Michael L.J. Apuzzo
2001, San Diego
Michael L.J. Apuzzo was born in New Haven Connecticut, the son of a fine craftsman/precision machinist and an operating room nurse. The Apuzzo family had a long maritime heritage with roots in Amalfi on the southern Italian coast. The maternal Lorenz family was Austrian with ties to the Art department at the University of Vienna. From an early age he was influenced by family interests in music, art, and sports as well as significant cultural influences created by the Yale University environments working at the Yale Bowl and campus for various athletic and cultural events. As a child he acquired an admiration for refined craftsmanship while watching his father create exquisite wooden yachts and sailboats in a boatyard on the Quinnipiac River.
He received his secondary education at the Hopkins Grammar School. Founded in 1660 with yearly classes of 40 or fewer students, the highly intense and disciplined environment was singularly influential in developing his academic style and interests. Within that setting, the appreciation of classicism, art, history, literature, physical and biological science and particularly competitive sport were further developed and fostered.
He entered Yale College with a primary interest in architecture, but as a work study student was serendipitously assigned to catalogue books at the Harvey Cushing Library under the direction off Madeline Stanton, Cushing’s former secretary. This experience helped to redirect his goals. He ultimately graduated with a major focus in psychology and zoology with active participation in varsity-level intercollegiate sports and enjoying highly stimulating experiences at the Bingham Oceanographic Laboratories at the University that included biological research activities and performing hypophysectomies on various fish species.
After entering the Boston University School of Medicine, he was particularly influenced by noted neuroanatomist Arthur Lassek, gastroenterologist Franz Inglefinger (Editor, New England of Medicine), nephrologist Arnold Relman (later to become Editor of the New England Journal of Medicine), the esteemed neurologist and physiologist Derek Denny-Brown at the Boston City Hospital and the academic surgeons Reginald Smithwick, Richard Egdahl, John Mannick and Francis Moore, who were instrumental in initiating his concept of the surgeon as a physiologist and innovator. His senior thesis under Denny-Brown’s direction was entitled, “The Enigma of Parkinsonism” and dealt with basal ganglia pathophysiological states.
At Egdahl’s urging, he entered a period of general surgical training at McGill’s Royal Victoria Hospital under the direction of the brilliant and ebullient Lloyd B. MacLean. At that time he was influenced in his development channels by his contact with the famous cardiac surgeon and innovator Arthur Vineberg and the faculty of the Montreal Neurological Institute, particularly Theodore Rassmussen and William Feindel, who helped to arrange a residency opportunity within the Yale Medical School setting. There he was encouraged by William German (a former Cushing fellow and long-time Yale chairman), the flamboyant and creative William B. Scoville, and Benjamin B. Whitcomb. Finally, William F. Collins, Jr. (later Editor of the Journal of Neurosurgery), who came to Yale in a chair transition, was highly supportive but, more importantly, became powerfully influential as a quintessential academic role model who solidified his perception of career surgical objectives and fundamental standards. Under Collins’ direction, he undertook complex electrophysiological studies of thalamic and dorsal horn lamina mapping over an eighteen month period.
With Scoville he was introduced to the concept of minimally invasive techniques and the power of creativity and progressive thinking in the operative setting.
Apuzzo went on to enter the United States Navy Nuclear Powered Submarine Service where, after special training in submarine operations, deep sea diving, and nuclear, submarine, and diving medicine, he was assigned to hazardous duty on extended submarine patrols to Polar regions, the Mediterranean and Black Seas. He was awarded and given special commendations by the United States Surgeon General and the Commander of the Atlantic Submarine Fleet. This experience and scientific background proved to be singularly important in the development of his career and focus toward introduction and transfer of complex technology to hospital and patient care settings. Additionally he became more appreciative of the potential for the use of methods of employing ionizing radiation in the nervous system.
In 1973 Apuzzo joined the faculty of the department of Neurological Surgery at the University of Southern California School of Medicine, where his associations with Theodore Kurze in the early developmental refinement of microsurgery and its applications, particularly in deep cerebral microsurgery, and Martin Weiss as an academic role model and supporter were highly influential in establishing both directional substance, focus and motivation. During this early and later periods he focused intensely on detailed aspects of microsurgical, instrumentation, methodology, its application in both the head and spine as well as aspects of operating room design. The environment proved to be exceptionally fertile.
In 1976 he established an amalgam with the Jet Propulsion Laboratory in association with the California Institute of Technology working at the time with scientists at Cape Kennedy/Cape Canaveral in conjunction with the Mars Viking project. This interaction fostered a twenty-five year relationship that refocused on the development and transfer of complex technology to the operating room and other areas of patient care from the aerospace and defense industries. This included, in part, work on complex imaging utilization in intracranial surgery, robotics, the introduction of biosensors and the biological applications of the free electron laser.
In 1978, through the intercession of Edwin Todd, he established a working relationship with the genius biomechanical engineer Trent H. Wells, Jr. and over a 12 year period working with Wells in his machine shop/laboratory helped to develop and refine the initial and then developing novel imaging directed stereotactic systems for point and volume stereotaxy, and later, early units of linear accelerator developed radiosurgery. Over time he refined, applied, championed and popularized these concepts in the operating room and clinical settings. Importantly, he established dialogue and mutual projects with USC Schools of Engineering and Cinema-Television, developing programs with film industries computer graphics resources. The computer became a neurosurgical tool.
In 1976, at the urging of Harold Young and Stephen Mahaley, he established one of the nation’s first central nervous system tumor-immunology laboratories. He introduced the concept and terms “cellular and molecular neurosurgery,” eventually performing the first reported series of stereotactically bilaterally implanted adrenal medullary autograft for Parkinson’s disease in movement toward the concept of neurorestoration. During a prolonged period of study he focused on tumor immune relations and their therapeutic implications, developing many clinical protocols for application to cerebral malignant neoplasms. Subsequently he initiated studies of auto-immune responses in head injury.
Beginning in 1977, he moved to reintroduce neuroendoscopy as an adjuvant in cerebral surgery performing some of the initial third ventricular surgeries employing the endoscope and stereotactic methodology to facilitate these procedures.
In all of these developments Apuzzo pioneered and championed the concept of minimally invasive neurosurgery as a paradigm shift in the field. During this time he published more than 470 contributions to the scientific literature, including 35 published volumes on the topics of the future of neurosurgery, microsurgery, neuro-oncology, stereotaxy, head injury, epilepsy, benign cerebral gliomas, malignant cerebral gliomas, cerebral surgery, general intracranial neurosurgery and the neurosurgical operating room. His principal atlas texts, Surgery of the Third Ventricle and Brain Surgery: Complication Avoidance and Management, are considered invaluable resources.
During his career he has been an ardent advocate for internationalism, education and facilitated global communication in neurosurgery. He has presented more than 50 keynote, named, or commemorative lectures. These have included the prestigious Richard C. Schneider (AANS), Herbert Olivecrona (Karolinska Institute), and Sixto Obrador (Her Majesty Queen Sophia of Spain) Academic Lectureships. In addition he has conducted 130 invited professorships worldwide while holding principal leadership and innovative roles in publication, program and educational committees of all major national and international organizations.
Apuzzo has served on more than 25 editorial review boards. Since 1992 as Editor of NEUROSURGERY, he has instituted and fostered innovations in scientific publishing, internet activities and the scope of organized neurosurgery in global unification in education.
With a lifetime interest in recreational and competitive sport, for 23 years he has served as the primary neurosurgical consultant for the University of Southern California Athletic Department, caring for a wide range of neurosurgical problems and ultimately serving as a resource for Olympic and professional level athletics and sports organizations. In particular, he has served as special consultant to the National Football League, currently holding the position as Principal Neurosurgical Consultant for the New York Football Giants.
His professional activities have been influenced by and continue to reflect his avid personal interests in architecture, fine painting, classical musicology, history, mythology, athletics and historical elements of American cinema.
He is the Edwin M. Todd/Trent H. Wells, Jr. Professor of Neurological Surgery, Radiation Oncology, Biology, and Physics at the Keck School of Medicine at the University of Southern California in Los Angeles where he continues to persistently and vigorously pursue progress in multiple focused clinical and more global aspects of the neurosurgical discipline.
He is indebted to his senior neurosurgical colleagues at the University of Southern California, Martin H. Weiss, J. Gordon McComb and Steven L. Giannotta, for their stimulation and for setting an atmosphere of unusual standards, and a long line of remarkable residents who have continued to translate their vitality, ideas and freshness of thought to maintain a nearly daily intellectual renaissance.
His son, filmmaker Jason, has been a source of new perspective, ideas and inspiration.