dnan H. Siddiqui is a dual-trained cerebrovascular and endovascular neurosurgeon, clinician-scientist, and technology leader working at the intersection of surgery, stroke care, and innovation. He is Professor and Vice Chair of Neurosurgery at the University at Buffalo, leads one of the busiest comprehensive stroke services in the United States, and directs large NIH-funded research programs focused on aneurysms, stroke, imaging, and hemodynamics. He has led major international clinical trials, and plays a central role in shaping training standards, device development, and evidence-based practice in neuroendovascular surgery through national and regulatory bodies. He is also CEO of the Jacobs Institute, where he works to translate surgical ideas into real-world technologies that reach patients.This conversation goes beyond technique. It examines judgment, training, failure, and the systems that produce true surgical excellence.In this episode, we discuss:00:45 – Why Dr. Adnan Siddiqui Chose Neurosurgery02:00 – Personal Loss and the “Dark Ages” of Neurosurgery03:15 – What Cerebrovascular Neurosurgery Overestimates Today04:40 – How to Stay Curious Without Losing Focus05:55 – When Robotic Microsurgery Became Inevitable06:50 – First Experiences With Surgical Robotics (Da Vinci & Beyond)08:45 – What Robots Do Better Than Human Hands in Microsurgery09:50 – Patient Selection for Robotic Intracranial Surgery10:45 – Why Adult Moyamoya Was the Right First Robotic Case12:05 – Indirect vs Direct Bypass in Adult Moyamoya Disease13:00 – Training Surgical Judgment When Technology Removes Friction14:20 – Why Some Neurosurgery Programs Create Leaders, Not Technicians15:35 – How the Jacobs Institute Built Real Interdisciplinary Innovation17:50 – Designing Surgical Environments That Improve Collaboration18:30 – Does Innovation Create a Two-Tier System in Medicine?20:15 – Why Perfection Still Matters in Neurosurgery21:00 – Early Career Mistakes and Learning Through Failure