Dr. Brisman’s Bold Approach to Brain Surgery

When a neurosurgeon with more than 25 years of experience tells you to put down the knife, it is worth listening. That is exactly what Dr. Michael H. Brisman, CEO of NSPC Brain & Spine Surgery, argues in his recently published textbook. The book challenges some of the most deeply held assumptions in the field of adult brain surgery.

Put Down the Knife: A Fresh Look at Adult Brain Surgery is not a typical medical textbook. It is a carefully reasoned argument for restraint, precision, and rethinking when surgery is truly the right answer. For patients navigating a brain diagnosis, this book offers something rare: a surgeon who asks hard questions before reaching for a scalpel.

Modern Brain Surgery Is Newer Than You Think

Many people assume brain surgery has centuries of refined science behind it. In reality, modern adult brain surgery is a remarkably new discipline. While figures like Victor Horsley, Harvey Cushing, and Walter Dandy are considered fathers of modern neurosurgery, they worked in the early 20th century, long before the tools now considered essential to the field even existed.

It was only toward the end of the 20th century that truly transformative advances arrived. The operating microscope, widespread CT and MRI imaging, neuro-endoscopy, stereotactic neuro-navigation, stereotactic radiosurgery, interventional neuro-endovascular techniques, and intra-operative neuromonitoring all became available in relatively recent decades. Furthermore, many of these technologies have only recently become accessible to a broad range of neurosurgeons, not just those at elite research institutions.

This matters enormously. The scientific evidence supporting adult brain surgery in this new era is itself extremely new and still evolving. In other words, the field is operating with tools and knowledge that have not yet had generations of rigorous study behind them. Therefore, humility and caution are not weaknesses in this discipline. They are necessities.

The Art vs. Science Problem

There is both an art and a science to the practice of medicine, and adult brain surgery is no exception. A wide range of approaches exists, from the most conservative and minimally invasive options to the most aggressive interventions. All can fall within acceptable practice depending on the situation.

Dr. Brisman, however, believes the pendulum has swung too far toward the art side and too far away from the science. Clinical intuition and surgical confidence have their place, but they should not override evidence, especially when the stakes are this high. Adult brain surgery carries significant risks, and those risks demand a higher standard of justification before proceeding.

In contrast to a culture that can default toward intervention, Dr. Brisman argues that the starting point should be the most conservative and minimally invasive option whenever possible. Surgery should be chosen because the evidence supports it, not simply because it is technically feasible or because it has always been done that way.

What the Book Covers

Put Down the Knife explores adult brain surgery from this conservative vantage point. It examines potential errors in thinking related to surgical decision-making and challenges how the surgical literature is interpreted and applied. Additionally, it looks critically at the rationales used to recommend brain surgery in the first place.

Focused chapters then move into specific conditions, exploring less invasive and even non-invasive treatment approaches for brain tumors, cysts, hematomas, pain and movement disorders, skull base disorders, and much more. The book does not argue that surgery is never the answer. It argues that it should be the right answer, arrived at through sound reasoning and honest engagement with the evidence.

A Resource for Patients and Physicians

Put Down the Knife is written for medical professionals, but its message resonates far beyond the operating room. Patients diagnosed with brain conditions often feel pressure to pursue surgery quickly. Understanding that conservative options exist and that a cautious neurosurgeon is not a hesitant one can be genuinely empowering.

Family members supporting a loved one through a brain diagnosis will also find value in this perspective. A second opinion or a more conservative recommendation is not a sign of giving up. It may, in fact, be the most medically sound path forward.

Dr. Brisman’s willingness to put these arguments in print, as an actively practicing neurosurgeon, gives the message significant weight. This is not an academic abstraction. It is a perspective shaped by more than 25 years of patient care and a genuine commitment to doing right by patients, even when that means doing less.

Where to Find the Book

Put Down the Knife: A Fresh Look at Adult Brain Surgery is available now through major online booksellers, including Amazon Books.

For patients in the New York area seeking a consultation, NSPC Brain & Spine Surgery operates seven offices across Long Island and Manhattan and is consistently ranked among the top neurosurgical practices in New York. To schedule a consultation, visit nspc.com.