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Carilion Clinic P.O. Box 13727 Roanoke, VA 24036
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NEUR SURGERY update
Vol. 1 Issue 3 - Summer Volume 1- January 2012 2013
NEUR SURGERY update Volume1- January2012
©2013Carilion Clinic Strategic Development J1469 8/13/GG
“NEURO-SPINE” Few patients and even many physicians do not realize that, in addition to being “brain surgeons,” neurosurgeons are trained and experienced spine surgeons. In fact, from the first days of their seven years of residency training and throughout their careers, neurosurgeons are immersed in the world of spine care. A huge bulk of the nation’s degenerative spine work, disc surgery, fracture care, and complex spine reconstruction and instrumentation is performed by neurosurgeons. Furthermore, neurosurgeons are specially qualified to perform Spina Bifida repair, tethered cord release, rhyzotomies, chordotomies, syrinx repair, spinal cord tumor surgery, resection of intradural lesions, and surgery for spinal cord vascular malformations and hemorrhages. Board-certified neurosurgeons are qualified to care
for any and all spinal disorders and require no additional fellowship training. Neurosurgeons are consummate spine or “Neuro-Spine” surgeons. Fellowship-trained neurosurgeons acquire even further expertise in the most complex of spinal cord and column disorders.
“NEURO-SPINE” at Carilion Clinic
Most times, patients’ cases are extensively reviewed and discussed among multiple members of the team, informally or in formal conferences. In particularly challenging cases, two or more surgeons will operate together to decrease the operative time and decrease potential complications. Peri-operatively, patients are cared for by the entire team, including the surgeons, resident surgeons, physician assistants, nurse practitioners, and specialized nurses. Finally, Carilion Clinic neuro-spine surgeons combine their expertise with superb orthopaedic spine surgeons and physicial medicine physicians in a true interdisciplinary Spine Center to provide patients with the very best care.
INSIDE THIS ISSUE: Page 2: Carilion Clinic Welcomes Edgar N. Weaver Jr., M.D. Pages 2-3: Cases from a Week on the “Neuro-Spine” Service
Carilion Clinic Neurosurgery features a team of exceptionally experienced spine experts. Our six surgeons offer a combined experience of over 130 years of spine surgery practice and have performed tens of thousands of procedures. There are few institutions in the country with this much combined experience and expertise. Furthermore, the department truly functions as a team. Treatment decisions are seldom made in isolation.
Visit us on the web: Carilionclinic.org/neurosurgery • 800-422-8482
Carilion Clinic Neurosurgery offers a wide selection of neuroscience talks that we are happy to bring to your practice, group, hospital, service club, community gathering, or medical society. We are delighted to give these sessions to an audience of one or several hundred. Talks can be tailored in length and can even be paired with a lunch or dinner. Some common topics are listed to the right, but we are happy to cover virtually any neuroscience-related subject. To arrange a talk, please call us at 540-526-1200.
Low back pain Neck pain Pinched nerve syndromes Concussion Return to play after neurological injury Severe head injuries Hematomas Intracranial hemorrhages Aneurysmal rupture Spina bifida Chiari malformation Tethered spinal cord Spinal deformity Scoliosis Common brain tumors Seizures Stroke management Carpal tunnel syndrome/ulnar neuropathy Brachial plexus injuries
Hydrocephalus Ventricular-peritoneal shunts Normal pressure hydrocephalus Dementias Sports injuries Ethics in the neurosciences CyberKnife stereotactic radiation Pituitary tumors Neuro critical care Parkinson’s disease Epilepsy care and surgery Brain death Spinal fractures Breaking bad news Implantable pain devices Interesting cases Care of neurologic patients in the primary care office And many more...
Carilion Clinic Welcomes Edgar N. Weaver Jr., M.D. Carilion Clinic welcomes Edgar N. Weaver Jr., M.D., to its neurosurgery team. As anyone from the region is aware, Dr. Weaver has practiced in Roanoke for the past 32 years. He is a neurosurgeon of the utmost integrity and reputation, with exceptional experience, quality, and track record. Dr. Weaver originally trained at Tulane University in New Orleans. He has furthered his expertise in many subspecialty fields, particularly focusing of late on complex spinal instrumentation and “dynamic stabilization of the spine.” He has published his techniques in top national neurosurgical
Before X-ray/CT fracture.
journals. Dr. Weaver has also pioneered sharing of neurosurgical skills and technologies with the medical system in Ghana, Africa, where he makes frequent trips. Dr. Weaver was drawn to the Carilion Clinic neurosurgical team by its dedication to integrative and collaborative neurosurgical care, its interest in research and academics, and its educational efforts for the next generation of neurosurgeons. Carilion Clinic Neurosurgery in turn is delighted to feature Dr. Weaver’s expertise and experience in all realms of neurosurgery, particularly in the field of “Neuro-Spine.”
After X-ray/CT fracture.
Cases from a Week on the “Neuro-Spine” Service Cervical Radiculopathy This 54-year-old woman presented with rapid onset of severe right upper extremity pain. On the second day of symptoms, right triceps and wrist flexors showed 4/5 weakness. Medications, traction, and therapy proved futile in pain control. The only comfort was provided by upright position in cervical collar. Magnetic resonance imaging (MRI) disclosed right foraminal C6-7 disc herniation. With failure of therapies, Nicolas Qandah, D.O., per-
formed a right C6-7 posterior foraminal decompression through a 1.5-inch incision. The patient has experienced total relief of symptoms, and arm strength is improving daily. Lipomyelomeningocele This 4-year-old patient presented with progressive pain and lower extremity dysfunction. Previous “detethering” at an outside institution. MRI disclosed a large lipoma of the conus medularis stuck to the lower posterior spinal 2
canal. With neurologic progression, the child underwent microsurgical release of the adherent points of the spinal cord and resection of the lipoma from the conus. The cord was then folded upon itself and sewn closed to reconstruct more normal anatomy. The child is making a good recovery with no new deficits. Pathological Fracture/Dislocation This 58-year-old male patient developed progressive neck pain. Over
the course of a few weeks, the pain became incapacitating ,and he developed paraparesis. Imaging disclosed pathologic fractures of T2 and 3 with severe kyphosis over the fracture. The patient underwent resection of the residua of T2 and 3 and their replacement with a titanium cage, and instrumentation and fusion from C4 to T8 by co-surgeons Drs. Simonds and Qandah. He was found to have a staph aureus infection of the region. Post-operatively he originally had wound problems, but he has developed return of strength in the legs and walking ability.
Fracture This 22-year-old female patient sustained multiple trauma when she was thrown through the windshield of her car. She sustained a C6 burst fracture with kyphosis and quadriparesis. The patient was taken immediately to the operating room, where she underwent anterior and posterior open reduction and internal fixation of her fracture/dislocation. By the next morning, motor function had essentially returned to normal.
Scoliosis This 62-year-old female patient was plagued by incapacitating low back and leg pain. She had undergone years of conservative treatments to no avail. She was found to have severe multi-planar lumbosacral degenerative scoliosis with compensatory thoracic scoliosis. Drs. Qandah and Fraser performed osteotomies and instrumentation from T8 to the ileum. This included interbody spacer placement and fusions at L1-2, 2-3, 3-4, 4-5, and L5-S1. During her three-month follow-up, the patient says she feels the best she has in decades. Syrinx This 48-year-old male patient was slowly going quadriplegic. He had previously undergone multiple procedures for an extensive spinal cord syrinx. Drs. Simonds and Elias explored his thoracic spinal cord. Scarring was too severe to permit local decompression of the syrinx into the subarachnoid space. The surgeons therefore diverted fluid from within the spinal cord into the pleural space using silicon shunt tubing. The patient has experienced improvement in function in all limbs and collapse of his syrinx.
Spinal Cord Tumor This 45-year-old male patient developed progressive paraparesis and urinary incontinence. He was found to have a large intradural tumor extending from the conus medularis to L3. The tumor was resected from the conus and the cauda equina. It proved to be a myxopapillary ependymoma. The patient’s deficits have improved markedly. Because there was a gross total resection, no further treatment has been instituted. Serial MRIs will be followed over years.
Come Join Us We encourage any and all
members of the medical community to come to our campus and spend time with the neurosurgery team. On any given day, several operations can be observed. On Tuesday afternoons, you can participate in academic sessions with our residents, attending neurosurgeons, neuroradiologists, pathologists, traumatologists, critical care specialists, anatomists, and other providers. The experience includes traditional “walk rounds” filled with fascinating cases, exceptional neurologic exams, stunning radiographic findings, and a lot of open discourse and hearty discussions. You are always welcome! Furthermore, if you know of interested medical students, college students, or high school students, we routinely support their involvement in our surgeries, clinics, and rounds. If this sort of activity interests you, please call us at 540-526-1200.