Neuroneurosurgery chairreport 012213 v2

Departments of Neurology and Neurosurgery c h a i r s’ r e p o rt | w i n t e r 2013

accelerating science — advancing medicine Through strength in recruiting, the creation of interdisciplinary and specialized programs, and robust funding from the National Institutes of Health (NIH), Mount Sinai’s departments of Neurosurgery and Neurology continue to advance new therapies and cutting-edge research, and improve patient satisfaction.

The Department of Neurosurgery leads the institution in growth of surgical volume, with a 14 percent increase in 2012. An investment in Quality Assurance and staff training, as well as physical improvements, has led to an increased patient satisfaction rate for Neurosurgery, placing it among the Top 5 departments at Mount Sinai for patient satisfaction.

The Department of Neurology was awarded more than $17 million in total funding in 2012, including several new NIH grants, allowing for a nearly 50 percent increase from 2011.

Together, the departments recruited six fulltime faculty to further develop our clinical and research commitments. The key recruits for the Department of Neurology include: Shannon Babineau, MD, Assistant Professor of Neurology, and Pediatrics, who completed her child neurology residency at Columbia University Medical Center and a headache medicine

fellowship at Mount Sinai; and Lan Zhou, MD, PhD, Associate Professor of Neurology, Pathology, and Neurosurgery, who founded Mount Sinai’s Cutaneous Nerve Laboratory.

The Department of Neurosurgery recruited Brian H. Kopell, MD, Associate Professor of Neurosurgery, Psychiatry, Neuroscience, and Neurology, who co-directs the Center for Neuromodulation. He is a world-renowned clinician specializing in deep brain stimulation surgery for treating advanced movement disorders such as Parkinson’s disease. Also recruited were Raj K. Shrivastava, MD, Assistant Professor of Neurosurgery, who is a fellowshiptrained endoscopic and skull-base surgeon.

Dr. Shrivastava is developing new techniques of minimally invasive skull-base surgery. John Caridi, MD, who is fellowship-trained in spinal deformities, also joined Mount Sinai as Assistant Professor of Neurosurgery.

FROM LEFT: Stuart C. Sealfon, MD, Glickenhaus Professor and Chair of the Department of Neurology, and Joshua B. Bederson, MD, Chair of the Department of Neurosurgery

Our virtual reality brain surgery simulation project, the first of its kind in the United States, is changing the way we train and assess residents, and is the foundation for a number of research studies focused on the role that confidence plays in surgical skill level. It is through groundbreaking research and a commitment to patient satisfaction that we continue to grow our programs.

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COMPLE X CASES

Treating Multiple Levels of Degenerative Disc Disease and Lumbar Scoliosis A 55-year-old woman presents to The Mount Sinai Hospital Emergency Department with the sudden onset of severe back and right lower extremity pain and weakness. She was found to have multiple levels of degenerative disc disease and lumbar scoliosis. Disc herniations and foraminal stenosis were present at L2/3, L3/4, and L4/5.

Given the patient’s complicated pathology, a simple decompression would have been inadequate and could have actually destabilized her spine further.

John Caridi, MD, Assistant Professor of Neurosurgery, decided to perform a less invasive, two-staged procedure. In the first stage, lateral transpsoas interbody fusions were performed at L2/3, L3/4, and L4/5 to properly realign the spine. Once this was accomplished, posterior instrumentation was placed from T10 to S1 in order to facilitate her fusion.

Immediately postoperatively, the patient’s leg pain and weakness had improved. After five days of inpatient physical therapy, she was discharged home. Six weeks after surgery, the patient was walking without any assistance and had a very tolerable level of back pain.

Figure 1 Preoperative AP x-ray of the lumbar spine showing degenerative scoliosis

Figure 2 Postoperative AP x-ray showing anterior and posterior instrumentation and correction of the deformity

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D r i v i n g C l i n i c a l a n d r e s e a rc h Exc e l l e n c e

Helping To Restore Function through Neuromodulation

Brian H. Kopell, MD, and Barbara Kelly Changizi, MD, lead the Center for Neuromodulation.

Mount Sinai’s Center for Neuromodulation is the oldest of its kind in the tri-state area.

It has become a leader in offering cuttingedge technology and therapies to restore function or to slow further functional decline in patients who suffer from debilitating neurological conditions, such as Parkinson’s disease, essential tremor, and trigeminal neuralgia, and other forms of chronic pain.

Our newly appointed co-directors, Barbara Kelly Changizi, MD, Assistant Professor of Neurology, and Brian H. Kopell, MD, Associate Professor of Neurosurgery, Neuroscience, Psychiatry, and Neurology, lead an interdisciplinary team committed to refining current surgical techniques to make implantation surgeries safer and more effective. The most common of these surgeries, deep brain stimulation (DBS), requires electrodes to be

implanted in a targeted area of the brain, which are then connected to a battery pack beneath the skin of the chest wall. Obsessive compulsive disorder (OCD) was recently approved for DBS, using a treatment that Wayne Goodman, MD, Chair, Department of Psychiatry, helped pioneer, and we are participating in a National Institute of Mental Health-funded multicenter trial of DBS to treat OCD. The center is also driving research to find novel DBS targets for other movement disorders, genetic markers of response to DBS for dystonia, and novel image-guidance techniques for DBS surgery.

A key member of the neuromodulation team, Steven Frucht, MD, Professor of Neurology and Director of the Department of Neurology’s Movement Disorders Division, recently cast light on an emerging disorder known as musician’s dystonia, which can result from a musician’s repetitive movements. Dr. Frucht was integral in developing a new therapy that involved injecting botulinum toxin directly into muscle areas. He is especially well-suited to understand this disorder: Dr. Frucht is a classically trained musician himself.

A dva n c i n g Qua l i t y C a r e

Reducing External Ventricular Drain Infection Rate The Quality Assurance committee, led by Nirit Weiss, MD, Assistant Professor of Neurosurgery, tracks and evaluates the department’s clinical performance. In the past year, they evaluated mortality rates and length of stay, relative to Diagnosis-Related Groups. Consolidating spine patients to one floor, extending hours and weekends for physical therapy, and introducing a regular “Spine School” education program for patients and their families, are helping to decrease length of stay.

We are continuing to identify and address factors contributing to 30-day mortality rates by examining the need for more detailed documentation, and exploring more efficient ways to triage patients transferred from outside institutions.

The Neurosurgery Performance Improvement (PI) committee, led by Errol Gordon, MD, Assistant Professor of Neurosurgery, and Neurology, is a multidisciplinary team that collects and reviews data, analyzes trends, and

develops strategies to improve quality of care.

One of the key performance indicators the committee looked at was external ventricular drain (EVD) infection rate.

EVD infection rates, a common problem in many institutions, can lead to increased morbidity and mortality in patients. Our committee determined three key practices to reduce EVD infection rates: creating a dedicated dressing/shunt-tapping kit; using sutures, not staples, to secure the drains; • running a course of antibiotics prior to interstation and removal of EVDs. • •

Since we began monitoring these rates in 2009, our infection rate has dropped by more than 50 percent.

The department met new EVD infection rate goals in 2012 and is establishing new benchmarks for 2013. This year, the committee will also examine nursing rations, length of hospital stay, and readmission rates, as well as collaborate with the Stroke PI committee to devise methods to

Errol Gordon, MD, leads the Neurosurgery Performance Improvement committee, and Nirit Weiss, MD, heads the Quality Assurance committee.

improve the identification and treatment of acute stroke patients. Key goals of the Stroke PI committee are to reduce the length of time required to diagnose and treat an acute stroke patient presenting to the Emergency Department, and to treat all patients eligible to receive tissue plasminogen activator (t-PA) within one hour of presentation to the hospital.

NEW FACES Lan Zhou, MD, PhD, Associate Professor of Neurology, Pathology, and Neurosurgery, who recently joined Mount Sinai as a specialist in neuromuscular medicine, is a National Institutes of Health-funded researcher exploring the molecular mechanisms underlying muscle inflammation and fibrosis associated with muscular dystrophy and acute skeletal muscle injury repair.

Her research is aimed at developing novel pharmacotherapy to modify inflammation, reduce fibrosis, promote regeneration, and improve muscle function and phenotype in patients with muscular dystrophy.

Dr. Zhou opened the Mount Sinai Cutaneous Nerve Laboratory, which is a part of the Mount Sinai Neuromuscular Pathology Laboratory that she directs, to process and interpret skin, nerve, and muscle biopsies to facilitate

the diagnosis and management of neuromuscular diseases. The Cutaneous Nerve Laboratory is one of only a few of its kind in existence, and is used by physicians throughout the United States to help them in their diagnoses of small fiber neuropathy.

After receiving her medical degree at Fudan University Shanghai Medical College and her PhD at the University of Cincinnati, Dr. Zhou did her Neurology residency at Wayne State University and her neuromuscular fellowship at Johns Hopkins University. She spent eight years at the Cleveland Clinic before joining Mount Sinai. Dr. Zhou’s clinical research into small fiber neuropathy and myopathy, and her basic research into muscular dystrophy and skeletal muscle injury repair, have appeared in numerous prestigious journals.

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