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A master neurosurgeon of international rank, a mentor, a saviour.
These are just a few of the ways that friends, colleagues and patients are paying tribute to the late Dr. Fred Gentili, a man known as much for his candour and love of Italy, as he was for his dedication to his craft.
"Fred didn't play golf, he didn't play squash, he didn't do much of anything except work," says Dr. Alan Hudson, former President and CEO of UHN, and a long-time friend and colleague of Dr. Gentili.
"He always took the very long, very demanding cases and in the OR he only ever gave 110 per cent," Dr. Hudson recalls. "If you were really sick, Fred was the guy you went to see."
"Fred lived and breathed neurosurgery. It was his life, his passion, his fire," says his wife, Gina.
Dr. Gentili died Saturday of glioblastoma, the very type of brain cancer that he treated many of his patients for.
Glioblastoma is the most common type of brain cancer in adults, with approximately 1,000 Canadians diagnosed each year.
"When I heard the description of the MRI, I thought, 'This can't be,'" says Dr. Gelareh Zadeh, neurosurgeon, Medical Director of the Krembil Brain Institute, Senior Scientist at Princess Margaret Cancer Centre and the Dan Family Chair in Neurosurgery. "He was trying to make light of it, but I think we both knew that this was going to be a turning point for him.
"This type of tumour, it never goes away. From the moment you get diagnosed, you need to continue battling it," she says, adding, "Every day is the best you're going to have."
Dr. Fred Gentili specialized in skull base surgery, using both open and minimally invasive endoscopic techniques, pituitary surgery and radiosurgery.
He completed neurosurgical training at the University of Toronto in 1980 and was awarded a McLaughlin Fellowship to pursue advanced training in skull base and micro-neurosurgery, completing clinical fellowships at the University of Zurich with Professor G. Yasargil and at the National Hospital Queen Square in London, England with Professor L. Symon.
Dr. Gentili joined the neurosurgical staff at Toronto General Hospital in 1982, and at the time of his death, was a Full Professor in the Division of Neurosurgery, Krembil Brain Institute at Toronto Western Hospital, and the University of Toronto.
"Fred really became an ambassador internationally for Toronto neurosurgery, raising the bar and the profile," remembers Dr. Hudson. "He was a very amiable sort of guy, very friendly. He was welcomed as a teacher wherever he went."
Dr. Gentili authored more than 100 publications and over 25 book chapters, and received numerous honours, including: The College of Physicians and Surgeons of Ontario Council Award recognizing clinical excellence in patient care and the Sir Charles Balance Memorial Medal from the British Skull Base Society.
In July 2021, he was awarded the first World Federation of Skull Base Societies Gold Medal of Honour.
Other career highlights include:
Career accomplishments aside, Dr. Gentili's great love – in addition to his beloved wife Gina – was helping patients, including Judith John.
"I was diagnosed with a pituitary tumour 20 years ago. That's when I first met Dr. Gentili," says Judith. "It was a frightening time. I had little kids and I had never heard of anyone surviving brain surgery.
"At my sisters' urging, I sent my scans to my nephew, who happens to be a high-ranking doctor at a U.S. hospital. He sent them to the head of neurosurgery, who called me personally and said, 'I've seen your scans and I know you're being treated by Fred Gentili at Toronto Western. So, why come to me? Fred is the best.'
"It was such a tribute to Dr. Gentili," Judith recalls with a smile. "I knew I was in the right place."
Seven years after her first surgery, Judith returned to Dr. Gentili when her tumour grew back.
"I was giving a presentation at work and suddenly I had a severe migraine and began having double vision," Judith recalls. "Dr. Gentili saw me and scheduled an emergency craniotomy for the following day.
"Then he told me that unfortunately he wouldn't be able to do the surgery himself, as he was scheduled to leave on a flight to Italy that night.
"I begged him to stay, but I never thought he would. The next day, as I was prepped for surgery, there he was in his scrubs. He delayed his vacation. I could not believe it."
recent video featuring an interview with Dr. Gentili about his experience as both a doctor and a patient has garnered a large and emotional response, both from the neurosurgical community and from patients.
"Watching that tribute video to Dr. Gentili just tore me up," says Judith. "He really came to understand patient care in a way he hadn't before. The irony was as brutal as the prognosis, for him."
"He learned about what it's like to walk through those doors. When you have to wait in a waiting room for the blood to be taken. When you have to go into the room where they perform radiation," Gina says.
"We don't realize what our patients go through," Dr. Gentili remarked in the tribute video. "Doctors can be more advocates for patients and encourage patients to be advocates for themselves."
Legacy will live on in neurosurgeons he trained and mentored
Dr. Gentili started by advocating for himself and insisted on staying at UHN for treatment.
"When Fred was diagnosed, he and I discussed if he wanted to go away for surgery and have somebody else do the operation or get another opinion," Dr. Zadeh recalls. "I have to say he was actually quite brave and I would have to say, sweet, because he said, he wouldn't want anybody else to do it but me.
"This is an operation that I can do regularly with no strain, but operating on my mentor, my colleague, it was quite stressful. I was really proud and honoured that he felt comfortable."
"When we took him in for surgery, he joked, 'Well, I trained all of you. So, of course I'm the patient, but I'm also the surgeon today,' says Dr. Ivan Radovanovic, a neurosurgeon and a senior scientist with the Krembil Brain Institute, who worked with Dr. Gentili. "It was pretty amazing to think of his impact on all of us."
Dr. Gentili's legacy will live on in future generations of neurosurgeons whom he trained and mentored, and in the memories of his colleagues and patients.
"He wasn't a warm and fuzzy guy, he was a surgeon. But after two years, he actually laughed at one of my jokes! That was a great day. I had huge respect and admiration for Dr. Gentili," says Judith.
"When I think about the number of patients' lives that he's lifted up and resurrected, I count myself as one of the fortunate ones," she recalls tearfully. "He saved my life."
"Fred advanced traditional neurosurgery and he was able to skillfully adapt to the changes in the field," says Dr. Hudson. "He will always be remembered as the guy who never hesitated to take on the toughest clinical cases."
Dr. Farshad Nassiri, a neurosurgical resident at the Krembil Brain Institute and the University of Toronto, adds, "It's really devastating for the society of neuro-oncologists, for neurosurgeons, for future trainees. Overall, it's just really heartbreaking, but it was also very inspiring to hear Dr. Gentili speak about his perspective as a patient."
Dr. Gentili's experience as a patient also inspired him to advocate for increased research funding to study brain cancer at the cellular level, in the hopes of advancing the discovery of new treatments.
"The solution to my problem is not going to be surgery," he said in the tribute video. "It's going to be research, funding, molecular biology, looking under the microscope to check the cells. The way we're going to solve this problem is by studying it, by researching it."
UHN is paying tribute to Dr. Gentili's career and legacy by establishing the Dr. Fred Gentili Skull Base Surgery Clinic.
Read how to make a gift to this fund in honour of Dr. Gentili