University Professor Stefan Ioan Florian , MD, PhD

Neurosurgery- the greatness of cerebral and vertebral restoration

Motto: The brain is sublime. Without brain there is no life.

University Professor Doctor TEFAN IOAN FLORIAN

Neurosurgery- the art of cerebro-vertebral reconstruction.

Neurosurgery represents the professional identitys domain, in which the first

university professor of neurosurgery from Cluj, Stefan Florian became acknowledged.
The progressive accumulation of his vertiginous medical reputation registered at the age
of 46, consists in a highly impressive activity which includes, only in the last 5 years
more than 2065 brain, spine and peripheral nerves.surgeries.
Formed at the medical school from Cluj and specialized in complex and
exhaustive activities of diagnosis, functional and clinical evaluation, treatment,
prophylaxis, rehabilitation, structure education and research programs, the senior
neurosurgeon Stefan Florian fits in the gallery of the elite professionals thanks to the
results of his career consolidated through his skills, abnegation and surgical talent. The
instruments of his restless excellence, contribute not only to the recovery of the ill
people, who later are reintegrated in the society, but even with the framing of the
scalpels specialist in the extremely limited category of people, who are born, live and
accomplish things for their fellows.
The well grounded professional training, its prolific clinical experience, and the
effectuated scientific research assured and empowered him with multiple competencies
in a profession, which places the secret of the brains life above everything. The
fascination, produced by the labyrinth of the gathered neurons in a never ending
network, which globally works thanks to the billion of connections established among
more region of the cerebellum in a spinning of an incomparable complexity defined as
brain, arouse his interest from since he was a high school pupil, moment which coincided
with the outlining of the option for medicine. The revealing episode of his future
profession took place at the biology-chemistry class of the Mathematics - Physics High
School from Miercurea-Ciuc, high school graduated by him in 1979. In the same year
the crucial biographical landmark appeared once he was admitted at General Medicine
Faculty of the Institution of Medicine and Pharmacy from Cluj. Encouraged
stimulated by meeting several teachers with high prestige, real moral and professional
models of famous medical university in the 80s, Stefan Florian completed his education
graduating triumphal with the best qualification (mark 10). The attraction towards
neurosurgery became obvious beginning from the second year of university, when he
made acquaintance for the first time with the Neurosurgery Clinics, assisting actively at
the at the unbinding of the central nervous system pathology, at the process of diagnosis
and treatment, or surgical remedies of the brain and of the vertebral spine. All these
persuaded him for a thoroughly study of the neuroscience spectrum. After completing
the three years training at the Neurosurgery Clinics he received the repartition for
Fildu, Salaj County. After promoting the secondary exam in neurosurgery in 1990
offered him the chance to evolve competitively within the Neurosurgery Clinics, and to
accumulate knowledge and experience in order to amount to perfection through a
harmonious interpenetration of the clinical activity with the didactic-training one.

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Starting with admissions based on examination at the University of Medicine and
Pharmacy Iuliu Hatieganu as assisting professor of neurosurgery, the phenotype of
the specialist shaped on the increasing slope described by important levels of enlightened
career development through participation at postuniversitary courses, exchange of
experience and neurosurgical training under the guidance of Romanian specialists like
Alexandru Vlad Ciurea, Al. Constantinovici, Constantin Ciuce, and abroad as well at the
University Hospital of Grenoble, France, and in different European neurosurgical
centers within the training completed at the European Association of Neurosurgical
Societies.
The concept of neurosurgery based on a fundamental knowledge of
neuroanatomy, neurophiziology and surgical particularities of the brain calibrated by a
supported surgical activity propelled him professionally not only as a clinician but also
hierarchic as a specialist neurosurgeon, head of the Neurosurgical Department since
1995, senior and associate professor (2000), from 2001 in front of the Authority of Public
Health of Cluj County, institution led by him until 2004 as executive director. Head of
the First Neurosurgical Department within the Cluj County Emergency Hospital, Stefan
Florian succeeded in bettering the therapeutic protocols applied differentiate in the
whole pathology nationwide including cerebral, medullar or vertebral tumors, arterio-
venous malformations, cerebral aneurysms, ischemic or hemorrhagic strokes, internal
hydrocephalus, congenital cerebral malformations, cerebral and spinal cord abscesses,
and cerebral and vertebro-medullar neurotraumatology.
He obtained significant results in cervical or lumbar disc degenerative pathology,
approaching successfully the microneurosurgery of the peripheral nerves and
reconstructive neurosurgery of bone defects of brain calotte etc.
On scientific level, after presenting his PhD thesis entitled The neurosurgical
Treatment of Pituitary Adenomas, he engaged in a febrile research activity, which
congruently capitalizes the experimental and clinical results with a solid documentation
in the area of advanced neurosurgical performances. Multidisciplinary specialized in
complex diagnosis and treatment evaluation of patients with serious neurological
pathology, occurred as a consequence of lesions of the central nervous system, the
neurosurgeon Stefan Florian treating cases of neurotraumatology, cerebro-vascular
emergencies, intracranian expansive masses or arterio-venous malformations identified
and introduced a series of neurosurgical techniques in premiere on local and regional
levels. His scientific contributions are highly relevant regarding the multidirectional
microsurgical approach of brain tumors and vascular lesions of the brain stem, the
microsurgical approach of arterio venous malformations, the multimodal treatment of
brain tumors, the microsurgical approach of intramedullary tumors, the approach of
intracranial aneurysms, the counter-lateral microsurgical approach of multiple
intracranial aneurysms, the microsurgical approach of pituitary adenomas through
bifronto-pterional craniotomy (personal technique), the translabyrinthic approach of
the acoustic neurinoma (national priority), the combined transthoracic and posterior
approach of intra-extra rachidian thoracic tumors, the anterior approach of the
cervical spine and the introduction of new materials for cranioplasty. The salt from the
title of associate professor to professor in 2007 validates the precious results obtained by
Stefan Florian in his neurosurgical, didactic and research activity. In the cavalcade of
preoccupations of the professionally crowded neurosurgeon an important area is
represented by the summarize of the research results, conceptualized in over 131
scientific papers published in international and national specialty journals, studies cited
ISI and BDI, articles in study volumes, studies presented at diverse scientific
manifestations, seminars, workshops and symposiums. He elaborated courses and

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specialty books as single author and discussed a series of topic issues in multi-author
papers. The neurosurgical treatment of pituitary adenomas, Health management in Cluj
County, Neurosurgery - Course for students, Neurology Course for Students Neurologic-
Neurosugrical Semiology (in collaboration with L. Perju-Dumbrava, S.K. Calomfirescu),
Treatment options in hemorrhagic cerebral vascular stroke (co-author L. Perju-
Dumbrava), Guide of Neuro- Ophthalmology (in collaboration with Adriana Stanila).
Member of different scientific research committees, he participated at the
accomplishments of important projects and in research-development grant contract
based programs.
Within his professional arsenal he designed the development of a reference
neurosurgery center and modernized the medical unit, which he has been leading,
having the ambition and perseverance to increase the level of neurosurgery in Cluj, in
Transilvania and in Romania. Along the neurosurgical domains already adopted and
applied in the practice of current neurosurgery, the introduction of neuronavigation,
functional and stereotactic surgery are the goals that the cordial neurosurgeon is aiming
for in not a far-off future.
In the existence of the neurosurgeon Stefan Florian, who intensively feels the
responsibility of a profession engaged in the service of those who suffer, and of
spectacular remedies, the episodes which enlighten his identity and altruism, reflect the
balance in his career with results and echoes.
For his prolific activity he obtained numerous prizes for the papers entitled The
surgical treatment of intracranial aneurysms (2000), Tumors of the lateral ventricle
(2001), Tumors of the Posterior Fossa (2002), Prognostic criteria in severe head
injury (2002), Our Experience in Third Ventriculostomy (2003), Multiple
Intracranial Aneurysms (2005), Oligonendrogliomas (2006), Statistic presentation
of the results obtained at the First Neurosurgical Department of the Cluj County
Emergency Hospital (2006), as well distinctions and decorations such as Diploma of
Honor for the contribution brought to the protection of health, security and economical
interests of the costumers (2005), Diploma of Excellency for the performing management
of the health system in Cluj and for the promotion of the reforms in the benefit of the
community (2004) and the Order Health Praiseworthy in Commander Rank (2004).
The national and international acknowledgement is also given by the membership of
prestigious scientific societies such as vice-president of the Romanian Society of
Neurosurgery, member of the European Association for Neurooncology (EANO),
member of European Association of Neurosurgical Societies (EANS), World Federation
of Neurosurgical Societies (WFNS), member of the Romanian Society of Reconstructive
Microsurgery, chairman at the 13th World Congress of Neurological Societies, as well as
participations as invited speaker, chairman and co-chairman at conferences and
congresses held in the country and abroad.
In nowadays society of risk which deepens the rupture within modernity, the
neurosciences underline the existence of a tight relationship between thinking and
neuronal activity of the brain, emphasizing not only the medical processes, diagnosis and
therapy, not only the cerebral material, the organ conducting all functions of the
organism, but also the transmitted influx from the analogical functioning to cognitive
operation in the configuration of thinking. The queen of the surgical arts charms and
engages Stefan Florian in a permanent competition, which stake is the health of the
central nervous system and also the premise of future victories in his career of
neurosurgeon.

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 **

A neurosurgeon must be not only a surgeon always looking for technical perfection;
he must be a very good neurologist and an exceptional neuroradiologist. Without these
aces, he can be just a handyman. There are no inborn surgeons, just built, formed ones.

Professor Florian, what are the cardinal premises of your medical career?
The desire, the will and passion to do neurosurgery. I have always wanted to do
medicine, I had been dreaming to a doctor since I was five. I had been dreaming and I
discovered for the first time the notion of neurosurgery at the age of 17, and since then I wish
I had become a neurosurgeon. I had the will, the persistence and I discovered neurosurgery in
the second year of the university, and since then until the present I am doing it with pleasure.
Under what biographic circumstances is the image of your identity shaping?
I was born on 24 March 1961 in Ludus, Mures County, where I had spent the first
years of my childhood and started the gymnasium. My parents, legal counselors by
profession, were forced at the moment of the territorial administrative reorganization in 1968
to choose another location in order to continue their work, and this is how we reached
Miercurea-Ciuc, the residence of Harghita County. If the memories related to Ludus are a
conglomerate of sunny days, flowers, a permanent game of joy with my childhood, the first
memory related to Miercurea-Ciuc is dated from April 1969, when after having left Ludus
wearing shorts, I found myself in the middle of a snowdrift. This is a memory which I can call
anyhow, but not warm. The impression had been perpetuated during the years of gymnasium
and high school graduated with the evaluation a little bit better than mediocre if I quote a
very warm impression of one my former teachers, impression which in the last years
explicably underwent metamorphosis by me becoming an eminent pupil. Lets say I was a
pupil with potential. Related to that period I remember a little hockey and less football,
holidays spent at my grandparents in Cluj, and an event, which has marked my later
professional evolution; I was in the 10th grade, when while being on duty at the gate, I read an
article about the human brain in the Science and Technology Journal. I have read then for
the first time about neurosurgery, surgeries on the brain and about the developmental potential
of this specialty. The neurosurgical spectrum has been joining me during the whole period of
preparing for the admission and even a while after...
The steps that you made can be evoked by the integrative excitement of your
youth as student. In a few words: how would you describe this period?
I believe that the greatest professional achievement was the admission at the Faculty
of General Medicine of the Institute of Medicine and Pharmacy in Cluj, in 1979. Without this,
nothing would have been the same today. After completing the obligatory military service,
which was a true school for hardening through humiliation, I finally started my studies in
1980. The whole period of my studies was a very pleasant mixture of useful and pleasant
things. The whole education was useful, and I gave the best of me. Coming for far away and
being no ones, in a university city I wish I had done neurosurgery, I tried to come to the
maximum in all domains, in all disciplines, so that I graduated university with 10, in order to
have, as you said, a few solid premises to reach at that time (in 1986) neurosurgery. Even if I
had graduated university with ten, I wouldnt consider myself a swot. Besides being a period
of accumulating knowledge in the fascinating area of medicine, the university also meant a
period of self discovery of some unknown valences: writer of humoristic texts, director, actor
and coordinator of the Artistic Group of University, three times laureate at the Nationals of
Student Festivals, individual prizes for interpreting roles in comic scenes/ productions, shows,
festivals, wonderful student camps at Izvorul Mures, Costinesti with groups, whose members

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later became great humorists like Divertis, Vacanta Mare, all from my generation, of course,
each of them in their own style. All in all, besides learning, university life was a genuine one
for me.
I dont regret, not even for a moment that I chose neurosurgery. Faith made that in the
same year, only a month after I entered for the first time the Neurosurgical Clinic in 1981, I
met Emese, who two years later accepted to became my wife. Thus I can say that 1981
represented the year of true meetings, the meeting with my future profession and my future
wife. We both were kids from other places, from Miercurea-Ciuc, offering support to each
other, being in the same time an impulse for the other. My wife was a law school student, as
well an extraordinary student, so we could check 10 of tens in every examination sessions.
As an eminent student can you name someone, who especially contributed to
your education?
The first university course that of the Human Anatomy presented by the regretted
Prof. Ciobanu was the first professional conduit lesson. Two phrases of that course, thanks to
its true meaning, constitute a belief for me: Medicine cant be learnt from a book, but from
books and every doctor leaves a cemetery behind, so do what you can so that your cemetery
would be as little as possible. Even if since then, I partly understood the true meaning of his
words, during university I became aware that a true professor does not only succeed in
transmitting professional informational, but succeeds in transmitting the landmarks of the
profession. Thus Dr. Ciobanu represented one of the greatest moral and professional models
of my life. Thanks to this man and to the relationship had with Gheorghe Muresan, medical
doctor, I accessed the fascinating world of neurosurgery starting with the second year of
university. Dr.Muresan became my mentor, who had patience and the perseverance in leading
me and opening the gates of a specialty of a rare beauty and of unique complexity step by
step. From Dr. Muresan I learnt not only to operate, but also the patients language, to be able
to communicate with them according their own abilities and their sense of reality, to gain their
trust for a mutual goal, to respond to everyones expectations as much as possible. And today
while talking to my patients, I surprisingly observe I am quoting Dr. Muresan, borrowing not
only the words, but his intonation also.
How did your entrance take place?
Thanks to Professor Ciobanu, who was keen on the nervous system, and to whom I
confessed my desire of practicing neurosurgery, and who introduced me to Dr. Muresan
Gheorghe, my later mentor. In the second university year, in the holiday in 1981 I entered the
Neurosurgery Clinic for the first time. I introduced myself to Dr. Muresan. At that time I had
long hair and a more impolite attitude. The next dialog took place: You want to become a
neurosurgeon?/ Yes./ Then you would come back tomorrow, dressed up properly, wearing a
white overall, white slippers and your hair cut.
Clear exigencies posted from the start.
Exactly. The next day I came back, he looked at me and asked me Who are you? I
told him about our meeting a day before, and he asked me And you believed me? At my
affirmative answer he said Maybe we can do something with your head! Probably it was
something of my head, because something has been done. Starting from that moment I
spent every minute of the holidays, all periods in which I could learn and acquire as much
information as possible. I started working as a nurse in the wards together with the other
nurses, acquiring primary techniques such as giving an injection, putting on a perfusion,
giving an intravenous injection, a probe, performing angiography through precutting
punctions. All these techniques I learnt together with the nurses, being aware that if you ask a
nurse to make something, you should be firstly able to execute that medical act. Therefore in
each holiday, and even when skipping classes, I used to come to the clinic. In the terminal
years of university, especially in the sixth year I was quite often at the clinic, replacing the

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doctor, who was on duty, and who had examinations to do or went elsewhere. I had been
progressively integrating within the staff, so at the moment of graduating university in 1986 I
was very well accommodated with everything in the clinic and with the staff also.
Graduating university practically meant a very different, but not less passionate stage
of my life, that of assuming professional responsibility. The final departure of two doctors,
and deaths of other two, brutally generated superior and absolutely unbelievable medical staff
deficit; two specialists and two practitioners assured neurosurgical medical assistance in a
famous medical center. Under these conditions I was forced to assume more responsibilities
than normally expected from a practitioner. But this soliciting and difficult stage was the
period of accumulation of exquisite clinical experience and practice, which led to my
integration within the staff dedicated and devoted to their profession. Even if in the next
couple of years the staff was completed by two specialists, my place and my role have never
been questioned.
After graduating the university I attended the compulsory training of 3 years at Cluj, at
the County Clinic Hospital, and as a result of an agreement with the executive director at that
time, Mrs. Professor Albu I completed this training at the Neurosurgical Clinic. I made
rotation on the spot, situation which was favorable for me, since at that time the clinic had
only two specialists and two practitioners, Dr. Szabo and I, in total four people assured
specialty medical assistance. We had to make great efforts, during the summers we used to
have 15-17 calls, thus being on duty every second day.
It was a period of qualitative accumulation, but mainly a quantitative one, this
experience being of great help later. Now I tell my residents with fun, but then it wasnt fun at
all, that in that period we didnt have stretcher bearer on the nightshifts, had only two nurses
for the whole clinic, didnt have instrumentation nurse, no anesthesiologist either, then when
an emergency arrived if it was necessary we were the stretcher bearer, then radiologist
performing angiography, then anesthesiologists, we sedated the patient if necessary, intubated
him in need, and till the operator teams arrival formed by nurses and nurses aids from the
OR, we were again stretcher bearer, checking the patient hygiene, positioning him and only
after the arrival of the instrumentation nurse we turned into operators. It was a period that not
only I have gone through, but my colleagues also. I dont wish to transmit this to my younger
colleagues, I dont want to feel what we felt backwards. It is great that progresses were done,
that now we have totally different conditions. But I want them to know that even worse is
possible.
The polyvalence acquired through interactive interactions with environment
from the clinic. What had been going on in the Neurosurgical Department in the
moment of your integration?
When I first entered the clinic there were seven specialists and beautiful things were
happening. When two specialists remained the beautiful and exquisite things lessened,
because the clinic was focusing primary on emergencies, thus slowly losing the pathology of
brain tumors, specific to this center. Naturally, due to the investigation means, to proper
endowment, patients were sent to especially Bucharest, where a mammoth, a neurosurgical
plant existed, a hospital with 660 beds and adequate endowment. But besides al these,
tumor pathology were also encountered, difficult cases were solved, yet the number of
surgeries remained low. As the staff had been growing, in 1987 the regrettable Dr. Buica came
to the clinic, later other two specialists joined us, who left the country in the meantime, thus
we could enlarge our activity field. The tumors of the cerebellum were operated, just like now,
in sitting position. We are the only neurosurgical centre in the country that operates so. There
is a theoretical dispute related to this position, the risks involved, and about the advantages
offered. Having maybe the richest experience from Europe in this position, we can state that it
is a secure position both for patient and surgeon.

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 Does it presume an interventional particularity?
Yes, there is an interventional particularity, which I recommend my colleagues. But
there are objections also, especially from the anesthesiologists regarding some anesthesia
related risks, air embolism, and of other aspects, but I consider further details should not be
discussed. The position offers a permanent and clean operatory field in a normal anatomical
position, nothing is up side down. There are surgeons, who are against this position because
you have to operate with your hands lifted, and not only having a support, it can become
exhausting for the arm. But there are solutions for everything. Anyway I consider it a good
position. Then at the vertebral spine, at disc herniation, an extremely usual pathology called
the neurosurgeons bread, is a surgery which in Cluj is minimally invasive since 1975. In
Romania, at Bucharest and all over the country this pathology was operated with bone
resection, with big bone departure, which led to the destabilization of the spine. We were the
only ones who tried to promote this procedures, being considered dreamers, but in time it
proved that we were right all the time. Now all neurosurgeons proceed the same way. Of
course, there are other methods even more minimally invasive. The carotidal angiography was
introduced and it is practiced nowadays too. So good things were done, even if the diversity
of neurosurgical interventions wasnt very high, everything we did, we did it correctly,
honestly, with very good results for the patients. The volume of surgeries wasnt high, varying
from 300 to 400 per a year, some years even more, other years less. For example I offer you
some comparative numbers: in 1995 around 400 surgeries per year were made while in 2007
their number rose to 2010. A huge salt. Of course, this salt did not occur all of a sudden, from
1995 to 2007 not only a year passed, but many. Briefly thats all I can say about the situation I
found at the clinic. But there is something else too, there is the spirit of the medical school
from Cluj that one can feel within these walls of the Cluj medical school, that you can find
elsewhere, there is still the respect towards the patient. I saw other medical centers in the
country, I observed other doctors also, but here I learnt that if you wish to have success you
must establish a close relationship with the patient. I told it many times and I am continuously
repeating that healing depends partly on the patient, what a surgeon does is to remove
something which is in addition, which is growing and is pressing. The neurosurgeons repairs
something, but for an ascending and a natural evolution healing must be coming from the
patient. Yet he cant find his own resources for healing, if you dont know how to be trustful,
to make him trust you, to offer courage, if you dont know to tell him how to help you. The
patient-doctor relationship is different here, and always has been different in this center, and I
believe this is something we have learnt and have assimilated in time.
How were the stages toward perfection that the neurosurgeon Stefan Florian
went through?
I was obliged to go through all stages that every neurosurgeon must go through. As I
told you I must have burnt a series of stages. I was a practitioner, but I had a rich
experience. So after the revolution I could sustain the specialty exam, and I obtained by
national examination in 1990s autumn the secondary doctor title (today a resident), at the
Neurosurgical Clinic in Cluj-Napoca. Although this should have represented a great
professional success, for me it was only the confirmation of a state of being. 1991 represented
a year with a special signification: the triumphal scream of Alex, who once with his first
breath announced that our family life would have other sense from that moment on, and that
no success would ever compare with this accomplishment, and everything we were going to
do from that moment on would have another meaning. This year my university entrance took
place as an assisting professor at the newly founded Neurosurgical Department, but I had to
leave for Bucharest for compulsory specialty training for a year, under the guidance of
Professor Alexandru Vald Ciurea at the Pediatric Neurosurgery Department, the only training
center from the country. I lived in the hospital for six months because my goal was to

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assimilate and accumulate as much as possible. Having already a clinical experience, it made
all easier. I was considered from the very beginning a doctor with responsibilities, I was in
charge for half of the department, I was the second hand of the Professor Ciurea, equal to
the specialist responsible for the other part of the department, who was 6-7 years older than I.
This helped me. I saw pathology, which wasnt approached at Cluj, I assimilated a lot of
useful things. I was at the clinic all the time, when being on duty I was wandering in the
emergency room, ORs, anywhere I could find something to do, performing and angiography
and then going back to the OR, and so one. I could and I did take full advantage of this
period. It was a year when I hade to harmonize the professional obligations with the desire of
being next to my family, the biggest problem being the distance that separated us. Coming
home weekly was the only solution, through which in every weekend I recharged my batteries
in order to face the professional challenges of the capital.
Once I returned home after completing my training, my activity at the Neurosurgery
Clinic from Cluj-Napoca was only interrupted by short experience exchanges done at clinics
in France (Grenoble 1993), and later by the course organized in a four years-period by EANS
(European Association of Neurosurgical Societies) at Southampton (1997), Madeira (1998),
Barcelona (1999) and Nice (2000).
Sustaining the specialty exam in 1995 (I was the first nationwide from a generation of
24 young specialists), and then the primary exam in 2000, were stages which proved not only
the progressive growth of professional responsibilities, but also confirmed the increasing
enlargement of the area in the inexhaustible field of neurosurgery. Through permanent study,
through work often beyond physical boundaries, permanently adopting the modern
neurosurgical techniques to poor endowment, I succeed introducing new neurosurgical
techniques, which progressively enlarged the palette of affections treated in our clinic, with
results which could be compared to the results of recognized European neurosurgical centers.
Neurosurgery is a surgical specialty in which irreproachable theoretical knowledge of normal
and pathological anatomical notions of the nervous system, of the neurological pathology, but
also of the diagnosis means and surgical techniques must be strengthened by a permanent
perfection of microsurgical techniques, by a perpetual mental and physical practice. A
neurosurgeon must be not only a surgeon always looking for technical perfection, but also a
good neurologist and an exquisite neuroradiologist. Without these aces he can be just a
handyman. All these are lessons that I learnt day by day, with successes and failures,
because if you want to progress you lean more trying to recognize and correct the mistakes
you make, rather than enjoying success.
Regarding my academic activity, in 1991 I was admitted as an assisting professor at
the Neurosurgical Department, department, which was founded in order to bring Professor
Leon Danaila to Cluj, and for not being the single professor at this department, an assisting
professor position was also found. The assisting teacher position was taken by me, after
sustaining an exam, and the professor position remained vacant as Professor Danaila received
other offers from Bucharest. The vacant position was later handed to Dr. Muresan, who was
Associate Professor until 1995, when he retired. From 1995, being delegation I took over the
Neurosurgical Department, the position of Head of Department, being yet assisting professor
till 2001. 2001 brought besides academic ascension, that of acquiring the title of Associate
Professor after having presented my PhD thesis, and promoting the exam, a bare new
experience, I was appointed to the position of executive director of Cluj County Public Health
Authority. It was the opening towards a very different world, to a very new assignment, but
not less interesting than my previous experiences.
Without neglecting my neurosurgical tasks, this assignment offered the opportunity of
practicing an especially complex managerial side in parallel, which presumed a massive
assimilation of new information in a relatively short time. It was an exhausting experience

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sometimes, full of contradictions and responsibilities, and with fewer satisfactions. Even if at
the end of my mandate my activity was praised by collaborators and even by the President on
that period (the distinction the Order of Health Praiseworthy in Grade of Commander being
a testimony of this), as well as by political adversaries, who thanked me for quitting, although
I have been a 10 grade professional. When leaving the Authority, my only regret was that
the building of a new Emergency Hospital was not built.
As I mentioned my professional activity was not interrupted not even for a moment,
and because of the professional results obtained at the Neurosurgical Congress in 2003 I was
elected the vice-president of the Romanian Society of Neurosurgery. In parallel my didactic
and scientific activity made possible to be appointed associate professor in 2004, and later in
2006 adjunct dean of the Faculty of Medicine within the University of Medicine and
Pharmacy Iuliu Hatieganu.
Renouncing at the administrative assignment was considered a good decision not only
by my family, but also by the staff, and especially by my patients, they being the first who felt
me being freed from such a time consuming activity, and not only. My return represented a
substantial growth of time allocated to operatory activity, which resulted in progressive
growth year by year; if in 2004, last year as a director, the number of surgeries effectuated
was of 550, at the end of 2006 I accounted fro over 740 surgeries, which means an average of
two surgeries per day.
Not only the number, but the complexity and results of surgeries represent exquisite
achievements, the operatory results reported to numerous series of diverse neurosurgical
pathologies, being at least comparable to, if at some part even better than specialty literature
data.
For any surgeon these numbers have the mission of rewarding the professional ego,
but perhaps more important are the patients words of gratitude, when at the moment of being
discharged, with tears in their eyes, they say Professor, thank you for everything, I had a
great time here. I didnt believe that in Romania such a clinic really exist. You have a
wonderful staff!
And because patients rarely lie, starting from the 1 st October 2007 I obtained the title
of University Professor at the Neurosurgical Department, being the first professor in the
history of neurosurgery in Cluj. I dont know whether this means a lot or little, but from my
46 years perspective I feel I still have a lot to offer...
After so many achievements I can say you are a specialist of performances. I
ask you frankly how would you characterize the curative, operative strategy that you
are currently applying in the OR?
I am one of those surgeons who think ten times before cutting. The strategy is simple
and complex in the same time. Ten years ago my concerns and my thoughts before a difficult
surgery were different than now. The curve of learning is compulsory for all of us. Like in any
other professions certain dexterity is necessary, a lot of thinking and also practice. This mental
and physical practice and training I perform daily. In 1997 when I operated the first
intracranial aneurysm the surgery lasted for about 12 hours, the cerebral time was around 8
hours, until I made the dissection and reached that aneurysm. Today I operate an aneurysm in
20 minutes. It is an obvious progress. The first pituitary adenoma I operated lasted for about
the 10-12 hours of worries, fear and emotion of intervention. I read books, and studied a lot to
adjust. Today this intervention rarely take me more than an hour at a localization with tumor,
where all vital elements are such as carotidal, peripheral nerves, diencefalum, and extremely
fine blood vessels. They are all in that area. There is a conglomerate on a little surface, on a
little volume. Practice helped me to shorten the operatory time, thus today the strategy I apply
is relatively simple, because all that I know I have to do, has already gone through the filter of

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thousands surgeries. When you recorded more than 6.000 surgeries you think and act
differently.
Which are the more difficult intervention areas on the brain, and which were
the fatal lesions you have encountered?
At the first neurosurgery course I always tell my students that neurosurgery is the
most important subject. Of course every professor does so.
Pro Domo pleadings are present
I ask them what the most important organ is: the cord, the kidney, prostate? How
do you define death? Death is when all cerebral functions cease. What is the first death cause?
And they answer, based on their general medical culture, correctly most of the time: the brain.
And then I ask again what the most important specialty is. Is it the one which deals with the
direct, immediate treatment of the most complex organ? I dont even like the word organ
Yes liver is an organ, so is the heart. The brain is sublime! We dont know what it is yet, but
it is the only which is truly vital, because brain defines life. Without brain there is no life. You
cant either understand or perceive it. Every human being has at least an embryo, a precursor
of the nervous system to be able to function. Without this life cant, doesnt exist; you cant
perceive it and you dont exist either. It is the one, which cant be transplanted. Of course
every intervention on the brain is risky, involving a vital risk and this it not an overreaction at
all. Anytime anything can happen while working on it. There are real dramatic areas, such is
the sellar and parasellar area of where lies Pituitary gland, which is the real endocrinological
conductor of the whole body, where the carotid arteries are, the optic nerves, and many tiny
vessels, many of them with a vital role. And also the brain stem, where most of the vital
centers are located, which control the breathing, and the heart etc. When you reach this
region, the risk is very high. The first surgery in a certain area is always extremely difficult,
the second one is easier, the third becomes even more and so on. When I performed the first
operation and I entered the trunk, an area considered for a long time as inaccessible,
proscribed, who enters there is a criminal, and I came out with the child alive ameliorated,
then it was a success. When you split the marrow, you remember that for years intramedullary
tumors were considered inoperable, because you couldnt cut the marrow. You can! Provided
you know how to cut it and remove tumor from it. You can remove tumors from regions
considered inaccessible. I operated a female with five aneurysms, I started on the right side,
and one by one I clipped until the opposite bifurcation, using the natural ways, which are the
arachnoidal cisterns. These things cant be performed only after accumulating a many years
experience.
Can you describe briefly the configuration of these interventions that we are
discussing about in the cervical and lumbar degenerative pathology that you are dealing
with?
The degenerative pathology of the spine is extremely common, but its not really my
favorite. I operate it because I have experience in it. Its not a very complicated pathology to
operate. Once you know how to do it, things are relatively simple, and the discal or
degenerative pathology which causes the narrowing of the rachidian channel or of the root, if
well done, can have spectacular results. Many patients tell me after surgery, that they dont
know what were they thinking and why they supported that much pain. Theoretically this
pathology is also extremely diverse. More attention is paid to the dynamic of the spine, which
results in more advanced technology through the spine implants. That can also be considered
a whole industry. You dont know how much of what is discovered within this pathology and
the adequate implant is real, or imposed by the necessity to sell, by business. This is
questionable. But all in all it isnt a very hard pathology, it is complex, and arises many
disputes between neurosurgeon and orthopedist in Europe. Fortunately in Romania it belongs
to neurosurgeons.

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 What are your operatory preferences? I understood that there is palette that
you operate, but not with the same pleasure like when you operate on brain.
Operations on the brain, the vascular pathology, which challenges me, the pathology
which is in forbidden areas, vascular strokes really constitute an extraordinary professional
challenge, an extraordinary requirement, and when you are safely out, the professional
satisfaction is huge. But it lasts only for short time because another case comes, other
pathology. Not professional satisfactions are stressful, but those unsolved cases fro which you
did everything you could, and in spite of these, complications appear; or I believe there are
some cases, which in spite of any human effort, are predestined to fail. These are the cases in
which we try surgery, desperate gesture, offering hope for the family and maybe for us. There
are cases in which wonders happen, and a second chance is given. For everyone it is
extremely important to keep the dear person beside for a few months more, for a year or two.
To see him, to feel him, to know that he/she is there for him. Its one thing to have someone
beside and one to accept his disappearance. I tried to analyze the cases that didnt go well
critically. And I learnt a lot from these too. I had the courage to go on, but I havent forgotten,
not even for a minute, what Professor Ciobanu told us at that first course.
After the evoked experience, tell me how could a neurosurgical centre of
Excellency function at Cluj?
It can function very well, and it is already functioning under certain restrictions.
Your contribution to this is enormous. Dont forget to mention it.
A centre o Excellency requires a certain technical endowment. My dream is to fully
accomplish that centre of Excellency with real, up-dated technical endowment, harmonized
with the clinics experience. What we do can be called professional excellence in the clinical
area, rather than scientific research. The present conditions given are far from being ideal.
When I am thinking of a centre of Excellency Im thinking of a neurodiagnosis centre, which
requires MRI, CT-scan, angiograph, PET, all in the buildings appendage, an OR in which all
data would be centralized, to see them on the monitor, on the microscope, to be able to
operate through neuronavigation like in other European centers, because having a wand you
exactly know where the lesion is, how deep it is. This is a technology taken over from the
American aviation technology, the technology of aiming, targeting, a technology applied,
which became very fashionable the last few years. We dont have this possibility yet. I
imagine a research center where the youth can design and apply scientific studies, research,
cells cultures, and genetics. I am sorry that I dont have the necessary time left and maybe
energy either to do myself these researches, which can result in revealing the unknown
aspects of the oncological cerebral pathology, because here we have serious deficits, not only
us, but the whole mankind. Too little can be done in malignant cerebral tumors. Surgery offers
the chance to prolong the patients life with up to a year. The rest, chemotherapy and
radiotherapy result in few cases of healing. I have been trying hard in this area, within this
clinic to place neurosurgery in the centre of interest. I wish to draw attention that besides
heart, lungs, prostate, kidneys etc. people have brain too, and that this pathology must be
given the proper attention and resources as well. How much I accomplished till now, well
see. We made important steps, but we still have a lot to do.
Is the beginning of millenniums neurosurgery ready to face these challenges
that we are speaking about?
The last decade and the present one are the decades of neurosciences in Europe. If
the 60s-70s were the decade of the heart, the 9th decade and this one are of neurosciences. I
dont know whether you have noticed or not, but worldwide substantial funds are allocated
for researches in the domain of neurosciences. We, as a country are far from this. We have
always been a little bit tick; we have always taken advantage of others science and made
progresses on other researches expense. This can also be a solution, but I believe we should

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allocate more funds for our own researches, for the development of the scientific research,
and especially to neurosciences. In our country there are numerous good minds, who think,
and it would be a shame not to exploit them in order to add something to the findings/
discoveries of international neurosciences. Many Romanians made researches in the domain
of the nervous system, such personalities like George Marinescu, so we have the premises to
do more and better. We mustnt wait for our results to be confirmed and to eventually make
some clinical studies financed by medical companies. It doesnt seem fair and useless from
the point of view of creating a competitive spirit, a creating spirit in the field of neurosurgery.
How does the neurosurgeon Stefan Florians record of complex operatory
achievements look like, interventions with spectacular results?
It looks fine. Obviously there is a permanent progress in the number of operations,
because these are also a part of every neurosurgeons record. Surgeons are very vain. Their
vanity consists in more, and better surgeries, effectuated faster, in being recognized and
appreciated, and their results praised; as many times as a case is solved within another second
operatory time than theirs, their vanity suffers terribly. Actually it is all about the surgeons
vanity. I am also a surgeon, I have my own vanities. I didnt increase the number of surgeries
due to my vanity, because as much vanity you can have, if people arent looking for you, there
is nothing you can do. The number of surgeries increased as my addressability increased. The
addressability has been increasing not because I became more visible, but because my patients
were pleased of me. Patients come to us sent by doctors, but most of them are sent by former
patients. And when you treat 10 patients, you can be sure that in time twenty patients will
come. When you operate 500 patients in a year, you should anticipate that in the future you
would operate 700.
Starting with the good rating, what surgeries does the specialist Stefan
Florian effectuate well?
The specialist Florian is trying to operate well everything. I dont accept the
compromise. I havent accepted it when I was a student, or after. I have the vanity that
everything I do must be perfectly accomplished. I operate very well, I want to do everything
properly and I wish to do everything, which depends on me. This what I can guarantee and I
really do every time my patients ask me about the guarantees of their recovery. I answer them
that no one can assure any guarantee, because we are working on the nervous system. What I
can guarantee on the other hand, is that Ill do everything what depends on me. And I am
trying hard to obtain good results. The number of surgeries increased. Taking into
consideration the data I have, I had the most patients operated in the last years nationwide.
From the point of view of quality, the results count. There are statistics that I compare to
international ones, and Im not ashamed of myself. As many times as I study statistics with
the results of internationally acknowledged neurosurgeons, in the last column there are the
results of mortality, morbidity, successes and I notice my results fit in very well. There is no
shame, no embarrassment regarding the results of comparison. I think that the best proof is
the permanent growth of the patients number who address to a service. When starting with
400 surgeries I have reached over 2000 in a year, it means that something can be learnt about
this clinic out there.
I believe that this reputation is consolidated by some particular interventions
too.
Yes, it is by vascular and tumoral pathology. I approach brain tumors in all sites, I
opened a series of paths, introduced a series of techniques, not in international premiere,
because you cant do that at Cluj-Napoca today, yesterday or a day before yesterday. But I
registered national premieres; I had many priorities in this area. Among the achievements I
accomplished there are the first brain stem tumor reported nationwide, the first
translabyrinthine approaches for acoustic neurinoma performed together with Prof. Silviu

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Albu from the ANT Department, the first combined approaches for cranial base tumors along
with Prof. Bciu from the Maxilo-Facial Department, and the first anterior approach of the
cervical spine effectuated together with Dr. Turdeanu from the Fist Surgical Department 20
years ago.
Since I became a specialist and primary physician, I opened numerous doors for my
colleagues, I guided them towards certain specializations within neurosurgery, and I can say I
am content with my achievements, but with what I taught others to achieve also. Today I have
at the clinic specialists trained by me from the very beginning, and Im not ashamed at all of
what they do, how they think and act.
You approached the brain so pragmatically. You studied it more thoroughly
than those who deal with reflections on the brain only. What is your opinion about the
evolution of the intelligent world, of the universe?
Such a general question, and I am a surgeon who appreciate things mechanically. If I
refer strictly to the evolution of natural, human intelligence as far as I know it from literature,
from philosophy, reading and observing, I can say that we arent cleverer than those who lived
in Sophocles, Aristotles and other great philosophers time. Our mind isnt more curly,
maybe opposite even. They had to see things, understand and explain them, things which you
consider absolutely natural, so certain parts of our brain, which should have thought
creatively maybe are even more atrophied than theirs. We have artificial intelligence, which
helps us to connect, to interconnect, to develop, to build, even to operate virtually. In many
European countries there are computer practice programs for surgeries for residents. When
they reach the lesions, things complicate a little bit. I was recently at a conference at Glasgow,
at the European Neurosurgical Congress and I returned having learnt two important things.
Translating what was said there: you can teach a monkey to operate, but you can never teach
it when not to. And the second is a fool with instruments remains still a fool with
instruments. This means that one can have as many instruments, accessories as possible,
after all everything begins with the brain, which must think. If you arent able to think, if you
arent able to make your hand function through thoughts, attention and the necessary
concentration, there is nothing you can do.
What judgment do you emit when being a meditative, thinker neurosurgeon?
I am not really philosophic. Everyday life is not philosophy, and when after a few
highly requiring surgeries you reach home, wishing to relax and often you are called back to
the clinic because of an emergency, because a case has aggravated, and you must return, you
arent any longer in the mood for a transcendental meditation, and you must live permanently
connected to everyday reality. When I am thinking about life, I think of it beautifully, being
convinced that what I do, I do it well most of the times, that luck depends on every person,
that life is an hourglass in which every sand bean can be a drop of love. It depends on you
how much love you give and receive, so that you can conclude in the end that I loved and it
worth living.
Returning to the ultra pragmatic environment of neurosurgery concerning your
participation at the congress, where is neurosurgery today, what are the top progresses
on international level?
Progresses were made the field of neuroimagimg, which means modern investigation
means, which help establishing the diagnosis very precisely, as the type of the pathology and
locations are clearly defined; it even shows you the way to reach there. All these investigation
means are transposed through computerized systems, reconstructed on the screen and with the
aid of a magic wand placed in the cranium, where you can visualize where the fascicules, the
locomotory centers, the centre for speaking are, you can locate your position clearly, and the
vital centers as well, which help you to avoid, to preserve what you wish to do so. So you can
visualize in real time, what you are doing. It offers the chance to perform intraoperatory MRI,

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to see where you exactly are, how much did you remove, and how much of the tumor is left.
These devices confer a special comfort and an exquisite security, but all these devices do not
operate by themselves.
To what is the contemporary human brain exposed?
To foolishness! This is the gravest thing.
Is brainwashing a reality?
Yes, it is. There is a campaign presented the National Geographic I agree with. One
must think. I had been thinking since I was 5 that I want to do medicine, I wish I had became
a neurosurgeon when I was 17, and I did everything depended on me in order to assure these
premises. The youth must think starting from today, what is he going to in about a few years.
On the other hand two many sources of information stop you to think. The information supply
is flooding the paths of our brains, which cant think, filtrate, and adjust this information to
reality anymore. I dont believe this permanent bombing; this intellectual rape would have a
happy ending. When cartoons appeared on the Cartoon Network, they were in English. My
son learnt English by watching Cartoon Network. He speaks English perfectly, without having
ever taken any meditation, besides regular English classes at school. He learnt then the
language by listening it. Today Cartoon Network is completely translated into Romanian. This
way you arent helping the child to progress. There is nothing he should think about anymore.
Actually not the cartoon, but the fact that they were speaking in another language helped him
to understand that cartoon. Almost nothing within the media contributes to the development of
thinking, or even more towards a culture of beauty, of common sense. Nevertheless it is
natural to happen so, as long as those, who have the role to educate by the media, can barely
read from the prompter, not to mention speaking free. A culture of kitsch, of seasonable stars,
of tricks and rude attitude are promoted. The results of intellectual development can be
already noticed, but would be even more obvious in not so many years. Yes, I believe we can
speak about brainwashing, of value washing, and the replacements are quite doubtable.
How does the therapist of the brain think and react in searching for himself?
This was an issue I solved quite quickly, when I discovered neurosurgery at the age
of 17. The fact that today I practice it, is a proof that I found myself. Of course during my
formation I had moments of doubts and hesitation. When I was a teenager I wish I had had a
special talent, to play an instrument, to draw something, to be able to represent in that
drawing a horse, which wouldnt look like a mouse, or even to be able to build something
with bare hands. I had the feeling I wouldnt accomplish anything with my hands. Later, at the
beginning of neurosurgery, one of the surgeons I met told met that a good surgeon must be a
good drawer also. I told myself I was in trouble. It seemed it wasnt definitive. Someone else
in the same period told me that one can never become a neurosurgeon, without a solid basis of
general surgery. I couldnt achieve this either, because I started with neurosurgery and I went
on with it. And despite all these I made it, I became a neurosurgeon. Thus I concluded that
here is no inborn surgeon, just formed, trained one. What can be inborn is the vocation to do
well, to help your fellows and for this to be prepared to do numerous sacrifices, to give up
many things. Once I became a neurosurgeon it was more than self-searching, it turned into
exploring the limits you can reach while exploring the brain, in order to help the patient.
These limits were pushed further and further, deeper and deeper, while the number of those
who has been beneficiating of this searching has been progressively increasing.
What are your preoccupations which are beyond the medical sphere, and
involve the private sphere, your family and spare time activities?
I owe most of my achievement to my family, especially to my wife, who has been
permanently supporting, and encouraging me, and more than anything she accepted this
infernal family schedule, I can say we grew up together, progressed together and weve been
together in every important stage of my training. And all these with an exceptional didactic

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activity at the Faculty of Law of the Babes-Bolyai University, where my wife is an associate
professor, one of the most appreciated professors of this high prestige faculty. Our sons,
Alexs appearance, gave a new meaning for our family life. We have an extraordinary child, a
child that every parent would wish to have, a child who inherited, but maybe even more
developed a series of qualities, which I am sure, will assure him a bright future.
I am often asked about what I do in my spare time. And I answer: what spare time?
My day begins before 7oclock when before leaving home, I receive a telephonic report about
the evolution of the patients during the night, and it ends around 9 p.m., when I arrive home
from the clinic. Around 11 p.m., before going to bed, I receive a second telephonic report
from the clinic. Except this, I have free time. Of course, there are the weekends that every
time I decide I would dedicate to my family. Unfortunately I rarely succeed in doing so, first
of all due to the unpredictable aspect of my profession. Despite all these, when I succeed it is
a great pleasure for me to take a walk with Alex, to spend a few quiet hours together. Then it
is a pleasure I discovered in the last couple years, that of working in the garden, planting and
weeding the flowers in our garden, I like to contemplate the natures beauty in our little oasis
of greenness. Two or three times a week I do fitness from pleasure and also in order to
maintain a certain physical condition, which is absolutely necessary for a surgeon, but not
only for him, for everyone. We are being conceived to use not only our brain, but also our
muscle, which we almost completely neglect. Lack of movement, lack of education for the
physical culture is another important deficit of our culture. If we pay more attention to
physical maintenance, we would pay less for the disease. Here the empowered organs are
more preoccupied with inducing a state of illness on national scale, rather than with education
for health. But this is another discussion.
What picture do you have in your mind regarding the fate of values in the
contemporary society and of the exponents of the elites spirit?
As I mentioned earlier there is an overthrow of values in the contemporary society.
Promoting some personalities on other basis than those of the values is widely spread in the
media. The sensational, the vulgar, the immoral are criteria, that overwhelm us, and educate
the population, especially the youth. And the true elites, true values, independent of the
domain of interest, arent taken into consideration, partly because there arent interesting,
partly because a valuable person has the decency most of the times not to boast his values.
There is another aspect too. Today we can still notice the tendency of values to remain in
shadow because of precaution, the desire of not generating reactions of the non-values, which
are overwhelming in number anyway, and because of the noise they provoke. This is also a
way of adjustment, a proof of intelligence.

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