About Us

The Neurosurgical Innovations and Training Center is a state-of-the-art research and education facility within the Department of Neurological Surgery at Weill Cornell Medicine in New York City. Staffed by highly experienced and dedicated faculty, it serves as the home of our Fellowship Program in Skull Base and Microneurosurgery. The center also supports resident education, medical student electives and programming, and hosts a range of ongoing research initiatives aimed at advancing surgical innovation in neurosurgery.

Our Mission

We are committed to the advancement of the art and science of neurological surgery through excellence in research, education, and the maintenance of scientific and clinical scholarship. To this end, we seek to preserve and advance skull base surgical expertise by providing skills-based educational opportunities and training that equip neurosurgeons worldwide with the skills to perform safe, effective, and appropriately aggressive skull base surgery and that contribute to improved surgical practice and clinical outcomes.

Our Philosophy of Skull Base Surgery

Skull base surgery is a highly specialized area of neurosurgery focused on the management of tumors and vascular lesions in the confined and complex region at the base of the skull beneath the brain. These lesions, which occur in the narrowest recesses of the cranium and are often intertwined with critical neurovasculature, present a unique challenge due to their deep location surrounded by brain, bone, nerves, and blood vessels. Highly specialized training and an exacting understanding of three-dimensional microsurgical anatomy are required to perform safe and effective surgery within these microscopic corridors.

Skull base surgery also remains one of the few surgical domains in which operability, extent of resection, and patient outcomes are directly linked to the surgeon’s technical skill, particularly given the often benign nature of many lesions involving the skull base.

The prolonged and demanding training required for complex transcranial skull base surgery, combined with an accelerating rate of retirement among experienced surgeons, is driving a critical loss of expertise, particularly in highly developed countries. The effects of this are already being seen in some Western nations, where patients with potentially curable diseases are being denied curative and at times life-saving interventions due to a lack of surgical expertise.

To address this gap, we have created and utilize a skills-based approach to teach surgeons the full spectrum of what is surgically possible, from the most minimally invasive to extensive combined approaches, using microscopic, endoscopic, and exoscopic techniques, while deeply reinforcing the underlying rationale for each component and maneuver, thereby equipping them with a comprehensive skull base surgical armamentarium and empowering them to exercise sound and independent clinical judgment. In doing so, we train surgeons to utilize the most minimally invasive and tailored means for achieving maximal safe resection, thereby reducing unwarranted declarations of inoperability and mitigating morbidity from over-reliance on nonsurgical adjuvants.

Our Concept of Skills-Based Medicine

Today, the apprenticeship model remains the basis for surgical education and provides the foundation for surgical knowledge. However, the inability to alter or repeat surgical steps in order to satisfy or expand educational objectives, combined with the limits of performing only what is clinically warranted and the inherent stress of live surgery, render the operating room a far from perfect classroom for learning or refining surgical skills. Moreover, this model exposes living patients to the learning curves of trainees, with potentially devastating or life altering consequences. Shifting the learning curve to a nonpatient environment allows us to provide hands-on experience unbounded by case volume. As such, we have created a competency-based model of training that we refer to as skills-based medicine, which we define as an approach to surgical education and practice that promotes the primacy of technical skills and capabilities with deep understanding of their underlying rationale and that allows practitioners to develop fluent proficiency in new skills, procedures, and technologies that are not in one’s procedural repertoire, while promoting the development of mechanisms that allow for this—and the associated learning curves—to be traversed in nonpatient-based learning environments.

Skills-based medicine seeks to foster a deep understanding of surgical acts that transcend mere technical proficiency. Simply learning and repeating technical gestures in a recipe-like fashion does not lead to mastery unless accompanied by sufficient understanding of each gesture’s underlying rationale, recognition of the associated anatomical planes, and an appreciation of the intricate architectural scaffolding of each tissue layer. Accordingly, safe surgery necessitates the careful separation rather than the transection of this architecture. This requires knowledge of that architecture’s development and topography—learned through methodical and meticulous dissection—and permits atraumatic or minimally traumatic surgical traversal, exposure of deeper structures, and the faithful reconstruction of that architecture. Collectively, these elements constitute the foundation of deep knowledge and true excellence—understanding why, for example, the specific placement of the scalpel blade can avoid unnecessary bleeding and iatrogenic injury when separating juxtaposed structures. As such, the authors aim to cultivate surgeons who combine technical proficiency with deep anatomical insight, rather than merely training technicians to repeat gestures.

Additionally, skills-based medicine is an approach that seeks to reinforce the accuracy and replicability of evidence-based medicine by reducing heterogeneity and inadequacy in surgical skills and armamentaria.

Our Core Tenets of Instruction

As strong proponents of teaching the surgical component of neurosurgery, we fundamentally believe in teaching trainees the full spectrum of what is surgically possible so that they are prepared for the full scope of independent practice, guided by the following principles of instruction:

• Anatomical exploration independent of surgical approach, so that fellows explore beyond the boundaries of any surgical field
• Initial freedom from stepwise technique, so that fellows’ dissections are guided by the natural anatomy rather than by books or manuals
• Use of the surgical drill for all bone removal, so that fellows gain extreme confidence with the drill, allowing it to become an extension of their hands
• Development of a mental spatial map of the anatomy, so that fellows understand the necessity of unlocking structures to maximize exposure in skull base surgery
• Extradural preparation of the surgical field, so that fellows understand and can perform the techniques required to maximize both extradural and intra-dural access
• Intentional absence of dogmatic instruction, so that fellows learn the full skull base surgery armamentarium and can decide for themselves as to the optimal approach
• Importance of cadaveric dissection in skills development, so that fellows understand there are surgical skills and knowledge that cannot be learned by reading or observing
• Modulation of the curriculum’s pace and tempo, so that fellows can engage in immersive attention and perceive complex relationships that emerge only with strategic patience
• Deliberate environmental immersion and protection, so that fellows work in a purpose-built setting removed from everyday duties and distractions
• Documentation of dissection, so that fellows record their thought process as well as their evolving observations and the questions and speculations that arise from those observations

Our Approach to the Temporal Architecture of Microneurosurgical Training

The following is directly adapted from the brilliant commentary of Harvard’s Dr. Jennifer Roberts on immersive attention, as well as from the writings of Dr. Shari Tishman of the Harvard Graduate School of Education in her book Slow Looking: The Art and Practice of Learning Through Observation.

Within our fellowship training program, we not only organize the sequence of the material, but also engineer, in a conscientious and explicit way, the pace and tempo of the learning experience. We also actively engineer an environment where fellows can engage in deceleration, patience, and immersive attention. In response to the tendency toward immediacy, rapidity, and spontaneity, we provide fellows with the ability and the structures to slow down.

The entirety of the first week—forty hours—is devoted exclusively to the meticulous dissection of a single orbit and the tedious removal of all periorbital fat while carefully preserving each intraorbital structure. During this and all subsequent dissections, fellows are expected to document their thought process, noting down their evolving observations as well as the questions and speculations that arise from those observations. The time span is explicitly designed to seem excessive. Crucial to the experience is the lab setting itself, which removes the fellow from his or her everyday duties and distractions.

At first, many fellows resist being subjected to such a tedious exercise involving a region often relegated to the periphery of neurosurgery. How can there possibly be days’ worth of nuance and information on these small surfaces? How can there possibly be days’ worth of things to see and think about in such a small space? But after following the curriculum, fellows repeatedly report that they have been astonished by the potentials this process unlocked. This initial exercise not only gives fellows the opportunity to orient themselves to working under the surgical microscope and hone their microdissection skills, but also allows them to almost subconsciously develop a mental-spatial map of the region—its components and topography—merely from the time spent looking at it, and it lays the foundation for the expected pace of dissection going forward.

This approach reinforces, in a visceral way, that there are complex anatomical details and relationships that take time to perceive. This is an exercise in immersive attention that demonstrates to the fellow that just because you have looked at something does not mean that you have seen it. That is, just because it is available instantly to vision does not mean that it is available instantly to consciousness. Or, in slightly more general terms: observing is not synonymous with learning, and visualization does not always infer access. What turns observing into learning is time and strategic patience.

While the fellowship is principally about learning the full spectrum of skull base surgery, it also serves as a master lesson in the value of critical attention, patient investigation, skepticism about immediate surface appearances, and the outsized importance of immersive attention in skills-based surgical training, where it is not ancillary to expertise but foundational to generating deep, reliable, and enduring knowledge.

For more information, please see Bernardo A, Evins AI. The Weill Cornell Skull Base and Microneurosurgery Skills-Based Neurosurgery Fellowship: A 20-Year, 200-Fellow Retrospective. World Neurosurgery. 2025;197:123948.