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A magazine for the friends of Barrow Neurological Institute of St. Joseph’s Hospital and Medical Center

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Vol. 24, Iss. 1, 2012

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50th anniversary

Barrow Neurological Institute celebrates its inspiring past, amazing future

Robert F. Spetzler, MD Up close and personal


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Opening thoughts Barrow Neurological Institute will celebrate its golden anniversary on September 23, 2012. This milestone is a wonderful opportunity to remember all that has been accomplished here, to celebrate our inspiring past. But, more importantly, our 50th anniversary is an ideal time to look ahead to what is sure to be an amazing future. This is the beginning of the “golden age” of Barrow Neurological Institute. With the best clinical and research staff in the nation, Barrow is and will be at the forefront of finding answers to some of the most devastating medical conditions, including Parkinson’s disease, epilepsy, Alzheimer’s disease, Lou Gehrig’s disease, stroke, depression, degenerative disk disease and, of course, brain tumors. During this special year, we could spend a lot of time celebrating our remarkable legacy, but instead we are challenging ourselves to take medicine beyond its current frontier, to do the impossible everyday. The Barrow story has just begun. You have been a vital part of that story. We invite you to be part of all that is to come by making a gift to Barrow Neurological Foundation in honor of Barrow’s golden anniversary. We are grateful for your support.

Sincerely,

Robert F. Spetzler, MD Director, Barrow Neurological Institute

Kathy X. Kramer President and CEO, Barrow Neurological Foundation

P.S. Please make your gift today. You can give online at Barrow50.org or SupportBarrow.org. If you would like to discuss giving opportunities, call the foundation office at 602-406-3041, Monday-Friday, 8 a.m.-5 p.m. A postage-paid giving envelope is included in this magazine for your convenience.

On our cover: Robert Spetzler, MD, director of Barrow Neurological Institute, in a surgery suite at the institute.

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A magazine for the friends of Barrow Neurological Institute of St. Joseph’s Hospital and Medical Center

Vol. 24, Issue 1, 2012

barrow

Contents

It started with a dream: Barrow Neurological Institute’s inspiring past

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An interview with Robert Spetzler, MD, director of Barrow Neurological Institute

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Out of the dark into the light: The evolution of neurosurgery

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Barrow today: A continued focus on clinical care, research and medical education

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50 Years, 50 Faces Patients tell their stories at Barrow50.org

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Help make Barrow’s future amazing

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Endovascular neurosurgeons operate from inside blood vessels to treat woman’s difficult condition

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Huntington’s disease proves devastating to patients and families

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Barrow Grand Ball, Celebrity Fight Night, Lou Grubb Friends Fore Golf raise funds for Barrow

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St. Joseph’s Amazing: Patient stories from the files of Barrow Neurological Institute

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Benefactor Briefs

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Planned Giving

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How to Reach Us | Barrow is published twice a year. We welcome your comments, suggestions and requests to be added to or deleted from our mailing list. Call 602-406-1041, email Catherine.Menor@DignityHealth.org or mail to Barrow magazine, Office of Philanthropy, St. Joseph’s Hospital and Medical Center, 350 W. Thomas Rd., Phoenix, AZ, 85013. Please include your name, address, email and phone number in all correspondence. Visit us online at www.SupportBarrow.org.

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Editor: Catherine Menor Catherine.Menor@DignityHealth.org Art director/designer: Justin Detwiler

Photography: Brad Armstrong; Gary Armstrong; D Squared Productions, Murphy/Scully Photography; Jeff Noble

Printer: Panoramic Press

Robert F. Spetzler, MD, Director Barrow Neurological Institute®

Contributing writers: Lindsey Burke, Sally Clasen, Melissa Morrison, Sarah Padilla

Kathy X. Kramer, President and CEO Barrow Neurological Foundation


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It Starte With A D When John Green, MD, moved from Chicago to Phoenix in 1947, he brought with him his own surgical tools and a big dream: He would establish the Southwest’s first neuroscience institute, an institute dedicated to learning all there is to know about the human brain. Dr. Green’s dream seemed impossible in such a young desert community. But then he met Julia Barrow, who was gravely ill with a malignant brain tumor, and her husband, Charles. Using the most advanced techniques available, Dr. Green operated on Julia, extending her life for several years. So impressed was Charles that he offered $500,000 for Dr. Green’s dream institute, provided that Sister Mary Placida, St. Joseph’s administrator at the time, match his gift. She did just that, and Charles Barrow gave another $600,000. In planning Barrow, Dr. Green sought advice from leading neurosurgeons and neurologists from across the country. He organized Barrow into three areas: patient care, research and education. He also established Barrow Neurological Foundation to raise money for the new institute. Barrow Neurological Institute opened on Sept. 23, 1962. Now, just 50 years later, Barrow has become a world leader in the neurosciences. We believe that Dr. Green would be proud to reflect upon Barrow’s inspiring past and to look forward to its amazing future.

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Barrow Magazine Barrow Neurological Institute 1962-2012


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ed Dream


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Barrow Neurological Institute

An inspiring past

1959 Charles Barrow gives $500,000 to St. Joseph’s Hospital for the construction of Barrow Neurological Institute as thanks for the care John Green, MD, gave his wife, Julia. The Sisters of Mercy match the gift by obtaining $500,000 in Hill-Burton funds. In all, the Barrow family contributes $1.1 million to the project.

1960 Barrow Neurological Foundation is established to raise funds for research at Barrow. 1961 The Neurosurgery Residency Program receives accreditation from the American Board of Neurological Surgery.

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BARROW The Division of Neuroanesthesiology is established under the direction of Elizabeth Wilkinson, MD.

1976 The Microneurosurgical Laboratory opens, with funding from the Barrow Women’s Board.

1977 The James R. Atkinson Pain Research Endowment Fund is established. Bud Craig, PhD, is awarded the endowed chair.

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1975 Barrow acquires a computerized axial tomography (CAT) scanner, the first in Phoenix.

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1979 The Neurorehabilitation Unit opens. Now called the Deborah and Bruce Downey Neuro Rehabilitation Center, it has become a world-class center offering therapy to patients with brain and spinal cord injuries. 1981 The Multiple Sclerosis Clinic is established.

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1983 The Stroke Center opens. The J.N. Harber Foundation endows the Chair of Neurosurgery at Barrow, enabling the institute to recruit Robert Spetzler, MD.


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1962 Barrow Neurological Institute opens. At the time, it is one of three neuroscience institutes in the country. Dr. Green Arizona’s first neurosurgeon, is its director, and the five-story building has 50 patient beds.

1965 The Women’s Board of Barrow Neurological Foundation is established to raise funds for Barrow. The first Women’s Board fundraiser, a masked ball held on New Year’s Eve of that year, raises $26,000.

1966 Microneurosurgery is performed at Barrow for the first time.

Barrow researchers, led by Dr. Spetzler, refine the cardiac standstill procedure for use in treating previously inoperable cerebrovascular disease. The operation involves putting the patient in a state of suspended animation—with no heart beat or blood flow—so that surgeons can operate without the risk of bleeding.

1987 The A.B. and Anne Merete Robbs Jr. Stroke Prevention Treatment and Research Center is endowed.

1967 The Neurosurgical Research Lab opens, with funding from the Barrow Women’s Board.

1972 A $3-million expansion, funded in part by donations, adds three stories to the Barrow building and brings its bed count to 114. 1974 The first Barrow Symposium attracts 250 neurologists and neurosurgeons from the U.S., Canada and Mexico.

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1984 The Neurological Rehabilitation Day Hospital opens. The innovative outpatient program is now called the Center for Transitional NeuroRehabilitation. 1986 Dr. Spetzler succeeds Dr. Green as the director of Barrow.

1988 Former First Lady Nancy Reagan dedicates the Dr. Loyal and Edith Davis Neurological Research Laboratory in honor of her parents. Dr. Davis served as interim director of Barrow.

The Epilepsy Monitoring Unit opens for the diagnosis of seizure disorders. The Kemper and Ethel Marley Chair of Neurology is established, enabling Barrow to recruit William Shapiro, MD, formerly of the Sloan Kettering Institute of Cancer Research.

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1989 A Barrow team, led by Volker Sonntag, MD, makes international headlines for successfully reattaching the skull of Timothy Mathias after a bicycle-car accident. The Parkinson Disease and Information Referral Center is established. In 1997, the center is renamed the Muhammad Ali Parkinson Center.

1999 A bequest from Marjorie Newsome enables Barrow to establish the Barrow Foundation UK. The Karsten Solheim family establishes the Karsten Solheim Dementia Research Chair at Barrow in honor of the creator of PING golf clubs.

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1992 Curtis A. Dickman, MD, pioneers spinal thoracoscopy, a method of operating on the spine using endoscopic tools through tiny chest incisions. 1993 The Barrow Balance Center, directed by Terry Fife, MD, opens for the treatment of balance disorders and vertigo.

2000 Cambridge University honors A.D. “Bud” Craig, PhD, for research showing that specific neural pathways carry sensations from peripheral nerves up the spinal cord to the brain. The Neuroendocrine Clinical Conference is established by William L. White, MD.

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Dr. Sonntag performs neck surgery on the wife of King Fahd of Saudia Arabia. 1994 Dr. Spetzler receives neurosurgery’s highest recognition: Honored Guest of the Congress of Neurological Surgeons. He is the youngest person to receive the honor.

In honor of his late wife, Bill Levine establishes a fund to endow the Ina Levine Brain Tumor Center. 2001 The Muscular Dystrophy Association recognizes the MDA Clinic at Barrow as one of only 24 MDA-ALS Centers in the country.

Lou Grubb names Barrow Neurological Institute the beneficiary of his charity golf tournament to thank the hospital for the care he received in 1986 after suffering a ruptured aneurysm. The annual fundraiser, now called the Lou Grubb Memorial Tournament, has raised millions of dollars for the hospital.

Dr. Sonntag receives the Alumni Spine Chair, an endowed chair funded by physicians, former residents, patients and benefactors in recognition of his contributions to spine surgery. The Annette and Harold Noren Stroke Intensive Care Unit opens.


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1995 Barrow surgeons, led by Dr. Spetzler, perform the world’s first cardiac standstill on a pregnant woman. Cheryl Jones delivers a healthy boy several months later. The Huger Mercy Living Center, a residential facility for people with dementia, opens with major funding from Raymond Huger, MD.

2002 Dr. Spetzler performs a cardiac standstill on Chase Meseroll, 5, the youngest person to undergo the operation. Dr. Sonntag is named the Honored Guest of the Congress of Neurological Surgeons. Dr. Dickman uses a technique developed at Barrow to reattach

1996 Muhammad Ali appears at Celebrity Fight Night for the first time. Proceeds from the event benefit Parkinson’s services at Barrow.

The 70,000-square-foot Neuroscience Research Center opens, with major funding from the Hyman Golden family, the Del E. Webb Foundation, and Mr. and Mrs. Leonard Goldman.

1999 U.S. News & World Report recognizes Barrow as one of the 10 best centers for neurosurgery and neurology in the country, an honor Barrow continues to earn.

1997 Barrow acquires a Gamma Knife, still the only one in Arizona and one of about 125 in the U.S. Kris Smith, MD, serves as the director of Gamma Knife.

The Horace W. Steele Chair of Neurosurgical Education, funded by the Steele Foundation, is awarded to Dr. Spetzler.

Joseph Zabramski, MD, and Eric Johnson, PhD, contribute to the Human Genome Project by identifying the gene that causes the inherited form of cerebral cavernous malformations.

Marcos Parra’s skull to his spinal column after a nearly fatal car accident.

2003 Barrow opens the nation’s first Hypothalamic Hamartoma Center, successfully treating children from around the world with the devastating brain tumor.

Michelle Robson and Julie Wrigley. Major gifts come from Julie Wrigley, Michelle and Ed Robson, the Earl Petznick family, the Virginia G. Piper Foundation, the Kemper and Ethel Marley Foundation, Barrow Neurosurgical Associates, the Stardust Foundation, Stevie and Karl Eller, Deborah and Bruce Downey, and Doris and John Norton.

Jim Pipe, PhD, leads development of PROPELLER, a method of obtaining clear MRI images regardless of patient movement. The John and Betty Vandenburgh Chair is endowed for ALS treatment and research.

The Pushing Boundaries campaign is launched to raise funds for a $200-million hospital building project. Co-chairs are

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2003 St. Joseph’s Foundation and Barrow Neurological Foundation launch the St. Joseph’s Health & Wealth Raffle, the first mega raffle of its kind in the U.S., to raise funds for education, research and care for those in need at the hospital.

2005 The first TelePresence videoconferencing system of its kind is installed at Barrow, facilitating real-time global consultation during surgery. Support for the project comes from Stevie and Karl Eller.

2006 The 430,000-square-foot Barrow Neuroscience Tower opens. It is the largest, most technologically advanced neuroscience facility in the world and includes the first ever 3-Tesla intraoperative MRI. Donors give about $30 million.

2007 Robert Spetzler, MD, performs his 5,000th aneurysm operation, the most of any neurosurgeon.

2009 The Leona M. and Harry B. Helmsley Charitable Trust funds a new research facility with a 7-Tesla MRI at Barrow.

2010 Marian H. Rochelle gives $10 million to establish the Barrow Center for Neuromodulation and complete funding of the Sonntag Academic Pavilion. It is the largest gift in Barrow’s history.

find a cure for brain tumors. Amy and Ray Thurston donate $3 million to the center, which is directed by Nader Sanai, MD.

2011 The Barrow Center for Neuromodulation is founded to explore the use of deep brain stimulation and other new approaches to treating a wide range of brain disorders. Francisco Ponce, MD, is named director of the new center.

Jean Grossman endows the Harold and Jean Grossman Israeli Fellowship at Barrow to enable Israeli neurologists to teach and work at the Muhammad Ali Parkinson Center.

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The Barrow Brain Tumor Research Center is established to develop new treatments and

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After Micah Andrews suffers an internal decapitation in a car crash, Nicholas Theodore, MD, reattaches his skull to his upper cervical spine, using a procedure perfected at Barrow.

The new Deborah and Bruce Downey Neuro Rehabilitation Center opens. The much larger facility features 52 patient beds, three gyms and specialized equipment. It was funded by

Barrow partners with the Arizona Interscholastic Associa-


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the Downeys in appreciation of the care Bruce received after suffering transverse mylitis in early 2003. Barrow vision researchers Susana Martinez-Conde, PhD, and Stephen Macknik, PhD, make international headlines for their research ending a 50year debate over the purpose of small involuntary eye move-

tion and the Arizona Cardinals in developing the nation’s first mandated concussion education and prevention program for student athletes. Mary Lou and Ira Fulton honor their late son with a $2.5-million gift for the new Gregory W. Fulton ALS and Neuromuscular Disorders Clinic, directed by Shafeeq Ladha, MD.

ments called microsaccades. Their research, which received funding from Barrow Neurological Foundation, is featured on the cover of Scientific American. The two researchers later edit an entire issue of Scientific American Mind dedicated to illusion and the brain.

2008 Joan Shapiro, PhD, and William Shapiro, MD, establish a fund to endow a Chair in Neuro-Oncology Research at Barrow.

2009 The Muhammad Ali Parkinson Center moves into a new facility that is twice as big as the old center, thanks to funding from the Celebrity Fight Night Foundation. It is the most comprehensive movement disorder center in the U.S.

Construction begins on the Ashlyn Dyer Aquatic Center, which is funded through $1.6 million in contributions to Barrow Neurological Foundation.

2012 The Women’s Board celebrates Barrow’s 50th Anniversary at the 2012 Barrow Grand Ball. The Women’s Board has raised more than $42 million for Barrow, making it the institute’s largest benefactor.

surgeons, neurologists and researchers at Barrow. Celebrity Fight Night has contributed $19 million to Barrow over the past 16 years.

Lonnie and Muhammad Ali and the Celebrity Fight Night Foundation honor 50 neuro-

Mary Lou and Ira Fulton donate $1.5 million for an expansion of robotic surgery. The Sonntag Academic Pavilion opens. ■

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by Sarah Padilla

Up close and personal with Barrow’s director

Robert Spetzler, MD ■ Robert Spetzler, MD, has been at the helm of Barrow Neurological Institute for more than half of its 50 years. Here, the director reflects on Barrow’s remarkable past and looks ahead to a dramatically different future. You’ve said that you wanted to be a neurosurgeon since you were a boy. What drew you to medicine? Truth be told, I don’t know where my desire to practice medicine came from. I just know that it is what I always wanted to do. However, my first personal healthcare experience, as a five-year-old boy in Germany, no doubt helped shape my views about patient care. I had been diagnosed with tetanus, and the doctors saw little hope for survival. Ultimately, they tried a new drug, penicillin, which killed the bacteria. The case was a celebrated success, and I mostly enjoyed the attention, with the exception of one very traumatic event in which I was presented to a large audience of physicians. The professor placed me on a small table in the middle of the stage and unceremoniously undressed me so he could perform a neurological exam. I still shudder at the humiliation I felt. This experience has stood out as a lifelong lesson to make every effort to avoid putting my patients into similar situations. How did you end up at Barrow? In 1983, I received a request from Dr. John Green to consider the position of chairman of neurosurgery. I met so many incredible people on that visit, and my wife, Nancy, and I fell in love with Phoenix. There was so much potential here that I couldn’t turn it down. Dr. Green had established a threefold purpose for Barrow that included patient care, research and medical education, and that three-legged stool is still our foundation today. Nearly 30 years later, Barrow’s

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Barrow Magazine Robert Spetzler, MD

potential for the future continues to inspire my colleagues and me. Are there any particular patients that stand out? Absolutely. I remember Mrs. Jones, a young pregnant mother with a basilar artery aneurysm that had ruptured. It was in the worst possible location in the brain for surgery; however, using a technique called hypothermic cardiac arrest, or cardiac standstill, we were able to clip the aneurysm. No pregnant patient with an aneurysm had ever been placed into cardiac arrest before. Incredibly, both mother and child survived. But on the other side, there are many patients who I wish I could treat again after the knowledge I have gained from their poor results. They have been my greatest teachers. Kathy was a beautiful little girl with a cavernous malformation, a benign tumor in the brainstem. We performed a difficult operation and were gratified to see significant improvement. Unfortunately, Kathy developed a venous stroke and passed away within 48 hours. By going over the case again and again, we realized that the large abnormal veins associated with this cavernous malformation carry out normal function. We now know that it is critical that these associated veins are preserved. Kathy taught us this, and today countless patients have benefited from this knowledge. Aside from these clinical lessons, what life lessons do you hope to impart to Barrow’s residents? I have told my residents ad nauseam that there are two blessings in life: to be happy at home and happy at work. I have been incredibly blessed on both counts. I believe it is your attitude, in large part, that paves the road to happiness.


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You are a role model to so many. Who do you look up to? There are many heroes who have helped shape my life, from Albert Schweitzer, a missionary physician, to Gandhi. But I also have a very personal hero—my youngest brother, Bertram, an orthopedic surgeon who became a quadriplegic after a biking accident in 2008. In a split second, he lost his surgical profession, his ability to be independent and his livelihood. He had every reason to be bitter and rage at the injustice that serendipity had thrown at him. Instead, he stayed positive, and he lives his life fully without bitterness or regrets. He remains extremely grateful for what he has received in life and makes those he meets feel thankful for their own good fortune. As director of Barrow, what are you most proud of? Barrow has achieved a level of recognition of which we can all be proud, from being named a top 10 hospital to performing more neurosurgeries than any other facility in the United States. I’m particularly proud of creating the largest neurosurgery residency program in the country. I like to say that we teach tomorrow’s medicine today. But, what I’m most proud of, very simply, are the people I work with—my neurosurgical and neurological colleagues; all the physicians, nurses and techs who play a role in patient care; the benefactors who help fund our work; and, of course, the patients we treat. All of the lovely notes I receive from patients attest to the fact that our team has achieved a degree of excellence that is a source of great pride.

“I still shudder at the humiliation I felt. This experience has stood out as a lifelong lesson to make every

What do the next 50 years have in store for Barrow? We’re going to see dramatic changes, both at Barrow and in the neurosciences as a whole. I believe that Barrow will be at the forefront of finding answers to some of the most devastating neurological conditions—Alzheimer’s disease, Parkinson’s disease, degenerative disk disease. Malignant brain tumors will be effectively treated and controlled. And the Barrow Center for Neuromodulation has an incredible potential impact on society. We will help nonfunctional individuals become functional again, and that is remarkable. Barrow surgeons will largely put themselves out of business in the coming years. Rapid advances in minimally invasive surgery, and gene and stem-cell treatments will mean that the traditional role of the brain and spine surgeon will disappear. Our profession will drastically change, and that is very good news. ■

effort to avoid putting my patients into similar situations.”

Robert Spetzler, MD Barrow Magazine

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by Melissa Morrison

Out of the dark into the light

Neurosurgery Evolution Neurosurgery’s history is one of mapping unknown terrain, an adventure as risky in its early years as an actual expedition to parts unknown. ■ The surgeon drills gently into the skull, sensitive to the moment he has broken through the bone’s barrier but has stopped short of actual brain. With access established, he saws a porthole the size of a poker chip into the 43-year-old female patient’s head. He hands the bone to the scrub nurse for safekeeping in a sterile blue plastic dish. “Bring in the scope,” the surgeon says. A nurse swings what is essentially a giant microscope in front of him. Peering through it, cautery in one hand, scalpel in the other, he slices millimeters at a time into the tough membrane revealed by the missing bone. As he progresses, he lifts the flap to reveal the solid lump attached underneath. It’s a tumor the size of a walnut that, if ignored, would have grown larger, crowding the brain beneath it, suffocating its oxygen supply and eventually erasing its functions—perhaps even the life of its owner, a supermarket cashier from Peoria. The tumor excised, the surgeon retraces his steps, replacing the bone, then stapling the skin over it. For a few vulnerable moments, however, the exposed brain pulsated in the open air, glistening, a diaphanous web of veins overlaying it like a map of newly charted territory.

“...the results were discouraging” Neurosurgery’s history is one of mapping that terrain, an adventure as risky in its early years as an actual expedition to parts unknown. The patient had an equal chance of dying as surviving. The greatest cause of death was hemorrhage. Harvey Cushing, credited as the first modern neurosurgeon in the United States, improved the odds considerably. In 1910, he created a silver clip that blocked blood flow during surgery. Fifteen years later, along with physicist William Bovie, he

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invented an instrument that used an electrical current to coagulate blood. (The Bovie is still used today.) As a result, a Cushing patient’s chance of dying was reduced to a mere one in 10. Still, actually curing the patient remained a gamble. “To find any young man who would even consider going into this field was a real problem,” wrote Ernest Sachs, a Cushing colleague, in a memoir. “House officers disliked working in neurosurgery because the results were so discouraging. The number of times that craniotomies were done and the tumor not found was disheartening, to say the least, and required a stiff upper lip.” Fast-forward to the 21st century, when a tumor the size of a pea deep within the brain’s most valuable real estate can be identified before the first incision is made. “Success is easily measured by, one, removing the offending lesion; and two, maintaining the quality of life of the patient,” says Robert Spetzler, MD, Barrow Neurological Institute’s director since 1986. Likewise, neurosurgery’s evolving technology and technique have been focused on locating the problem and getting to it in the least invasive way possible. Barrow has been at the forefront of several key explorations. Dr. Spetzler considers Barrow’s greatest contribution on that score to be its treatment of a type of vascular abnormality that leaks blood into the brain. A cavernous malformation, basically a wad of capillaries, can develop anywhere in the central nervous system, but those in the brainstem are particularly dicey because the region regulates the basic functions of life, such as breathing. “We have devised new avenues to get to this place that had previously been considered inoperable,” Dr. Spetzler


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says. “Since billions of fibers run through the brainstem, which is the gateway to the rest of the body, you can affect anything. You can affect speech, movement of your arms and legs, breathing, bowel and bladder.” Barrow has pioneered safer pathways to such hard-toreach lesions, including dodging crucial blood vessels. “It is often just a few-millimeters access point,” Dr. Spetzler says. The result is a better outcome and a shorter recovery time for the patient. That is true even for less life-threatening lesions, such as pituitary adenomas. The pituitary gland is located in the center of the skull. Tumors there, usually benign, occur in 1 out of 1,000 adults. They can wreak havoc by accelerating the release of hormones controlled by the gland; for example, excessive growth hormone results in abnormally large hands, feet and facial features in an adult, a condition so pronounced that some early sufferers found work as circus freaks. The first surgeries to remove pituitary tumors involved removing the front side of the skull and reaching beneath the frontal lobe, the region of the brain responsible for higher mental functions, such as problem-solving. In 1977, William White, MD, performed Barrow’s first transsphenoidal approach—a much less invasive technique that reaches the target through the nasal cavity. It is now the most common route, and far easier on the patient. “In the old days people would be in the hospital for a week to 10 days,” says Dr. White, who began his neurosurgery career at Barrow. “Now they go home on the second post-op day.”

“...as if you had cut off the top of the head and looked right in” The advancement of neurosurgery is as much about technology as it is technique. New ways of mapping the brain have transformed the field. Computerized guidance systems identify the safest route to the offending lesion, so the surgeon knows the precise angle and location of approach. For example, the recent introduction of a carbon-dioxide laser that vaporizes a fiber’s-width tunnel through brain tissue enables Barrow to reach previously inaccessible cavernous malformations. But when Barrow opened, imaging was far more primitive.

“If you go back to the early days of Barrow, there was no real way to look inside the head directly,” says Joseph Heiserman, MD, a Barrow neuroradiologist. “There were ways to diagnose problems in the brain, but indirectly. The only way to see what the problem was, was to do neurosurgery.”

“If you go back to the early days of Barrow, there was no real way to look inside the head directly. The only way to see what the problem was, was to do neurosurgery.” One early imaging method involved injecting air into brain cavities and then x-raying the head. The technique was still in use when Dr. White, fresh out of the University of Kansas School of Medicine, showed up at Barrow for his residency in 1970. He describes a mechanism known as an isocentric chair: “We’d do a spinal tap and fill the patient’s head full of air,” he says. “It gave them a tremendous headache. Then this chair would spin and somersault to move the air into the different cavities—which would make the headache even worse— so we could outline the brain and localize brain tumors.” The “Eureka!” moment in brain imaging came with the invention of computed tomography (CT) in the 1970s. “CT scans use computers that make images as if you had cut off the top of the head and looked right in,” Dr. Heiserman says. “Now you could actually see the lesions: where they were, what they looked like.” John Hodak, MD, a radiologist who specialized in the central nervous system, pioneered the use of CT scans, bringing the first to Barrow in 1975. Previously, a general radiologist interpreted images of the brain. “He brought skills that upped the game and helped make more subtle diagnoses,” Dr. Heiserman says. About a decade later, magnetic resonance imaging was another giant leap forward. The MRI’s spinning magnet creates a super-conducting field that pulls the patient’s atoms

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into a formation that results in detailed internal images. “Rather than just see the lesions themselves, you could see subtle changes in the brain and blood vessels,” Dr. Heiserman says. Unlike a spinning isocentric chair, all the patient must endure is the machine’s loud electronic burps and clangs.

“...so they can know exactly where they need to go” Since the MRI, imaging technology has been steadily refined. Dr. Heiserman describes a navigation technique similar to placing a divining rod on the patient’s head that transmits to surgeons a computerized picture of what’s directly underneath “so they can know exactly where they need to go,” he says. Such technology has helped reduce the need for surgeries in which the patient stays awake, which are among the most challenging cases. The placement of deep-brain implants to control Parkinson’s disease or surgical ablation to control intractable seizures are two examples. Lisa Wilkinson-Fannin, MD, Barrow’s first neuroanesthesiologist, recalls the balancing act. “These are difficult cases for the patient and the anesthesiologist because it is necessary to communicate with the patient, but also to medicate them in order to keep them comfortable and pain free,” says Dr. Wilkinson-Fannin, who retired in 2006. While the surgeon was probing the patient’s brain, the patient had to answer questions to ensure that the parts of the brain known as “eloquent tissue” weren’t being damaged. “They would be asked to repeat numbers or sentences to make sure areas of speech were not being affected, or shown pictures of things and asked to identify them,” she says. More recently, however, a functional MRI done before surgery looks at blood flow to the brain when a patient is asked to speak and move. The resulting map allows surgeons to establish beforehand where such tissue is located in an individual patient and avoid it. Neurosurgery’s evolution has not just made life easier on the patient, but also on the doctor.

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Barrow Magazine Neurosurgery Evolution

As Barrow’s first dedicated neuroanesthesiologist, Dr. Wilkinson-Fannin was also its only one for three years, which meant she was constantly on call. Some cases lasted as long as 15 hours—she recalls one that took 23 hours and involved a tumor in a particularly difficult location. Sometimes physicians would have to request a pause in longer surgeries so they could use the bathroom or eat and drink. Improvements in neurosurgical technique and technology have shortened surgeries, while advances in anesthesiology have improved outcomes, Dr. Wilkinson-Fannin says. Aided by technology, specialties such as radiology and anesthesia enable today’s surgeons to know even the most remote regions of the brain. Certain territory, however, remains stubbornly inscrutable. “The most common primary brain tumor is a glioblastoma. And it’s also the most malignant,” Dr. White says. “There’s been a lot of research on that since I was a resident, and I don’t think we’ve added four to six months of life expectancy to those patients.”

Neurosurgery in the future may not even involve actual surgery. DNA research will determine ways to prevent brain tumors and abnormal blood vessels from developing. Neurosurgery’s steep and steady advancement holds promise that even these most deadly of brain tumors, too, will eventually be vanquished. “There’s a lot of tantalizing hopes that, as time marches on, we will make a difference,” Dr. Spetzler says. “With tumors, it is to put these abnormal cells asleep so they don’t multiply. I think that’s the next step.”


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In other words, neurosurgery in the future may not even involve actual surgery. DNA research, including that done at Barrow, will determine ways to prevent brain tumors and abnormal blood vessels from developing, Dr. Spetzler says. Already, he points out, noninvasive techniques such as Gamma Knife—in which radiation beams are directed through the skull very precisely at a tumor—have taken the scalpel and drill out of the procedure. “As we move along that continuum of progress, we are going to get rid of neurosurgery as we know it now,” Dr. Spetzler says. “We are going to have better and better imaging, and smaller and smaller surgical exposures. We are going to rely more and more on robotic interventions.” As Dr. Heiserman says, “There hasn’t been a time in the past 30 years when there wasn’t new innovation out there and

we weren’t thinking about new ways to use it.” As far as Kacy Hess is concerned, a brain tumor that, in Cushing’s day, meant a 50-50 chance of surviving surgery let alone resuming her former life is, well, not a big deal. The Fry’s cashier had her first brain tumor removed a few years ago when her sister noticed that one of her eyes looked different than the other. The culprit was several unusually fast-growing but benign meningiomas, requiring a total of three surgeries, including one earlier this year. “I wasn’t scared,” says Hess from her Peoria home, one week post-surgery. “I figured I was in safe hands.” She had surgery on a Monday. She went home Tuesday. By Wednesday, Hess says, she felt like herself again. ■

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Barrow Today Barrow Neurological Institute has become a leading neuroscience center—routinely recognized as one of the top 10 centers for neurology and neurosurgery by U.S. News & World Report—because of its unwavering focus on patient care, medical education and research. How do the brain and spine work? What causes disease? What role do genetics play? How can we better diagnose and treat spine and brain problems? How can we train young neurologists and neurosurgeons to always do their best for patients? What can we do to help patients both in the hospital and when they go home? How can we improve their length and quality of life? These are the questions that Barrow physicians, nurses, residents, researchers and staff ask every day. Their commitment to excellence and to each and every patient has created a neuroscience center that draws patients from throughout the world for care available at few other hospitals. On the following pages are examples of the medical education, patient care and research at Barrow today. At the heart of every service, every program, every research project is the patient, Barrow’s reason for being.


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REHABILITATION DESTINATION

TRAINING TOMORROW’S DOCS Katherine Cronk, MD, PhD, is a fifth-year Neurosurgery resident at Barrow. The seven-year-long Neurosurgery Residency Program includes experience in Barrow surgery suites, clinics, in-patient units and research laboratories. It is the largest neurosurgery training program in the world and one of the most prestigious. In all, Barrow offers 56 residency spots, including 28 in neurosurgery, 21 in neurology and seven in neuropsychology. Another 26 neurologists and neurosurgeons are doing fellowships in a variety of subspecialty areas, such as neuromuscular disease, movement disorders and epilepsy.

BEYOND BARROW’S WALLS Mike Benge (right) shows Barrow neurorehabilitation patient Bernard Dime how to move from a car seat to a wheelchair. Benge volunteers for the Barrow Connection, an outreach program that helps patients like Dime live active lives after leaving the hospital.

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Barrow Magazine Barrow Today

After a nearly fatal car crash, Dr. Jose Villela Vizcaya of Mexico City came to Barrow for neurorehabilitation. Barrow offers a wide range of rehabilitation programs, including the Deborah and Bruce Downey Neuro Rehabilitation Center, the Center for Transitional NeuroRehabilitation and the BRAINS Clinic.


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TUMOR CELL DETECTIVE The intraoperative confocal microscope, which was tested at Barrow, enables neurosurgeons to detect individual brain tumor cells during surgery. Barrow works with biomedical companies to develop and improve surgical tools such as this one, including microscopes, image guidance systems and stents.

FUTURE SCIENTISTS Raj Vatsa, a sophomore at Brophy College Preparatory (second from right), and Claire Woodrow, a sophomore at Xavier College Preparatory, are participating in Barrow’s Scientific Enrichment Program for Students. The program gives students interested in science the opportunity to work in a lab at Barrow. The students work in the neuro-oncology laboratory of Adrienne Scheck, PhD, along with research tech Eric Woolf.

MRI EVOLUTION Jim Pipe, PhD, director of the Keller Center for Imaging and Innovation at Barrow, led the development of PROPELLER, an MRI method that gives high-quality images even when a patient is unable to remain still, as in some movement disorders. The bottom image illustrates how much clearer scans are on MRI equipped with PROPELLER. Nearly every commercial MRI system now includes PROPELLER. The Keller Center is teaming with Philips Healthcare on a new initiative to make MRI up to four times faster.

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NEW WAYS OF OPERATING Endovascular neurosurgeons Felipe Albuquerque, MD, and Cameron McDougall, MD, are pioneering new, less invasive ways of operating on the brain. These surgeons insert thin catheters into blood vessels and then maneuver stents, coils and other devices through the catheters up into the brain to treat diseased areas.

PROFESSIONAL EDUCATION Barrow hosts several annual conferences for physicians, nurses and other medical professionals, including the Barrow Neurosurgery Symposium in the spring.

A WINDOW INTO SURGERY Eller TelePresence @ The BARROW provides an ideal teaching environment for doctors in training at Barrow. Residents and visiting physicians can view live surgeries in the suite, and Barrow can broadcast educational conferences around the world via TelePresence. The technology is also being used to show live and taped surgeries in the Neuro Theater at the Arizona Science Center.


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FIT FOR THE CHAMP The Muhammad Ali Parkinson Center is the most comprehensive movement disorders center in the country. The center brings together all the services needed by patients and their families. It is one of only 27 National Parkinson’s Foundation Centers of Excellence in the U.S. The Celebrity Fight Night Foundation funded the center’s facility, which opened in late 2009.

EPILEPSY AT THE CELLULAR LEVEL Peter N. Steinmetz, MD, PhD, is recording the electrical activity of individual brain cells in patients with epilepsy, such as Guadalupe Garcia. Dr. Steinmetz and David Treiman, MD, are exploring whether single cell recordings might give epilepsy specialists a new tool for locating the center of seizure activity in patients with hard-to-manage epilepsy. The research is one of 400 investigative studies underway at the hospital.

LEARNING YOUNG TO USE YOUR HEAD All Arizona high school student athletes are now required to learn about brain concussions through Barrow Brainbook, a website designed to look and feel like a social media site. Barrow, the Arizona Interscholastic Association and the Arizona Cardinals teamed up to produce the site in an effort to reduce the incidence and impact of concussions.

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A FOCUS ON PATIENTS Helping patients navigate the many services available in the new Barrow Brain Tumor Research Center (BBTRC) is the job of Gracia Nicolaescu, RN, shown here with Nader Sanai, MD, director of the center. The goal of the BBTRC is to extend the lives of people with brain tumors.

SURGERY STATS

ANEURYSM EXPERTISE Robert Spetzler, MD, director of Barrow, has performed more aneurysm surgeries than any other neurosurgeon in the world—more than 5,900 and counting. Barrow conducts ongoing research to assess the effectiveness of different surgical options. One trial, for example, compares the effectiveness of endoscopic procedures to craniotomies for treating aneurysms.

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Barrow Magazine Barrow Today

The average brain or spine surgery at Barrow takes 247 minutes, includes a 10-person operating team and requires at least 50 basic instruments. Barrow has the busiest neurosurgery center in the country, performing about 5,000 operations annually.

SPECIALTY NEUROLOGY CLINICS Benjamin Seltzer, MD, is the director of the Barrow Center for Alzheimer’s Disease and Cognitive Disorders. Other specialty clinics at Barrow focus on acoustic neuroma, hypothalamic hamartoma, normal pressure hydrocephalus, stroke, epilepsy, multiple sclerosis, Lou Gehrig’s disease, brain tumors and Parkinson’s disease.


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HIGHLY SKILLED NURSES Nicole Ballantyne, RN, CNRN, cares for Jeanne Albert in the Neurotelemetry Unit at Barrow. Ballantyne is one of about 135 certified neuroscience registered nurses at Barrow, the largest group of CNRNs in the country.

KNIFELESS SURGERY Radiosurgery offers a noninvasive way to destroy tumors and other lesions in the brain or spine. Barrow has the only Gamma Knife and CyberKnife radiosurgery devices in Arizona. David Brachman, MD, medical director of Radiation Oncology, is shown with CyberKnife.

GRAPHIC DETAIL The Barrow Neuroscience Publications Office annually publishes more than 200 peerreviewed journal articles, books and chapters written by Barrow physicians and scientists. The office also creates detailed anatomical illustrations, such as this image, for use in publications, resident training and public education.


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50 Years, 50 Faces Patients, doctors, nurses tell their story at Barrow50.org Arizona is known for brilliant sunsets, iconic saguaros, the Grand Canyon... and Barrow Neurological Institute. An estimated 1,500 people from outside Arizona come to Barrow each year for lifesaving care. To date, Barrow has treated patients from all 50 states and from more than 50 countries. In celebration of Barrow’s golden anniversary, we’ve asked patients, physicians, staff and benefactors to tell their Barrow story. You can hear and watch their stories at Barrow50.org. About 24 videos are currently on the site, and one will be added each week through the rest of 2012, Barrow’s 50th anniversary year. Here are a few examples of the stories taped for Barrow’s 50 Years, 50 Faces project:

When Erik Humphrey of Phoenix was diagnosed with a malignant brain tumor in 2003, he was given only a 20 percent chance of surviving another three years. After discussing his options with his wife, the 32-year-old man agreed to undergo aggressive surgery, radiation therapy and chemotherapy at Barrow. Kris Smith, MD, was his neurosurgeon. Now, eight years later, Humphrey’s tumor has not returned. Since his diagnosis, he and his wife have had three children. Humphrey has learned to ski and hike, and today manages a successful interior design firm. “I’m thankful every day that I’m here and grateful to Barrow, Dr. Smith and his staff. They saved my life.”

Ilya Morch was 15 when she flew from Denmark to Barrow for brain surgery. It was 2009, and Morch had already undergone five brain surgeries for cerebral cavernous malformations (CCMs), abnormal clusters of vessels in the brain that hemorrhage easily. But one difficult CCM remained, and when Morch began showing signs of paralysis, her parents knew they had to act quickly. “We wanted the best place in the world, and that’s when we found Barrow,” says her mother, Karin. Robert Spetzler, MD, successfully removed the large lesion, using a surgical approach that was researched and developed at Barrow. “Barrow gave my daughter a new life,” says Karin in their Barrow 50th video.

In 2010, Ryan Westmoreland was considered a top prospect for the Boston Red Sox. Then he was diagnosed with a very complex cavernous malformation, an abnormal cluster of blood vessels that had caused his brain to bleed and was resulting in paralysis. The deadly malformation was located in his brainstem—the part of the brain that controls all vital life functions. Westmoreland sought the top brain surgeons in the medical field and selected Robert Spetzler, MD, at Barrow to operate on him. “I went from not being able to throw the ball 10 feet to now where I’m pretty much doing everything any other professional baseball player is doing,” says Westmoreland.

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In 2009, Isobel Malloch-Brown flew from the United Kingdom to Barrow to undergo surgery for a complex structural problem of her brain stem and spinal cord. Malloch-Brown, 15, had a Chiari malformation and a basilar invagination. The abnormalities were putting pressure on her brainstem and spinal cord, and causing migraines, breathing difficulties and seizures. Determined to find the best surgeon for their daughter, MallochBrown’s parents learned of Curtis Dickman, MD, a leading expert on this area of the brain. Dr. Dickman was not only successful in correcting the girl’s structural problem, he did so in just one operation instead of two.

Joe Garagiola came to Barrow in 2009 with a large tumor behind his left eye. Untreated, the tumor could rob him of his vision and cause a stroke, speech difficulties and other problems. Barrow neurosurgeon Joseph Zabramski, MD, operated to remove the tumor while preserving the baseball legend’s vision. Using a sophisticated imaging system to identify tumor tissue, Dr. Zabramski removed as much of the tumor as possible. Then, Garagiola underwent CyberKnife treatment to eliminate any remaining tumor tissue. Garagiola has made a real comeback. He works out to rebuild his strength and has returned to the Arizona Diamondbacks broadcast booth.

Cat Kozuch was treated at Barrow for a severe spinal cord injury she suffered while on spring break in Rocky Point. When she arrived at Barrow, she could not move her legs. Barrow spine surgeon Nicholas Theodore, MD, removed fragments of two vertebrae that had shattered into her spinal cord. Just three months later, Kozuch was walking again and went on to make a remarkable recovery. Many patients with this type of spinal cord injury do not improve. “From day one I wouldn’t picture myself in a wheelchair and pushed myself to get well,” says Kozuch. “I’m grateful to be standing on two feet again.”

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An Amazing Future with your continued support ■ Barrow Neurological Institute is well positioned to make breakthrough discoveries in a wide range of neurological disorders in the next 50 years. Benefactors will be critical to these efforts. Contributions will enable Barrow to invest in the facilities, technology, medical education, research and patient care that will drive new discoveries and result in improved care. Listed below are areas that need donor support. Consider being part of Barrow’s amazing future by making a donation today. All gifts, whatever the size, will contribute to keeping Barrow at the leading edge of medicine. Call 602-406-3041 for more information or to make a gift, or give online at SupportBarrow.org. A giving envelope is included in this magazine. Barrow Brain Tumor Research Center The goal of the Barrow Brain Tumor Research Center is to extend the lives of people with brain tumors, especially those with glioblastomas, the most deadly type of brain tumor. The center is establishing independent laboratories, each focused on an area of research. Discoveries in the labs will be made available to patients through clinical trials. As a result, Barrow patients will have access to new, promising treatments before they are available at other centers. The Barrow Brain Tumor Research Center is a legacy project of Robert Spetzler, MD. To learn more, visit SupportBBTRC.org. Barrow Center for Neuromodulation The Barrow Center for Neuromodulation, a legacy project of Dr. Spetzler will explore and expand the use of therapies

that restore or improve function in patients by correcting abnormal electrical or chemical activity in the brain. The center’s goal is to offer new hope and help to patients struggling with such disorders as depression, epilepsy, obsessive compulsive disorder and Alzheimer’s disease. The center’s first focus is deep brain stimulation, a therapy that has proven effective for Parkinson’s disease and essential tremor and that appears promising for many other disorders. For more information, visit SupportBCN.org. Gregory W. Fulton ALS and Neuromuscular Disorders Clinic The Gregory W. Fulton ALS and Neuromuscular Disorders Clinic will focus on some of mankind’s cruelest diseases, including ALS, or Lou Gehrig’s disease. The goal of the center is to establish an integrated research and patient care center where patients can get exceptional care and education, along with access to cutting-edge research. More information is available at SupportBarrowALS.org. Neurology Fellowships Barrow hopes to establish eight new neurology fellowships in the next few years. These physician-training programs give young neurologists the opportunity to receive subspecialty training in a narrow area of neurology. Fellows conduct research and see patients in Barrow’s neurology clinics. Fellowships provide well-trained specialists for our community. Endovascular Neurosurgery Fellowships Barrow plans to establish two new fellowships in endovas-

Larry Santoro, who has Parkinson’s disease, says, “Deep brain stimulation gave me back my life.” The new Barrow Center for Neuromodulation will make deep brain stimulation (DBS) available to more patients like Santoro. In addition, the Center will explore the use of DBS and other types of neuromodulation for the treatment of a wide variety of disorders from depression and bipolar disorder to Alzheimer’s disease and epilepsy.

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Marilyn Parke, a member of the Women’s Board of Barrow Neurological Foundation, received rehabilitation in the Center for Transitional NeuroRehabilitation after sustaining a head injury in an auto accident. The Physical Medicine and Rehabilitation Residency and Fellowship program will prepare young neurologists for this important area of medicine.

The new Gregory W. Fulton ALS and Neuromuscular Disorders Clinic will help people like Brett Booge, who has ALS, also known as Lou Gehrig’s disease.

cular neurosurgery. Endovascular procedures are performed in an angiography suite rather than a regular surgery suite. Endovascular neurosurgeons use x-ray guidance and thin catheters inserted into the body’s system of blood vessels to perform diagnostic and surgical procedures. The two fellowships would give young neurosurgeons subspecialty training in this emerging field of medicine.

Research Support Contributions to research at Barrow allows Barrow Neurological Foundation to provide seed funding for promising research ideas. Gifts of all sizes are welcome. ■

Endowed Chairs in Stroke, Neurobiology, Neurotrauma and Neurorehabilitation Endowed chairs in specialty areas of neurology help attract leading physician-scientists. Ongoing revenue generated by the endowments enable these physician-scientists to conduct research and participate in educational activities. Physical Medicine and Rehabilitation Residency and Fellowship Barrow offers excellent neurorehabilitation programs, including the Deborah and Bruce Downey Neuro Rehabilitation Center, the Center for Transitional NeuroRehabilitation and the BRAINS Clinic. What is missing are educational opportunities in this area. This initiative would establish a residency and fellowship program for physical medicine and neurorehabilitation.

Help make Barrow’s future bright Please consider making a gift in honor of Barrow’s 50th anniversary. You can choose to support a particular project or make an unrestricted gift that can be used for the area of greatest need. There are many ways to give. Visit our website— SupportBarrow.org—to learn more or to make an online gift. You can also call our office at 602-4063041 or use the postage-paid giving envelope included in this magazine.

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by Sally Clasen

Brain Plumbers Endovascular neurosurgeons operate from inside blood vessels to treat woman’s difficult condition ■ Jennifer Kane, 43, had had migraines on and off for years, but her pain intensified and became constant in 2011. “It felt like someone had hit me on the head with a shovel,” she says. “The pain pulsated to the bone, and I would come home from work every day and go to bed with ice on my head.” On a Monday in September, the pain became so debilitating that Kane, a medical assistant, left work early. The only thing she remembers after that is telling her daughter to call 9-1-1. She was taken to Banner Del Webb Medical Center and then quickly transferred to Barrow Neurological Institute. Kane’s left vertebral artery—one of two arteries in the neck that supply blood to the brain—had ruptured as a result of a disruption in the vessel wall known as a dissection. A dissection occurs in a blood vessel wall when the layers of the wall become separated. Blood pulses through the layers further separating and distorting the vessel walls. Eventually, the outer layer can rupture, spewing blood into the brain. Kane spent the next 2½ weeks at Barrow in a coma—a stay that included several life-threatening complications created by the hemorrhage, including a stroke, respiratory failure and hydrocephalus. “Jennifer was in bad shape, and it took a team of medical experts to care for her,” says Cameron McDougall, MD, chief of endovascular neurosurgery at Barrow. “Her heart muscle was not pumping normally due to the brain hemorrhage, and her heart couldn’t generate adequate blood pressure to supply her brain with enough blood. If we moved her or took head scans, her blood pressure would drop, so she first had to be stabilized with a balloon pump.” Kane’s situation was compounded by the fact that she had only one vertebral artery instead of the two that most people have. “Normally, we can treat a vertebral artery dissection by simply blocking off the damaged artery endovascularly because the other healthy artery will provide enough blood flow for the brain. We didn’t have that option in Jennifer’s case,” Dr. McDougall says. Instead, the Barrow team used a Pipeline Embolization Device (PED) to stabilize the ruptured artery. This device was approved by the FDA in 2011 for the treatment of complex aneurysms. Barrow was the second largest site in the clinical trial that tested the PED technique prior to its approval, but the trial was only for unruptured aneurysms in the carotid circulation.

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Barrow Magazine Brain Plumbers

“Very few ruptured aneurysms have been treated this way,” Dr. McDougall says, “and there were significant concerns about using the device to treat a ruptured arterial dissection.” During the procedure, Dr. McDougall threaded the PED device, a flexible mesh tube, through a thin catheter, or tube, inserted into Jennifer’s leg and then up to the ruptured artery in her neck. Once in place, the stent was expanded to fit against the artery walls and stabilize the damaged vessel. “The PED is like a glorified stent. It keeps blood flowing through the damaged artery while allowing the artery to heal,” Dr. McDougall says. Kane realized the depth of her health ordeal while undergoing intense physical therapy for short-term memory loss and mild weakness on her right side. In a short span, she’s made a remarkable recovery, and though she still deals with memory issues, she sees improvement every day and is able to care for her two children. “I don’t know if I’m ever going to be like I was, but I’m doing well, and I’m thankful. I should have died, but Dr. McDougall saved my life. I’m supposed to be here for a reason.” ■

When a vital artery supplying Jennifer Kane’s brain with blood ruptured, Barrow endovascular neurosurgeons used a new and unusual approach to deal with her life-threatening emergency.


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The two medical illustrations below show how Cameron McDougall, MD, maneuvered the Pipeline Embolization Device into the damaged vessel in Jennifer Kane’s neck to stabilize the vessel and correct blood flow. These illustrations were created by the Barrow Neuroscience Publications Department.

Before Hematoma or bleed pseudo aneurysm

tear blood flow

After

pipeline device

blood flow

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by Sally Clasen

Huntington’s Disease Little-known movement disorder proves devastating for patients and families ■ Most people had never heard of Huntington’s disease (HD) until January 2012 when Kathleen Edward—a 9year-old Michigan girl who made headlines for being bullied on Facebook—died from the neurological disease that also claimed the lives of her mother and grandmother. Though not as well known as Parkinson’s, Alzheimer’s and other neurological disorders, HD is a hereditary disease that is just as devastating to patients and their families, according to Arshia Sadreddin, MD, a movement disorders specialist at Barrow Neurological Institute. “Approximately 25,000 people are affected by HD in the United States,” says Dr. Sadreddin, who treats the highest number of HD patients in the Southwest. As an autosomal dominant disorder, HD is passed down via a defective gene through family members and attacks nerve cells that cause parts of the brain to slowly deteriorate. “Each child of a carrier has a 50 percent chance of inheriting the gene and being diagnosed with HD,” says Dr. Sadreddin. The neurodegenerative disease produces gradual motor and cognitive problems but psychiatric issues tend to appear early in many individuals. “It can cause severe depression and anxiety,” explains Dr. Sadreddin.

Barrow treats the largest number of patients with Huntington’s disease in the Soutwest.

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Barrow Magazine Huntington’s Disease

Mistaken for intoxication Eventually many with HD develop involuntary movements. The most common type is referred to as chorea, which are random, dance-like twisting and jerky movements that start mild-


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ly and then progress. It can cause many to appear as if they are intoxicated due to the abnormal movements and erratic behavior. “Those with HD are often in trouble with the law since their behavior is misunderstood. It’s a frustrating disease, and the suicide rate is high with HD,” Dr. Sadreddin says. In retrospect, Gordon Sanders believes his wife, Marcilla, began to exhibit emotional issues well before she was diagnosed with HD 10 years ago. “She blamed me for everything. I was the anti-Christ,” he says of her erratic moods. The couple has been married for 46 years and worked together as scuba instructors but separated for a while due to the strain. It was during that time that Marcilla was diagnosed with HD. “It all made sense then,” Gordon says of her evolving symptoms, which included falling down and making grunting sounds for no reason. “Her father was a carrier, but we were blind-sided. We had never heard of HD.” Gordon is dedicated to his wife and provides her 24-hour care, although most HD patients end up in a care facility, according to Dr. Sadreddin. Marcilla is prescribed medications to quell the chorea and manage her emotions, but she is nearly immobile and eats with a feeding tube. While her decline is noticeable, Gordon says Marcilla’s condition has improved since being treated by Dr. Sadreddin. “I learned more about HD from Dr. Sadreddin in 15 minutes than in the last 10 years,” he says. “She blows me away with her knowledge, and she really takes the time to describe what is happening to my wife.”

Money needed for research Due to its unique factors, HD takes a heavy psychosocial toll on patients, families and caregivers. To address the effects, Dr. Sadreddin uses a multidisciplinary approach to treating the disease. A free support group for anyone affected by HD is held monthly at St. Joseph’s Hospital and Medical Center. Group attendance averages 30 participants and reflects the high number of those affected by HD in the Southwest. Yet, HD and its debilitating effects suffer from an image problem. Gordon believes that if HD had the star power of other neurological disorders, it would shed some muchneeded public awareness on the disease. “It’s not my wife’s fault that she has HD. It’s the luck of the draw. If a big name came forward, like a Michael J. Fox or a Muhammad Ali, we could increase interest and generate money for HD research. We have the experts at Barrow who can do this. We just need funding.” Dr. Sadreddin agrees. “Much more research is needed to better understand the pathophysiology of the disease and to help develop treatments to reduce symptoms, alter the disease course, slow the progression and one day cure HD,” she says. “We plan to start by enrolling our HD patient population in a global registry to accumulate important data on Huntington’s disease. My goal is also to partner with colleagues around the country with their efforts on stem-cell research, gene therapy and neuromodulation. Ultimately, my hope is that Barrow becomes a center of excellence for HD.” ■

Huntington’s disease services Arshia Sadreddin, MD, a movement disorders specialist at the Muhammad Ali Parkinson Center, treats the highest number of Huntington’s disease patients in the Southwest. A free support group for patients and their families is held the third Monday of each month at 6 p.m. in rooms 4 and 5 of St. Joseph’s Conference Center. Barrow also offers genetic screening for families of HD patients. To learn more, call 602-406-4261.

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Three Class Acts Barrow Grand Ball, Celebrity Fight Night, Lou Grubb Friends Fore Golf raise funds for Barrow

■ Barrow Neurological Institute is proud to be supported by three of our community’s classiest fundraisers: Barrow Grand Ball, Celebrity Fight Night and Lou Grubb Friends Fore Golf. This year’s events celebrated Barrow’s 50th anniversary and raised significant funds to help ensure a bright future for the institute.

Barrow Grand Ball The Women’s Board launched Barrow Neurological Institute’s 50th anniversary with a special edition of the Barrow Grand Ball. Guests to the event, held Jan. 21 at the Arizona Biltmore, were encouraged to make “Gifts of Gold” in honor of Barrow’s golden anniversary. The black-tie fundraiser netted $1.9 million for Barrow. Nita Francis and Nancy Gaintner were co-chairmen. Of special note are these exceptional contributions:

Above, Nita Francis, Penny Gunning and Nancy Gaintner. Right, Ross and Judy Shannon. Bottom, Ardie and Steve Evans.

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Chief of Staff Philip L. and Juanita F. Francis, The F2 Family Foundation - underwriting of the 2012 Barrow Grand Ball Mr. and Mrs. David Glew - Neurosurgery Research The Bruce T. Halle Family Foundation - B.R.A.I.N.S. Clinic Collaboration Mr. and Mrs. Lee T. Hanley, Hanley Family Charitable Trust - Barrow Center for Neuromodulation Charles and Lynne Schusterman Family Foundation - Tel Aviv University/BBTRC collaboration on “Split Immunity” Human Glioma Vaccine Gift of Gold Anonymous - Barrow Center for Neuromodulation Mr. and Mrs. Bennett Dorrance - In honor of Robert F. Spetzler, MD Mr. and Mrs. Karl Eller - 3D Telemedicine Mr. and Mrs. Robert C. Hobbs, Sr. - Karen and Robert Hobbs and the Hobbs Family Grant for Multiple Sclerosis Research Julie Ann Wrigley Foundation - In honor of Patricia Gentry, Barrow Brain Tumor Research Center Dr. and Mrs. Volker K.H. Sonntag - Neurosurgery Research Dr. and Mrs. Robert F. Spetzler - Neurosurgery Research


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Mrs. Jane Wallace Thorne - Neurosurgery Research U.S. Airways - In honor of C.A. Howlett, “Helmet Your Head” Brain Injury Prevention Program Mr. and Mrs. Rob Walton - Barrow Center for Neuromodulation, Dr. Leslie Baxter Women’s Board - Barrow Center for Neuromodulation Mr. and Mrs. Michael Ziegler - Barrow Center for Neuromodulation White Coat Fellow Barrow Neurological Institute - General Research Fund Mr. and Mrs. Geoffrey Edmunds - Barrow Center for Neuromodulation Mrs. Patricia Goldman - Neurosurgery Research Mr. and Mrs. J. Jerome Hirsch - Neuroscience Research Mr. and Mrs. Robert H. McKee - Barrow Center for Neuromodulation; Genomics PetSmart - Neurosurgery Research DJ and Terri Susan Ponville - Barrow Brain Tumor Research Center Dr. and Mrs. Nicholas Theodore - The Sonntag Academic Pavilion Valley Anesthesiology Consultants, Ltd. - Pediatric Neurogenetic Disease Research Multi-Year Commitment Mr. and Mrs. Philip L. Francis - Barrow Brain Tumor Research Center

From top to bottom: Lionel Richie; Muhammad Ali and Miley Cyrus; Reba McEntire, Rita Wilson and Tom Hanks; Rascal Flatts; John Corbett.

Celebrity Fight Night XVIII On March 24, stars and athletes from around the country converged on the J.W. Marriott Desert Ridge Resort & Spa in Phoenix for Muhammad Ali’s Celebrity Fight Night XVIII. Reba McEntire returned for her seventh year as emcee of the event, which this year celebrated Muhammad Ali’s 70th birthday. The 2012 extravaganza raised $9.1 million for the Muhammad Ali Parkinson Center at Barrow and other charities; over the years, it has raised nearly $80 million for charity. The event featured performances by Rascal Flatts, Miley Cyrus, Rita Wilson, Michael Johns, Jackie Evancho, John Corbett, Sinbad and Lionel Richie, under the direction of David Foster. The 2012 Muhammad Ali Celebrity Fight Night Awards were presented to Larry Fitzgerald of the Arizona Cardinals; Bill Austin, founder and CEO of Starkey Labs; and Diane and Bruce Halle, philanthropists and founders of Discount Tire. Bob Parsons, founder and executive chairman of Go Daddy, kicked off the evening with a special $1-million donation. The black tie event included cocktails, a silent auction, an elegant dinner and an exciting live auction. Celebrity Fight Night Foundation is a non-profit organization that was founded in 1994 by Jimmy Walker. For information, visit CelebrityFightNight.org.

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Lou Grubb Friends Fore Golf

Photos from top: Kathy Watson, Marci Reed, Dr. Omer Reed, JoAnn Wanamaker, Evie Grubb; Booker T. Evans, Al Loveless, Ethan Pajak and Jason Pajak; a ladies foursome; Lou Grubb; Roger Maxwell.

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The 2012 Lou Grubb Friends Fore Golf —renamed this year the Lou Grubb Memorial Tournament—was all about remembering the beloved man who created this popular fundraiser. Lou’s friends and family honored the well-known businessman and philanthropist, who passed away earlier this year, in a big way: The event netted about $500,000 for Barrow and St. Joseph’s—by far, the most the event has ever raised in its 39-year history. The highlight of the dinner on April 19 at Scottsdale Plaza Resort was a tribute to Lou that began with a bagpiper performance. Guests watched a video about Lou’s life, and then two proclamations were read—one from the Governor, read by Sister Madonna Marie Bolton, and one from the Arizona Automotive Dealers Association, read by Uglies member Tom Ambrose. (Lou belonged to the Uglies, a group that included some of his closest friends.) In attendance were Lou’s widow, Evie, and all four of their children. Roger and Kathy Maxwell received a special award for their many years of service to the Lou Grubb event. Emcee Tara Hitchcock said that she was especially touched to be part of the event because her stepson, Dylan Francis, was a patient at Barrow Neurological Institute the day after Lou passed away. (See next story.) So many people signed up for the golf tournament that five teams of women golfers held their own tournament at Camelback Golf Club, while a full field of 260 played at McCormick Ranch Golf Club. Golfers enjoyed a golf clinic with Tina Tombs before the tournament, and a dinner and awards ceremony afterward. John Dawson, Ken and Randy Kendricks, and Shelly and Steve Butterfield provided special underwriting for the event. Sponsors were the Arizona Cardinals, Arizona Diamondbacks, CBIZ, DPR Construction, Greenberg Traurig, Dan and Kathy Grubb, Lou and Evelyn Grubb, Bill and Linda Hunt, Kitchell, Roger and Kathy Maxwell, Panoramic Press, St. Joseph’s Health & Wealth Raffle, Symmetry Software and Xerox. Tournament co chairs were Mike Medici and Dennis Sage. Other committee members were Greg Anderson, Scottie Button, Brent Cannon, Dawn Cirri, Hamilton Espinosa, Booker T. Evans, Michael Haenel, Bill Hunt, Stuart Kirk, Kathy Kramer, Roger Maxwell, Larry Mayhew, Loui Olivas, Tom Reahard, Anne Robbs, Lee Rosenthal, Dennis Scully, Joanne Springrose and Kelli Smith. ■


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St. Joseph’s Amazing Patient stories from the files of Barrow Neurological Institute Dylan Francis by Sarah Padilla In her 15 years as a reporter and morning show anchor for Channel 3’s Good Morning, Arizona, Tara Hitchcock covered her share of inspirational stories about Barrow patients, families and staff. The Valley resident never imagined that one day the tables would be turned. But on Jan. 25, Hitchcock’s 16-year-old stepson, Dylan Francis, was hanging out with friends when his left ear started ringing and the left side of his face went numb. Within minutes, he was vomiting. Dylan was rushed to Scottsdale Healthcare Osborn Medical Center, where a CT scan revealed what doctors initially identified as a cancerous brain tumor. “When they put up the results of the scan, everyone in the ER went silent,” says Kenn Francis, Dylan’s father. “We knew then that something was significantly wrong.” Dylan was immediately transferred to Barrow, where Nader Sanai, MD, made the official diagnosis—an arteriovenous malformation (AVM), a tangled mass of blood vessels, at the base of his brain. The AVM had ruptured, causing bleeding and the potential for serious brain damage. Dylan would spend the next several weeks in the ICU, recovering from three separate surgeries. In one, Robert Spetzler, MD, removed the AVM, as well as part of Dylan’s cerebellum. Dr. Spetzler had told Dylan’s family that the malformation was extraordinarily large and that the procedure would be complex. “As the doctors explained the surgery, it seemed inconceivable that it could be accomplished,” says Kenn. But Hitchcock, who, along with Dylan’s mom, Rebecca, kept a constant vigil at Dylan’s bedside, was confident. “From the minute I heard he was going to Barrow, I wasn’t stressed at all,” she recalls. “I just kept thinking of all of the families that had been through this before us with successful outcomes.” Today, the Francis family feels grateful to be on that list. Dylan spent a month in the Deborah and Bruce Downey Neuro Rehabilitation Unit. Then, he transitioned to the hospital’s outpatient Center for Transitional NeuroRehabilitation (CTN), where doctors and therapists will work with him on physical, speech and occupational therapy. He still has

A tangled mass of blood vessels had ruptured in Dylan’s brain. weakness on his left side and some speech and memory deficits. But with time, the laid-back teenager, who loves music and DJing and who can’t wait to get his driver’s license, will be back to his old self. When he returns to Brophy College Preparatory, likely in the fall, Dylan will have some impressive stories to share. On March 24, he and his family attended Celebrity Fight Night, an event Hitchcock has been involved in for several years. But this year was different. Dylan had the opportunity to take the stage and publicly thank the doctors who saved his life. Then, if for nothing else than to prove that his sense of humor is still intact, he opened bidding on a macaroni and cheese dinner at his family’s home. The star-studded crowd gave Dylan his first standing ovation. And though his recollections of the past few months are hazy, this is one memory that Dylan and his family are bound to remember forever.

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Sergio Rodriguez by Sally Clasen In May 2012, Sergio Rodriguez will proudly walk across a stage to receive his MBA from the University of Phoenix. Four years ago, the Gilbert resident couldn’t stand without falling or speak without mumbling. Rodriguez's troubles started after he had a mountain biking accident, which caused a bulging disc and left him with some unusual symptoms that didn't add up. “I deteriorated quickly once I started taking pain medication for my back. My speech was slurred and I had facial paralysis. I looked like I had a stroke,” he explains. “I attributed the issues to the medication, but once I stopped taking it, I got worse.” His mother, a registered nurse, realized her son was in trouble and took him to the emergency department at St. Joseph’s Hospital and Medical Center, where Rodriguez was quickly admitted to Barrow Neurological Institute. He was diagnosed with a virus that attacks the central nervous system—called acute disseminated encephalomyelitis. He spent 30 days at Barrow, followed by 15 days in an inpatient rehab facility to learn to walk and talk again. A few months later, Rodriguez experienced another neurological episode and was diagnosed with Marburg variant of multiple sclerosis, an aggressive form of the autoimmune disease that was triggered by the virus, according to neurologist Roberto Bomprezzi, MD. “Marburg variant of MS is rare. MS isn’t caused by a virus, but a virus can be the underlying reason for a weakened immune system, which can lead to a number of health issues, including MS,” says Dr. Bomprezzi. “Sergio’s symptoms have grown milder, and he now has a classic form of

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Barrow Magazine St. Joseph’s Amazing

Despite a diagnosis of MS, Sergio Rodriguez is running half marathons. the disease called relapse remitting MS, which follows a chronic course and affects about 85 percent of those with the disease.” Since learning he has MS, Rodriguez has been able to maintain his function due to a well-controlled regimen of IV-infusion therapy that he receives at Barrow every two months to suppress cell inflammation. He recognizes that his limitations—he still has tingling in his leg and hand, and some balance and cognitive issues—are manageable compared to others with the disease. Rodriguez also is mindful of the role proper nutrition and regular exercise play in his health and continued recovery. He’s run in several races and a half-marathon and has never felt better. “It’s been a long journey, but I’m physically 100 percent—200 percent compared to what I was.”


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Art Snyder by Sally Clasen Most seniors aren’t thankful for having an injury, but 84year-old Art Synder of Florence, Arizona, believes a 2010 fall in which she hit her head was a “blessing in disguise.” After the accident, the retired science teacher says she was in a mental and physical stupor. “I was experiencing balance and gait changes and felt like I was underwater. Even though I’ve never been drunk in my life, I call it my drunken period,” she says of the off-kilter effects that prompted a visit to a Casa Grande neurologist, who referred her to Barrow Neurological Institute. At Barrow, Snyder was evaluated by neurologist Anthony Santiago, MD, and learned her odd symptoms were caused by normal pressure hydrocephalus (NPH), which occurs when there is an increase in intracranial pressure due to an abnormal accumulation of cerebrospinal fluid in the ventricles, or cavities, of the brain. It is most common in elderly people and can lead to gait issues, urinary incontinence, memory loss and dementia. NPH can masquerade as other neurological issues, such as Parkinson’s, Alzheimer’s, stroke and spine disease, so careful examination is necessary to make an accurate diagnosis. Snyder underwent a series of clinical evaluations and neural screenings at Barrow, including a lumbar puncture under fluoroscopy (spinal tap) in which cerebrospinal fluid is withdrawn to measure a patient’s reaction to the pressure change, according to Dr. Santiago. Neurologists use the lumbar test to confirm NPH and identify patients who are ideal candidates for stent surgery, which alleviates the excess pressure. Snyder was considered a favorable patient for the procedure, and in June 2011, neurosurgeon Joseph Zabramski, MD, placed a programmable shunt into her brain. “NPH is relatively rare, but timely diagnosis can lead to effective reversal of symptoms through ventricular shunting,” explains Dr. Santiago. Since her surgery, Snyder has slowly regained her footing. She sees Dr. Santiago for occasional “tweaks” to her shunt and has resumed her varied interests, including writ-

ing letters to the editor and volunteering for diverse civic projects in her community. “My new normal is different,” she says. “But it’s better than getting progressively worse and ending up in a nursing home.”

Gait changes, memory loss, dementia and incontinence can be signs of normal pressure hydrocephalus, a condition that can be treated. Anthony Santiago, MD, examines Art Snyder in the Normal Pressure Hydrocephalus Clinic, located in the Muhammad Ali Parkinson Center at Barrow. NPH can mimic other neurological disorders, including Parkinson’s, Alzheimer’s, stroke and spine disease. NPH can often be treated with the insertion of a shunt to drain excess fluid from the brain. For information, call 1-800-BARROW1 (2277691) or 602-406-6281.

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Benefactor Briefs Sonntag Academic Pavilion opening honors retired Barrow neurosurgeon The new Sonntag Academic Pavilion was dedicated at a dinner April 4 at St. Joseph’s Hospital and Medical Center. The event honored retired Barrow neurosurgeon Volker K.H. Sonntag, MD, for his many contributions to neuroscience and to Barrow Neurological Institute. In attendance were friends and colleagues who contributed to the new facility, located near the Marley Lobby and Goldman Auditorium. The Sonntag Academic Pavilion will be used for lectures, exhibits, demonstrations and meetings. It has seating for up to 200 people and is equipped with the latest audio and video technology. Top photo, Volker and Lynne Sonntag

Celebrity Fight Night, Lonnie and Muhammad Ali honor 50 at Barrow Lonnie and Muhammad Ali honored 50 neurosurgeons, neurologists and researchers at Barrow Neurological Institute for their outstanding contributions to medicine during a reception sponsored by Celebrity Fight Night and Barrow Neurological Foundation on Feb. 22. The tribute was part of Barrow’s 50th anniversary celebration. During the reception, Robert Spetzler, MD, director of Barrow, accepted a Muhammad Ali Celebrity Fight Night award on behalf of the institute, and each of the 50 Barrow specialists received an individual gift marking the occasion. A video of the tribute was shown during Celebrity Fight Night on March 24, and Barrow doctors attending the fundraiser were recognized. Over the years, the Celebrity Fight Night Foundation has contributed more than $19 million from its annual star-studded fundraiser to the Muhammad Ali Parkinson Center at Barrow.

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Barrow Magazine Benefactor Briefs

Renee and Bob Parsons were honored for their many contributions to Celebrity Fight Night and the Muhammad Ali Parkinson Center at a reception on Feb. 22 at Barrow. Lonnie and Muhammad Ali attended the event, which dedicated the Renee and Bob Parsons Gallery at the Muhammad Ali Parkinson Center.


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Women’s Board presents $1.9-million check during spring luncheon The Women’s Board of Barrow Neurological Foundation celebrated the end of another successful year and looked forward to the coming year at their spring luncheon April 5 at Paradise Valley Country Club. The highlight of the event was the presentation of a check for $1.9 million to Robert Spetzler, MD, director of Barrow. New members and officers for 2012-2013 were introduced during the luncheon. The three new members are Mrs. Christopher Cacheris, Mrs. Arthur E. Moreno and Mrs. Ray Thurston. Incoming officers are: Mrs. Ross L. Shannon, chairman Mrs. William D.H. Francis, chairman elect Mrs. R. David Martin, treasurer Mrs. Thomas Cheek, corresponding secretary Mrs. Joseph Melczer III, recording secretary Mrs. Gary J. Hewson, yearbook chairman Mrs. Edward W. Guenther, parliamentarian Mrs. Michael A. DeBell, Barrow Grand Ball co-chair Mrs. Michael Watts, Barrow Grand Ball co-chair.

Over the years, the Women’s Board has contributed about $42 million to Barrow, making the group the institute’s largest benefactor. Penny Gunning, left, is the outgoing chairman of the Women’s Board. Judy Shannon will serve as chairman for 2012-2013.

Benefactors create group to support Barrow Three couples—Shannon and Keith Mishkin, Lisa and Jeff Geyser, and Sharon and Paul Pollock—have joined together to engage the next generation of philanthropists in supporting Barrow Neurological Institute. They recently launched Barrow Beyond, a special donor group that will raise funds and awareness for Barrow.

Founding Barrow Beyond members Shannon Mishkin, Lisa Geyser and Sharon Pollock with new member, Brooke Zilveti.

The group’s first order of business is to recruit 50 individuals/ couples to become Barrow Beyond founding members. Each individual/couple will be asked to contribute $1,000 or more to Barrow. Initial funds raised by Barrow Beyond will go to the Barrow Brain Tumor Research Center (BBTRC). In the future,

the group plans to contribute to other areas at Barrow, such as the Muhammad Ali Parkinson Center and the Barrow Center for Neuromodulation. The couples decided to contribute first to the BBTRC because of the great need for research into brain tumors. While the field of neuroscience has made amazing advancements in the last 50 years, little progress has been made against brain tumors, especially the worst of the worst—gliobastomas. About 64,000 new primary brain tumors will be diagnosed in the U.S. this year, and more than 22,000 of those will be malignant. The average survival after diagnosis of a glioblastoma is just 14 months—little better than it was 30 years ago. Barrow Beyond is committed to helping the BBTRC evolve into the premier brain tumor research and development site in the world. Funds from Barrow Beyond will enable researchers to launch clinical trials and to develop new techniques specific to brain tumors. Members of Barrow Beyond will be invited to special social and educational events throughout the year. They will have the opportunity to hear from Barrow’s world-class physicians and researchers. For more information, contact Kathleen Norton at 602406-1039 or Kathleen.Norton@DignityHealth.org.

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Where There’s A Will Leave a legacy by planning your estate now

by Kathy Kramer President and CEO Barrow Neurological Foundation, St. Joseph’s Foundation

Help create an amazing future for Barrow Neurological Institute through a bequest to our foundation

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Barrow Magazine Planned Giving

■ A bequest is one of the easiest gifts to make to charity. Here are three examples of bequests that you may wish to consider: 1. Charitable bequest. A charitable bequest is written in a will or trust and directs a gift to be made to a qualified exempt charity when you pass away. A charitable bequest enables you to further the good work of an organization you volunteer with or support long after you are gone. Better yet, a charitable bequest can help you save estate taxes by providing your estate with a charitable deduction for the gift. A bequest can be made in several ways: • A gift of a percentage of your estate • A gift of a specific asset • A gift of the residue of your estate • A gift of a specific dollar amount. 2. Bequest of an IRA. A retirement asset like an IRA account makes an excellent bequest to charity. If the IRA were given to your family, much of the value would be depleted through estate and income taxes. By designating charity as the beneficiary of part or all of your IRA, the full value of the gift is transferred tax-free at your death, and your estate receives a charitable deduction. If you wish to leave your IRA to your spouse at your death, you may also designate a charity as the secondary beneficiary of your account. Contact your IRA or retirement account custodian to obtain a beneficiary designation form and make a bequest from your IRA. 3. Bequest of an insurance policy. An insurance policy makes a nice bequest to charity. As an asset of your estate, an insurance policy is taxable at your death. However, if the policy is gifted to charity, your estate avoids paying tax on the value of the policy and receives a charitable deduction for the gift. You may generally name anyone as beneficiary of your insurance policy and change your designation at anytime. Contact your insurance company to obtain a beneficiary designation form and make a bequest of your policy to charity. I would be glad to meet with you to discuss your philanthropic goals and explore ways you can contribute to Barrow Neurological Institute’s future. Just call 602406-3041 or email Kathy.Kramer@dignityhealth.org. ■


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Sept. 17, 2012 | 6 p.m. Phoenix Theatre

Mac King and the Amazing Randi Stephen Macknik, PhD, and Susana Martinez-Conde, PhD

Get a behind-the scenes look at how magicians trick us, what magic tells us about the brain and why it matters. Proceeds benefit Barrow Neurological Institute. Tickets go on sale May 2012. Tickets: $75, $100 and $150 ($150 ticket includes VIP reception) For more information, call 602-406-3041.


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Dignity Health Barrow Neurological Foundation 350 W. Thomas Rd. Phoenix, AZ 85013-4496 www.SupportBarrow.org

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Barrow magazine Volume 24, Issue 1, 2012