All these tools have revolutionized neurosurgery but, just as in his lab work, Black keeps pushing to improve them. He is advising a student, for example, on a project aimed at essentially bringing functional MRI into the operating room in real time. This would permit a surgeon to re-image the brain constantly during surgery in order to observe the changing geography of the brain as the operation progresses. Black is also seeking advances in noninvasive surgery, used when a tumor is so deeply embedded in eloquent tissue that it cannot be cut out. Surgeons now use focused beams of X rays to kill cancer tissue, but because these devices rely on radiation to destroy tumors, they can be used only sparingly. And because tumors killed this way take months to die, there is no way for the surgeon to know during treatment if he has got all of the tumor.

Instead, Black began to use radio waves, which cook the cancer to death right away. A few years ago, he developed a treatment that uses an MRI-guided radio-wave probe to reach into a tumor. The procedure can be performed under local anesthesia on an outpatient basis and be repeated as needed. Now Black wants to eliminate even this mildly invasive probe with something he calls the MedArray. The prototype, which Black expects to be ready for trials next year, looks like an MRI with microwave antennas lining the chamber. Using the MRI's images, the MedArray computer maps out the cancer, then directs the antennas to cook it like a rump roast. Because the entire process is controlled by computers, it is conceivable that the surgeon will not have to be at the scene of an operation. Just imagine, says Black, "the patient is lying in the MedArray machine in Nairobi. The MRI image is sent to a surgeon at Johns Hopkins, who directs the machine to destroy the tumor while he's getting feedback via the Internet. And then the patient walks out."

Armed with such powerful weaponry to kill the main body of the enemy, and backed up by new therapies like TGF-beta antisense to hunt down straggler cells, Black believes the audacious course he set for himself in medical school may be attainable. Along with other top neurosurgeons, he may yet find a way to defeat--not just hold off--malignant brain tumors.

If that occurs, old-fashioned cutting may become obsolete, and surgeons like Black could be put out of business."That would be fantastic," he says. But a man like Black would not go meekly into retirement. What would he do instead? "I guess I'd go back and try to define consciousness," he speculates. "That's what I would really love to do." He would, in short, move from a seemingly impossible crusade to one that promises to be even more difficult. For anyone who knows Keith Black, that would come as no surprise.