FALL 2023 HEADlines

HEADlines TIMELY NEWS FROM THE DEPARTMENT OF NEUROSURGERY

Fall 2023

MESSAGE FROM THE CHAIR OF NEUROSURGERY: Neuroscience innovation at the University of Colorado continues to thrive and we are proud to say that the Department of Neurosurgery is a large part of this. Our Neuroscience Innovation Initiative (the NII) is growing exponentially with more than 600 graduate students, residents, fellows and faculty working together in the various areas of the Neurosciences (via research and clinical practice). Currently, there are more than 150 primary investigators on campus, working in the Neurosciences, from almost every department in the School of Medicine.

Neuroscience has been named as one of the top five clinical and research priorities over the next five years by our hospital affiliate, UCHealth. Together, we are all working on building a Neuroscience culture of excellence with innovative programs covering all aspects of neurologic dysfunction.

Recently, a new initiative was announced, “The Anschutz Acceleration Initiative.” With $50 million set aside for transformational projects that can make an impact on patient outcomes within the next five years, many researchers and clinicians were encouraged to submit letters of intent. Fourteen of these projects in the Neurosciences were encouraged to submit full proposals.

We are proud that three of the projects that were accepted for final review originated from members of our own department. One project, led by Dr. Cristin Welle, would create a Cognitive Neuroprosthesis.

A second, led by Drs. Michael Graner and Kevin Lillehei, along with faculty from the University of Minnesota, would launch a clinical immunotherapy trial for Glioblastoma. The third project, led by Dr. Lotta Granholm-Bentley is focused on a large consortium of faculty from across the Neuroscience spectrum to develop personalized treatment paradigms for neurodegenerative disorders and neuro oncology, using Artificial Intelligence, and Spacial Transcriptomics. Although we know that there is not enough funding to go around, we are hopeful that at least one of these projects will be funded, and we are excited that there is so much happening across the entire spectrum of Neurosciences!

We are encouraged by all the incredible work our faculty is doing. They are key leaders and role models for the future of Neuroscience innovation.

Sincerely, Kevin O. Lillehei, MD Chair, Department of Neurosurgery Ogsbury-Kindt Professor of Neurosurgery University of Colorado

NEW NEURO ICU OPENS AT UNIVERSITY OF COLORADO HOSPITAL AT ANSCHUTZ MEDICAL CENTER UCHealth University of Colorado Hospital on the Anschutz Medical Campus is celebrating the opening of the hospital’s new tower, Anschutz Inpatient Pavilion 3. Located on the west side of the existing hospital, the 11-story tower includes a new 24 bed Neuro ICU which opened in August. When fully completed the tower will include 215 new inpatient beds, including a 40-bed inpatient behavioral health unit. There are also 10 new operating rooms and shelled space to accommodate additional growth in the future.

“Our new tower will allow us to continue to provide extraordinary care for patients,” said Tom Gronow, president and CEO of the hospital. “As the Rocky Mountain region’s only adult academic medical center, University of Colorado Hospital cares for seriously ill patients with the most complex medical conditions. Thanks to our providers and staff, we have a survival rate at UCH that is 27.3% better than the national average, translating to 323 additional lives saved each year.”

In the past year, the University of Colorado Hospital had more than 50,000 inpatient admissions and received more than 4,000 transfers from other facilities. This newest construction will allow for more than 800 inpatient beds, now the largest hospital in the region.

NEUROSURGERY DEPARTMENT REPRESENTED WELL AT THE CONGRESS OF NEUROLOGICAL SURGEONS CONFERENCE IN WASHINTON DC EARLIER THIS MONTH Dr. Samy Youssef

Dr. Timothy Ung

presented four sessions at the conference, including “Now What?

Management of Intracranial Complications,” “3D Surgical Neuroanatomy,” “Resident CNS and SANS Challenge,” and he announced the winners of the SANS Challenge, Top Posters and Residency Program Abstracts.

presented on CNS guidelines.

Dr. Kevin Lillehei

Dr. Gregoire Chatain

presented the CNS guidelines for surgical treatment of Functioning Pituitary Adenomas.

(PGYVII) presented a “Multi-center Comparison of Chiari I Malformation in Children vs. Adults.”

Dr. Ryan Ormond

Dr. Michael Kortz

presented on Low grade glioma, the Impact of Initial LGG guidelines, and the Recurrence of these tumors.

(PGYII) presented two sessions, “Osteopathic Presence in Neurosurgery” and “Utilization of Adiposederived Stem Cells.”

INVESTIGATING “WORKPLACE WELLNESS” IN THE DEPARTMENT OF NEUROSURGERY What is well being? According to Dr. Daniel Craig, it is basically the fight against burn out. Dr. Craig, our Department of Neurosurgery Wellness Champion, also serves as a representative for this university-wide effort to decrease burn out amongst physicians and other health care workers. Thanks to Dr. Craig and an active committee he has put together, the Neurosurgery faculty and staff members are being asked significant questions about the sustainability, resources, supports and stress levels they experience within our system.

Dr. Craig presented these findings at one of the Neuroscience Innovation Initiative events this past summer, “TED for your Head.” See link to the presentation below. Like other areas of medicine, he believes that this nebulous term of “well being” is difficult Daniel Craig, MD. Neurosurgeon because, like any “dis-ease” we must investigate the cause before we diagnose & Department Wellness Initiative and treat. Physicians currently have a 50% burnout rate, one of the highest of any Leader profession. This is costing the hospital systems, insurance companies and tax payers millions of dollars annually. Burn out increases malpractice claims, decreases successful patient outcomes and reduces patient satisfaction. Experts have estimated that the US Health system is losing the equivalent of seven graduating classes of medical students per year.

On our own campus, because of burn-out, physicians and advanced practice providers (nurse practitioners and physician assistants) cite the advent of computerized health records and the demands of these systems as increasing their exhaustion by 30%. Payment methods are a second cause of overall burn out, and the lack of leader engagement and understanding of day to day work flow is a third.

Dr. Craig and his committee have begun their work. It includes: • Setting healthy, realistic boundaries.

• “Loading the boat” – meaning assembling our team (committee) that will work on this.

• Creating a language that is common amongst all of us for defining “wellness” AND identifying the stressors of daily work load, personal life, and the corporate life.

• Looking at practical solutions vs. critical solutions, and the cross-overs that are within our control to implement.

• Starting slowly and not quitting.

• Beginning to treat each other the way we do our patients, using a “palliative care” model to simply reduce suffering.

• Begin projects and initiatives that are repeatable next year.

Overall, his goal is to make sure we pay attention and listen to each other, recognize each other and the work we do, reduce fear and anxiety, help people to understand they are not alone, and work toward a common goal.

Dr. Craig would love for us to throw out the word “well being” and replace it with “thriving.” Are you thriving?

If not, why not? Let’s start there…

LINK to VIDEO : https://www.dropbox.com/s/k8fs6fbz6y3zmra/TED%20for%20your%20Head%20-%205-18-23.mov?dl=0

First Neurosurgery Department “Wellness Family Picnic” at Washington Park in Denver. Sept 9, 2023

CONGRATULATIONS WELCOME ABOARD, NEW FACULTY! Timothy H. Ung, MD

Evan Winograd, MD

Former Chief Resident at CU Now: Assistant Professor | Department of Neurosurgery Neuro-oncology / Gamma Knife Program

Former Neuro-oncology Fellow at CU Now: Assistant Professor / Department of Neurosurgery Neuro-oncology Program – primarily at Highlands Ranch Hospital

Mohammed Alshareef, MD Former Pediatric Neurosurgery Fellow Now: Assistant Professor / Department of Neurosurgery – Pediatric Neurosurgery at Children’s Hospital Colorado.

CONGRATULATIONS TO THESE FACULTY MEMBERS WHO HAVE RECEIVED ACADEMIC PROMOTIONS THE PAST FEW MONTHS! Lotta Granholm – Bentley, DDS, PhD

Aurelie Ledreux, PhD, MS

Promoted to Tenured Professor Neurosurgery Research

Promoted to Associate Professor Neurosurgery Research

Christopher Roark, MD

Joshua Seinfeld, MD

Promoted to Associate Professor Department of Neurosurgery, Inpatient Medical Director Neuro Endovascular Program

Promoted to Professor Department of Neurosurgery Director, Neuro Endovascular Program

David Case, MD Promoted to Associate Professor Department of Neurosurgery Neuro Critical Care Program

Corbett Wilkinson, MD Promoted to Professor Department of Neurosurgery Pediatric Neurosurgery Program

Helen French, PA-C

Erika Bergstrom, PA

is working again in Neurosurgery, this time with Dr. Samy Youssef.

Welcome back, Helen!

has joined our tumor pod and is working with Dr. Ryan Ormond. She is a Colorado native, born and raised in Golden. She went to South College in Knoxville, TN for her PA training. She is very interested in medical oncology, neurooncology, and nutrition. Her main hobbies include spending time with her dog, exercise, traveling, hiking and camping! Welcome aboard, Erika!

Christopher Domen, PhD

Peter Lennarson, MD

Promoted to Associate Professor Department of Neurosurgery Neuropsychology Program

Som Phommatha, PA-C Promoted to Senior Instructor Department of Neurosurgery Physician Assistant, Neurosurgical Spine

Promoted to Associate Professor of Clinical Practice Department of Neurosurgery Neurosurgical Spine and Neuro Trauma Programs

Azin Alizadehardebili, PA-C Promoted to Senior Instructor Department of Neurosurgery Physician Assistant, Stereotactic & Functional Neurosurgery

WELCOME TO OTHER NEUROSURGERY STAFF! Shayok Dutta (aka Shay), PhD, is joining the Department of Neurosurgery as a Postdoctoral Fellow, working in Dr. Cristin Welle’s lab. Shay recently completed his PhD in Electrical and Computer Engineering at Rice University, where he received training as a rodent hippocampal electrophysiologist. Leveraging his background in computer engineering, his graduate work involved fabricating a novel, real-time, closed-loop system and subsequently interrogating specific temporal functions of hippocampal sharpwave ripples in spontaneous learning. Broadly, his research interests lie in therapeutic bidirectional neural interfacing. In those fleeting moments when studying the mysteries of neural functionality fails to fully engage his attention, Shay reads to his pet rabbits, engages in community outreach work, and enjoys staying active --- be it hiking, foraging for food, playing sports or napping.

Shafiqa Zadron has joined the Neurosurgery Administrative team and will serve as Program and Website Coordinator. She will also be taking over social media accounts and other administrative duties, as assigned. “Hello everyone, my name is Shafiqa. I am in school completing my degree in HR management. I love working in a team that feels like family, and where everyone wants to support each other. I am thrilled to start my new journey here and will learn as much as I can!”

Lauren Seelye has recently joined the Administrative team to help with medical student and fellowship programs, as well as administrative support for the spine team. She previously worked as the medical student and fellowship program coordinator with the Department of Ophthamology. Prior to her time with CU, she worked in private practice as a clinic manager for a small TMS clinic and a medical assistant at Neurosurgery One. She is from the mountains and enjoys spending time outside with her family hiking, running and snowboarding.

Scott LeBeau, M.S. has joined our pediatric neurosurgery department as a Senior Clinical Research Coordinator, after spending the three previous years doing research with the Department of Plastic Surgery. His research interests are neurorehabilitation of TBI, fluid replacement technologies in the hypovolemic trauma patient, improving patient outcomes in the acute care setting, Neuropharmacology, Syndromic Craniosynostosis, and hypothermia neuroprotection after cardiac arrest. In his free time, Scott enjoys flyfishing Colorado’s rivers, challenging himself in the gym, learning new things, and spending time with family and friends.

Jonathan Platt is a new Clinical Research Services Professional working with Dr. John Thompson and Dr. Daniel Kramer. Jonathan is a first generation who earned his BS and MS in bioengineering at CU Anschutz. His clinical interest is understanding how movement is affected by neurodegenerative diseases. To unwind, he enjoys traveling and camping with his wife and 3 boys.

RESIDENT NEWS It seems we just “onboarded” our new residents, and it’s already time to start interviewing for next year! The residents have so much going on, it’s hard for them to keep their heads above water. One such resident we are featuring in this issue is Dr. Lindsay Freeman (PSY V).

Lindsay is studying both adults and children with traumatic ICH/head bleeds. She is looking at the various degrees of injury, who ends up having neurosurgery, anticoagulation with these patients, how much patients are scanned, and whether or not certain factors may predict patient outcomes.

TANZANIA NEWS Thanks to the organization of Dr. Luis Cava, weekly meetings have been held in our Neuro ICU since our last visit to Tanzania (February of 2023). Specific cases, clinical research and new technology are all discussed, and guest speakers have been brought in. We are working actively to educate those in Tanzania and help them identify ways in which they can adapt their practices to have the best possible outcomes. Those who have attended include, Dr. Kevin Lillehei, Chair of our department, Drs. Robert Neumann, Luis Cava, and David Case who all cover the Neuro ICU, Dr. Andrei Alexandrov, Chairman of Department of Neurology, University of Arizona- Phoenix; Dr Hamnis Shafii, Neuro Intensivist, MOI in Dar es Salaam, Tanzania; Dr. Laurence Lemeri, Director of Neurosurgery, MOI in Dar es Salaam, Tanzania; Dr. Nicephorus Rutabasibwa, Neurosurgeon, MOI in Dar es Salaam, Tanzania; and nurses and other providers from Tanzania.

SKULL-BASE NEUROSURGERY PROGRAM NEWS Congratulations to Dr. Samy Youssef who recently returned from the European Association of Neurosurgical Societies meeting in Barcelona, Spain. While there, he spoke on several topics, including “Improving functional outcomes in large vestibular schwannomas,” “Surgical Outcome of Foramen Magnum Meningiomas As Predicted

by Topographic Position Relative to Neurovascular Bundle, a Novel Classification,” and “Surgical outcomes in large vestibular schwanommas: should cerebellopontine edema be considered in the grading systems?”

In addition, Dr. Youssef completed his summer course for our Neurosurgical Residents, and is gearing up for his national Skull Base course in early November.

SKULL BASE PUBLICATIONS THIS PAST QUARTER Ung TH, Freeman L, Hirt L, Kortz M, Belanger K, Baird-Daniel E, Hosokawa P, Thaker A, Thompson JA, Youssef AS. Surgical outcomes in large vestibular schwannomas: should cerebellopontine edema be considered in the grading systems? Acta Neurochir (Wien). 2023 May 18. doi: 10.1007/s00701-023-05627-1. Epub ahead of print. PMID: 37204532.

STEREOTACTIC & FUNCTIONAL NEUROSURGERY NEWS Steve Ojemann, MD has recently returned from the European Association of Neurosurgical Societies meeting in Barcelona, Spain. While there, his sessions included “Kinematics and Machine Learning for the Surgical Treatment of Movement Disorders,” and “Enhancing Brain Functions at the Service of Humanity.”

Dr. Ojemann is gearing up for his annual stereotactic and functional neurosurgery course in early November.

BRAIN COMPUTER INTERFACE LAB Dr. Dan Kramer and several associates are working on an exciting new project involving “Neuropixels.” Neuropixels is a recently developed neurotechnology that leverages silicon fabrication techniques to massively expand the possibilities of recording brain signals.

The device is called Neuro”pixels” because it overlaps with fabrication processes used to make the pixels in sensor arrays for cell phone cameras. But instead of capturing light, the array is stretched out with thousands of individual sensors all packed onto a needle.

This can yield recordings from hundreds of neurons at a time; a scale of 100x beyond the current state of the art, packed into a size thinner than human hair.

“Here at CU, we will make use of this brand-new technology, called the Neuropixels Probe, to record from hundreds of neurons simultaneously in Parkinson’s disease patients in a key Executive Function area of the brain, called the Prefrontal Cortex,” Dr. Kramer states. “ While performing standard deep brain stimulation cases, where the electrode passes through the Prefrontal Cortex, we will insert these Neuropixels probes, record from up to 384 simultaneous neurons during executive function tasks, and uncover the neural code for dysfunction. With this information, we can target these circuits and develop neuromodulation technology, like deep brain stimulation, but for cognitive deficits.”

PUBLICATIONS IN STEREOTACTIC NEUROSURGERY & MOVEMENT DISORDERS THIS PAST QUARTER Thompson JA, Hirt L, David-Gerecht P, Fasano A, Kramer DR, Ojemann SG, Kern DS. Comparison of Monopolar Review to Fixed Parameter Fractionation in Deep Brain Stimulation. Mov Disord Clin Pract. 2023 May 5;10(6):987-991. doi: 10.1002/mdc3.13750. PMID: 37332654; PMCID: PMC10272899.

West LC, Summers M, Tang S, Hirt L, Halpern CH, Maroni D, Das R, Gliske SV, Abosch A, Kushida CA, Thompson JA. Evaluation of consensus sleep stage scoring of dysregulated sleep in Parkinson’s disease. Sleep Med. 2023 May 18;107:236-242. doi: 10.1016/j.sleep.2023.04.031. Epub ahead of print. PMID: 37257366.

Radcliffe EM, Baumgartner AJ, Kern DS, Al Borno M, Ojemann S, Kramer DR, Thompson JA. Oscillatory beta dynamics inform biomarker-driven treatment optimization for Parkinson’s disease. J Neurophysiol. 2023 May 17. doi: 10.1152/jn.00055.2023. Epub ahead of print. PMID: 37198135.

di Giacomo E, Leone BE, Clerici M, Grassia F. Evidence of a third branch in the uncinate fasciculus and possible implications. J Neurol Neurosurg Psychiatry. 2023 Jun;94(6):497-498. doi: 10.1136/jnnp-2023-331289. Epub 2023 Mar 22. PMID: 36948578.

Welton TA, George NM, Ozbay BN, Gentile Polese A, Osborne G, Futia GL, Kushner JK, Kleinschmidt-DeMasters B, Alexander AL, Abosch A, Ojemann S, Restrepo D, Gibson EA. Two-photon microendoscope for labelfree imaging in stereotactic neurosurgery. Biomed Opt Express. 2023 Jun 27;14(7):3705-3725. doi: 10.1364/ BOE.492552. PMID: 37497482; PMCID: PMC10368057.

Domen CH, Sillau S, Liu Y, Adkins M, Rajkovic S, Bainbridge J, Sempio C, Klawitter J, Leehey MA. Cognitive Safety Data from a Randomized, Double-Blind, Parallel-Group, Placebo-Controlled Phase IIb Study of the Effects of a Cannabidiol and Δ9-Tetrahydrocannabinol Drug on Parkinson’s Disease-Related Motor Symptoms. Mov Disord.

2023 Jul;38(7):1341-1346. doi: 10.1002/mds.29447. Epub 2023 May 22. PMID: 37212386.

Zhang J, Ryu JY, Tirado SR, Dickinson LD, Abosch A, Aziz-Sultan MA, Boulos AS, Barrow DL, Batjer HH, Binyamin TR, Blackburn SL, Chang EF, Chen PR, Colby GP, Cosgrove GR, David CA, Day AL, Folkerth RD, Frerichs KU, Howard BM, Jahromi BR, Niemela M, Ojemann SG, Patel NJ, Richardson RM, Shi X, Valle-Giler EP, Wang AC, Welch BG, Williams Z, Zusman EE, Weiss ST, Du R; GENIE Investigators. A Transcriptomic Comparative Study of Cranial Vasculature. Transl Stroke Res. 2023 Aug 23. doi: 10.1007/s12975-023-01186-w. Epub ahead of print.

PMID: 37612482.

Valencia I, Alexander AL, Andrade DM, Arevalo-Astrada M, Rubinos C, Auer N, Bainbridge JL, et. al.

Highlights From the Annual Meeting of the American Epilepsy Society 2022. Epilepsy Curr. 2023 doi: 10.1177/153575977231187227. Epub 2023 Aug.

BRAIN TUMOR PROGRAM NEWS Dr. Ryan Ormond completed his summer resident course in advanced ultra sound techniques, and he is working on a new national course on this same topic for residents and providers from all over the country, to be held in 2024.

Dr. Kevin Lillehei, along with Dr. Margaret Wierman (endocrinology) were invited speakers at the Regional Meeting of the National Acromegaly Community in October.

His topic, “The Surgical Treatment of Acromegaly,” was well received, being one of a small handful of international experts in this field. Acromegaly is a disorder in adults in which the pituitary gland produces too much growth hormone, caused by a benign pituitary tumor. Middle-aged adults are most commonly affected. Symptoms include enlargement of the face, hands, and feet. Surgery remains the first line of therapy, with treatment needed to avoid serious illness. Although rare (less than 20,000 cases in the US), when treated appropriately, patients can have a normal life expectancy.

NEW CLINICAL TRIAL COMING FOR GLIOBLASTOMAS Drs. Kevin Lillehei, Neurosurgeon, Douglas Ney, MD, Neuro Oncologist, Michael Graner, PhD, Neurosurgery Researcher, and Bette DeMasters, MD, Neuropathologist – all from the University of Colorado Anschutz, are currently partnering with researchers from the University of Minnesota and OX2Therapeutics to roll out a clinical trial using Immunotherapy for Adult Patients with Recurrent Glioblastoma. While brain tumors are considered a rare disease by NIH measures (some 25,000 patients are predicted to have malignant central nervous system cancers in 2023), almost 19,000 patients will die from malignant brain tumors this year, which is more than will die from melanoma, despite the far greater incidence for the latter.

The goal is to increase the survival time for patients with recurring GBMs, using a drug to prevent multiple immune checkpoints from engaging in tumor-induced immune suppression, thereby eliciting an anti-tumor response when administered at therapeutic doses in an adult recurrent glioblastoma. This is a phase I trial, with current funding pending.

BRAIN TUMOR PUBLICATIONS THIS PAST QUARTER: Travers SS, Fisher CM, Kabos P, Cittelly DM, Ormond DR. Breast cancer brain metastases localization and risk of hydrocephalus: a single institution experience. J Neurooncol. 2023 May;163(1):115-121. doi: 10.1007/s11060023-04314-6. Epub 2023 May 2. PMID: 37131107.

NEUROSURGICAL SPINE PROGRAM NEWS The CSF dynamics program continues to grow under the direction of Dr. Peter Lennarson (neurosurgeon) and Dr. Andrew Callen (neuroradiologist). This program at the University of Colorado is becoming one of the top programs in the country for evaluating and treating the occurrence of Cerebral Spinal Fluid (CSF) leaks. Only recently has this entity been recognized, and diagnosis can be difficult. Symptoms can include low-pressure headaches, neck pain, ringing in the ear, and (occasionally) loss of smell or taste. A leak can be detrimental to blood supply and function of the brain, and can increase the risk of direct trauma to the brain parenchyma due to loss of the fluid cushion. 80% of CSF leaks are due to nonsurgical trauma, 16% are iatrogenic, and 4% are spontaneous. The incidence of spontaneous leaks has been estimated at 4 per 100,000 per year, with a peak around age 40 years. Obesity and sleep apnea are considered potential causes. The University of Colorado is nationally recognized as the place to go if you or someone you love is suffering from this problem.

Our spine team has been very busy both clinically and as researchers. Some of the exciting things they are currently studying include reviewing spine surgeries of octogenarians, post operative posture predictions using musculoskeletal modeling, the use of distal fusion cobalt chrome rods and screws, protein enhanced bone grafts, TTIF (Thoracic interbody fusion) for disc herniations, and erector spine pain blocks for thoracolumbar fusion surgeries.

NEUROSURGICAL SPINE PUBLICATIONS THIS PAST QUARTER Nevzati E, Poletti N, Spiessberger A, Babler S, Studer G, Riklin C, Diebold J, Chatain GP, Finn M, Witt JP, Moser M, Mariani L. Establishing the Swiss Spinal Tumor Registry (Swiss-STR): a prospective observation of surgical treatment patterns and long-term outcomes in patients with primary and metastatic spinal tumors. Front Surg 2023 Volume 10 - 2023 | doi: 10.3389/fsurg.2023.1222595

Smith AC, Draganich C, Thornton WA, Berliner JC, Lennarson PJ, Rejc E, Sevigny M, Charlifue S, Tefertiller C, Weber KA 2nd. A Single Dermatome Clinical Prediction Rule for Independent Walking 1 Year After Spinal Cord Injury. Arch Phys Med Rehabil. 2023 Jul 5:S0003-9993(23)00374-X. doi: 10.1016/j.apmr.2023.06.015. Epub ahead of print. PMID: 37414239.

Callen AL, Lennarson P, Carroll IR. A causative role for remote dural puncture and resultant arachnoid bleb in new daily persistent headache: A case report. Headache. 2023 Jul-Aug;63(7):981-983. doi: 10.1111/head.14584.

Epub 2023 Jun 26. PMID: 37358488.

NEUROPSYCHOLOGY PROGRAM NEWS Congratulations to Dr. Michelle Miranda for her recent funding from the American Psychological Association for her Collaborative Health Initiative for Spanish Multicultural Education (CHISME): A Pilot Program for Graduates Trainees and Early Career Professionals

Dr. Michael Greher, as a core member of the Traumatic Brain Injury (TBI) task force at CU Anschutz, has been busy for the past several months putting together a very comprehensive program for those who have suffered a traumatic brain injury. Making sure we are all using common definitions, severity levels and tools that measure overall functioning, clinicians and researchers from several different departments are building a robust program that will treat patients with severe injuries, as well as those with milder concussion-like symptoms.

Mental health disorders are commonly observed in TBI patients. In the first-year post-injury, up to 77% of patients receive a psychiatric diagnosis: anxiety, mood and substance-use disorders are common and often present. One significant obstacle in treating these patients is finding enough community resources. As with all mental health issues, Colorado does not have adequate providers or funding.

The percent of need for mental health professionals met in Colorado is 34.6%, compared to the national percent of need met (27.7%). KFF.org. Colorado ranked 51st among U.S. states and the District of Columbia for adult mental health in 2021 but 45th in 2022. KDVR.com. The task force is currently putting together a resource list that will be used across the UCHealth system, with community resources, referral sources, etc.

ENDOVASCULAR NEUROSURGERY PROGRAM NEWS GROUNDBREAKING STROKE STUDY SEEKS WAYS TO KEEP BRAIN CELLS ALIVE In partnership with the UCHealth Mobile Stroke Treatment Unit, University of Colorado School of Medicine researchers are measuring blood samples of patients within minutes of stroke onset and discovering data that could change the way many stroke patients are treated.

Time of onset remains unknown in nearly a quarter of the 800,000 strokes in the United States each year, leaving patients unable to receive clot-busting medicines that have a short treatment window and can dramatically improve outcomes. The study aims to use levels of the cytokine interleukin-6 (IL-6) measured from blood obtained from patients on the mobile stroke unit during an active stroke, typically in the driveways of their homes, to create a tool to estimate when the stroke began. This information will be vital and open the door for thrombolytic treatment for the 200,000 patients who experience an acute stroke in the U.S. each year, but are unable to receive this therapy because it is unknown when the stroke began. Click on link below to learn more!

Link to full article: Groundbreaking Stroke Study Seeks Ways to Keep Brain Cells Alive (cuanschutz.edu)

ENDOVASCULAR NEUROSURGERY PUBLICATIONS THIS PAST QUARTER Bounajem MT, Joyce E, Scoville JP, Seinfeld J, Hoffman J, Grossberg JA, Waiters V, White AC, Nerva J, Burkhardt JK, Tonetti DA, El Naamani K, Gooch MR, Jabbour P, Tjoumakaris S, Ortega Gutierrez S, Levitt MR, Lang M, Ares WJ, Desai S, Mascitelli JR, Kilburg CJ, Budohoski KP, Couldwell WT, Gross BA, Grandhi R. Safety and efficacy of the Pipeline Flex embolization device with Shield Technology for the acute treatment of ruptured internal carotid artery pseudoaneurysms: a multi-institution case series. Neurosurg Focus. 2023 May;54(5):E4. doi: 10.3171/2023.2.FOCUS233. PMID: 37127036.

Vranic JE, Harker P, Stapleton CJ, Regenhardt RW, Dmytriw AA, Doron OM, Alotaibi NM, Leslie-Mazwi TM, Gupta R, Berglar IK, Tan CO, Koch MJ, Raymond SB, Mascitelli JR, Patterson TT, Seinfeld J, White A, Case D, Roark C, Gandhi CD, Al-Mufti F, Cooper J, Matouk C, Sujijantarat N, Devia DA, Ocampo-Navia MI, VillamizarTorres DE, Puentes JC, Patel AB. The Impact of Dual Antiplatelet Therapy Duration on Unruptured Aneurysm Occlusion After Flow Diversion: A Multicenter Study. J Comput Assist Tomogr. 2023 Aug 3. doi: 10.1097/ RCT.0000000000001457. Epub ahead of print. PMID: 37531646.

Sethi, A., Chee, K., Chatain, G., Wittenberg, B., Seinfeld, J., MilgromS., Kavanagh B., Breeze, R. Time-Dosed Stereotactic Radiosurgery for Treatment of Cerebral Arteriovenous Malformations: An Early Institution Experience and Case Series. Neurosurgery Practice 2023

PEDIATRIC NEUROSURGERY PROGRAM NEWS CONGRATULATIONS TO OUR PEDIATRIC NEUROSURGERY FACULTY WHO HAVE RECEIVED FUNDING FOR RESEARCH PROJECTS THIS PAST QUARTER. Dr. Allison Alexander is a Co-Investigator on a NIH RO1 grant in conjunction with the University of North Carolina, studying “Identification and molecular characterization of somatic mutations in MC.”

Dr. Eric Prince (pediatric neurosurgery fellow, under the mentorship of Dr. Todd Hankinson) has received an NIH F31 Fellowship grant to study the Human-centered design of clinical AI to support the diagnosis of pediatric suprasellar tumors.

Dr. Todd Hankinson has received funding from the Meghan Rose Bradley Foundation to study the Role of Macrophages in Pediatric Adamantinomatous Craniopharyngioma

Dr. Mohammad Alshareef (our newest Pediatric Neurosurgery Faculty member) is working on a proposed project that evaluates how the complement immune system is activated and regulated following neonatal intraventricular hemorrhage (IVH). IVH is a devastating disease for neonates and leads to over 90% morbidity and mortality while having no viable medical or surgical interventions. Dr. Alshareef has found that complement system inhibition leads to reduced injury and lower hydrocephalus rates in an animal model. If funded, he will use the K12 award to further explore the mechanism behind complement’s involvement in IVH. He will also examine the CSF of his neonate patients from the Children’s Hospital Colorado to identify complement-related markers that may predict outcomes in these neonates. Dr. Alshareef hopes that the complement modulators and inhibitors he is exploring may eventually be used in clinical trials for the treatment of neonatal IVH.

PEDIATRIC NEUROSURGERY PUBLICATIONS THIS PAST QUARTER CreveCoeur TS, Alexiades NG, Bonfield CM, Brockmeyer DL, Browd SR, Chu J, Figaji AA, Groves ML, Hankinson TC, Harter DH, Hwang SW, Jea A, Kernie SG, Leonard JR, Martin JE, Oetgen ME, Powers AK, Rozzelle CJ, Skaggs DL, Strahle JM, Wellons JC, Vitale MG, Anderson RCE. Building consensus for the medical management of children with moderate and severe acute spinal cord injury: a modified Delphi study. J Neurosurg Spine. 2023 Mar 17:1-14. doi: 10.3171/2023.1.SPINE221188. Epub ahead of print. PMID: 36933257.

Wilkinson CC, Belanger K, Elbadry R, Hoffman J, Ryan M, Stence NV, Graber SJ, Ridder T, Batista L, French BM. Fusion of Lateral Calvarial Sutures on Volume-Rendered Computed Tomography Reconstructions in Patients With Known Craniosynostosis. J Craniofac Surg. 2023 May 1;34(3):969-975. doi: 10.1097/ SCS.0000000000009278. Epub 2023 Mar 20. PMID: 36939862.

Donson AM, Bertrand KC, Riemondy KA, Gao D, Zhuang Y, Sanford B, Norris GA, Chapman RJ, Fu R, Willard N, Griesinger AM, de Sousa GR, Amani V, Grimaldo E, Hankinson TC, Booker F, Sill M, Grundy RG, Pajtler KW, Ellison DW, Foreman NK, Ritzmann TA. Significant increase of high-risk chromosome 1q gain and 6q loss at recurrence in posterior fossa group A ependymoma: a multicenter study. Neuro Oncol. 2023 May 29:noad096. doi: 10.1093/neuonc/noad096. Epub ahead of print. PMID: 37246777.

Donson A, Bertrand K, Riemondy K, Gao D, Sanford B, Norris G, Fu R, Willard N, Griesinger A, Amani V, Grimaldo E, Hankinson T, Booker F, Grundy R, Pajtler K, Ellison D, Ritzmann T. EPEN-07. A MULTICENTER STUDY OF POOR PROGNOSIS CHROMOSOME 1Q GAIN AND/OR 6Q LOSS IN POSTERIOR FOSSA A EPENDYMOMA SHOWS INCREASED PREVALENCE FROM 20% AT DIAGNOSIS TO 60% AT FIRST RECURRENCE. Neuro Oncol.

2023 Jun 12;25(Suppl 1):i28. doi: 10.1093/neuonc/noad073.111. PMCID: PMC10260028.

Ravindra VM, Jensen H, Riva-Cambrin J, Wellons JC, Limbrick DD, Pindrik J, Jackson EM, Pollack IF, Hankinson TC, Hauptman JS, Tamber MS, Kulkarni AV, Rocque BG, Rozzelle C, Whitehead WE, Chu J, Krieger MD, Simon TD, Reeder R, McDonald PJ, Nunn N, Kestle JRW; Hydrocephalus Clinical Research Network; HCRN Members. Comparison of outcomes in the management of abdominal pseudocyst in children with shunted hydrocephalus: a Hydrocephalus Clinical Research Network study. J Neurosurg Pediatr. 2023 Jun 9:1-12. doi: 10.3171/2023.4.PEDS23129. Epub ahead of print. PMID: 37327184.

Bsat S, Alshareef M, Pazniokas J, Handler MH. Technical evolution of pediatric neurosurgery: the evolution of intraoperative imaging. Childs Nerv Syst. 2023 Jul 31. doi: 10.1007/s00381-023-06040-w. Epub ahead of print.

PMID: 37518061.

Zhou Y, Guglielmi G, Garg S, Hankinson TC. Delayed Diagnosis of Cervical Epidural Hematoma in a 3-Year-Old Boy: A Case Report. JBJS Case Connect. 2023 Aug 31;13(3). doi: 10.2106/JBJS.CC.23.00170. PMID: 37651573.

Grob ST, Miller KR, Sanford B, Donson AM, Jones K, Griesinger AM, Amani V, Foreman NK, Liu A, Handler M, Hankinson TC, Milgrom S, Levy JM. Genetic Predictors of Neurocognitive Outcomes in Survivors of Pediatric Brain Tumors. Res Sq [Preprint]. 2023 Aug 7:rs.3.rs-3225952. doi: 10.21203/rs.3.rs-3225952/v1. PMID: 37609195; PMCID: PMC10441450.

RESEARCH PROGRAM NEWS CONGRATULATIONS TO ALL THOSE WHO HAVE RECEIVED FUNDING FOR RESEARCH THIS PAST QUARTER! Dr. John Thompson received funding from the National Science Foundation for the Graduate Research Fellowship Program.

Dr. Cristin Welle received funding from OEDIT-SPARK for her work with Vagus Nerve Stimulation in the treatment of Multiple Sclerosis. She also received an NIH R25 award, in conjunction with the University of Minnesota for her work with Extramural Research Programs in the Neurosciences and Neurological Disorders.

Dr. Daniel Kramer received an “Across the Finish Line” award from the School of Medicine for his research, “Neural population encoding of executive function flexibility in human prefrontal cortex.

Dr. Robert Kowalski received a Chancellors Discovery Innovation Fund Award for his research with the mobile stroke unit involving Time of Stroke Diagnosis.

ADDITIONAL PUBLICATIONS FROM RESEARCH FACULTY THIS PAST QUARTER Kumar V, Behrman K, Speed F, Saladrigas CA, Supekar O, Huang Z, Bright VM, Welle CG, Restrepo D, Gopinath JT, Gibson EA, Kymissis I. MicroLED light source for optical sectioning structured illumination microscopy. Opt Express. 2023 May 8;31(10):16709-16718. doi: 10.1364/OE.486754. PMID: 37157744; PMCID: PMC10316754.

Zhou W, Graner M, Paucek P, Beseler C, Boisen M, Bubak A, Asturias F, George W, Graner A, Ormond D, Vollmer T, Alvarez E, Yu X. Multiple sclerosis plasma IgG aggregates induce complement-dependent neuronal apoptosis. Cell Death Dis. 2023 Apr 8;14(4):254. doi: 10.1038/s41419-023-05783-3. PMID: 37031195; PMCID: PMC10082781.

Snider SB, Temkin NR, Barber J, Edlow BL, Giacino JT, Hammond FM, Izzy S, Kowalski RG, Markowitz AJ, Rovito CA, Shih SL, Zafonte RD, Manley GT, Bodien YG; TRACK-TBI investigators. Predicting Functional Dependency in Patients with Disorders of Consciousness: A TBI-Model Systems and TRACK-TBI Study. Ann Neurol. 2023 Jul 20. doi: 10.1002/ana.26741. Epub ahead of print. PMID: 37470289.

Granholm AC. Long-Term Effects of SARS-CoV-2 in the Brain: Clinical Consequences and Molecular Mechanisms. J Clin Med. 2023 Apr 28;12(9):3190. doi: 10.3390/jcm12093190. PMID: 37176630; PMCID: PMC10179128.

TO ALL NEUROSCIENCE INNOVATION INITIATIVE RESEARCHERS, CLINICIANS AND STUDENTS!!

REGISTRATION LINK BELOW!

SPINAL CSF LEAK: BRIDGING THE GAP BETWEEN PATIENTS AND PROVIDERS –DEPARTMENTS OF NEURORADIOLOGY, NEUROLOGY AND NEUROSURGERY

SAT, 11 NOVEMBER, 2023 | 7:30 AM – 5 PM MST HYBRID: ONLINE & IN-PERSON {ANSCHUTZ HEALTH SCIENCES BLDG, AMC}

FREE Registration here | 7.25 AMA PRA credits The symposium will feature educational insights provided by physicians experienced in CSF leak diagnosis and treatment (from local, national and international institutions) alternating with patient speakers and recorded patient video presentations about their challenges of CSF leak diagnosis, treatment and recovery. This blend of clinical expertise and personal narrative is what sets the upcoming symposium apart in the hot topic field of Spinal CSF leak and beyond!

GET INVOLVED How to Support the CU Department of Neurosurgery Call or email Tami Lack, Director of Strategic Planning & Program Development tami.lack@cuanschutz.edu 303-907-8977 She will walk you through the CU Office of Advancement giving process and make sure your funds are directed to the correct area of research and/or clinical care.