Neurosurgery Update - Summer/Fall 2012

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...

Volume1- January2012

update

NEUR SURGERY Carilion Clinic P.O. Box 13727 Roanoke, VA 24036

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.

Topics include:

©2012 Carilion Clinic Strategic Development J706 2/12/GG

Neuroscience Talks

NEUR SURGERY update

Vol. 1 Issue 2 - Summer/Fall 2012 Volume 1- January 2012

Brain Surgery at Carilion Roanoke Memorial Hospital The Carilion Clinic Neurosurgery team offers the full spectrum of state-of-theart brain surgery. No type of surgical case needs to be sent out of the region.

Our surgeons are exceptionally trained and extensively experienced in all aspects of intracranial surgery. Operating theatres possess the best of equipment and support. Teams of critical care physicians and nurses in several specialized intensive care units (ICUs) care for our peri-operative patients.

Although all our surgeons are experts in the full breadth of intracranial surgery, they each have subspecialty interests and expertise and readily share their knowledge and capabilities with each other.

Lisa Apfel, M.D. Pediatric, brain mapping, and endoscopic surgery Zev Elias, M.D. Pituitary, endoscopic skull base, and trauma surgery John Fraser, M.D. Tumor, trauma, and functional surgery Nicholas Qandah, D.O. Tumor, vascular, and functional surgery Gary Simonds, M.D. Complex micro surgery, epilepsy, and pediatric surgery

A handful of recent cases performed at Carilion Clinic illustrate the breadth and depth of brain surgery coverage available in our region, including: • Eight CM pituitary tumor • Complex giant carotid wall aneurysm • Cerebellar arteriovenous malformation (AVM) • Craniopharygioma in an adult patient • Massive intraventricular neurocytoma • Gunshot wound to frontal sinuses and brain • Subdural empyema • Acoustic neuroma • Bilateral cerebello-pontine angle meningioma • Pineal tumor in an 8-year-old patient • Colloid cyst of the third ventricle • Glioma in frontal speech area • Multiple abscesses • Craniosynostosis • Chiari malformation • Brainstem hemangioblastoma

Visit us on the web: Carilionclinic.org/neurosurgery • 800-422-8482

• Massive olfactory groove meningioma

INSIDE THIS ISSUE: Page 2: Ongoing Research Cranial Case of the Month Page 3: Spine Case of the Month Outreach Clinics

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Ongoing Research

Spine Case of the Month

Come Join Us We encourage any and all

The Carilion Clinic Neurosurgery team of attending and resident surgeons and neurosurgical physician assistants has steadily ramped up investigational activities. The team currently is running multiple institutional review board (IRB) approved clinical and bench studies in the fields of patient education in spinal disorders, surgical fine motor performance, spinal fractures, intracra-

nial pressure (ICP) monitoring in head injury, depression in brain tumor patients, and several others. The team has also entered into collaborative partnership with researchers at the Virginia Tech-Carilion School of Medicine and Research Institute (VTCSOMRI) to study markers in malignant brain tumors and potential therapeutic interventions.

The team is also launching studies in

spinal instrumentation in conjunction with Globus Medical, the world’s largest privately held spinal company, and is opening up research channels with Edward Via College of Osteopathic Medicine (VCOM). The hope is to bring cutting edge care to the population of southwestern Virginia.

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After

The patient developed severe lumbar pain and weakness of both legs. MRI and computer tomography (CT) imaging disclosed possible osteomyelitis of L4 and L5 with severe destructive changes of the L5 vertebral body and severe cauda equina compression. In surgery, the patient’s L5 vertebral body and associated discs were resected and

an expandable titanium cage was placed. Pedicle screws were then placed from L2 to the ilium and connected to titanium rods. The infectious agent proved to be methicillin-sensitive staphylococcus aureus (MSSA), and the patient is making a remarkable recovery on eight weeks of intravenous antibiotic therapy.

Outreach Clinics

Cranial Case of the Month A 59-year-old patient began experiencing transient ischemia-like events.

Magnetic resonance imaging (MRI) disclosed some small strokes in the right middle cerebral artery distribution. In the region of the right Sylvian fissure a giant, partially thrombosed aneurysm was detected. The aneurysm was studied via angiography and reviewed by the integrated neurovascular team at VTCSOMRI. The aneurysm was deemed untreatable via endovascular methods.

Surgery required either reconstructing the patient arteries or bypassing the affected region. In surgery, the aneurysm was isolated microscopically and temporarily blocked of blood flow.

Multiple “clips” were then used to re-

Before

construct the middle cerebral artery and obliterate the aneurysm. The patient made a great recovery, with no residual deficits.

Complete obliteration of aneurysm on post-op angiogram.

Aneurysm identified by 3-D imaging.

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.

Carilion Clinic Neurosurgery is delighted to announce the institution of two regular “outreach clinics.” Responding to patient and primary care provider requests, outreach neurosurgery clinics have been established in Martinsville and Blacksburg. The clinics have been very warmly received. Patients are grateful for not having to travel to Roanoke to see a neurosurgeon. Appointments can be made by calling 540-526-1200 and requesting a location.

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