About Dr. Fernandez-MirandaProfessor of Neurosurgery at Stanford University; Surgical Director, Brain Tumor, Skull Base, and Pituitary Centers; internationally recognized for endoscopic skull base surgery, pituitary and cavernous sinus surgery, and white-matter–respecting approaches.In this episode, Professor Juan C. Fernandez-Miranda, MD (Stanford Neurosurgery) unpacks the decision to leave Spain for Albert Rhoton’s lab, what “complete resection” means when function is at risk, why restraint can be braver than reach, and the reconstruction choices that truly reduce CSF leaks. We also dig into training realities: endoscopic endonasal technique, cavernous sinus work, simulation that includes stress and chaos, and how to prepare teams for the complications that matter.Topics:• Spain → Rhoton: the leap that changed his career• The line he refuses to cross, even when he could “get it done”• Functional risk and defining “complete resection”• CSF-leak reduction: grafts, flaps, lumbar drains, and when to go free flap• Overused approaches in 2025 and where they still belong• Simulation that’s actually useful: bleeding, pressure, and team choreography• Habits outside medicine that sharpen intraoperative judgment• What to audit when technical perfection doesn’t help the patient• Training the next generation without shortcuts.Chapters00:00 Intro00:30 Spain → Rhoton: strategy vs leap of faith05:10 The surgical line he won’t cross07:20 What “complete resection” means when function is on the line10:50 Reconstruction to reduce CSF leaks (high-flow vs low-flow; flap strategy)15:05 Overused approaches and narrow indications (endonasal, transorbital)17:50 Simulation and realistic visualization (VR + cadaveric, carotid-injury drills)23:10 Concentration, meditation, and pre-op mental rehearsal26:15 When technical success ≠ patient benefit: indication, timing, expectations28:05 Teaching: wide base before tall tower; what he hopes fellows surpass him in29:35 What changed him most across a career — and what stayed the same
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