January 24, 2020

Dean B. Kostov, MD

Riverside Neurosurgery Center
Neurosurgeon, Neurointerventional Specialist


When Dean Kostov was a student at University of Pittsburgh Medical School, his original intention was to become a cardiac surgeon.  However, as he was doing extensive research, he discovered he had a passion for neurosurgery, and with the approval and encouragement of his mentors, he decided to pursue that field.

He did, and upon graduation, Dr. Kostov remained at University of Pittsburgh for an internship in general surgery, a six-year residency in neurological surgery, and a fellowship in endovascular surgery.

He was invited to stay on at the University of Pittsburgh, but declined the offer.  “If you stay in academia, you tend to super-specialize,” he says. “And I had spent nearly a decade learning different leading-edge procedures from the tremendous mentors I’d had.  I wanted to put the breadth and depth of knowledge and skill I had acquired into practice on patients who needed that level of care.”

Thus, he came to Hampton Roads when Riverside Health System offered him the opportunity to do just that.  Today, while his practice focuses on complex spine problems, he routinely does a variety of neurosurgical procedures: “radiosurgery, biopsies (including awake biopsies), craniotomy for tumors, trigeminal neuralgias.  In fact,” he says, “I trained where that particular operation was invented.”

But he feels his unique specialty is knowing the right treatment for each individual patient.  “I tell each patient, I don’t operate on their pictures – I operate on them.  You have to tailor your operation to the symptoms the patient is having, not exclusively to what the pictures show.  Too often, the pictures don’t tell the story – but the symptoms do.”  He adds, “Our understanding of the nervous system, spine, bones around nerves, have changed – with the instrumentation now available, our techniques have grown and matured, so that when the right patient is selected and the right surgery is performed, that patient has the right outcome.”

For the majority of the patients he does take to the operating room, he performs minimally invasive, instrumented operations with the goal of restoring their quality of life.  With the support of a sophisticated system of computer assisted navigation for both cranial and spinal surgery, as well as ultrasound, MRI and CT-assisted image guidance, Dr. Kostov believes the care he’s able to provide is equivalent to the care his patients could get at larger, more metropolitan university centers.

“We conduct weekly neurosciences conferences, tumor boards,” he says.  “We treat patients with a multidisciplinary approach.  And while that level of research is standard in a university hospital, it’s par for the course for Riverside.  We meet with the radiologists, neurologists, pathologists, neurosurgeons.  We present cases and discuss them and figure out what’s the best thing for each individual patient.  It provides all of us steady learning opportunities.”

Dr. Kostov recalls another thing one of his mentors told him about caring for patients.  “In addition to being exquisitely trained and skilled, he told me a surgeon should be available, able and affable,” he says.  “I’ve never forgotten that lesson.”

Finally, he says, “Few specialists have the luxury of such a diverse and exciting practice.  I never have a boring day at work.  It’s thrilling, it’s exciting.  And neurosurgery is the most humbling profession, because just when you’re patting yourself on the back, you get humbled real quick.  It’s a reality check every single day.”