Innovate

To create a better tomorrow

VOLUME 2

Innovate DEPARTMENT OF NEUROSURGERY

In This Issue 4

Michigan Medicine: Building a Strong Base and Ensuring a Bold Future David C. Miller, MD, MPH (CEO, Michigan Medicine) & Scott A. Flanders, MD (CCSO, Michigan Medicine)

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Artful Communication and Technical Mastery: Pathways to Clinical Excellence Jody Stern, MD (Clinical Assistant Professor)

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Excellence in Multidisciplinary Care: University of Michigan Health’s Multidisciplinary Pituitary Program Joanna Spencer-Segal, MD, PhD (Assistant Professor) & Todd C. Hollon, MD (Assistant Professor)

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Multidisciplinary Neuro-Spasticity Program: Innovations in Selective Dorsal Rhizotomy Program

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A New Era of Innovation and Excellence in Neurosurgical Patient Care: University of Michigan Health-Sparrow Neurosurgery Michael Karsy, MD (Clinical Assistant Professor), Margaret Dimond, PhD (President, UM Health-Sparrow), et al.

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University of Michigan Health-West Comprehensive Stroke Program: Innovating Stroke Care in West Michigan Augusto E. Elias, MD (Adjunct Professor), Ronald Grifka, MD (President, UM Health-West), et al.

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Munson Medical Center Comprehensive Stroke Program: Taking Rural Stroke Care to the Next Level Gary B. Rajah, MD (Neurosurgeon), Laura Glenn, MHA (COO, Munson Medical Center), et al.

Neena Marupudi, MD, MS (Clinical Associate Professor)

2 | University of Michigan Health Department of Neurosurgery

Innovating Excellence Through Collaboration As Chair of the Department of Neurosurgery at the University of Michigan, I am continually inspired by the dedication and innovative spirit of our faculty, staff, and partners across the state. Our department’s mission is rooted in excellence—serving patients, advancing education, and pushing the boundaries of research. At the heart of this mission is collaboration, which enables us to better serve our communities and patients by transforming patient care, driving innovation, and extending the benefits of neurosurgical excellence throughout Michigan. This issue of Innovate highlights how multidisciplinary collaboration fuels our progress and accelerates the quality of care we provide at both University of Michigan Health-Ann Arbor and throughout the state.

Join the U-M Health Department of Neurosurgery email list and receive the latest updates in patient care, research and innovations. https://michmed.org/8xjXG or scan this QR code:

The first article showcases that effective communication is essential for optimal patient care, and as such, we provide communication courses for all our providers and team members. We then highlight two of our multidisciplinary programs—The Comprehensive Pituitary Program, as well as the Comprehensive Spasticity Program. The final three articles showcase our contributions to enhancing cerebrovascular and neurosurgical care throughout the state of Michigan. Our opportunities to contribute statewide neurosurgical care are a byproduct of the innovative statewide strategies led by Dr. David Miller, Chief Executive Officer for Michigan Medicine, and Dr. Scott Flanders, Chief Clinical Strategy Officer for Michigan Medicine. Drs. Miller and Flanders introduce this Innovate issue with their strategies in contributing to enhancing local clinical care throughout the state of Michigan.

Sincerely, Aditya S. Pandey, MD Julian T. Hoff Professor and Chair Department of Neurosurgery University of Michigan Health

Innovate | Volume 2 | 3

Michigan Medicine:

Building a Strong Base and Ensuring a Bold Future DAVID C. MILLER, MD, MPH, CEO, MICHIGAN MEDICINE & SCOTT A. FLANDERS, MD, CCSO, MICHIGAN MEDICINE

Miller

4 | University of Michigan Health Department of Neurosurgery

Flanders

Our mission statement at Michigan Medicine is to “advance health to serve Michigan and the world.”

That statement is a powerful one that speaks to all aspects of our tripartite mission. Advancing health to serve Michigan recognizes our unique role as a state institution and our commitment to extend our cutting edge clinical capabilities to as much of Michigan as possible through continued growth and partnerships.

Serving the world sounds audacious, but it is an accurate reflection of our world-class undergraduate and graduate training programs producing the next generation of clinicians, educators, scientists, and leaders, as well as our nationally ranked research programs that deliver new therapies and novel approaches to disease prevention, diagnosis, and treatment that truly do serve the world.

Michigan Medicine’s strategic priorities were developed with a goal of maximizing our mission impact and are reflected in our Strong Base, Bold Future framework. Building a strong base includes several priorities specifically focused on addressing and enhancing belonging, access, safety and quality, and experience for our patients, providers, and team members within the medical school, academic medical center, and our regional network that now includes University of Michigan Health-West (UMH-W) and University of Michigan Health-Sparrow (UMH-S).

But more than that, it includes a series of efforts to better integrate and coordinate care across our growing statewide system and expand our clinical delivery system to better meet the needs of our patients, and to do so closer to home within the growing list of communities we now serve.

Innovate | Volume 2 | 5

D. Dan and Betty Kahn Health Care Pavilion in Ann Arbor

As we look to the future, our continued growth will help us provide better access for the patients that need our care and will also support advancements in education and research critical to our mission. This growth will be enabled by new and exciting investments in state of the art facilities, possible because of the generous gifts from many donors, and include new sites of care including the D. Dan and Betty Kahn Health Care Pavilion and the Forbes Sports Medicine Institute (both in Ann Arbor), as well as the Eisenberg Troy Center for Specialty Care, the Forbes Advanced Imaging Center, and the Frankel Cardiovascular Center (all in Troy). Growth will also come in the form of new partnerships and emerging opportunities reflected in our work with other health systems across Michigan. Growth, while necessary, is not sufficient to meet the needs of patients and communities across Michigan. We also need to accelerate innovation and are well positioned to do so through our work with AI, our plans to integrate Epic across all our sites in Michigan, and our commitment to identify and invest in several key clinical and academic programs where we can leverage not just our clinical care capabilities and our statewide network, but our education and research expertise to impact care in Michigan in a way that no other health system can achieve.

Across the tripartite mission, the work of the Department of Neurosurgery directly reflects the goals of Michigan Medicine’s Strong Base, Bold Future framework. This issue of Innovate highlights several key clinical programs that are exemplars of extending advanced clinical capabilities to deliver care closer to home. The expertise of our new neurosurgical team in Lansing has allowed UMH-Sparrow to elevate neurosurgical

6 | University of Michigan Health Department of Neurosurgery

As we look to the future, our continued growth will help us provide better access for the patients that need our care and will also support advancements in education and research critical to our mission.

care capabilities and quality, enabling care closer to home and creating a shining example of the benefits Michigan Medicine can bring to the communities we serve. Similarly, the neurosciences and stroke programs at UMH-West and Munson Healthcare were partnerships that built clinical capabilities and improved outcomes for patients in a way that neither organization could have accomplished alone. The innovative multidisciplinary clinical programs and novel approaches to training and education reflected in this issue demonstrate the unique expertise and capabilities our state looks to us to deliver. And beyond the programs described in this issue, the Department of Neurosurgery delivers countless examples of cutting edge care, such as use of the AI-powered “FastGlioma” technology that significantly reduces the risk of missing residual tumor during glioma resection—a great example of serving as leaders and best. We are grateful for all the efforts, expertise and teamwork reflected on these pages. We are optimistic and confident that, with continued efforts like these across all of Michigan Medicine, we are poised to become one of the most consequential academic health systems in the country.

Go Blue!

David C. Miller, MD, MPH Executive Vice President for Medical Affairs, University of Michigan CEO, Michigan Medicine Scott A. Flanders, MD Chief Clinical Strategy Officer, Michigan Medicine

Innovate | Volume 2 | 7

Artful Communication and Technical Mastery Pathways to Clinical Excellence JODY STERN, MD

Encouraged by Dr. Aditya Pandey and Don Tomford, I returned to Michigan Medicine, University of Michigan, in May 2024 as a Clinical Assistant Professor of Neurosurgery— nearly 30 years after completing my neurosurgery residence in 1996. This Stern followed my multi-decade career in private practice at the Carolina Neurosurgery and Spine Associates in Greensboro, North Carolina.

At U-M Health, I am engaged in three projects aimed at enhancing clinical excellence in neurosurgical practice and education.

Integrating Palliative Care into Neurosurgery

My first project focuses on embedding palliative care into neurosurgical practice by developing communication skills training and clinical integration. Collaborating with palliative care colleagues across the country, such as Jonathan Fischer at Duke, and Laura Taylor and Mike Mendez at U-M, we have developed two novel smallgroup training courses based on the VitalTalk method.

VitalTalk is a structured communication training program for serious illness conversations, initially developed in oncology and palliative care. Known as M Talk at U-M, this program has trained over 1,000 trainees in medicine, family practice, and other disciplines such as OBGYN and anesthesia around the world. However, before these efforts, there was virtually no training provided in any surgical areas, particularly neurosurgery.

These courses, focusing on delivering serious news (DSN) and discussing care goals (GOC), utilize real

neurosurgical cases and actors. The DSN course focuses on providing a clear headline about an illness and responding to emotions empathically rather than cognitively. The GOC course incorporates patient’s values and circumstances into formulating treatment plans.

We began this training with Advanced Practice Providers (see images), receiving positive feedback. Some neurosurgical case scenarios include: (A) Managing an intraoperative aneurysm rupture followed by a medically induced coma with the attendant concerns of uncertain prognosis and addressing an untoward operative event; (B) conducting a clinic visit for a 45- year-old patient who underwent an incomplete brain tumor resection of what was initially believed to be a low-grade neoplasm, but which pathology later revealed to be a glioblastoma; (C) deciding whether to return to the OR to remove a recurrent subdural hematoma in an elderly man who is his wife’s primary caregiver, but who is himself having diminished quality of life.

In February, we extended the training to all neurosurgical residents. By May, neurosurgery faculty attended the DSN course and APPs took GOC. We achieved full departmental engagement by July 2025. The program has been introduced at Duke and will soon be launched at the University of Rochester. Conversations are underway with the University of North Carolina, Stanford, Beth Israel Deaconess in Boston, and The Royal Melbourne Hospital and Alfred Health in Australia, to offer this training to their residents.

This initiative, which builds on a national presentation at the AANS in May 2024, also aligns with the upcoming publication of Palliative Care in Neurosurgical Practice: A Practical Guide to Improving Patient Care. The book

8 | University of Michigan Health Department of Neurosurgery

(Left) Participants modeling a discussion. (Right) M Talk training session in action.

is co-edited by me, Dr. Martina Stippler (Associate Professor of Neurosurgery Harvard Medical School and President-Elect of the Congress of Neurosurgeons), and Dr. Kate Drummond (Chief of Neurosurgery at The Royal Melbourne Hospital). It will be published by Springer in early 2026.

As neurosurgeons, we often deliver serious news and guide patients and their families through life-changing illnesses. Through my experiences, both as a caregiver and a care recipient of neurosurgical care, I have become increasingly passionate about the importance of skilled communication. Just like performing a skillful craniotomy, you can become an expert neurosurgical guide for others through the training and practice of effective communication. These courses provide a safe environment to try out skills, make mistakes, and learn from peers. Becoming a talented communicator is a step on the path towards becoming an exceptional neurosurgeon. These skills foster not only superior patient care but also increase comfort and resilience in helping patients manage challenging circumstances with empathy and compassion.

Revitalizing the Resident Clinic

The second project seeks to rejuvenate the resident clinic experience. Historically, neurosurgery training included significant time in outpatient settings, but changes in duty hours, surgical volume, and supervision have diminished this aspect of training.

Dr. Pandey and I believe that outpatient management of neurosurgical patients is crucial for developing wellrounded neurosurgeons. Initially, I have been educating

interns on assessing patients, conducting neurological examinations, interpreting imaging, and advising patients. Our broader rollout aims to equip residents with these skills throughout their training, ensuring they feel confident in surgical decision-making and patient counseling. Residents are eager to master these skills, and patients desire clarity regarding prior treatments and future options.

Surgical Ergonomics and Surgeon Health

My third project addresses surgical ergonomics for neurosurgeons. This concern arose after an elbow injury forced me to stop operating. While patient safety rightfully takes precedence, little attention is given to the safety, injury prevention, and career longevity of surgeons. Notably, surgical instruments, especially for spinal surgery, are often poorly designed for the surgeons who use them, and don’t take into account the diversity of hand sizes, despite the increasing number of women in neurosurgery. We are examining the forces and positions surgeons adopt during procedures and exploring design modifications to enhance comfort and extend surgeons’ careers, ultimately benefiting the patients.

These projects reflect a broader initiative to create opportunities for seasoned neurosurgeons to contribute to the field innovatively, sharing their expertise, energy, and purpose to benefit patients and trainees. We hope this model, led by Dr. Pandey and Don Tomford, will inspire similar efforts in other settings.

Innovate | Volume 2 | 9

Excellence in Multidisciplinary Care:

University of Michigan Health’s Multidisciplinary Pituitary Program JOANNA SPENCER-SEGAL, MD, PHD AND TODD C. HOLLON, MD

Todd Hollon, MD Neurosurgery

Joanna Spencer-Segal, MD, PhD Endocrinology

David Altshuler, MD Neurosurgery

Farah Daneshvar, DO Endocrinology

Stephanie Roath, PA-C

The Department of Neurosurgery has been the physical home for University of Michigan Health, Michigan Medicine’s Multidisciplinary Pituitary Program since the Program’s founding more than 25 years ago. Currently led by surgical and medical co-directors Todd Hollon, MD and Joanna Spencer-Segal, MD, PhD, the program allows neurosurgeons and endocrinologists to see patients side-by-side in a singular clinical setting, providing efficient co-management in real time to best address patients’ needs. As one of the first such programs in the world, this program quickly became the standard-bearer for multidisciplinary pituitary centers around the country.

The success of our program lies on the contributions and legacy contributions of Drs. William Chandler, Steve Sullivan, and Ariel Barkan who set the foundation for multidisciplinary pituitary care.

and Farah Daneshvar, DO), and Stephanie Roath, PA-C. Surgeries are performed by neurosurgeons, Drs. Hollon and Altshuler, in collaboration with otolaryngologists, Drs. Erin McKean, Amarbir Gil, and Scott McLean. But full care for complex pituitary patients requires an even bigger multidisciplinary team of specialists, which at U-M Health includes endocrinology, neurosurgery, otolaryngology, neuro-ophthalmology, radiation oncology, neuro-oncology, pathology, neuroradiology, and more. A multidisciplinary group comes together once a month for a pituitary conference where most difficult cases are discussed, including malignancies and hormone-secreting tumors. Patient volume is high and continues to expand year after year. In fiscal year 2024, more than 140 patients had pituitary surgery at U-M Health.

Since 2020, the core Pituitary Clinic in neurosurgery has expanded and comprises two neurosurgeons (Todd Hollon, MD and David Altshuler, MD), two endocrinologists (Joanna Spencer-Segal, MD, PhD,

Hormone-secreting pituitary tumors causing acromegaly and Cushing’s disease are some of the most challenging pituitary cases, as the hormone excess can continue or recur after surgery. Our Pituitary Program has a long

10 | University of Michigan Health Department of Neurosurgery

Multidisciplinary Pituitary Team members in February 2025 at the joint meeting in New Orleans, LA.

history of participation and leadership in clinical trials for new pharmacotherapies for hormone-secreting tumors. Dr. Spencer-Segal was site principal investigator for clinical trials for a new formulation of subcutaneous octreotide, CAM2029, for monthly home injection in patients with acromegaly. She was a co-author on the publication of results from the randomized placebocontrolled trial, ACROINNOVA 1 (J Clinical Endocrinology and Metabolism, 2024) and recently presented global results from the open-label ACROINNOVA 2 trial at the European Congress of Endocrinology in Copenhagen, Denmark. The program is also currently participating in three clinical trials for medications for Cushing’s disease.

The program has also recently joined a national effort, the National United States Pituitary Adenoma Registry, led by Cedars-Sinai Medical Center. The goal of this project is to systematically collect data on surgical cases and outcomes across multiple Pituitary Centers of Excellence in the United States and to make this data broadly available to researchers so that the epidemiology and outcome can be better understood.

several of these therapies to benefit patients with aggressive Cushing’s tumors. President McKean gave an outstanding Presidential Address.

Looking to the future, U-M Health envisions the Multidisciplinary Pituitary Program becoming the nation’s preeminent Pituitary Center of Excellence, characterized by expeditious, outstanding, and wellcoordinated multidisciplinary pituitary care, as well as access to the latest therapeutics. Evolving models for the provision of medical care in academic centers around the country have the potential to threaten the success of highly specialized multidisciplinary centers. We owe the continued success of our program to support from the Department of Neurosurgery in partnership with Internal Medicine, as well as the dedication of our many partners in other specialties.

Number of Patients

Between July 1, 2019 and May 21, 2025 by Year 250

224

200

In February 2025 Pituitary Program physicians got the opportunity to showcase and celebrate their achievements at the joint meeting of the North American Skull Base Society and World Federation of Skull Base Societies in New Orleans, LA, with our very own Dr. Eric McKean, MD presiding as President.

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199

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More than 25 presentations were made by U-M Health faculty, including an Honored Guest Lecture by Dr. Karin Muraszko. Dr. Hollon impressed the crowd with his recent work on intraoperative molecular imaging, and Dr. Altshuler reviewed a case series on the surgical approach to cystic craniopharyngiomas. Dr. SpencerSegal gave an update on medical treatments for Cushing’s disease and discussed how we have used

0

Jul. 1–Dec. 31 2019 2020

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2022

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YTD

Patients from July 1, 2019 – May 2025 that have a Dx of Malignant tumor of pituitary gland or Tumor of pituitary and suprasellar region.

Innovate | Volume 2 | 11

Multidisciplinary Neuro-Spasticity Program:

Innovations in Selective Dorsal Rhizotomy Program NEENA MARUPUDI, MD, MS Enhancing pediatric neurosurgical care with innovation and compassion, Dr. Neena Marupudi, MD, MS, Associate Professor of Neurosurgery and Director of the Pediatric Surgical Spasticity and Tone Management Program at the University of Michigan Health C.S. Mott Children’s Hospital, exemplifies how expertise and empathy can profoundly enhance young patients’ lives. Together with her dedicated team, Dr. Marupudi is at the forefront of pioneering advanced surgical treatments tailored for children with cerebral palsy and other movement disorders, offering an approach that goes beyond conventional medical practices by integrating personalized care that is customized to each patient.

Under Dr. Marupudi’s leadership, the team’s innovative work in selective dorsal rhizotomy (SDR) has transformed traditional surgical methods. Historically a more invasive procedure, the SDR procedure offered

at C.S. Mott Children’s Hospital has been meticulously refined to minimize the surgical footprint and preserve spinal integrity. The technique involves the precise targeting of sensory nerve rootlets with minimal to no bone removal, leading to immediate muscle relaxation and optimization of postsurgical functional recovery, specifically early participation in intensive inpatient rehabilitation therapies. This refined approach provides young patients, typically between the ages of three and eight, with both increased comfort and enhanced motor function following surgery.

In addition to SDR and intrathecal baclofen therapy, Dr. Marupudi’s team utilizes customized rhizotomy techniques, such as ventral-dorsal rhizotomy, to improve the care and comfort of patients with complex hypertonicity. Customized “palliative” rhizotomy for patients with more severe forms of cerebral palsy and

Our Surgical Tone Intervention and Rehabilitation (STIR) Multidisciplinary Clinic brings together experts dedicated to improving the care of children with tone and movement disorders.

Pictured here (left to right): Michelle Demarco, OT; Amanda Hughes, PT; Neena Marupudi, Pediatric Neurosurgery; and Angeline Bowman, Pediatric PM&R. Not pictured but integral to the team: Santia Sims and Hanna Ammons (Speech Therapy) and Erika Erlandson (Pediatric PM&R).

12 | University of Michigan Health Department of Neurosurgery

Comprehensive Evaluation Process • Initial Evaluation • Coordinate Surgical Plan with Neurosurgery • Postoperative Care Plan • Long Term Management

• Short Term/Long Term Coordination of Orthopedic Interventions

Rehab

PT/OT

Orthopedics

Neurosurgery

• Initial Evaluation • Preoperative Assessment • Postoperative Care Plan • Long Term Management

• Initial Evaluation • Surgical Intervention • Postoperative Management

Left: Intraoperative illustration of selective dorsal rhizotomy (SDR): sensory nerve rootlets are identified, stimulated with electromyography, and selectively cut to reduce spasticity (illustration by Megan Foldenauer). Right: Diagram illustrating the comprehensive, multidisciplinary evaluation process for patient care, integrating rehabilitation, PT/OT, orthopedics, and neurosurgery across initial assessment, surgical planning, and long-term management.

tone disorders is demonstrating a notable trend towards improving long-term comfort with reduction in the drugrelated and device related complications of intrathecal baclofen therapy. This comprehensive approach addresses complex tone-related disorders and ensures a holistic management plan for each child.

Central to their care model is the Surgical Tone Intervention and Rehabilitation (STIR) Clinic, which Dr. Marupudi helped establish in conjunction with her partner from Physical Medicine & Rehabilitation (PM&R), Dr. Angeline Bowman. This multidisciplinary hub offers a seamless and integrated care environment, bringing together neurosurgery, physical medicine, rehabilitation, and other essential services under one roof. The cohesive approach simplifies care for families, reducing the need for multiple appointments and fostering

collaborative treatment strategies. Our pediatric PM&R and orthopedics teams play crucial roles in the comprehensive management of patients undergoing selective dorsal rhizotomy by facilitating postoperative recovery and optimizing functional outcomes. PM&R specialists focus on designing customized rehabilitation programs that enhance motor skills and support longterm mobility, while orthopedic specialists address any underlying musculoskeletal issues that may affect the efficacy of a surgical intervention.

By leveraging meticulous precision medicine practices, Dr. Marupudi’s team customizes procedures to align with each child’s unique needs and aspirations, drawing families from all over the state of Michigan and around the world to seek their expertise. Such thoughtful and customized care reflects their commitment to unlocking each patient’s full potential, offering significant improvements in quality of life without overreliance on pain medications.

Through these groundbreaking programs, the Department of Neurosurgery is redefining care for children with tone-related and movement disorders, offering improved comfort, functionality, and overall joy while significantly reducing healthcare costs. By establishing new benchmarks in pediatric neurosurgical care, Dr. Marupudi and her team are not only enhancing immediate outcomes but are also creating pathways to brighter futures for children everywhere.

Children at the hospital’s Memorial Day Parade with a sign that reads “Dorsal Rhiz Kids” (i.e., “Whiz Kids”).

Innovate | Volume 2 | 13

A New Era of Innovation and Excellence in Neurosurgical Patient Care

University of Michigan Health-Sparrow Neurosurgery MICHAEL KARSY, MD; NASSER K. YAGHI, MD; OMAR M. QAHWASH, DO; BADIH JUNIOR DAOU, MD; KATIE STONE; AND MARGARET DIMOND, PHD

spine procedures to complex brain tumor surgeries to cerebrovascular and endovascular management, we share the highlights of our journey in serving the Lansing and mid-Michigan region.

Use of UniD Patient-Specific Rods for Deformity Correction

In a major milestone for our spine surgery program, we are using Medtronic UniD patient-specific rods to correct spinal deformities.

In partnership with the Department of Strategy, the Department of Neurosurgery has established a Division of Neurosurgery at the University of Michigan Health-Sparrow in Lansing. This initiative reflects our commitment to delivering high-quality, comprehensive neurosurgical care to the mid-Michigan community. We have recruited four neurosurgeons and partnered with the Michigan State University Department of Neurology to develop a Neuro Care Network aimed at providing neurological and neurosurgical care.

We have also recruited nurse practitioners, medical assistants, and outpatient staff to support the UM Health-Sparrow Neurosurgery Program. From advanced

These custom-designed rods, based on the patient’s unique anatomy, ensure a more precise and effective alignment, leading to quicker recovery and better longterm outcomes for patients suffering from complex spinal deformities. By using custom rods, UM HealthSparrow has been able to provide advancements care.

Expansion of the Minimally Invasive Spine Program

Our minimally invasive spine program has experienced significant growth, offering patients less invasive surgical options with smaller incisions, reduced blood loss, and faster recovery times. This expansion has allowed us to treat a wider range of spine conditions, including degenerative diseases and spinal tumors, using state-ofthe-art techniques that minimize pain and disruption to the patient’s daily life.

14 | University of Michigan Health Department of Neurosurgery

Left to right: Pre- and postoperative images of spinal deformity, patientspecific rods for correction of spine deformity where instrumentation can be optimized prior to surgery, Drs. Nasser Yaghi and Michael Karsy after completion of a UniD custom spine case at UMHSparrow holding the rod design template.

Advancement of Care for Endoscopic Skull Base Cases

In a major leap for our program, we successfully performed a highly specialized procedure that allows for the removal of tumors at the base of the skull with minimal disruption to surrounding tissue.

This technique, which provides unparalleled precision and improved recovery times, has allowed us to treat complex tumors in a way that was not previously possible in our region.

Innovations in Glioma Surgery: Use of Gleolan for Glioma Resection

We are proud to have introduced Gleolan (5-ALA) at UM Health-Sparrow and regionally, a novel fluorescenceguided surgical tool, to aid in the resection of gliomas.

By illuminating tumor cells in real-time, Gleolan improves the precision of the surgeon, ensuring a more complete removal of the tumor while minimizing damage to healthy brain tissue. This groundbreaking technology is a step forward in the treatment of brain cancers, improving survival rates and postoperative recovery.

Use of Leica MyVeo Headset with Augmented Reality in Brain Tumor and Spine Surgery

PREOP

Our program has also integrated the Leica MyVeo headset, an advanced augmented reality technology into our surgical practice. This state-of-the-art device provides real-time, 3D visual overlays during tumor and spine surgeries, enhancing surgical precision and safety.

By superimposing critical information directly onto the surgeon’s view, the Leica MyVeo headset allows for a more efficient, accurate, and safe procedure, especially in complex surgeries where precision is paramount.

Advancement in Neuro-Oncology at Hebert Herman Cancer Center

POSTOP Endoscopic Skull Base Case. (Upper) Preoperative image of tumor. (Lower) Postoperative image with gross total resection of a pituitary macroadenoma with optic nerve compression and visual loss.

We have directly contributed to the formation of the Neuro-Oncology Tumor Board Conference at the UM Health-Sparrow. The multidisciplinary participation from a Neuro-Oncologist from Ann Arbor (Dr. John Fortunato), and participation from medical oncology, radiation oncology, neuropathology, and neuroradiology at the UM Health-Sparrow leads to comprehensive and cuttingedge management of patients with brain tumors. We have initiated review of the patient’s chart by the Clinical

Innovate | Volume 2 | 15

brain tumors, including newly diagnosed glioblastoma, recurrent glioblastoma, and brain metastasis.

Expansion and Growth

As part of our efforts, we have also expanded our team to better meet the needs of our community. We have hired three Advanced Practice Providers, who have enabled us to provide even more comprehensive care to our patients. Our team has also grown to include three MAs, two RNs, a practice coordinator, and two front office secretaries. Additionally, our new clinic space at UM Health-Sparrow in Lansing has been well suited to provide a comfortable and accessible environment for patients to receive care. This state-of-the-art facility enhances our ability to deliver top-tier neurosurgical care to patients in the region, ensuring they have access to the latest treatments and innovative solutions close to home.

From left to right: intraoperative and preoperative images of a glioma resection, Drs. Michael Karsy wearing the Leica MyVeo headset and Nasser Yaghi resecting a brain tumor, 5-ALA/ Gleolan lighting up a tumor pink, post-resection after removal of the brain tumor, MRI showing the preoperative enhancing tumor in the temporal lobe

Trials Nurse from oncology to determine patient eligibility for clinical trials ahead of the Tumor Board meeting. We have also added a Neuro-Oncology Nurse Navigator to help with Tumor Board documentation and coordination of care for neuro-oncology patients. Lastly, we have three open enrolling clinical trials to offer patients with

Through these advancements and expansions, the University of Michigan Health-Sparrow Neurosurgery Department is committed to raising the bar in neurosurgical care, offering our patients in mid-Michigan access to the latest technology and treatments. These efforts not only improve patient outcomes but also position our program as a leader in neurosurgical excellence, delivering hope and a better quality of life to individuals facing neurological challenges in our community. As we look to the future, we remain committed to pushing the boundaries of medical science to provide the best care possible for our patients.

Neurosurgical Procedures and Admissions 200 180 160 140 120 100 80 60 40 20 0

Jun. Jul. Aug. Sept. Oct. Nov. Dec. Jan. Feb. Mar. Apr. May 2024 2024 2024 2024 2024 2024 2024 2025 2025 2025 2025 2025 Invasive Surgeries

Hospital Admissions

Hospitalizations and invasive surgeries performed at UM Health-Sparrow from June 2024 to May 2025.

16 | University of Michigan Health Department of Neurosurgery

University of Michigan Health-West Comprehensive Stroke Program

Innovating Stroke Care in West Michigan FAZEEL M. SIDDIQUI, MD; AUGUSTO E. ELIAS, MD; BRYAN E. FIGUEROA MD; JEFFREY J. FLETCHER, MD; JOHN KELLER, MD; RONALD GRIFKA, MD

A decade ago, stroke patients in West Michigan faced a challenge with minimal access to immediate, specialized stroke care. Many hospitals did not have the capability to provide advanced interventions such as mechanical thrombectomy and neurosurgical procedures, which often necessitated patient transfers to distant facilities, resulting in lost critical time. The University of Michigan Department of Neurosurgery and the Department of Strategy collaborated to develop a comprehensive stroke center at University of Michigan Health-West.

Given the lack of durable programs in West Michigan, this investment in developing a comprehensive stroke center would lead to high quality cerebrovascular and stroke care for patients within the Western Michigan Region. The Departments of Neurosurgery and Strategy collaborated to recruit neurointerventionalists, stroke neurologists, and neurocritical care physicians, strategically expanding the expertise of the Great Lakes Neurosurgical Associates (GLNA) team and strengthening the ability to deliver comprehensive cerebrovascular and stroke care.

Dr. Fazeel Siddiqui is the neurointerventional neurologist at UM Health-West. Dr. Augusto Elias and Dr. Jeffrey Fletcher are Neurointerventional Radiologist and Neurocritical Care physicians who spearheaded the stroke program at UMHW. Dr. Ronald Grifka, previously the CMO and now President of UMHW, was instrumental to make the UMHW stroke program successful. Dr. Bryan Figueroa is the Vascular Neurosurgeon and Dr. John Keller is a Neurosurgeon and the president of GLNA responsible to UMHW stroke program success.

Siddiqui

Elias

Fletcher

Grifka

Figueroa

Keller

Innovate | Volume 2 | 17

Stroke is a major cause of mortality and long-term disability, making rapid treatment crucial for both survival and functional recovery. In response to this critical need, the UM Health-West launched an initiative to establish a comprehensive stroke center (CSC) in West Michigan with the aim of improving regional stroke care. Formerly operating as a primary stroke center, UM Health-West attained CSC certification within a year of its acquisition by Michigan Medicine, the University of Michigan health system. This transformation involved strategic investments, interdisciplinary collaboration, and overcoming logistical and operational challenges.

As a result, the hospital’s capabilities have been significantly enhanced, strengthening stroke care across West Michigan and ensuring that patients receive faster and more effective treatment closer to home.

This achievement was facilitated through investment in skilled physicians and advanced technological resources. UM Health-West recruited two full-time Neurointerventional specialists and a full-time Neurocritical care physician. Another significant milestone was the establishment of a Biplane Angiography catheterization lab, which enables highprecision neurovascular procedures with real-time, high-resolution imaging. Collaboration with GLNA further bolstered the stroke care team, providing 24/7/365 emergency neurosurgical coverage with fellowshiptrained specialists in cerebrovascular surgery.

Emphasizing the development of multidisciplinary teams, UM Health-West fostered seamless collaboration between GLNA and its own stroke and endovascular teams. This combination of a skilled team and a worldclass neurointerventional suite has enhanced the safety and accuracy of thrombectomy procedures, aneurysm coiling, and AVM embolization. Additionally, UM HealthWest further augmented its capabilities with a state-ofthe-art hybrid operating room, allowing for seamless transitions between minimally invasive endovascular procedures and open cerebrovascular surgeries within the same facility. The integration of technological advancements and expert partnerships has positioned UM Health-West as a leader in stroke care, capable of managing even the most complex neurovascular cases.

Previously, patients needed to be transferred to other institutions for these urgent procedures. Now, they receive life-saving care locally, reducing treatment times and improving outcomes. This transformation is also reflected in procedural trends—an upward trajectory in mechanical thrombectomy and aneurysm interventions underscores the program’s growing impact.

18 | University of Michigan Health Department of Neurosurgery

University of Michigan Health West 70

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Total Neurointerventional Cases Mechanical Thrombectomies Cerebral Aneurysms Annual trends in mechanical thrombectomy, cerebral aneurysm treatments, and total neurointerventional volume at UM Health-West. This chart illustrates the rapid growth in advanced stroke interventions, highlighting improved local access and system efficiency.

To improve emergency response and streamline care, UM Health-West implemented an innovative stroke alert system that enhances communication between EMS providers and in-hospital teams. The adoption of Vocera, a secure mobile alert system, allows stroke specialists to be mobilized before the patient arrives at the hospital, resulting in a 47% reduction in door-to-needle time, from 53 minutes to just 28 minutes. Similarly, door-togroin puncture times for thrombectomy were nearly halved, reflecting substantial improvements in response efficiency.

Looking ahead, UM Health-West is committed to further investments in artificial intelligence and advanced imaging to improve stroke detection and decisionmaking. UM Health-West plans to extend telestroke

services to better support rural hospitals and community healthcare providers, ensuring that more patients receive expert stroke care, regardless of their location. Stroke prevention programs will be expanded, integrating lifestyle modification and early detection strategies into our primary care offices, while ongoing research and clinical trials will bring the next generation of stroke treatments to West Michigan.

What began as a vision—to address a critical gap in stroke care—has evolved into a center of excellence, saving lives, reducing disabilities, and setting new standards for stroke treatment. The journey of UM Health-West’s stroke program is a testament to what is possible when dedication, collaboration, and innovation come together to focus on improving patient care.

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Munson Medical Center Comprehensive Stroke Program:

Taking Rural Stroke Care to the Next Level GARY B. RAJAH, MD; DAVID ROSENBAUM-HALEVI, MD; ALEXIS CARROLL, PA; CHRIS PEPLINSKI, BSN, RN, SCRN; LEEDA BASHARDOST, MD; RAMIRO CASTRO-APOLLO, MD; BRENT FLUSTY, DO; THOMAS SCHERMERHORN, MD; LAURA GLENN, MHA

Rajah

Rosenbaum-Halevi

Carroll

Peplinski

Bashardost

Castro-Apollo

Flusty

Schermerhorn

Glenn

20 | University of Michigan Health Department of Neurosurgery

Stroke is the fifth leading cause of death in the United States and the leading cause of disability. Munson Medical Center, in Traverse City, Michigan, has been a longtime rural community hospital, serving nearly 500 stroke patients a year in northern Michigan since 2012. Munson is committed to bringing the community the best care possible and is focused on growing to serve the nearly 1,200 patients per year after the arrival of the Neurovascular Program. In a true spoke and hub fashion, the Medical Center now serves all of northern lower Michigan, including 24 counties and the eastern Upper Peninsula.

(Top Left to Right) Gary B. Rajah, MD, Cerebrovascular/Endovascular Neurosurgeon, Surgical and Interim Medical Director of CSC; David Rosenbaum-Halevi, MD, Stroke Neurology, Neurointerventionalist; Alexis Carroll, PA, Lead Neurovascular PA. (Middle Left to Right) Chris Peplinkski, BSN, RN, SCRN, Stroke Program Manager of CSC; Leeda Bashardost, MD, Neurocritical Care/Stroke Neurology; Ramiro Castro-Apollo, MD, Neurocritical Care/Stroke Neurology; Brent Flusty, DO, Stroke Neurology, Neurointerventionalist; Thomas Schermerhorn, MD, Neurosurgeon, Chief Medical Officer MMC; Laura Glenn, MHSA, Chief Operating Officer, Munson Medical Center

Munson Medical Center Stroke Volumes 1200

1198

1000

1018

800 600 563

873

903

101

99

38 2021

119

105

37

41

43

2022

2023

2024

400 200 0

30 7 2020

Volume — Aneurysm Repair — Thrombectomy Bar graph depicting stroke admission volumes, as well as thrombectomy growth and aneurysm repair volumes since program inception in 2020.

Munson Healthcare has served patients across northern Michigan as a Primary Stroke Center since 2012. In 2015, multiple randomized trials demonstrated the significant benefits of thrombectomy for patients experiencing stroke due to large vessel occlusion. In response to these advancements, strategic planning at the board and administrative levels, as well as capital investments, were initiated in 2018 to bring this lifesaving capability to our region.

This initiative was accelerated through clinical collaboration and partnership with Michigan Medicine— an established partner in numerous clinical, educational, and research efforts, particularly in neurosurgery. The shared goal and vision were to rapidly expand access to thrombectomy services for patients throughout northern Michigan, with point of care services, an undertaking that would be the first for the northern half of the state. As seen in numerous states across the country, metropolitan areas have interventional stroke programs, while this resource is lacking in more rural areas for many reasons—a problem Munson Healthcare worked to solve with its lead physicians and partners.

The Covid Pandemic was a difficult time for all. Starting in 2020 with the addition and leadership of Dr. Rajah (Endovascular Cerebrovascular Neurosurgeon, Director of Stroke Program), Munson Medical Center (part of Munson Healthcare) embarked on a journey to change

stroke care in northern Michigan, with the inception of the Neurovascular Program, which revolutionized stroke algorithms across the system. Two state-ofthe-art Siemens biplanes were added over two years, and our NIR lab was eventually designated a Siemens Center of Excellence. Previously a primary stroke center, our goal was to ensure patients had emergent treatment options and high-level neurovascular care close to home. Recognizing that “time is brain” and that helicopters may have weather related no-fly days, it was imperative for the northern Michigan community to have neurovascular care, in addition to the trauma and cardiac care already being provided locally. By 2023, our Neurovascular Program was a TJC certified comprehensive stroke center (CSC), one of a few in the country in a true rural designated area. Currently, we have added numerous staff, including advanced practice providers, stroke neurologists, rehab personnel, and have created northern Michigan’s only Neuro ICU with fellowship trained neurocritical care physicians.

We train EMS to identify stroke in the field and have taken it a step further and trained the staff to recognize potential large vessel occlusions. With this training, we have decreased our door to treatment times as well as increased the probability of a better outcome. Utilizing AI triage software, patients are triaged in real time across our system, facilitating the best chance for excellent outcomes. Our center also came up with an innovative

Innovate | Volume 2 | 21

fast MRI brain protocol for emergent stroke decision making, which will also come to our triage software in real time along with the CTA/P. We utilize this fastMRI adjunct when further information is needed post CTA/P as in some posterior fossa cases.

to grow Neurosciences at Munson Healthcare; with a stroke program that has made the medical center a true tertiary referral center for the area, we will continue to offer high-quality advanced neurovascular options to our communities.

We now see more than 1,200 stroke patients each year and perform over 100 thrombectomies annually, as well as many other emergent and elective neurovascular open and endovascular procedures. We collaborate closely with our oncology, vascular, and cardiology colleagues as well, allowing multimodal treatment options. We partner with Michigan Medicine for TeleStroke in some of our communities’ hospitals. Our stroke center has worked through our Neuroscience Research department to perform the first of several multicenter studies within the neurovascular field at our institution. In addition, our physicians and surgeons lecture, publish, and participate in ongoing trials and registries pertaining to neurovascular care. We are ever evolving and will utilize this momentum

As the only CSC in northern Michigan, our program continues to hire and post positions. Dr. Brent Flusty (Stroke Neurology/NIR) joined our team in August 2025.

We now offer a stroke neurology clinic for patients within a few weeks post-discharge or during outpatient workups, which is a new outpatient service to ensure patients remain proactive in stroke prevention. Lastly, through generous outreach and philanthropy, our Center was renamed the Witham Family Comprehensive Stroke Program, following a generous multimillion-dollar gift by the Dick Witham Family. CSC certification has strengthened community support and enhanced our ability to recruit and retain high-level professionals for our community.

THE REGENTS OF THE UNIVERSITY OF MICHIGAN Jordan B. Acker Michael J. Behm Mark J. Bernstein Paul W. Brown Sarah Hubbard Denise Ilitch Katherine E. White Domenico Grasso (ex officio) UNIVERSITY OF MICHIGAN HEALTH EXECUTIVE OFFICERS David. C. Miller, MD, MPH, Executive Vice President for Medical Affairs and CEO, Michigan Medicine Steven L. Kunkel, PhD, Chief Scientific Officer, Michigan Medicine and Executive Vice Dean of Research, University of Michigan Medical School Thomas J. Wang, MD, Dean, University of Michigan Medical School and Chief Academic Officer, Michigan Medicine

NONDISCRIMINATION POLICY STATEMENT

DEPARTMENT OF NEUROSURGERY

The University of Michigan, as an equal opportunity/ affirmative action employer, complies with all applicable federal and state laws regarding nondiscrimination and affirmative action. The University of Michigan is committed to a policy of equal opportunity for all persons and does not discriminate on the basis of race, color, national origin, age, marital status, sex, sexual orientation, gender identity, gender expression, disability, religion, height, weight, or veteran status in employment, educational programs and activities, and admissions. Inquiries or complaints may be addressed to the Senior Director for Institutional Equity, and Title IX/Section 504/ADA Coordinator, Office for Institutional Equity, 2072 Administrative Services Building, Ann Arbor, Michigan 481091432, 734-763-0235, TTY 734-647-1388, institutional.equity@umich.edu. For other University of Michigan information call 734-764-1817.

3552 Taubman Health Care Center 1500 E. Medical Center Dr. Ann Arbor, MI 48109-5338

© 2026 Regents of the University of Michigan

22 | University of Michigan Health Department of Neurosurgery

734-936-7010 medschool.umich.edu/departments/ neurosurgery

Department of Neurosurgery 3552 Taubman Health Care Center 1500 E. Medical Center Dr. Ann Arbor, MI 48109-5338 734-936-7010 medschool.umich.edu/departments/neurosurgery

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