E. Antonio “Nino” Chiocca, MD, PhD, believes neurosurgery is entering one of the most transformative periods in its history.
AI is beginning to reshape diagnosis. Robotics are redefining surgical precision. Gene therapy is pushing neurosurgery into diseases once considered untreatable. And increasingly, patients may become more active participants in navigating their own care.
“We’re undergoing a period of tremendous change in healthcare,” Dr. Chiocca said. “There are disruptions, challenges and opportunities happening simultaneously, and the revolution over the next five years is going to be how we deliver care faster, better and more efficiently while always keeping the patient first.”
He recently stepped into the presidency of the American Association of Neurological Surgeons while continuing to serve as neurosurgeon-in-chief and chair of the Boston-based Mass General Brigham department of neurosurgery. He is also the executive director for the Center for Tumors of the Nervous System at Mass General Brigham Cancer Institute and the Harvey W. Cushing professor of neurosurgery at Harvard Medical School, also in Boston.
The AI transformation already reshaping care
For a field already known for technological adoption, he believes the pace of change is only accelerating.
According to Dr. Chiocca, some of the most significant changes in neurosurgery are beginning to alter how patients move through the healthcare system.
“We have people writing computer programs right now using AI agents to help patients navigate their symptoms and signs, so we can get them to the right doctor at the right time,” he said. “That’s something that’s really emerged in the last year, and it’s amazing.”
Beyond navigation, he said AI and machine learning will improve detection and diagnostic efficiency.
“Gone are the days when there’d be a miss on an MRI scan or CT scan,” Dr. Chiocca said. “We’re moving toward a world where these systems can identify abnormalities immediately, contact the right specialist and dramatically shorten the pathway between diagnosis and treatment.”
For neurosurgery specifically, he sees AI becoming deeply integrated into imaging, surgical planning and precision-guided procedures.
“When I was training, we started using imaging, real-time imaging, intraoperative MRI scans and image-guided surgery,” Dr. Chiocca said. “Now a lot of other specialties are doing that, but we were amongst the first specialties to do this.”
He said those technologies will continue advancing neurosurgery toward increasingly precise and minimally invasive procedures.
Why brain cancer research is changing quickly
While AI is reshaping clinical care, Dr. Chiocca said another revolution is unfolding inside brain cancer research.
Historically, much of neuro-oncology research relied heavily on animal models and indirect biomarkers because obtaining human brain tumor tissue repeatedly over time was extremely difficult.
That limitation slowed progress, he said.
“The problem was we were always studying surrogates instead of what was actually happening at the tissue level,” Dr. Chiocca said.
Researchers can now repeatedly study human tumors at far greater resolution than previously possible. New technologies such as single-cell RNA sequencing and tumor cartography are allowing researchers to map the cellular composition of tumors and study how those cells interact and evolve.
“We can now map all the cells and all the components of a tumor and understand their interactions dynamically,” he said. “That gives us unprecedented views into why therapies fail or why they succeed.”
For researchers developing genetic and immune-based therapies for malignant gliomas, the implications are profound.
“That’s going to be one of the biggest revolutions over the next five years,” he said.
A growing concern among neurosurgeons
Despite rapid innovation, Dr. Chiocca said many neurosurgeons remain deeply concerned about the broader structure of modern healthcare.
As health systems consolidate and physician employment rises nationally, he worries neurosurgery risks losing some of the professional autonomy and advocacy that historically defined the field.
“Surgery has always been an intensely individual enterprise,” he said. “At the end of the day, it’s your eyes, your hands, your judgment and your patient.”
While he acknowledged that larger systems can improve coordination and team-based care, he also expressed concern that younger surgeons are increasingly being pushed toward a more transactional model of medicine.
“We start talking about FTEs and production lines and shift work,” Dr. Chiocca said. “But taking care of a neurosurgical patient is not a 9-to-5 mentality. If I were sick, or if one of my family members were sick, I would want to know that my surgeon is thinking about me all the time, not that at 5 o’clock somebody else takes over because the shift changed.”
For neurosurgery, a relatively small specialty compared to many others, he said maintaining advocacy and professional identity may become increasingly difficult as systems continue to grow.
“We worry about losing autonomy, losing individuality and losing advocacy,” he said. “I think healthcare is going to suffer if we lose that,” he said.
The next frontier
One of the developments Dr. Chiocca finds most exciting is the possibility that neurosurgery may expand into new categories of disease. For decades, many neurodegenerative disorders existed largely outside the realm of surgical treatment.
That may no longer remain true.
He pointed to Huntington’s disease and ALS as examples of disorders that could increasingly involve neurosurgical intervention through targeted delivery technologies and genetic therapies.
“I can’t wait to see what’s going to happen over the next decade in terms of technology, in terms of the precision surgeries that we are able to do,” Dr. Chiocca said.
Advice for younger neurosurgeons
Despite the technological acceleration reshaping the field, Dr. Chiocca said the core mission of neurosurgery has not changed.
“Number one, have fun,” he said. “Number two, keep your passion alive for what you do and always keep the patient front and center.”
For all the advances in robotics, AI and genetic engineering, he believes that principle remains the profession’s most important safeguard.
“If you keep the patient front and center, you never go wrong,” he said.
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