A new frontier in neurosurgery: restoring brain function with brain-computer interfaces, advancing glioblastoma care, and new hope for devastating brain diseases | Edward Chang, M.D.

**Peter Attia** (0:11)
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My guest this week is Dr. Edward Chang. Edward is the chair of neurosurgery at UCSF and a leading innovator in functional neurosurgery and brain computer interface. Edward's work bridges the operating room, the research lab and the engineering bench to restore speech and movement for patients who have lost these traits. In this episode, we discuss how modern neurosurgery evolved, dramatically reducing collateral damage and recovery time. What happens during awake brain surgery? Why the brain feels no pain? How real-time mapping protects language and motor function? And the split-second decision surgeons make at the edge of the eloquent cortex? Breakthroughs in brain computer interfaces? Neural engineering's next frontier, fully implantable wireless brain computer interfaces and functional electrical stimulation systems that may bypass damaged nerves to restore breathing or limb control? How genomic profiling, immune-based strategies and more extensive resections are slowly turning glioblastoma, a once uniformly fatal tumor, into a slightly longer survivable disease? Edward's vision for 2030 and beyond, slimmer, safer brain implants to restore speech for people with paralysis and other injuries, and how advances will help turn conditions like ALS, spinal cord injury, and even aggressive brain tumors into more chronic, manageable illnesses. So without further delay, please enjoy my conversation with Dr. Edward Chang. Betty, thank you so much for taking a time out of your very busy schedule to come to Austin. Really excited to talk with you today.

**Edward Chang** (2:44)
Oh, I'm thrilled to be here. Thanks, Peter.

**Peter Attia** (2:46)
So there's so much I want to talk about with respect to what your career is about today, and what the field of neurosurgery is in today, and how the bounds are really being pushed. But as we were talking earlier, I think that neurosurgery remains a little bit of a black box, and it might help orient our listeners if we give a little bit of a history lesson. So, can we orient ourselves back into the latter part of the 19th century, and what were the typical problems that would have presented to a neurosurgeon, and what were the tools that they had at their disposal? And let's posit that we're speaking after the development of anesthesia, at least, so we're not in completely gruesome lands of holding people down.

**Edward Chang** (3:28)
That is a really interesting question, and one of the reasons neurosurgery is a little bit of black box is, in many ways, people consider it sort of like extreme medicine. It's like a very small group of physicians that are taking care of patients with fairly severe indications, a really rarefied field that takes a very long training in addition. But let's say we go back a hundred years. We're talking about the era of Harvey Cushing, who's considered really the father of modern neurosurgery. I think that was a clear inflection point in the history of medicine, in the history of neuroscience, in the history of neurosurgery, really the beginning of what we would call the modern neurosurgery. Why I think that Cushing was so powerful was his observation, in addition to his ability to do extraordinary surgeries. So in addition to being really an astute observer, in addition to being an incredibly technically skilled surgeon, I think he was also an incredible internist too, diagnosing some of the first pituitary tumors and the effects of those on endocrine function. And then really the era of modern tools of craniotomy, opening the skull to get access to brain tumors. And everything followed since then. The main categories of neurosurgery have to do with tumors, the vascular system, which are aneurysms and strokes and blood clot, spine. And then probably the most recent one is the one we call functional, which actually has to do with understanding the functions of brain circuit, but also intervening to change how they work using deep brain stimulation or other ablation methods. And those are the really exciting new developments.