Yale Neurosurgery News PROVIDING EXCELLENCE IN BRAIN AND SPINE NEUROSURGERY YALE SCHOOL OF MEDICINE
Yale Welcomes
Message from the Chair
Welcome
to the inaugural issue of the Yale School of Medicine Department of Neurosurgery newsletter. Our goal with this and subsequent newsletters is to keep you abreast of our clinical and research programs, which strive to provide the highest standard of care for our patients by offering the most advanced surgical techniques at state-of-the-art facilities. Our Department is undergoing exciting changes as we continue to expand our clinical offerings, foster relationships with community physicians, and build exceptional clinical and translational research programs to discover new ways of treating neurological diseases. We are also committed to educating some of the best and brightest medical students and resident physicians. In this issue you will meet our newly recruited Clinical Vice Chair, Joseph Cheng, MD, MS, who joins us from Vanderbilt University Medical Center, where he was Director of the Neurosurgery Spine Program. Dr. Cheng is widely recognized for his expertise in complex spine surgery, his work in outcomes research, and his role in shaping national health policy. You will also hear from our Academic Vice Chair, Joseph Piepmeier, MD. Last May, Michael L.J. Apuzzo, MD, PhD (hon), joined our faculty as distinguished Adjunct Professor. Dr. Apuzzo has long been recognized internationally for his important contributions to neurosurgery and medicine in general. A world-renowned authority in the field, he has been and remains an activist in the realm of neurosurgical education and we look forward to him functioning in this capacity at Yale. In July, Kristopher Kahle, MD, PhD, joined our faculty as a pediatric neurosurgeon. He completed his neurosurgery training at the Massachusetts General Hospital and a pediatric neurosurgery fellowship at Boston Children’s Hospital, where he served as an Instructor at Harvard Medical School. In addition to his wide range of surgical expertise, he is widely recognized for his scientific contributions in understanding the developing nervous system. In the months ahead, we will be introducing you more specifically to the wide array of specialized surgery and advanced treatments we provide for all types of neurological disorders, as well as our complementary research programs that are truly on the cutting edge, with our particular expertise in the molecular genomics of brain tumors and other disorders. I am very proud of our Department and the exemplary care we provide to our patients. I look forward to sharing our progress and accomplishments going forward, as well as to collaborating with colleagues across Connecticut and beyond.
Murat Gunel, MD, Chairman and Chief, Department of Neurosurgery Yale School of Medicine and Yale-New Haven Hospital
Vol.1 Issue 1 | Spring 2016
Joseph Cheng, MD, MS The Department of Neurosurgery is delighted to welcome Joseph Cheng, MD, MS, FACS, FAANS, as Clinical Vice Chair beginning January 2016. Dr. Cheng joins Yale from Vanderbilt University School of Medicine, where he was Associate Professor of Neurological Surgery; Director of the Neurosurgery Spine Program; and Co-Director of the Vanderbilt University Spine and Bone Research Laboratory. While at Vanderbilt, Dr. Cheng built a reputation as an expert in complex spinal surgery. Known as “the surgeon’s surgeon,” approximately 70 percent of his referrals originated from other surgeons, who relied on him for revision surgeries or complex cases that were outside their realm of expertise. In the national arena, Dr. Cheng is recognized for spearheading outcomes research in neurosurgery to improve patient care. He is also renowned for his role in guiding national health policy and for creating and refining CPT codes related to neurosurgery to ensure that patients have access to care. At Yale, he hopes to have further opportunities to help shape the direction of neurosurgery and will play a key role in expanding the service lines for neuroscience and musculoskeletal diseases. Early on, he plans to establish a registry continued on page 2
medicine.yale.edu/neurosurgery | Neurosurgery News 1
YALE NEUROSURGERY FACULTY From the Vice Chairs Part of my role in selecting young clinician scientists for our resident training program is to help identify the future leaders of tomorrow and provide them with a training experience that enables them to launch their careers. Our residents, like the faculty who mentor them, are committed to outstanding clinical care, research, and education. They dedicate two years of their training to research in a discipline of their choosing. Whether it is basic laboratory research, obtaining a Master’s degree in Public Health, or pursuing specialized training in conducting clinical trials, we provide them with the resources they need to attain their goals. This support, combined with the infrastructure of the hospital – our operating room suites are second to none – allows us to offer a diverse opportunity for our residents as they train to provide the best possible patient care. My responsibilities also include promoting faculty careers, academic rank, and promotions. Our department has outstanding surgeons and I assist them in sustaining successful careers as surgeons, educators, and scientists.
(continued)
Murat Gunel, MD, FACS, FAHA
Yale Welcomes Joseph Cheng, MD, MS
Clinical Focus: Surgical treatment of aneurysms, vascular malformations, brain tumors, stroke; carotid artery surgery; gamma knife radiosurgery Research Focus: Molecular genetics of intracranial aneurysms and cavernous malformations; genomics of developmental structural brain disorders; genomic basis of brain tumors
Joseph Cheng, MD, MS, FACS, FAANS Vice Chair for Clinical Affairs
Help Us Discover | Be Part of Clinical Research at Yale. While we provide the most current standard of care to all of our patients with the highly specialized and dedicated care of our faculty neurosurgeons, we strive to develop novel approaches to better serve our patients. Research in the Department of Neurosurgery at the Yale School of Medicine covers a broad range of interests, reflecting the diversity of contemporary research. We are honored to be one of the most heavily funded neurosurgery programs in the country. Our programs focus on ultimately translating laboratory results into patient care to further improve patient outcomes. Our research efforts mirror our clinical subspecialties, with a particular international expertise in the molecular genomics of brain tumors and other neurological diseases. For more information, visit: medicine.yale.edu/neurosurgery
2 Neurosurgery News
Clinical Focus: Surgical and endovascular treatment for aneurysms, vascular malformations, skull-based tumors, trigeminal neuralgia, and hemifacial spasm Research Focus: Clinical trials for stroke, aneurysms, and cerebral vasospasm
Veronica Chiang, MD Joseph Cheng, MD, MS Clinical Focus: Complex spine surgery, minimally invasive spine surgery for degenerative spine disease, spinal tumors, and spinal deformities Research Focus: Outcomes research to improve patient care
Joseph Piepmeier, MD Vice Chair for Academic Affairs
As a tertiary referral center, our goal is to help foster care for patients in the community and across the region. We serve as a resource to help treat patients with the most challenging and complex conditions that other excellent hospitals may not have the expertise to handle. We also want to collaborate with surgeons throughout Connecticut on research using population health data to develop treatments that will benefit patients. Together with our colleagues around the state, I believe we can be exemplary stewards of the available health care resources, with the patients as the ultimate beneficiaries. Our doors are open and we hope to build collaborative relationships with the common goal of improving people’s lives.
Ketan Bulsara, MD
Joseph Piepmeier, MD for the Department. “Our ability to collect data and demonstrate our outcomes on a population level is important,” he said, adding that he hopes to foster multicenter clinical trials to determine if interventions can be practically applied at other centers. He is enthusiastic about utilizing Yale’s informatics infrastructure – which integrates enterprise-wide electronic health record and clinical research management systems – for data collection and analysis. “Yale has the institutional commitment and support required to establish such a robust infrastructure, so I won’t need to reinvent the wheel,” he said. Dr. Cheng is also a respected mentor and teacher, who is committed to providing a level of training to residents and fellows that goes above and beyond the knowledge and skill base offered elsewhere. “Training residents is the heart and soul of our academic program,” he said. He looks forward to contributing to the high level of training offered at Yale to ensure that doors open for young neurosurgeons.
Clinical Focus: Advanced surgery for all types of brain and skull-based tumors (i.e. meningiomas, gliomas, acoustic neuromas); gamma knife radiosurgery
Clinical Focus: Surgery and gamma knife radiosurgery for brain metastases; laser thermal ablation Research Focus: Clinical outcomes in patients with metastatic brain tumors; imaging changes following stereotactic radiosurgery for brain tumors
Nihal DeLanerolle, DPhil, DSc Research Focus: Epilepsy, seizures, traumatic brain injury
Research Focus: Convection enhanced delivery for brain tumors, nanoparticles
Michael DiLuna, MD Khalid Abbed, MD Clinical Focus: Minimally invasive spine surgery, spine tumor surgery Research Focus: Clinical trials for spinal cord injuries, radiculopathy, spinal fusion, and minimally invasive surgical procedures
Michael Apuzzo, MD, PhD (hon)
Clinical Focus: All aspects of pediatric neurosurgery (i.e. brain and spine tumors, hydrocephalus, epilepsy, dysraphism, scoliosis, Chiari malformations, craniofacial disorders) Research Focus: Clinical trials for pediatric neurosurgery
Charles Duncan, MD
Clinical Focus: Disorders and surgery of the
Clinical Focus: Hydrocephalus, craniofacial disorders
cerebrum
Research Focus: Adaptations of the developing brain to injury
Research Focus: Minimally invasive therapeutic techniques and functional restoration
Angelique Bordey, PhD Research Focus: Understanding cortical development and malformation-related neurological disorders
Jason Gerrard, MD, PhD Clinical Focus: Epilepsy and movement disorders (i.e. Parkinson’s, Essential Tremor), and spasticity, deep brain stimulation (DBS), stereotactic neurosurgery; gamma knife radiosurgery Research Focus: Neural network functions and malfunctions that underlie epileptogenesis and movement disorders Neurosurgery News 3
YALE NEUROSURGERY FACULTY From the Vice Chairs Part of my role in selecting young clinician scientists for our resident training program is to help identify the future leaders of tomorrow and provide them with a training experience that enables them to launch their careers. Our residents, like the faculty who mentor them, are committed to outstanding clinical care, research, and education. They dedicate two years of their training to research in a discipline of their choosing. Whether it is basic laboratory research, obtaining a Master’s degree in Public Health, or pursuing specialized training in conducting clinical trials, we provide them with the resources they need to attain their goals. This support, combined with the infrastructure of the hospital – our operating room suites are second to none – allows us to offer a diverse opportunity for our residents as they train to provide the best possible patient care. My responsibilities also include promoting faculty careers, academic rank, and promotions. Our department has outstanding surgeons and I assist them in sustaining successful careers as surgeons, educators, and scientists.
(continued)
Murat Gunel, MD, FACS, FAHA
Yale Welcomes Joseph Cheng, MD, MS
Clinical Focus: Surgical treatment of aneurysms, vascular malformations, brain tumors, stroke; carotid artery surgery; gamma knife radiosurgery Research Focus: Molecular genetics of intracranial aneurysms and cavernous malformations; genomics of developmental structural brain disorders; genomic basis of brain tumors
Joseph Cheng, MD, MS, FACS, FAANS Vice Chair for Clinical Affairs
Help Us Discover | Be Part of Clinical Research at Yale. While we provide the most current standard of care to all of our patients with the highly specialized and dedicated care of our faculty neurosurgeons, we strive to develop novel approaches to better serve our patients. Research in the Department of Neurosurgery at the Yale School of Medicine covers a broad range of interests, reflecting the diversity of contemporary research. We are honored to be one of the most heavily funded neurosurgery programs in the country. Our programs focus on ultimately translating laboratory results into patient care to further improve patient outcomes. Our research efforts mirror our clinical subspecialties, with a particular international expertise in the molecular genomics of brain tumors and other neurological diseases. For more information, visit: medicine.yale.edu/neurosurgery
2 Neurosurgery News
Clinical Focus: Surgical and endovascular treatment for aneurysms, vascular malformations, skull-based tumors, trigeminal neuralgia, and hemifacial spasm Research Focus: Clinical trials for stroke, aneurysms, and cerebral vasospasm
Veronica Chiang, MD Joseph Cheng, MD, MS Clinical Focus: Complex spine surgery, minimally invasive spine surgery for degenerative spine disease, spinal tumors, and spinal deformities Research Focus: Outcomes research to improve patient care
Joseph Piepmeier, MD Vice Chair for Academic Affairs
As a tertiary referral center, our goal is to help foster care for patients in the community and across the region. We serve as a resource to help treat patients with the most challenging and complex conditions that other excellent hospitals may not have the expertise to handle. We also want to collaborate with surgeons throughout Connecticut on research using population health data to develop treatments that will benefit patients. Together with our colleagues around the state, I believe we can be exemplary stewards of the available health care resources, with the patients as the ultimate beneficiaries. Our doors are open and we hope to build collaborative relationships with the common goal of improving people’s lives.
Ketan Bulsara, MD
Joseph Piepmeier, MD for the Department. “Our ability to collect data and demonstrate our outcomes on a population level is important,” he said, adding that he hopes to foster multicenter clinical trials to determine if interventions can be practically applied at other centers. He is enthusiastic about utilizing Yale’s informatics infrastructure – which integrates enterprise-wide electronic health record and clinical research management systems – for data collection and analysis. “Yale has the institutional commitment and support required to establish such a robust infrastructure, so I won’t need to reinvent the wheel,” he said. Dr. Cheng is also a respected mentor and teacher, who is committed to providing a level of training to residents and fellows that goes above and beyond the knowledge and skill base offered elsewhere. “Training residents is the heart and soul of our academic program,” he said. He looks forward to contributing to the high level of training offered at Yale to ensure that doors open for young neurosurgeons.
Clinical Focus: Advanced surgery for all types of brain and skull-based tumors (i.e. meningiomas, gliomas, acoustic neuromas); gamma knife radiosurgery
Clinical Focus: Surgery and gamma knife radiosurgery for brain metastases; laser thermal ablation Research Focus: Clinical outcomes in patients with metastatic brain tumors; imaging changes following stereotactic radiosurgery for brain tumors
Nihal DeLanerolle, DPhil, DSc Research Focus: Epilepsy, seizures, traumatic brain injury
Research Focus: Convection enhanced delivery for brain tumors, nanoparticles
Michael DiLuna, MD Khalid Abbed, MD Clinical Focus: Minimally invasive spine surgery, spine tumor surgery Research Focus: Clinical trials for spinal cord injuries, radiculopathy, spinal fusion, and minimally invasive surgical procedures
Michael Apuzzo, MD, PhD (hon)
Clinical Focus: All aspects of pediatric neurosurgery (i.e. brain and spine tumors, hydrocephalus, epilepsy, dysraphism, scoliosis, Chiari malformations, craniofacial disorders) Research Focus: Clinical trials for pediatric neurosurgery
Charles Duncan, MD
Clinical Focus: Disorders and surgery of the
Clinical Focus: Hydrocephalus, craniofacial disorders
cerebrum
Research Focus: Adaptations of the developing brain to injury
Research Focus: Minimally invasive therapeutic techniques and functional restoration
Angelique Bordey, PhD Research Focus: Understanding cortical development and malformation-related neurological disorders
Jason Gerrard, MD, PhD Clinical Focus: Epilepsy and movement disorders (i.e. Parkinson’s, Essential Tremor), and spasticity, deep brain stimulation (DBS), stereotactic neurosurgery; gamma knife radiosurgery Research Focus: Neural network functions and malfunctions that underlie epileptogenesis and movement disorders Neurosurgery News 3
YALE NEUROSURGERY FACULTY Charles Greer, PhD
Jennifer Moliterno, MD
Research Focus: Axons and dendritic segregation differentiation in the olfactory system during development and degradation during aging
Clinical Focus: Advanced surgery for all types of brain and skull-based tumors (i.e. meningiomas, gliomas, acoustic neuromas), trigeminal neuralgia and hemifacial spasm, Chiari malformations; gamma knife radiosurgery Research Focus: Clinical trials and personalized medicine for brain tumor patients
Kristopher Kahle, MD, PhD Clinical Focus: All aspects of pediatric neurosurgery (i.e. brain and spine tumors, hydrocephalus, epilepsy, dysraphism, scoliosis, Chiari malformations, craniofacial disorders) Research Focus: Identifying genes and pathways that regulate ionic plasticity in the developing nervous system; how changes in these processes contribute to neurodevelopmental disorders
Joseph King, Jr., MD Clinical Focus: VA Hospital Neurosurgery
Clinical Focus: Minimally invasive spine surgery, spine tumor surgery Research Focus: Health care delivery, outcomes, new technologies
Angeliki Louvi, PhD
With almost 40 years of experience in the surgical treatment of epilepsy, the Yale Epilepsy Program has been
Clinical Focus: Spine surgery, minimally invasive spine surgery
instrumental in developing many of today’s widely practiced surgical procedures, including the medial temporal
epilepsy surgery and leads the way with cutting edge therapies when surgical resection is not possible or poses risk to neurological function. These include neuromodulation, with stimulation devices such as NeuroPace,
Dennis Spencer, MD Research Focus: Glutamate metabolism and neurobiological study of human epiletogenic tissue
Neurosurgical Oncology The Yale Brain Tumor Surgical Program and the Neurosurgical Oncology Program are part of an interdisciplinary
Patrick Tomak, MD
team of experts that offers highly specialized, personalized care for patients with brain tumors. Our surgeons
Clinical Focus: Spinal tumors, vascular malformations, and rheumatoid disorders; lateral minimally invasive spine surgery; Chiari malformations; Transnasal endoscopic surgery for pituitary and skull-based tumors
are dedicated solely to performing complex brain tumor surgery for patients with all types of brain tumors,
Research Focus: Bioengineering of surgical instrumentation
mapping, allowing our surgeons to achieve more successful, safer surgery. Yale is one of the few centers capable
Anthony Van den Pol, PhD Research Focus: Mechanisms of action of hypothalamic peptides and amino acid transmitters; neurovirology
4 Neurosurgery News
both benign (such as meningiomas, acoustic neuromas) and malignant (i.e. gliobastomas). The state-of-the-art neurosurgical operating rooms in Smilow Cancer Hospital at Yale-New Haven are the only ones in the region to offer intraoperative MRI, intraoperative angiography, stereotactic surgical guidance, and operative brain of offering personalized oncologic care, when appropriate, based on the genetic make-up as determined by next generation exome sequencing (all protein coding regions of the genome) of the individual’s tumor. Yale brain tumor surgeons maintain a close working relationship with physicians practicing in the community and readily accommodate referrals and second opinions.
Neurovascular Surgery Clinical Focus: Brain Neuronavigation
Research Focus: Clinical trials for stroke, aneurysm and carotid revascularization; advanced imaging of cerebrovascular disease
responsive stimulation, Vagal Nerve Stimulation, and minimally invasive therapies such as laser ablation.
Clinical Focus: Surgery for epilepsy, pituitary tumors
Kun Wu, MD, PhD
Clinical Focus: Surgery and endovascular treatment of vascular disorders of the brain and spinal cord (i.e. aneurysms, vascular malformations); carotid artery surgery and stenting; Adult-onset (Normal Pressure) Hydrocephalus
lobe resection, corpus callosotomy, and intraoperative or extraoperative mapping of the primary functions of the cortex. Collectively this team brings more experience than almost any other program in the world in
Research Focus: Molecular and cellular mechanisms underlying neurodevelopmental disorders
Charles Matouk, MD
Epilepsy Surgery
Debra Petrucci, MD
Research Focus: Health care system, outcomes, quality of life
Maxwell Laurans, MD
SURGICAL SERVICES
Research Focus: Image-guided transcranial magnetic stimulation in patients with neuropsychiatric disorders
The Neurovascular Surgical Program has expert clinicians who specialize in the management of all brain and spinal cord vascular disorders using various therapeutic strategies, including surgery, minimally invasive endovascular interventional treatments, such as state-of-the-art flow diverting devices (such as Pipeline), stereotactic radiation (Gamma Knife radiosurgery), and rehabilitation. Yale is home to Connecticut’s first Tele-Stroke Program, so that life-saving therapies for acute stroke can be initiated at a referring hospital prior to transfer to Yale-New Haven Hospital. SkyHealth, an emergency patient transport helicopter, ensures that life-saving interventions are delivered en route to Yale-New Haven Hospital. The state-of-the-art VISIUS Surgical
Jiangbing Zhou, PhD
Theater is equipped with a ceiling-mounted, 3-Tesla MRI, and an integrated, bi-plane x-ray angiography system.
Research Focus: Translational nanomedicine and stem cell therapy for brain tumors
The ability to perform pre-operative diagnostic imaging, open micro-surgery, percutaneous, catheter-based endovascular treatments, and post-operative checks all in the same room is unique in the tri-state area and a model system in North America and the world.
Neurosurgery News 5
YALE NEUROSURGERY FACULTY Charles Greer, PhD
Jennifer Moliterno, MD
Research Focus: Axons and dendritic segregation differentiation in the olfactory system during development and degradation during aging
Clinical Focus: Advanced surgery for all types of brain and skull-based tumors (i.e. meningiomas, gliomas, acoustic neuromas), trigeminal neuralgia and hemifacial spasm, Chiari malformations; gamma knife radiosurgery Research Focus: Clinical trials and personalized medicine for brain tumor patients
Kristopher Kahle, MD, PhD Clinical Focus: All aspects of pediatric neurosurgery (i.e. brain and spine tumors, hydrocephalus, epilepsy, dysraphism, scoliosis, Chiari malformations, craniofacial disorders) Research Focus: Identifying genes and pathways that regulate ionic plasticity in the developing nervous system; how changes in these processes contribute to neurodevelopmental disorders
Joseph King, Jr., MD Clinical Focus: VA Hospital Neurosurgery
Clinical Focus: Minimally invasive spine surgery, spine tumor surgery Research Focus: Health care delivery, outcomes, new technologies
Angeliki Louvi, PhD
With almost 40 years of experience in the surgical treatment of epilepsy, the Yale Epilepsy Program has been
Clinical Focus: Spine surgery, minimally invasive spine surgery
instrumental in developing many of today’s widely practiced surgical procedures, including the medial temporal
epilepsy surgery and leads the way with cutting edge therapies when surgical resection is not possible or poses risk to neurological function. These include neuromodulation, with stimulation devices such as NeuroPace,
Dennis Spencer, MD Research Focus: Glutamate metabolism and neurobiological study of human epiletogenic tissue
Neurosurgical Oncology The Yale Brain Tumor Surgical Program and the Neurosurgical Oncology Program are part of an interdisciplinary
Patrick Tomak, MD
team of experts that offers highly specialized, personalized care for patients with brain tumors. Our surgeons
Clinical Focus: Spinal tumors, vascular malformations, and rheumatoid disorders; lateral minimally invasive spine surgery; Chiari malformations; Transnasal endoscopic surgery for pituitary and skull-based tumors
are dedicated solely to performing complex brain tumor surgery for patients with all types of brain tumors,
Research Focus: Bioengineering of surgical instrumentation
mapping, allowing our surgeons to achieve more successful, safer surgery. Yale is one of the few centers capable
Anthony Van den Pol, PhD Research Focus: Mechanisms of action of hypothalamic peptides and amino acid transmitters; neurovirology
4 Neurosurgery News
both benign (such as meningiomas, acoustic neuromas) and malignant (i.e. gliobastomas). The state-of-the-art neurosurgical operating rooms in Smilow Cancer Hospital at Yale-New Haven are the only ones in the region to offer intraoperative MRI, intraoperative angiography, stereotactic surgical guidance, and operative brain of offering personalized oncologic care, when appropriate, based on the genetic make-up as determined by next generation exome sequencing (all protein coding regions of the genome) of the individual’s tumor. Yale brain tumor surgeons maintain a close working relationship with physicians practicing in the community and readily accommodate referrals and second opinions.
Neurovascular Surgery Clinical Focus: Brain Neuronavigation
Research Focus: Clinical trials for stroke, aneurysm and carotid revascularization; advanced imaging of cerebrovascular disease
responsive stimulation, Vagal Nerve Stimulation, and minimally invasive therapies such as laser ablation.
Clinical Focus: Surgery for epilepsy, pituitary tumors
Kun Wu, MD, PhD
Clinical Focus: Surgery and endovascular treatment of vascular disorders of the brain and spinal cord (i.e. aneurysms, vascular malformations); carotid artery surgery and stenting; Adult-onset (Normal Pressure) Hydrocephalus
lobe resection, corpus callosotomy, and intraoperative or extraoperative mapping of the primary functions of the cortex. Collectively this team brings more experience than almost any other program in the world in
Research Focus: Molecular and cellular mechanisms underlying neurodevelopmental disorders
Charles Matouk, MD
Epilepsy Surgery
Debra Petrucci, MD
Research Focus: Health care system, outcomes, quality of life
Maxwell Laurans, MD
SURGICAL SERVICES
Research Focus: Image-guided transcranial magnetic stimulation in patients with neuropsychiatric disorders
The Neurovascular Surgical Program has expert clinicians who specialize in the management of all brain and spinal cord vascular disorders using various therapeutic strategies, including surgery, minimally invasive endovascular interventional treatments, such as state-of-the-art flow diverting devices (such as Pipeline), stereotactic radiation (Gamma Knife radiosurgery), and rehabilitation. Yale is home to Connecticut’s first Tele-Stroke Program, so that life-saving therapies for acute stroke can be initiated at a referring hospital prior to transfer to Yale-New Haven Hospital. SkyHealth, an emergency patient transport helicopter, ensures that life-saving interventions are delivered en route to Yale-New Haven Hospital. The state-of-the-art VISIUS Surgical
Jiangbing Zhou, PhD
Theater is equipped with a ceiling-mounted, 3-Tesla MRI, and an integrated, bi-plane x-ray angiography system.
Research Focus: Translational nanomedicine and stem cell therapy for brain tumors
The ability to perform pre-operative diagnostic imaging, open micro-surgery, percutaneous, catheter-based endovascular treatments, and post-operative checks all in the same room is unique in the tri-state area and a model system in North America and the world.
Neurosurgery News 5
SURGICAL SERVICES (continued)
SPECIALIZED TREATMENTS
Spine and Peripheral Nerve Surgery
Gamma Knife Sterotactive Radiosurgery
Patients with pain and debilitation secondary to acute or chronic spinal disease can benefit from the advanced,
The Yale New Haven Gamma Knife Program is the first and most experienced radiosurgery unit in Connecticut
personalized care available at the Department of Neurosurgery’s Spine Institute at Yale. All patients referred to Yale
dedicated to the treatment of head and neck conditions. Staffed by a team of specialists with more than 30 years
benefit from the multi-disciplinary team approach that is an essential feature of our practice. Advanced, minimally
of cumulative radiosurgery experience, treatment at our center results in predictable and nationally recognized
invasive outpatient or one-day surgical procedures, including vertebroplasty and disk electrocauterization,
outcomes. While the majority of our patients are adults, we also treat many pediatric patients. The Gamma
are available for appropriate surgical candidates. Our surgeons also specialize in more complex spinal surgery,
Knife allows radiation to be precisely delivered to the designated target while sparing the surrounding tissues.
including spinal reconstructions and such leading edge techniques as discography, which allows the surgeon
Complex shaped lesions can be treated by combining varying-sized collimators with selected beam blocking
to track electrical activity within the spine with exceptional precision to localize the site of injuries.
and dose weighting using sophisticated computer planning software. This ensures that each patient’s lesion(s) receive a tightly conformed “tailored” treatment plan.
Functional Neurosurgery The Yale Functional Neurosurgical Program within the Yale Neuromodulation Center encompasses advanced surgical treatment of movement disorders (i.e. Parkinson’s Disease), spasticity, epilepsy, neuropsychiatric disordes, and intractable pain (i.e. Trigeminal Neuralgia). The Yale Deep Brain Stimulation Center at Yale-New Haven Hospital is the only center in the tri-state area that has the capabilities of performing all types of DBS implantation surgery, including asleep, frame based or frameless DBS. Our one of a kind – IMRIS MRI/OR Suite provides the accuracy of a 3T MRI in the operating room. In patients who suffer from severe spasticity secondary to spinal cord injuries, progressive neurological degenerative disorders, or birth defects, a program for the surgical management of spasticity is in place. A trial of intrathecal baclofen is commonly performed. The ability to deliver a drug directly to the subarachnoid space using a programmable pump has resulted in dramatic improvements in the patients’ spasticity, frequently resulting in improved wound healing and a decrease in the frequency of subsequent hospitalizations and
Precision Medicine for Brain Tumor Patients Next Generation Sequencing (NGS) technologies now allow for the rapid and accurate understanding of the molecular make-up of individual tumors, identifying driver mutations that play a significant role in the formation, growth, and spread of tumors. In 2009, Yale was one of two centers to invent exome sequencing, which allows for genome-wide search and identification of protein altering variations in tumors. Exome sequencing, hailed as one of the top 10 scientific discoveries of the year in 2010 by Science magazine, is routinely performed at Yale’s Center for Genome Analysis. Dr. Murat Gunel and his team have successfully applied exome sequencing and other cutting edge NGS technologies in the discovery of new brain tumor genes, and more recently in creating a paradigm applicable to day-to-day clinical patient care, making more personalized and precise oncological care a reality.
need for medication. Patients with complex pain disorders refractory to medication present a special challenge to the medical community requiring the resources of a multi-disciplinary team. At Yale, the latest therapeutic options are utilized for treatment of such pain syndromes as Trigeminal Neuralgia and Chronic Facial Pain when appropriate. Procedures include spinal cord or brain stimulation, rhizotomy, and thalamotomy. More recently, the Gamma Knife has been utilized for lesional treatments for Trigeminal Neuralgia.
Introducing Michael L.J. Apuzzo, MD, PhD (hon) Last May, we welcomed Dr. Michael L.J. Apuzzo to our faculty as distinguished Adjunct Professor. Dr. Apuzzo, a native of New Haven, is known for changing the field of neurosurgery. Prior to joining Yale, he served as the Edwin M. Todd/Trent H. Wells, Jr. Professor of Neurological Surgery and Radiation
Pediatric Neurosurgery For more than 25 years, Yale has had a dedicated pediatric neurosurgery program for children and adolescents ranging from infants to young adults. Common problems treated include concussion, hydrocephalus, brain and spinal cord tumors, spina bifida, craniofacial disorders, vascular abnormalities, Chiari malformations, and brain or spine trauma. Excellence in pediatric neurosurgery at Yale is possible because of experienced, refined surgical skills and the critical resources of a major Children’s Hospital with dedicated pediatric critical care, specialized age appropriate nursing units, a wide array of pediatric consultants, and operating facilities designed for children.
6 Neurosurgery News
Oncology, Biology, and Physics at the University of Southern California Keck School of Medicine in Los Angeles, having been on the faculty since 1973. He additionally served as Director of Neurosurgery at the Kenneth Norris, Jr. Cancer Hospital and Research Institute and Director of the Center for Stereotactic Neurosurgery and Associated Research at the institution, as well as Director of the Gamma Unit Facility at the USC University Hospital, and Neurosurgical Director of the Norris CyberKnife Facility. The recipient of numerous awards and with over 750 peer-reviewed publications, Dr. Apuzzo has successfully served as the Editor-in-Chief for two of the leading Neurosurgery journals. He has been and remains an advocate within the realm of education and we are delighted that he has joined our Department.
Neurosurgery News 7
SURGICAL SERVICES (continued)
SPECIALIZED TREATMENTS
Spine and Peripheral Nerve Surgery
Gamma Knife Sterotactive Radiosurgery
Patients with pain and debilitation secondary to acute or chronic spinal disease can benefit from the advanced,
The Yale New Haven Gamma Knife Program is the first and most experienced radiosurgery unit in Connecticut
personalized care available at the Department of Neurosurgery’s Spine Institute at Yale. All patients referred to Yale
dedicated to the treatment of head and neck conditions. Staffed by a team of specialists with more than 30 years
benefit from the multi-disciplinary team approach that is an essential feature of our practice. Advanced, minimally
of cumulative radiosurgery experience, treatment at our center results in predictable and nationally recognized
invasive outpatient or one-day surgical procedures, including vertebroplasty and disk electrocauterization,
outcomes. While the majority of our patients are adults, we also treat many pediatric patients. The Gamma
are available for appropriate surgical candidates. Our surgeons also specialize in more complex spinal surgery,
Knife allows radiation to be precisely delivered to the designated target while sparing the surrounding tissues.
including spinal reconstructions and such leading edge techniques as discography, which allows the surgeon
Complex shaped lesions can be treated by combining varying-sized collimators with selected beam blocking
to track electrical activity within the spine with exceptional precision to localize the site of injuries.
and dose weighting using sophisticated computer planning software. This ensures that each patient’s lesion(s) receive a tightly conformed “tailored” treatment plan.
Functional Neurosurgery The Yale Functional Neurosurgical Program within the Yale Neuromodulation Center encompasses advanced surgical treatment of movement disorders (i.e. Parkinson’s Disease), spasticity, epilepsy, neuropsychiatric disordes, and intractable pain (i.e. Trigeminal Neuralgia). The Yale Deep Brain Stimulation Center at Yale-New Haven Hospital is the only center in the tri-state area that has the capabilities of performing all types of DBS implantation surgery, including asleep, frame based or frameless DBS. Our one of a kind – IMRIS MRI/OR Suite provides the accuracy of a 3T MRI in the operating room. In patients who suffer from severe spasticity secondary to spinal cord injuries, progressive neurological degenerative disorders, or birth defects, a program for the surgical management of spasticity is in place. A trial of intrathecal baclofen is commonly performed. The ability to deliver a drug directly to the subarachnoid space using a programmable pump has resulted in dramatic improvements in the patients’ spasticity, frequently resulting in improved wound healing and a decrease in the frequency of subsequent hospitalizations and
Precision Medicine for Brain Tumor Patients Next Generation Sequencing (NGS) technologies now allow for the rapid and accurate understanding of the molecular make-up of individual tumors, identifying driver mutations that play a significant role in the formation, growth, and spread of tumors. In 2009, Yale was one of two centers to invent exome sequencing, which allows for genome-wide search and identification of protein altering variations in tumors. Exome sequencing, hailed as one of the top 10 scientific discoveries of the year in 2010 by Science magazine, is routinely performed at Yale’s Center for Genome Analysis. Dr. Murat Gunel and his team have successfully applied exome sequencing and other cutting edge NGS technologies in the discovery of new brain tumor genes, and more recently in creating a paradigm applicable to day-to-day clinical patient care, making more personalized and precise oncological care a reality.
need for medication. Patients with complex pain disorders refractory to medication present a special challenge to the medical community requiring the resources of a multi-disciplinary team. At Yale, the latest therapeutic options are utilized for treatment of such pain syndromes as Trigeminal Neuralgia and Chronic Facial Pain when appropriate. Procedures include spinal cord or brain stimulation, rhizotomy, and thalamotomy. More recently, the Gamma Knife has been utilized for lesional treatments for Trigeminal Neuralgia.
Introducing Michael L.J. Apuzzo, MD, PhD (hon) Last May, we welcomed Dr. Michael L.J. Apuzzo to our faculty as distinguished Adjunct Professor. Dr. Apuzzo, a native of New Haven, is known for changing the field of neurosurgery. Prior to joining Yale, he served as the Edwin M. Todd/Trent H. Wells, Jr. Professor of Neurological Surgery and Radiation
Pediatric Neurosurgery For more than 25 years, Yale has had a dedicated pediatric neurosurgery program for children and adolescents ranging from infants to young adults. Common problems treated include concussion, hydrocephalus, brain and spinal cord tumors, spina bifida, craniofacial disorders, vascular abnormalities, Chiari malformations, and brain or spine trauma. Excellence in pediatric neurosurgery at Yale is possible because of experienced, refined surgical skills and the critical resources of a major Children’s Hospital with dedicated pediatric critical care, specialized age appropriate nursing units, a wide array of pediatric consultants, and operating facilities designed for children.
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Oncology, Biology, and Physics at the University of Southern California Keck School of Medicine in Los Angeles, having been on the faculty since 1973. He additionally served as Director of Neurosurgery at the Kenneth Norris, Jr. Cancer Hospital and Research Institute and Director of the Center for Stereotactic Neurosurgery and Associated Research at the institution, as well as Director of the Gamma Unit Facility at the USC University Hospital, and Neurosurgical Director of the Norris CyberKnife Facility. The recipient of numerous awards and with over 750 peer-reviewed publications, Dr. Apuzzo has successfully served as the Editor-in-Chief for two of the leading Neurosurgery journals. He has been and remains an advocate within the realm of education and we are delighted that he has joined our Department.
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YALE DEPARTMENT OF NEUROSURGERY ACTIVE CLINICAL TRIALS AANS and ASTRO Stereotactic Radiosurgery Registry (SRS Registry) Dr. Veronica Chiang | veronica.chiang@yale.edu ASTROHÂ Aneurysmal Subarachnoid Hemorrhage Trial RandOmizing Heparin Dr. Charles Matouk | charles.matouk@yale.edu The CONFIDENCE Trial: A Carotid Stent Study Dr. Charles Matouk | charles.matouk@yale.edu Genetic Studies of Abnormal Nervous System Vasculature, Development, Tumors, and Migraine Dr. Murat Gunel | murat.gunel@yale.edu IMRIS Multi-center I MRI Neurosurgery Database (I-MiND) Dr. Jennifer Moliterno | jennifer.moliternogunel@yale.edu LAASR: Laser Ablation After Stereotactic Radiosurgery Dr. Veronica Chiang | veronica.chiang@yale.edu Neuroblate Retro Registry (LAISE) Dr. Veronica Chiang | veronica.chiang@yale.edu Park-Reeves Posterior Fossa Decompression with or without Duraplasty for Chiari Type I Malformation with Syringomyelia Dr. Michael DiLuna | michael.diluna@yale.edu Responsive Neurostimulator (RNS) System Long Term Treatment Clinical Investigation Dr. Brad Duckrow | robert.duckrow@yale.edu Retinoblastoma pilot study ARET12P1 Dr. Ketan Bulsara | ketan.bulsara@yale.edu Systematic Evaluation of Patients Treated with Neurothrombectomy Devices for Acute Ischemic Stroke Registry (STRATIS Registry) Dr. Charles Matouk | charles.matouk@yale.edu Trevo Retriever Registry Dr. Ketan Bulsara | ketan.bulsara@yale.edu
PROVIDING EXCELLENCE IN BRAIN AND SPINE NEUROSURGERY
For more information, visit: medicine.yale.edu/neurosurgery or call (203) 785-2805
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