Love at First Sight: How One Surgeon's Passion for the Brain Changed Her Career

When neurosurgeon Emanuela Binello, MD, PhD, ScD, FAANS , talks about the brain, her whole face lights up. “The brain pulses,” she says with glee, reflecting on the first time she saw a brain during her neurosurgery rotation. “Did you know that? It beats just like the heart.”

Her passion for her craft is evident as she continues to describe her love for the brain and spine.

“I still remember the first time I saw the spinal cord,” she says, miming the intricate pattern of vertebrae and tissue, “and then seeing all the arteries in the brain? It’s just so cool,” she says.

Though she’s been a neurosurgeon at Boston Medical Center (BMC) for 11 years, specializing in brain tumors and the spine, her path to neurosurgery wasn’t a “traditional” one. Already armed with a doctorate in nuclear engineering, Binello was looking for a change as an MD/PhD student in the Harvard Medical School – Massachusetts Institute of Technology Division of Health Sciences and Technology (HST).

“Everything is so technical with engineering,” she says, “There was always a medical bent to what I was researching as an engineer, but I felt I was missing a biological lens.” As a medical student, she explored many different surgical specialties — from radiation oncology to transplant surgery to otolaryngology — before becoming fascinated by the brain and spine on her very last rotation.

“It was love at first sight,” she says, “I also remember the case when I saw the dura for the first time. And I knew I would never be bored.” The dura, for those not as impassioned by the brain as Binello, is the outermost layer of connective tissue that surrounds the brain and spinal cord.

But, given that she fell in love with the brain and the spine close to the end of her clinical rotations, she had to rush to complete her application for neurosurgery residencies.  And against all odds, she did it. By January of her last year in medical school, she was on her way to a neurosurgical residency at Mount Sinai Hospital in New York. Eventually, Binello made her way back to Boston where she’s made a name for herself at BMC, performing complex spine and brain tumor surgeries and heading up the neuro-oncology tumor board for the brain and the spine.

Cultivating her surgical approach

Binello is unique in the way she practices her craft. She is a specialized spine surgeon, but she also specializes in brain tumors, which is unusual for a neurosurgeon — most have one specific area of interest, but Binello loves both forms of surgery equally. And, she says, having a more general perspective on the brain and spine is beneficial from a surgical perspective.

“When you know how to do both things, you can simultaneously bring different perspectives to the table. You can synergize and help you give a broader perspective,” Binello says. “Sometimes, for example, a surgeon seeing spinal stenosis and there’s a little cord signal change on the imaging. Someone who only does tumor surgery may immediately think there’s a tumor behind there. But if you’re a more general neurosurgeon, you know that it could just a result of simple arthritis or degenerative disease”

She adds, “Having had your hands in many different types of neurosurgery can really give you greater insight in some of the cases that require more nuance.”

By having a broad approach to neurosurgery, Binello can effectively tailor specifically to each of her patients, regardless of whether they are coming in for a tumor removal or a more emergent complex spine case. Though she operates from a philosophy of shared decision-making, she takes umbrage with the term itself, “Shouldn’t that be the norm?” she says, “We should always be involving the patient in their care.”

“Honestly, whatever the case is — spinal surgery or brain tumor surgery — when the patient has a good outcome, that is very satisfying and rewarding.”

Finding a home in Neurosurgery at Boston Medical Center

When asked why she’s stayed at BMC for most of her career, Binello has a few different answers: She appreciates BMC’s commitment to multiculturalism and equity. As an immigrant — Binello moved here from Italy in childhood with her mother and grandmother — she knows what it feels like to be an outsider.

“I think the immigrant experience — though, they’re all different, of course — helps me have patience and grace with our patients who may not speak English,” she says.  She describes sitting in hospital rooms with her grandmother who could only speak Italian and seeing doctors and nurses get frustrated with her.

“I remember so clearly one time she was trying to say ‘enough,’ which in Italian is ‘basta,’ and doctors thought she was [cursing at them],” Binello remembers. “I never forget that and try to practice understanding with all my patients.”

Another reason she is committed to BMC is her role in surgical education. As a faculty member of the neurosurgery BIDMC-BMC residency program, and as co-director of the neurosurgery pre-residency fellowship program: “It’s rewarding to try and foster growth in neurosurgery skills among all these trainees aspiring to be neurosurgeons,” she says.

She’s also buoyed by the breadth of surgeries she gets to do at BMC, which goes back to her early days of romance with neurosurgery. Binello is never bored. She gets to operate on brain and spine,  from pituitary tumor surgery, to lumbar laminectomies (“I call them a labor of love,” she says, “They’re relatively simple procedures but they provide a lot of relief for the patients in the end”), to radiosurgery (which uses radiation, rather than incision to treat tumors), to emergent spinal surgery, and also guides both surgical and nonsurgical treatments for brain tumors, degenerative and trauma spine disease, and peripheral nerve conditions.

But, at the end of the day, it all comes back to her zest for the brain and the spine.

“They’re still enchanting to me,” Binello says with a smile. “I’m still awestruck at times. It’s pretty amazing.”