Giants in Neurosurgery

All fields have leaders. All fields have people and personalities who are transcendent, rising above common practice. We all know of such individuals, and some we know personally. Recently, neurosurgery lost one who was also one of my mentors and dear friends. He was a real giant, Ronald R. Tasker of the University of Toronto. To those of us who knew him, he was “Ron.” Ron did not start functional neurosurgery, but he did lead its scientific renaissance. His education started at the University of Toronto, later working in the laboratory of Dr Charles Best, the codiscoverer of insulin. Neurosurgery training at the University of Toronto together with neurophysiology led to a McLaughlin Traveling Fellowship in the United States and Europe. He was inspired at the side of Dr Clinton Woolsey, Professor of Neurophysiology at the University of Wisconsin. He really was one of the initial neurosurgical physiologists, adapting instrumentation to the operating room and bringing together his expertise in neurophysiology and stereotactic surgery. He received numerous awards in Canada, the United States, and abroad, including the Spiegel and Wycis medal from the World Society of Stereotactic and Functional Neurosurgery in 1993. We always believed that Ron knew more about the thalamus than any other human. His meticulous studies with quantifiable metrics obtained with a multidisciplinary team of surgeons, fellows, observers, and physiologists allowed him to tackle problems such as movement disorders and chronic pain that others were just beginning to understand. His book, “The Thalamus and Midbrain of Man” (what a title), was published in 1982 (Charles C. Thomas, Publisher). His modesty was always on display, even when I asked him to autograph my copy (Figure 1).FIGURE 1.: A, The thalamus and midbrain of man. Used with permission of Charles C. Thomas, from the thalamus and midbrain of man: a physiological atlas using electrical stimulation, by Tasker RR, Organ LW, and Hawrylyshyn PA, CC Thomas, 1982; permission conveyed through Copyright Clearance Center, Inc. B, Dr Tasker's inscription.Together, we did one of the first studies to show the value of MRI stereotactic guidance compared with the CT gold standard. This may sound trivial now and not surprising given that MRI guidance is used daily all over the world for accurate stereotactic planning whether for open surgery or radiosurgery, but it was a big controversy in the late 1980s and 1990s. Indeed, it was one of the hottest debates at stereotactic surgery meetings. I was Ron's chief resident at the Toronto General Hospital, and I asked him if I could perform a detailed comparison of CT vs MRI coordinate accuracy, which he gratefully supported. It certainly was not at the level of scientific sophistication like recording thalamic neurons, but it was what I could contribute. I was willing to put the stereotactic frame on at some ungodly hour, get both scans done, and make sure that the patient was in the OR ready to start as the first case. Together with data we added from the University of Pittsburgh, this was published in Neurosurgery in 1992 and was not without controversy.1 Indeed, Pat Kelly was still doing stereotactic angiograms then and was not an early supporter. Both Ron and Dade Lunsford just had open minds. But we helped put an end to that controversy. Ron spoke softly. Sometimes, it was audibly just above a mumble. You had to lean in to make sure you heard what he said. Many sentences seemed to end with a smile, as if to say “I just told you something important but you probably already knew that.” Because his surgeries included a functional and neurophysiological exploration of the brain target, which took time, his surgeries were performed in a small room, set apart from the “regular” operating rooms. They included his visiting fellows, often from Japan, Brazil, or other countries, taking notes and making recordings, all the while elevating the intellectualism of what was going on in that room. “Regular” neurosurgery is what we did in the main rooms, and of course, there was often nothing really regular about that. But in Ron's functional room, half the size of a standard room or perhaps the size of two closets, neuroscience surgery was being performed. Was there any other way to describe it? Assuredly, it was not for everyone, but it was for some of us. He could not be everyone's giant, but to those of us who followed his direction and incorporated functional neurosurgery into our careers, he was ours. There is a wonderful book by Paul Bucy2 from 1985, describing a special group of giants. In 1998, we arranged a meeting in Pond Inlet, Baffin Island, in the Canadian Arctic, to celebrate Ron's retirement. His wife Mary, another force, had been there before, and several of us encouraged her to go again, this time with a bunch of neurosurgeons from across the world. About 35 of us attended in the end. What an event! In 2002, we returned as a small group to the high Arctic in Svalbard, Norway, for another stereotactic surgery meeting. Both Mary and Ron were vigorous participants, but Mary had cancer and died shortly after. This August 2023, we reconvened in Ilulissat, Greenland, for the most recent Arctic meeting and celebrated Ron's legacy (Figure 2).FIGURE 2.: Ron Tasker, Spitsbergen, Norway, 2002. Used with permission from the Tasker family.Like a true person who had so much more than what might have appeared at the surface, Ron was a name to be recognized in a field outside of neurosurgery. He had a real interest in nature conservancy and, in particular, birds. He was known to Canada's great historical author Pierre Berton but not through anything related to neurosurgery. Berton was a television and press icon and a name known to every Canadian of the 1960s–1990s. I had a complete collection of Berton's books and hoped to get them signed. Ron arranged for us to meet. However, when I arrived in Mr. Berton's office with my books and mentioned our mutual friend, he simply said, “Oh yes, the birder,” a giant even beyond neurosurgery. Ron died on April 19, 2023, at the age of 95 years. We all know such people and how special they are in their own ways. We continue on their path and example. Neurosurgery is built upon them. Douglas Kondziolka, MD, MSc Editor-in-Chief, Neurosurgery Publications New York, New York, USA

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