. “One of my enduring accomplishments has been recruiting and supporting the world’s best people to lead these programs,” Dr. Bederson said. “That’s what took our department from good to great, and it’s what’s taking us from great to best.”
Advances in Medical Imaging Technology
By becoming subject-matter experts, the specialists in Mount Sinai’s neurosurgery department stay on top of the latest tools and techniques. They also help invent them.
Mapping the anatomy of a brain tumor—and identifying the tiny nerves and essential blood vessels entangled within it—is one of the biggest challenges in neurosurgery. Dr. Bederson knew that new advances in imaging make brain surgery safer and more effective, and he wanted Mount Sinai to be at the forefront of those efforts. In 2012, he co-founded the Neurosurgery Simulation Core to devise new ways to see inside the brain.
Working with medical device manufacturers, he and his colleagues developed a simulation system based on virtual and augmented reality. They use many detailed scans of a patient’s brain to create a virtual reality version of the brain anatomy. That 3D virtual brain helps surgeons make a detailed plan before the operation—and helps them explain to patients exactly what will happen during surgery. Later, when Dr. Bederson peers into a patient’s brain during surgery, that same 3D image is projected onto the eyepieces of his microscope. The virtual version is superimposed on the real-life version, enabling him to “see” structures that lie hidden below. “I can make the bone transparent to see the tissues beneath or see through tissues to locate an artery that I need to avoid,” he said. “We helped develop this technology, and it’s just one example of the techniques our department has developed and brought to bear for our patients.”
The Burgeoning Field of Neurosurgery
The success of the Simulation Core evolved into Mount Sinai BioDesign, an innovative group that helps experts across the Mount Sinai Health System design new medical devices and bring them to market. In neurosurgery, the opportunities for new technology are almost limitless.
Advances in virtual and augmented reality, for instance, may make it possible for physical or “haptic” feedback in addition to visual feedback. Just as your phone buzzes silently in your pocket, surgeons’ instruments may buzz with haptic feedback to let them know they are getting close to an artery or nerve. Meanwhile, “the move toward minimally invasive treatments continues at a rocket ship pace,” he said. “What used to be big operations are becoming smaller and smaller and easier on the patient.”
Dr. Bederson is energized by those advances on the horizon and by the talent and passion of his colleagues. “I’m so proud of recruiting brilliant, kind and hardworking people to the neurosurgery department who will make the lives of Mount Sinai’s patients even better,” he said.
When he is not in the operating room or his sculpture studio, he enjoys piloting planes and long-distance running. He has two adult daughters, both of whom are pursuing careers in medicine. They are following in the footsteps of their dad as well as their mother, Isabelle Germano, MD, MBA, Professor of Neurosurgery, Neurology, and Oncological Sciences, who is the Chair of the American Association of Neurological Surgeons and Congress of Neurological Surgeons Section on Tumors.
Dr. Bederson has devoted his life to neurosurgery, and the field and his patients inspire him every day. “I’m constantly humbled by neurosurgery, and I feel so fortunate to have the trust of my patients,” he said. “I hope people feel that Mount Sinai’s ability to care deeply for each patient are hallmarks of their experience with us.”
