A young doctor is working inside the brain of a middle-aged man, fixing a bulge in an artery, when Nick Hopkins strolls into the operating room in Millard Fillmore Hospital.

It is late afternoon on a warm weekday, and Hopkins, 67, looks mildly out of place in his Cape Cod casual: a pinstriped Oxford, a tie patterned with tiny whales, a black cord to hold his metal-framed eyeglasses in place.

"Hiya, Paul," Hopkins calls cheerfully to the man lying on the operating table.

"Hello," the patient responds, from behind a curtain-like cloth that hangs between his face and abdomen.

"You doing OK?"

Hopkins' voice is confident, assured. It's the voice of a man who has stared down the barrel of a disfigured artery many times before and walked away the victor.

"OK!" The patient smiles.

Hopkins nods at the younger surgeon, Adnan H. Siddiqui, who launches into an explanation of the case. The patient has traveled from downstate to have the blood-filled swelling in his brain eased. His aneurysm, a lump the size of a large cherry tomato, has been reached by catheter and drained; the patient didn't even need general anesthesia.

Lots of people are choosing the hospital on Gates Circle for this kind of procedure.

Which really means -- though they may not know it -- that they are choosing a program built by neurosurgeon Dr. Leo Nelson Hopkins III: chairman of the University at Buffalo's neurosurgery department, chairman of the board of physicians for Buffalo's incipient global vascular center and research institute, and -- for background's sake -- subject of a 144-page professional resume.

Or, as he prefers to be called, "Nick."

The best in their field

Inside a surgical suite in the hospital, Hopkins and the 12 doctors who work with him on the neurosurgery team perform procedures that are at the cutting edge of medicine.

Hopkins, who frequently slips into superlatives when he describes their work, puts it this way: "In this area, neurovascular, there is nothing in the world that is being done that we are not pre-eminent in."

Take one example: a procedure that is the advance guard of care for aneurysms, a condition where blood collects at a weak point in an artery and can make it balloon and burst, with potentially fatal results.

Doctors make a small incision near the patient's groin, then thread a "pipeline" -- a bendable platinum- and cobalt-chromium tube -- through the femoral artery to the brain and to the aneurysm. Using the tube, doctors can simultaneously relieve pressure on the ballooned area and rebuild the artery from the inside out.

A major advantage to this new technology is that it forms a barrier to blood flow in the area, cutting down on the chance of recurrence of the problem, doctors said. The pipeline device in the aneurysm area remains in place; over time, tissue grows over and around it, forming an effective blockade to future blood flow to the affected area.

Some of the younger surgeons that Hopkins helped recruit to the hospital -- Dr. Elad Levy and Dr. Adnan Siddiqui among them -- are part of a staff that makes Gates one of about 10 hospitals in the nation that perform these procedures, according to Kaleida Health, the health care system of which Gates is a part.

"They really work well together as a team, and [Hopkins] is the conductor of it," said James R. Kaskie, chief executive officer of Kaleida Health. Kaskie said he expects those recruits will continue Hopkins' work and even expand upon it in bold new directions.

Siddiqui puts the relationship between these younger doctors and Hopkins simply.

"The way I think of him is really as my professional father," said Siddiqui, who trained in Rochester and Syracuse before joining the team at Gates. "Elad [Levy] and I, we call him 'Papa.' That's how we look at him.

"He's a true mentor: somebody standing right behind you when you need him."

Inspired by his sister's care

Hopkins was a kid growing up in a Buffalo business family -- his father ran John W. Danforth Co. -- when his younger sister was diagnosed with Wilms' tumor, a cancer that affects the kidney in children. Though now largely curable, the cancer took his sister's life by age 8.

The experience changed the teenaged Hopkins. He was moved by the caring way hospital staff and his sister's doctor, Winfield L. Butsch, handled her case.

"I got turned on by what medicine was all about," Hopkins said. "The surgeon that took care of her was an amazing person. That was a very impressionable time for me."

Hopkins followed through on his curiosity. After attending Nichols School and finishing his undergraduate work at Rutgers, he studied medicine at Albany Medical College, where he graduated in 1969. His senior year was spent at Massachusetts General Hospital in Boston, one of the nation's great training hospitals.

"I was the first person in my family to go into medicine," Hopkins said. "I had no real idea of what I wanted to do with it -- except I was interested by neurosurgery."

Hopkins returned to Buffalo to study neurosurgery at UB.

(Hopkins was also a family man by then, married to Bonnie Adam, whose family was part of the Buffalo-based department store chain AM&As. The couple -- now married 46 years -- have three children and eight grandchildren.)

As a young doctor, Hopkins decided to focus on the ways that doctors were approaching serious brain problems -- especially the ways in which such hard-to-reach areas of the body were accessed.

"I think you always learn," Hopkins reflected, "by seeing what other people are doing."

Ahead of his time by 15 years

Aneurysm was a good place to focus some of his attention.

Decades ago, the standard procedure for treating an aneurysm in the head or neck was straightforward:

Cut the skull open, reach inside, manually take the pressure off the ballooned vessel, then close the incision and let it heal.

It could work well, but it was also major surgery with a risk of complications and long recovery times.

Hopkins decided, in the 1970s, to find ways to operate on brains in a less invasive fashion. He realized that, by accessing the brain using catheters fed through an artery in the leg or groin, that he could operate remotely.

"My view is simple," Hopkins said. "The only organ in the body that goes everywhere is the vascular system. Veins and arteries go everywhere. And accessing the veins and arteries with a catheter -- it's very easy.

"I just thought, neurosurgery would have to become a minimally invasive surgery. I was convinced that this was the future."

Hopkins began pursuing his idea. He collected data and published his research. At first, people in medical circles thought he was -- well, "something of a curiosity," as he puts it.

"I was a bit of a pariah back then," Hopkins said, with a chuckle.

At the American Association of Neurological Surgeons in Chicago, the president said that "pariah" is not the right word for Hopkins.

He would say "pioneer."

"Nowadays, everybody does it. But [Hopkins] did this when nobody did it," said Dr. Paul C. McCormick, who is also the Herbert and Linda Gallen Professor of Neurological Surgery at the Columbia University College of Physicians and Surgeons. "He said, look, if you're going to treat this disorder, you need to be doing this. He was ahead of the curve -- 15 years ahead of the curve. In medicine, that's an eternity."

Over time, the benefits of this type of vascular-oriented neurosurgery became evident. Patients were not subject to complications that come with open surgery, they recovered quickly and they spent less time in hospitals.

Open surgery for conditions such as aneurysm still happens routinely. But many people have come to applaud the high-tech work led by Hopkins, and doctors who work with Hopkins respect him for his path-breaking approach.

"What has proven him so prescient in all of this is that now we are all doing it," said McCormick.

"Nick is the guy who is really the first North American surgeon to be interested in minimally invasive vascular neurosurgery," said Siddiqui, 42. "He was really the first to be doing it. He sort of took it on by himself and developed it."

Hopkins himself is looking ahead: "The next thing will be to launch collaborations with nanotechnology," he said.

Efforts brought recognition

Hopkins' work shot him to the forefront of his profession.

He has published more than 300 scholarly articles since 1975. He's served as chairman of national boards of neurosurgeons. He was editor for Neurosurgery, the journal of the Congress of Neurological Surgeons, and has been a director of the American Association of Neurological Surgeons.

And, oh, yes: the Commonwealth of Kentucky named Hopkins an honorary colonel, after he successfully treated a public official from that state. (His citation hangs on the wall of his modest office, near a bookcase into which he's stuffed samples from his rock and fossil collection.)

With his sandy hair barely tinged with gray and his twinkling blue eyes, Hopkins looks for all the world like one of the Hardy Boys.

Sitting behind his desk in a corner of the Gates Circle hospital, he holds aloft a 1-millimeter catheter that he sometimes carries around in a bag with an orange logo marked "Biohazard." He waves at the bag and laughs.

"I used to bring those things across the border," he said of the biohazard bag, "and get stopped all the time."

A 'warm and caring man'

Siddiqui, the younger doctor who works with Hopkins, said one moment in his first social meeting with the surgeon sticks with him.

While walking with his wife up the pathway to Hopkins' house, Siddiqui said, they spotted small bikes, tricycles and scooters scattered around the lawn and driveway, left by Hopkins' grandchildren.

"The driveway was just littered with them ... just all over the place. I said to my wife, 'This man looks like he has his priorities in the right place,'" said Siddiqui, laughing at the memory.

"The warmth that I felt from that scene on the driveway gave me an inkling of the man. Nothing that I've experienced has changed my perspective on that. He is a genuine, genuine warm and caring man."

Hopkins said that he hopes to build a legacy in the doctors he brings to Buffalo to carry on his work into the future.

Some who know him said that Hopkins would be proud if someday those doctors became better and more accomplished than he is.

Hopkins doesn't deny that.

"It's so exciting," he said, "to see your progeny doing good stuff."

Hopkins' role key in new center

Today Hopkins and his team are focused on the present -- and the future.

Hopkins is one of the guiding forces behind the $291 million vascular research and treatment complex now under construction next to Buffalo General Hospital on High Street -- a project attracting money and top doctors to Western New York. Its funding partners include Kaleida Health and the University at Buffalo.

"It's transformational," said Dr. Michael E. Cain, a cardiologist who is dean of the University at Buffalo's medical school. He expects the project to reshape Western New York's medical landscape.

"[Hopkins] has a national and international reputation," said Cain, who had heard of the doctor during the 31 years he spent at a university in St. Louis before coming to Buffalo.

"He had the vision for this," agreed Kaskie of Kaleida Health. "He had the passion to make it happen. He is the pacesetter for it -- his group [of neurosurgeons] is the pacesetter group for it."

The goal for the vascular center is simple: to make Buffalo a world-class destination for both healing and research.

It's a tough challenge.

But for Hopkins, such a quest is nothing new.

"People say to me, 'You've been swimming upstream your whole career,'" he said. "But I'm just doing things that are different."

When the center is finished, his team of doctors will move to the new site.

The 10-floor complex will include:

• An emergency room that handles a full range of health issues, specializing in those related to heart, stroke and vascular care.
• A global vascular center, encompassing cardiac, neurological and other areas of medicine and expertise.
• A center for clinical and translational research affiliated with UB and other partners.

Much of the complex will open next spring and early summer; the emergency room is slated to open in November, Kaleida and university sources said.

"Buffalo has all the ingredients to take its existing excellent medical center and transform it -- to go to the next level and make it outstanding," said Cain at UB.

The complex will also include:

• A research institute, currently dubbed the Jacobs Institute, for research in vascular medicine. The institute has received the majority of its funding from the Jacobs family in memory of Dr. Larry Jacobs, a prominent neurologist who died in 2002.
• The Toshiba Stroke Research Center, which has received a commitment of $7 million in funding from the Toshiba company in Japan, to further research into stroke and stroke treatment, Hopkins said.

Hopkins said that such hard research will form a key part of the complex's work.

"Collaborating with scientists can lead to some cool stuff," he said. "Out of this soup we're creating, new ideas will come. And that could lead to products -- and to jobs in Western New York."

cvogel@buffnews.comnull