Dr. Sisti (left) & Dr. Isaacson in 1998 when The Gamma Knife Center opened

In 1998, Dr. Michael B. Sisti and Dr. Steven R. Isaacson  opened our Gamma Knife Center with nurses Nenita Magpantay-Nadera and Jeraldine Lesser.

Thirteen years later, we are proud to say, the same team is still here!

“The equipment has changed but the people have not,” says Dr. Sisti. ” Except, of course, we have a heck of a lot more experience.  We just did our 3000th Gamma Knife.”

Today they run the state-of-the-art  Gamma Knife Perfexion System, thanks to a recent multi-million-dollar upgrade.

The Gamma Knife isn’t really a knife, but a large machine that generates a highly concentrated beam of radiation that is used to specifically target a lesion in the brain.

The Gamma Knife is used to treat a multitude of problems including Brain Tumors, Cerebral Arteriovenous Malformations (AVMs), Epilepsy, and functional dsorders such as trigeminal neuralgia.

In 1998, Leksell’s Gamma Knife Treatment Statistics, showed 100,000 patients treated with the Gamma Knife, ten years later that number had increased to half a million and has kept on growing.

Though this new Gamma Knife technology can be found in other centers around the world now, few can boast the experience that our team has.

This experience has paid off too; in patient satisfaction. Earlier this year, we sent out a bunch of surveys and the results were incredible.

The Gamma Knife Team today from left to right: Jeraldine Lesser, Dr. Sisti, Dr. Isaacson and Nenita Magpantay-Nadera

On 100% of the patient surveys we received, patients said they would recommend our center to a friend who needed Gamma Knife treatment. They also consistently said our staff was pleasant, courteous, and made every effort to make them feel at ease before,during, and after treatment.

Additionally, we have received countless letters from our patients grateful for the treatment they received. Here are Some of the many positive comments received by the Gamma Knife team over the years:

The headaches are gone entirely and we thank each and every one of you from the bottom of our hearts. Everybody at the Gamma Knife Unit went out of their way to make me feel comfortable and at ease. We still cant believe the change in me.  Thank you all.

I’d like to thank you for making my Gamma Knife Treatment a pleasant and positive experience. Your professionalism and knowledge together with your warmth and humor made me feel comfortable and allayed my fears. You have effectively been able to create a comfortable, caring and cheerful atmosphere for your patients.

My parents and children can now kiss me on my face. This may not be such a significant acheivemet to others, but to me its an accomplishment I doubted could ever take place.

The new facility looks amazing and everyone was great. They made me feel very comfortable and informed me of every step during the day. They answered all of my questions, and questions my family had were answered and even followed up with me after the procedure to
make sure I was doing O.K.

I thought the care and attention was the best I have ever received. My overall experience was incredible. The 1:1 attention was by far the best.

Today, through our New Jersey Practice, we are also treating patients at Valley Hospital’s new Gamma Knife Center.

Related blogs: Check Out Our New Gamma Knife: Upgrade Complete, Valley’s New Gamma Knife is up and Running

Photo by Alex Brandon, AP

Illinois’ Freshman Senator Mark Kirk is recovering from surgery after he suffered a stroke this weekend. Though he was not treated here at Columbia, Dr. E. Sander Connolly from the Cerebrovascular Center regularly sees patients in his condition and gave us some insight into the problem and its treatment.

According to news reports, Senator Kirk was diagnosed with a right carotid artery dissection which means, says Dr. Connolly, “The inner lining of the carotid artery was torn. Trauma is the most common cause but it can happen spontaneously.”

There are two carotid arteries located on either side of the neck and they are the main sources of blood feeding the brain.

The bleeding caused by a tear in the artery can cause a clot to form, this clot can then travel into the brain blocking blood flow and causing a stroke.  If this condition is caught before a stroke occurs, Connolly says, “You can sometimes treat it with just aspirin or anti-clotting agents to get it to heal. You can also stent the artery which means you put a metal mesh inside the artery to keep it open.”

Reportedly, the tear in his right carotid artery resulted in a stroke on the right side of his brain.  Due to the complex wiring of the brain, a stroke on one side of the brain causes the opposite side of the body to be effected.

Dr. E. Sander Connolly

Dr. Connolly says, “We don’t know how big his stroke is–that will have some effect on his recovery. The news reports suggest they are optimistic that he will walk again but that his left hand or arm may not be fully functional.”

According to an article in USA Today, he was treated Monday morning in Chicago where Kirk’s office says,”the Senator underwent surgery to relieve swelling around his brain stemming from the stroke. The surgery was successful.” More specifically, surgeons relieved the pressure by removing a piece of bone from his skull.

“We see a lot of these patients and the success is really related the how bad the stroke is before hand,” says Dr. Connolly. ” But, the procedure to remove the bone is almost always successful. It is possible that he could work again as a senator.”

Philip Meyers, MD

SAMMPRIS (Stenting vs. Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis), a large NIH funded trial comparing two methods of stroke prevention was recently published in the New England Journal of Medicine (N Engl J Med 2011; 365: 993-1003). This particular study showed that medical therapy was generally better than angioplasty with stenting for treating blood vessel narrowing in the head causing stroke.

SAMMPRIS enrolled 451 patients at 50 sites across the United States. Columbia was one of only 2 medical centers in New York City participating in the trial.

Dr. Philip Meyers from the Endovascular Center was the principle interventional investigator at Columbia and performed all the procedures for the trial. He was also a member of the credentialing committee selecting trial interventional physicians nationwide.

Patients who enrolled in the study were selected because they were all at high risk for stroke because of narrowing in brain arteries presumably due to atherosclerosis, the same disease that causes coronary artery narrowing and heart attacks. SAMMPRIS trial patients had all suffered a transient ischemic attack (TIA) or survived a recent stroke within 30 days of enrollment and exhibited severe (70-99%) blockage of a major artery to the brain. A previous trial called WASID (Warfarin-Aspirin Symptomatic Intracranial Disease trial) had shown that patients in this situation were at high risk for recurrent stroke or death within 2 years.

In SAMMPRIS, all the patients received intensive medical management including daily blood thinning medication, aggressive control of blood pressure and cholesterol. Half of the group also underwent a procedure to re-open the severely narrowed blood vessel causing the strokes with angioplasty and stenting using the Wingspan™ system (Stryker Medical, Fremont, CA), to widen the narrow vessel and to improve blood flow to the brain.

Researchers had predicted that patients receiving the stent would be less likely to have another stroke than patients receiving medicine alone.

The trial was concluded last April when a clear pattern emerged: those patients solely on medical therapy did significantly better than those who also received the stent.

Dr. Meyers says many physicians were surprised by the results of SAMMPRIS. “Although we at Columbia didn’t experience the problems stenting patients that occurred in the overall trial population, multi-center trial data is most important. The patients we treated did well. We all thought that stenting was going to be the best thing to do for these patients, but the results of the overall trial showed that it is not–medical therapy was found to be superior in SAMMPRIS. We are not entirely sure why patients in the medical arm of SAMMPRIS did so well. Apparently, modern intensive medical therapy with statins, anti-platelet drugs, and blood pressure control is clearly more effective than it has been in the past.”

The results of SAMMPRIS have caused a stir among those involved in the treatment of this type of stroke patient, not the least of which were endovascular neurosurgeons and the makers of the particular stent used in the trial.

Dr. Meyers and his colleagues in the Society of Neurointerventional Surgery (SNIS) recently met with representatives of the company that manufactures the Wingspan™ device at their recent Corporate Advisory Council meeting in Las Vegas, Nevada.

Meyers, who is currently Vice President of the SNIS, says, “The SNIS meets annually with the CEOs and senior executives of the various companies that make products we use to review important issues regarding patient care and safety, plan improvements, and make recommendations for future research and development.”

Not surprising, the results of the SAMMPRIS trial were on this year’s agenda. Meyers says, “We reviewed new approaches to intracranial revascularization and concluded that it is important to keep working on alternatives to help patients for whom medicine just isn’t working.”

Although not exactly the results we wanted, SAMMPRIS represents an important step forward in medical science. It is sure to guide many patients and physicians in their selection of therapy to prevent stroke due to severe intracranial atherosclerosis. “This is important information,” says Dr. Meyers. “As physicians, we want what is best for our patients. Scientific progress is not always simple or easy. There are many technological developments in the treatment of cerebrovascular diseases. We have to know what works and what does not to deliver excellent medical care.”

Dr. Christopher Winfree

About a month ago, we posted that Department Neurosurgeon Dr.Christopher Winfree and Nurse Practitioner Maria Farrow were taking part in CBS’s new show, A Gifted Man. We also mentioned they would be in a scene together in an upcoming episode and–that show airs tonight!

To recap: the show is about an unhappy, yet successful surgeon in New York City who’s life is turned around when he is unexpectedly visited by the ghost of his ex-wife.

Ms. Farrow and Dr. Winfree play surgeons #1 and #2 in a scene together and they each have small speaking parts, too!

Nurse Practitioner Maria Farrow

Ms. Farrow says, “Being a consultant for this intelligent TV series gives our department the opportunity to educate the public about what our field is, and what it can do. I am very proud that the production of ‘A Gifted Man’ works so diligently to help make the medical and neurosurgical aspects authentic.  The show educates while it entertains!”

Dr. Winfree added, “It was a fascinating experience working with a group of skilled actors, directors and producers who were practicing their craft as true professionals.  Acting is a lot harder than it seems!  I was impressed with the complexity of the production and all the hard work and talent it takes to put this show together.”

Don’t forget to watch Farrow and Winfree Tonight (Friday, Jan 6) on A Gifted Man at 8PM on CBS. 

You can watch older episodes of the show at CBS.com .

Related blog: Winfree And Farrow To Be On CBS Show ‘A Gifted Man’

Dr. Robert Solomon

Surgeons have been talking about how to treat brain aneurysms for over 250 years and though technology and medical knowledge have advanced them to a whole new level, they are still at it. The discussion today centers primarily around two specific treatments; endovascular coiling and surgical clipping (see definitions below).

This is what Department Chair, Dr. Robert Solomon and his colleagues were up to in their paper, Technological Advances in the Management of Unruptured Intracranial Aneurysms Fail to Improve Outcome in New York State, published earlier this year in Stroke: a Journal of the American Heart Association.

[Co-authors included department residents Brad E. Zacharia and Andrew F. Ducruet along with cerebrovascular specialist, Dr. E. Sander Connolly, Jr.]

The authors looked back at statistics gathered for thousands of patients treated for unruptured intracranial aneurysms (UIA) during two distinct periods (1995-2000) and (2005-2007) in the State of New York.

We asked Dr. Solomon a number of questions to help us understand the results of this research and the state of aneurysm treatment today.

Q: What does this research tell us?

A: There has been a doubling in the number of unruptured intracranial aneurysms treated in the two periods. This increase has been driven by a 5-fold increase in the use of endovascular coiling. However, there has been no data to suggest an expansion of indications for treatment.  While endovascular treatment as a whole had better outcomes than surgical treatment, the results were worse in low volume centers, and in centers that had a low percentage of patients treated with surgery.  The implication is that in low volume centers where endovascular treatment predominates, the overall results were significantly worse for the patients.  The likely explanation is that in high volume centers with expertise in both microsurgery and coiling, patients are selected for treatment based on the best approach for each patient.  Overall, this type of high volume collaborative team approach to unruptured aneurysms results in the best outcome for the patient.

Q: What would make a surgeon choose clipping over coiling at these large medical centers?

A: One reason that clipping is done more often at large centers is because patients have been specifically referred for clipping when coiling has failed.  Also, more clipping is done at large centers because inappropriate coiling is not done when there is a good surgical option.  Unfortunately, the surgical option is not always available at low volume centers, and without proper patient selection, the results are not satisfactory.

Q: Do you think that will change?

A: The large centers will change as the technology evolves and better endovascular options become available.  Surgery will be used only in appropriate cases.  If those indications for surgery change, the large centers will change accordingly.

Q: Why do you think coiling is being done more at these smaller facilities?

A: Coiling is done more at the smaller facilities because the surgeons at low volume facilities usually don’t have enough experience with aneurysm surgery to feel comfortable offering that alternative to their patients.

Q: Does your team at the Department of Neurosurgery perform more clipping or coiling for UIAs?

A: Here at Columbia we are about 50/50 with clipping and coiling.

Q: How is the decision made to do which procedure?

A: We review each case with experienced microvascular surgeons and expert neuro-interventionalists that perform coil embolization.  First we evaluate the risk of a complication with each procedure.  If there is a significant difference in the risk or a complication, we will generally choose the procedure with the lowest complication risk.  The other concern is the long-term outcome and chance for cure of the aneurysm.  We know that clipping usually offers a better chance of a complete cure, so when the risk analysis is favorable to clipping, we prefer clipping via microsurgery.  However, many factors such as patient health, age, and the exact anatomy of the aneurysm have to be considered for each case, and we choose the best option for each patient.

Q: Which do you think is better for UIAs (coiling vs clipping) from your own experience?

A: In my experience, clipping is a better option when all other issues are equal.  However, in the endovascular era, my surgical results have dramatically improved, because I will never attempt a surgical case that has high risk if there is a good coiling or endovascular option.  In a young patient with an aneurysm that has low surgical risk, clipping gives that patient the peace of mind that comes with a complete cure, and is worth undergoing the surgical procedure.

 

Definitions:
Intracranial Aneurysm: A medical condition where the wall of a blood vessel in the brain has weakend and creates a bulge or balloon like projection out the side. The aneurysm is dangerous because it can be at risk of bursting and causing a brain bleed or of pressing on vital structures in the brain.

Endovascular Coiling: A minimally invasive surgical technique where tiny metal coils are placed inside the aneurysm itself using X-Ray guidance. The coils fill up the aneurysm to prevent it from bursting.

Surgical Clipping: An open brain surgical procedure where a small clip is placed at the base of the aneurysm. This clip cuts off the blood supply to the aneurysm.

Related Blog: Solomon Heads Giant Aneurysms Off At The Pass

Dr. Robert Solomon (left) with Dr. Michael Sisti

From right to left, Dr. Michael Kaiser, Dr. Christopher Winfree, & Dr. Robert Solomon

More than 90 members of our staff attended our Holiday party this year at  Dylan Prime restaurant in New York City.

Everyone enjoyed the opportunity to relax in good company and to celebrate all the years’ achievements.

Our webmaster Greta Perovic did a wonderful job organizing the event. Everyone had a ball.

Here’s to another year!

Dr. Anthony D'Ambrosio (seated in white)

Dr. Robert Solomon (3rd from Left) and Dr. Sean Lavine (2nd from Left) joined by visiting Korean Neurologists and Neurosurgeons

Early last week we were honored with a visit from a group of neurology and neurosurgery colleagues from Korea.

They were on a tour of the United States and Canada’s leading neurological institutes in preparation for opening Korea’s first dedicated Neuroscience Institute; The Bundang Clinical Neuroscience Institute (BCNI) in Seoul, Korea.

They spent the afternoon with us getting a tour of our facilities and meeting with members of our department as well as our Department of Neurology.

Specifically they had meetings with Chairman, Dr. Robert Solomon and other members of the Cerebrovascular and Endovascular centers, Dr. E. Sander Connolly  and Dr. Sean Lavine.

Dr. Neil Feldstein

The annual Pool Symposium was held once again here at Columbia and the theme this year was pediatric neurosurgery.

Dr. Neil A. Feldstein, Dr. Richard Anderson, and Dr. Saadi Ghatan from the Pediatric Neurosurgery Center were all there and each presented in their areas of expertise.

Dr. Feldstein spoke about chiari malformations* and craniosynostosis** surgery. He can be seen in the top left photo discussing normal skull anatomy.

Dr. Richard Anderson

Dr Anderson presented Spinal Dysraphism and Neurosurgical Management of Childhood Spasticity. He can be seen at right elucidating spasticity treatment options.

Dr. Ghatan discussed hydrocephalus*** and epilepsy**** management. He can be seen in the bottom left photo relaying the history of epilepsy surgery.

Dr. Saadi Ghatan

Dr. Feldstein tells us, “We also had guest speakers who discussed pain management and Emergency Room management of our patients.”

Once again, the event was a great success!

*Read more stories about Chiari Malformation:
More Evidence That Riskiest Part Of Chiari Surgery May Not Be Necessary
Should We Let Our Chiari Kids Play?
Last Year…Brain Surgery, This Year…Freethrow Championship
Medical First: Boy’s Brainstem Saved By A Nose    

**You can learn more about craniosynostosis from our blog, The Importance Of Baby’s ‘Soft Spot’. 

***Read the story about Sherman Alexie: Born With Hydrocephalus, Now A Well Known Author. 

****Read this story, All He Wanted Was To Drive: An Epilepsy Success Story

Dr. Christopher Winfree

Department Neurosurgeon Christopher Winfree and Nurse Practitioner Maria Farrow are soon to be seen on CBS’ new show “A Gifted Man.”

The show is about an unhappy, yet successful surgeon in New York City who’s life is turned around when he is unexpectedly visited by the ghost of his ex-wife.

Nurse Practitioner Maria Farrow

Maria Farrow, who is a consultant for the show, says that she has a non-speaking role in this Friday’s episode.  ”I am in the scene with Patrick Wilson doing an angiogram,” she says.

In a later episode, she and Dr. Winfree have a scene together and this time she has a speaking part.  She says, “I will be playing Surgeon #1 and Dr. Winfree will play Surgeon #2.”

You can watch older episodes of the show on CBS.com and vote for it as Favorite New TV Drama for the People’s Choice Awards.

Keep your eyes peeled for our rising stars!

There he got to help test participants’ balance and grip strength. The tests were part of an interactive display developed by the NASS Exercise Committee to demonstrate how functional tests like these can be used to objectively assess patients with back and neck pain.

Pain can be highly subjective and clinicians strive to use objective measures in order to understand how to best treat their patients. The results can also be used as bench marks to show improvement. As decreased balance has been associated with chronic low back pain and decreased grip strength has been associated with chronic neck pain, these are two useful tests.

Balance was tested by timing participants for up to 30 seconds as they stood on one foot with their arms crossed over their chest. Participants were graded based on how many seconds they could remain on one foot. If they could stand the whole 30 seconds they were then asked to repeat the test with their eyes closed.

Grip strength was tested using a hand held dynomometer. This is a portable hand-held device that can measure strength in Newtons, pounds, or kilograms. The test is performed with the elbow bent to 90 degrees and held close to the body. The results can then be compared to established norms.

Evan says, “People learned a little something new and had a lot of fun trying to out do each other.  We even gave out prizes.”

Learn more about the 2011 annual meeting of the North American Spine Society.