During my fellowship I was consulted for a 58‑year‑old patient with a ruptured posterior communicating artery aneurysm presenting with subarachnoid hemorrhage.

My task was to evaluate treatment options, obtain informed consent, and perform a safe clipping while minimizing re‑bleeding risk.

I reviewed imaging, discussed endovascular coiling versus microsurgical clipping with the neuro‑interventional team, and elected clipping due to the aneurysm’s morphology. I led a 4‑person operative team, used intra‑operative neuro‑monitoring, and achieved complete aneurysm exclusion.

The patient recovered without neurological deficit, was discharged on day 7, and at 6‑month follow‑up imaging showed no residual aneurysm. The case reinforced my ability to balance technical skill with multidisciplinary collaboration.

While resecting a thoracic intradural extramedullary tumor, sudden venous bleeding occurred from a bridging vein.

I needed to control the hemorrhage quickly to maintain a clear field and prevent spinal cord ischemia.

I instructed the scrub nurse to provide suction, applied a temporary hemostatic clip, used bipolar coagulation, and coordinated with the anesthesiologist to maintain stable blood pressure. I also called in a senior colleague for assistance.

Bleeding was controlled within 3 minutes, the tumor was completely removed, and the patient retained baseline motor function post‑operatively.

A 45‑year‑old glioblastoma patient’s MRI showed tumor progression despite maximal therapy, and the multidisciplinary team recommended palliative care.

I needed to convey the prognosis honestly while supporting the family’s emotional needs and discussing next steps.

I arranged a private meeting, used clear, non‑technical language, confirmed understanding, expressed empathy, and provided written resources. I also introduced the palliative care team and offered a follow‑up appointment to address questions.

The family expressed appreciation for the transparency, agreed to a hospice plan, and reported feeling more empowered to make end‑of‑life decisions.

A 62‑year‑old patient required a lumbar laminectomy for spinal stenosis but was anxious about the surgery.

My goal was to explain the procedure in lay terms, set realistic expectations, and alleviate anxiety.

I used an anatomical model, described the steps as ‘removing a small portion of bone to relieve pressure on nerves,’ highlighted risks and benefits, and answered all questions. I also provided a pamphlet and a postoperative recovery timeline.

The patient reported feeling confident, signed the consent form, and had an uneventful recovery with improved mobility.

Our institution convened a weekly tumor board for a 55‑year‑old patient with a newly diagnosed high‑grade glioma.

I was responsible for synthesizing imaging, pathology, and patient preferences to guide consensus on the optimal treatment pathway.

I presented the case, highlighted key imaging findings, facilitated discussion among neuro‑oncology, radiation oncology, and neurosurgery colleagues, and proposed a combined resection followed by chemoradiation based on latest NCCN guidelines. I ensured each specialist’s concerns were addressed and documented the agreed plan.

The team approved the plan, the patient underwent gross‑total resection with no new deficits, and subsequent adjuvant therapy was initiated on schedule, leading to a progression‑free survival exceeding 12 months.

During a cervical spine fusion, I noticed that the surgical count protocol was being skipped due to time pressure.

I needed to ensure all instruments and sponges were accounted for to prevent retained items, while maintaining operative efficiency.

I paused the case, reminded the team of the mandatory count, assigned a circulating nurse to verify items, and documented the deviation in the operative report. I later reported the incident to the quality improvement committee and helped develop a checklist reminder integrated into the electronic OR workflow.

The count was completed without discrepancy, the surgery proceeded safely, and the new checklist reduced similar incidents by 40% over the next six months.