High on a shelf in Dr. Edie Zusman's office at the Sutter Neuroscience Institute, reachable by her on tiptoes, is a framed photograph of an august group of 37 neurosurgeons, deemed the best of the best in the United States.

At first glance, this snapshot of a 2004 gathering of the American Board of Neurological Surgeons looks like a sea of sameness: middle-age males, mostly white, buttoned down in starched dress shirts and ties.

But Zusman props the frame on her desk to give her visitor a closer look, as if administering a "Where's Waldo," what's-different-in-this- picture quiz.

Aha. There, on the left and near the front, isn't that a … woman?

Yes, it's Zusman. And it says a lot about her hard-won career success in an overwhelmingly male-dominated field that she fit in so well with this so-called boy's club.

She's wearing a dark suit jacket over a dress shirt buttoned to the top. Her long brown hair is modestly pulled back, and her rectangular eyeglasses try to harden her facial features.

"I'm definitely not wearing my red dress," Zusman says, laughing. "I'm trying really hard to blend in. But, guess what, I'm different."

Zusman, 45, the director of adult neurosurgery at Sutter's Sacramento facility, is one of the leading doctors in her field.

She was the first female board member in the 75-year history of the American Association of Neurological Surgeons, has lectured nationally on brain mapping and computer neuro-navigation, patented a new cellular labeling technique and authored several papers in the field.

And she recently co-authored a paper in the Journal of Neurosurgery that looked at ways to increase the number of women in the field, currently standing at only 2.5 percent.

Her latest publication, though, does not appear in a medical journal.

Zusman has written an essay about her gender-shattering journey in a new anthology, "Knowing Pains: Women on Love, Sex and Work in Our 40s" (WingSpan Press, $16.95, 222 pages), edited by Molly Tracy Rosen. Proceeds from the book benefit breast cancer research.

Her piece is a frank look at how a once-naive young medical student learned to navigate over, and sometimes dodge around, many gender- related obstacles. She also documents how she balances marriage and motherhood (son Adam, 13, and daughter Abby, 10) with a demanding career.

But her essay, titled "If It Were Only Brain Surgery," is not a feminist rant. As Zusman writes, she accomplished her goals "without bitterness and outrage" but admitted it often amounted to "an exercise in compromise."

That meant standing her ground when necessary, but also being calculatingly demure at times – behavior, she writes, "reminiscent of a 1950s housewife."

Those early struggles are mostly behind her. With experience, and mounting accolades, Zusman has been able to flex her power and influence. But she still calls neurosurgery a bastion of Y chromosomes.

To illustrate, she tells a funny story about that framed photo.

"I walked in there (for the photo) and they were having a discussion about women's underwear," she says. "I thought that wouldn't happen. I thought that was way too cliché. I said, 'Excuse me, I think I walked into the wrong room.' And they said, 'Come in. You're the only person who actually knows anything about this.' "

Earlier in her career, when she wasn't on such equal footing, Zusman faced more overt sexism. As a medical student at Northwestern, she approached the top neurosurgeon and told him she wanted to go into the field.

"He looked at me and said, 'I don't think women should be neurosurgeons,' " she says. "I said, 'OK, but I still need a mentor and someone to write my letters.' He wouldn't be my mentor."

But the doctor did deign to write a letter of recommendation for Zusman. Well, sort of.

"The first sentence of his letter for me began, 'Despite being a woman … ' " she recalls. "The turning point came when we were making rounds and he corners me, stands 2 feet in front and backed me against a wall, and says, 'You think you can be a neurosurgeon? Tell me, how many muscles does the ulnar nerve innervate?' I answered correctly. He says, 'Name them.' So I did. And he said, 'I don't think women can be neurosurgeons, but you can.' That was all I needed."

Still, Zusman didn't get accepted into her first residency program choice. When she interviewed with "a prestigious Eastern university" for a research position, the staff member "slid his hand along my thigh under the table."

Positive change has come at last, Zusman says.

Inappropriate jokes and unwanted touching are no longer tolerated in the operating room. And, according to Zusman, "Some of the same men who'd obliviously undermined my foray into the field now sit at the table with me, looking for ways to attract more women into neurosurgery."

To that end, Zusman has become a mentor.

She lectures across the country and often receives phone calls and e-mails from other women surgeons seeking counsel. She even let a medical resident, Kawanaa Carter, move in and live with her family while completing a residency at UC Davis Medical Center.

"She's been instrumental in working with me and other students and residents in neurosurgery," says Carter, who has just started a practice at Mercy Medical Center in Folsom. "She understands everything about what it is to make it in this field and how to survive as a woman in this field."

Call The Bee's Sam McManis, (916) 321-1145.