Like rocket science, brain surgery has become a byword for as complicated and challenging a job as you can imagine. Only 100 years ago, the most complicated organ in the human body was considered by many surgeons to be too delicate and risky to operate on.

In 1908, the following would have been unthinkable – a video of a recent operation conducted by Ludvic Zrinzo, a consultant neurosurgeon, and his colleagues at the National Hospital for Neurology and Neurosurgery in Bloomsbury, London.

In it, surgeons are clustered around a recumbent patient, who is awake, under local anaesthetic, with her brain exposed. Her left hand is shaking and flapping uncontrollably.

“This is a lady with Parkinson’s disease, she’s quite young – in her 50s and she’s lived with this constant tremour. You can imagine how disabling that is,” Mr Zrinzo, 36, said.

“The neurologists gesturing in front of her are trying to get her to put her thumb and fingers together. She just can’t do that, her hand is paralysed with stiffness and she can’t control it.

“Then we place an electrode deep within the brain – and at once, she’s laughing. The tremor, the stiffness, has gone and it’s like a switch has been turned on – suddenly she can control it.”

The relief of the patient, as well as the surgeons, is palpable. Mr Zrinzo, an expert in “functional neurosurgery”, such as deep brain stimulation in which electrodes are implanted in the brain to treat diseases such as Parkinson’s, grins.

“I see this every week and it never ceases to amaze me,” he said. “You can target the right area of the brain, flick a switch and have such a tremendous effect on a patient’s quality of life.”

He has wanted to be a brain surgeon since he was a child. “I was probably about 8 or 9 when I thought that brain surgery would be quite a cool thing to do. I was lucky that I was quite good at maths and physics, so for a while it was: brain surgeon or astro-physicist?” Curiosity concerning the mysteries of the cosmos eventually gave way to intrigue about the workings of the 1.5kg of grey matter trapped between our temples.

As the bank of four computer screens in his office suggest, when he is not seeing patients he is conducting research, at present focusing on a PhD on making better use of brain scans. The hours can be long.

“My wife says I’m married to two people: her and the job. I can do research work outside hospital, but I tend to come in early, catching the first Tube at 5am and am usually here until about 7pm.”

“One day might be a whole day in theatre operating on one patient, another day might be four or five patients on your operating list, another day might be seeing patients in clinic, another day might be on call, when you’re consulted as patients arrive at hospital as an emergency, with life-threatening conditions.”

It can be exhilarating, but modern surgery is a matter of teamwork, dedicated preparation and organisation. “As a consultant, you’re ultimately responsible for the patient and leading the team that looks after them. But the first thing you need to understand as a neurosurgeon is when you can help and when you can’t.”

Moreover, the philosophy and technique of brain surgery is very different to other types of operation. “If you have a kidney or liver tumour, the idea is to take that tumour out and a margin of tissue around it. In neurosurgery, you’ve got to respect the brain and remove the tumour without damaging the surrounding area as much as possible. Sometimes it’s better to leave some tumour there and preserve function of the patient, rather than to end up with someone who’s paralysed or can’t speak.”

The only surgeon who doesn’t have complications is the one who doesn’t operate. “It’s important to realise that even if you’ve done everything well, to the best of your ability, nature sometimes doesn’t play ball and the outcome isn’t as good as you expected. It’s very rewarding when things go well and it’s devastating when things don’t. But that’s something that every surgeon encounters, and grapples with, until the day he or she retires.”

What it takes

Qualifications Aspiring neurologists will need a good medical degree

Training Like all doctors, brain surgeons spend two years on a foundation training programme, before completing a core neuroscience two-year training programme. This is followed by approximately six years of speciality training

Attributes As well as technical knowledge and clinical expertise, brain surgeons need good hand-eye coordination. Also vital are the communication skills to deal with patients and colleagues in high-pressure situations

Salary expectations Doctors in specialist training earn between £43,000 and £68,000. Consultant neurologists earn between £73,403 and £173,638, dependent on length of service and additional performance-related awards

Working life Emergency work accounts for more than half of the case-load, so on-call work and out-of-hours emergency operating can be intensive. Most consultant neurosurgeons spend between four and five sessions in the operating theatre each week

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