Nelson “Nick” Hopkins, III, MD, FAANS(L) is revered as the father of endovascular neurosurgery. In addition to his many accolades and leadership positions in neurosurgery, he was a SUNY Distinguished Professor of Neurosurgery and Chair at the University at Buffalo (UB) from 1989 to 2013. Best venerated for his pioneering achievements in the field of endovascular neurosurgery, he innovated catheter-based minimally invasive treatment of vascular diseases in the brain and spine. He was my esteemed mentor and has trained countless other neurosurgeons throughout his career, many of whom have held the highest leadership positions in departments and academic organizations nationally and worldwide. 
In 2001, when I was training under Nick as an endovascular fellow at the University at Buffalo, I clearly recall him stating, “If the cardiologists can stop heart attacks, we can and will find a way to stop stroke.” Those words marked the beginning of a paradigm shift in neurosurgery. His relentless efforts to find a better treatment for stroke first started with translational animal models, which led to small case series and institutional studies. His work eventually led to multiple national and international stroke thrombectomy trials demonstrating in 2015 that stroke was no longer a disease treated with rehabilitation. Rather, it could be treated with thrombectomy, and is potentially curable as well as reversible. Nick’s contributions were pivotal in proving that the number needed to treat to save a life with mechanical thrombectomy was four.
What propelled Nick as a lifelong mentor for me and many others was his strong will for innovation, going against the grain, and collaboration. Nick was a man of many friends, and throughout his entire career worked and learned alongside colleagues in the cardiology, radiology, vascular medicine, and surgical space. Despite being ridiculed when he first wanted to introduce catheter-based therapies for neurosurgical pathologies, he never let such obstacles slow him down. This courage was infectious. As his disciple, I, too, was labeled a cowboy and a pariah. As Aidan Ryan wrote in his article, The End of Medicine: “Boos and jeers met … panels and lectures… an audience member remarking after a talk that ‘If I had a tomato, I would have thrown it at you.’”
Dr. Hopkins’ will to collaborate and foster interdisciplinary synergies led him to create the Toshiba Stroke and Vascular Research Center. The Center brings together physicists, engineers, and biologists to investigate blood flow and imaging techniques, with the goal of moving the needle forward in neurovascular research and ultimately improving patient outcomes.
His passion for innovation and collaboration led him, with the support of Jeremy Jacobs Sr. and Kaleida Health, to create a world-class institution called the Gates Vascular Institute, housing a translational research institute, hospital, and the independent not-for-profit entrepreneurial Jacobs Institute. Led by my partner and Distinguished Professor, Adnan H. Siddiqui, MD, PhD, FAANS, the Jacobs Institute is a premier innovation center that provides a space for entrepreneurs, inventors, physicians, and engineers worldwide to come to train, test, and develop new technologies to treat vascular and neurological diseases. Dr. Siddiqui continues to globalize and augment Nick’s vision of embedding entrepreneurship in a hospital ecosystem, fostering collisions with curious multi-disciplinary scientists and physicians.
While serving as the Chair of UB Neurosurgery, Chief Scientific Consultant at the Jacobs Institute, and mentoring trainees, Nick never lost his genuine compassion for his patients. He often reminded us that all that we do is for our patients. Despite being at the forefront of our field, he also portrayed a sense of humility and never forgot to learn from his worst patient cases. He created an annual complications conference in Jackson Hole, Wyo. where interventional neurosurgeons, neurologists, and radiologists come to talk openly about their more difficult cases, to reflect, to discuss, and to learn.
Nick never lost his sense of what it meant to be human. He was loved by his trainees in a manner rarely seen in our field. He was a family man who loved spending time with his wife, Bonnie, sister, Jane, children Bob, Margie, and Betsy, and grandchildren. He also loved being around diverse people, and selflessly uplifted so many others. I am forever grateful for him taking me under his wing and giving me the opportunity to pursue his path of greatness. I stand on the shoulders of a giant, and can attest that generations of endovascular neurosurgeons would not be here today if he hadn’t instilled in us the mantra that “We must do better”. As the Department Chair, I strive to foster a culture founded on his unparalleled legacy of collaboration, innovation, discovery, and mission to treat and enhance patient outcomes. Our specialty lost a titan, and while we are greatly saddened, his legacy gift of endovascular neurosurgery will persist in perpetuity through his many devoted disciples in academic neurosurgery.
Editor’s Note: For more information on Dr. Hopkins’ life and accomplishments, please see the University of Buffalo’s tribute here. We hope you will share what you learn from our posts. We invite you to join the conversation on Twitter by following @Neurosurgery and using the hashtag #Neurosurgery.
Elad I. Levy MD, MBA
University at Buffalo Neurosurgery
Buffalo, NY
