Dr. McKhann was Co-Director of a Practical Clinic on Brain Mapping and Awake Mapping Techniques.

He was the Discussant for a scientific paper, DBS of the Third Ventricle Using a Floating Electrode to Treat Cluster Headaches: Proof of Concept, presented during a Scientific Session on Stereotactic and Functional Surgery. 

He was co-author of a paper, Auditory Novelty Detection Encoded by Dopaminergic Neurons in Human Substantia Nigra, presented at the same session.

Dr. McKhann was a panelist at a seminar on Resective Strategies for Epilepsy.

And finally, he was Moderator at a seminar on Contemporary Management for Adult Hydrocephalus.

(from left to right) Dr. E. Sander Connolly, Dr. Michael Sisti, and Dr. Sean Lavine with course director Dr. Gavin W. Britz

Dr. Sean Lavine, Dr. Michael Sisti, and Dr. E. Sander Connolly are back from a rather unique medical conference in North Carolina last week, The Battle at Pinehust.

The meeting er… battle, officially called Cerebrovascular and Skull Base Course – Battle at Pinehust, was held over the course of four days at the Endosurgery Center at Duke University School of Medicine. Their overview is given below:

The Battle at Pinehurst is a gloves-off educational program that will feature British parliamentary-style debating techniques to present key aspects of diseases involving the cerebrovascular system and skull base. The speakers and moderators have been instructed to leave the show-and-tell talks behind. Instead, the speakers will bring their debating skills and data to support their argument. Duke Endosurgery Center

Dr. Lavine says, “The meeting had a refreshing style that allowed for an open and honest discussion of our opinions about controversial topics based on our clinical experience and the medical literature.”

Learn more about this video series and see our first one here: Meet Dr. Michael Sisti on Video 

Stay tuned for our next video…

“As a kid,” Winfree says, “ I made a long list of things I wanted to do in my life and I have systematically gone through it.” These things included some of the usual life goals like becoming a doctor and running a marathon, but they also included things like being struck by lightning and swept out to sea.

“I’ve checked all kinds of natural disasters off my life list,” says Dr. Winfree. “ I’ve been in a hurricane, tornados, floods. I’ve been burned in a forest fire and recently I checked off earthquake.”

He decided to become a doctor in the sixth grade. “I was a boy scout learning first aid,” he says. “It was a moment of clarity I had at that time and I never wavered. There were no doctors in the family. I just realized that dealing with trauma, injuries, sickness–that was what I was going to do. That is the story of my life. I’ve always been sure of stuff.”

As a Junior high student in Florida, Winfree decided he was going to be a neurosurgeon; a shortage of neurosurgeons was making front page news and he says he became fascinated with brain surgery. “I didn’t have to put a lot of thought into it. It was just, ‘BOOM! I’m going to be a neurosurgeon and I’ll do whatever steps I need to do.’”

Winfree was systematic in his approach, he says. “I was never looking too far ahead because I always had the comfort of knowing what I was going to do. I just had to worry about getting to the next step. When I was in high school, I was getting into college–a good college. When I was in college, I was getting into med school.”

Winfree attended medical school here at Columbia’s College of Physicians and Surgeons. That was where he first met Dr. E. Sander Connolly from the Department of Neurosurgery.

Connolly says, “In 1995 I was a resident running this lab here and Chris was a medical student in the lab. It was a fun and productive experience together. We had a great time.”

Dr. Connolly, who is now the Bennett M. Stein Professor of Neurological Surgery here at Columbia, remembers, “Chris was even crazier back then, than he is now. He was into arctic mountaineering, ice climbing, back country wood stuff. We went camping once in the middle of winter. We get up to the top of this ridge and we are supposed to turn around and hike back down and he announces to the group that he is not coming back; he’s going to through-hike across the White Mountains in the middle of winter. We are sitting there pleading with him to come back and he is completely not taking our advice when these two guys, who look like they have been living in the woods for a century, come hiking down the path. We tell them what he is going to do and they tell him, ‘You’ll die, you must turn back with these people.’ So, he finally took their advice and turned back. But that only lasted for a short period. About a year later, after he got into his residency, he made an Arctic expedition by himself.”

“Not the whole Arctic,” Dr. Winfree says. “Just a week or so driving a sled and surviving solo.” That arctic expedition was hard but, in many ways not nearly as hard as what he faced next in becoming a neurosurgery resident.

“I was almost a neurosurgeon and for the first time in my life,” he says, “I didn’t’ have a clue.  I had this plan to be a neurosurgeon since I was a kid and I was almost there and I thought, ‘what am I going to do now?’”

So, true to form, he sat down and made a list. A new life list. “That is when I decided, I wanted to work here at Columbia,” he says. “I wanted a job here and I wanted to do peripheral nerve surgery. I told [current Head of the Department of Neurosurgery] Bob Solomon what I wanted and he helped me get a peripheral nerve fellowship and a pain fellowship.”

Dr. Winfree was hired here at the Department of Neurosurgery and currently heads the Peripheral Nerve Center and the Pain Center. “I was basically hired for entertainment value–that is, at least, partially true,” he laughs.

“It has turned out that way,” says Dr. Connolly. “But it is not why we hired him. He is a very talented and committed physician and we had a spot for him to do something that we really weren’t doing at the time.”

That something was Dr. Winfree’s subspecialties of pain and peripheral nerve surgery. “A lot of it can be really complicated, requiring three dimensional thinking–all these nerves wrapping around muscles and bones,” he says. “I like pushing the envelope, using new technology to make the situation as safe as possible, doing things that no one has done before, and seeing the patients get better.”

“He is excellent with his patients,” says Dr. Connolly. “Very focused. Very intense. His patients love him. Unless something is perfect he won’t let it go.  That extends into the operating room.  He is very thorough.  Pathologically and obsessively thorough.”

Dr. Winfree says, “I love what I am doing. I have my dream job. I am surrounded by excellence. It has been a privilege to work here.”

As for that list he made as a junior resident, he is still at it. “There are a few more things I want to do,” he says. “I still want to have kids, ice dive in the arctic, dive with great white sharks, go to antarctica.” He wants to be in a tsunami, he says, “I want to be the guy crawling up a tree watching the water come in. I want to hear the waters and feel the danger.”

He was part of the faculty at a Practical Clinic on Spine Trauma Management.

He was a Panelist at a Seminar on Cervical Spondylotic Myelopathy.

Dr. Kaiser was also one of the authors of a paper presented at one of the Plenary Sessions. The paper was entitled, The Efficacy of Lumbar Discectomy and Single Level Fusion for Spondylolisthesis: Neuropoint-SD Registry Initial Results.

Learn more about this video series and see our first one here: Meet Dr. Michael Sisti On Video

Stay tuned for our next video…

(from left to right) John Collins, Dr. Anderson, & Dr. Lavine.

Summer is just around the corner and a trio from our department got to take advantage of the good weather by playing in the 2012 Golf Tournament for Denan.

Dr. Sean Lavine from the Endovascular Center and Dr. Richard Anderson from the Pediatric Neurosurgery Center, who both participated in the event last year, were joined by John Collins* this year.

The annual tournament was held last week at the Apple Ridge Country Club in Mahwah, New Jersey and earned much needed funds for The Denan Project.

The Denan Project is a nonprofit, grassroots organization whose volunteer members secure the necessary resources to provide free medical care, potable water, agricultural training, education, and other critical services for the people of Denan, Ethiopia and the surrounding villages, and to other impoverished communities in the developing world. Working with regional government and nongovernmental agencies, its ultimate goal is to make specific communities in these areas self-reliant by developing and implementing long-term, sustainable solutions.www.thedenanproject.org

* John Collins oversees finance and operations here at the Department of Neurosurgery.

As the Chair of the AANS/CNS Cerebrovascular Section, Dr. Connolly had an important role to play at the meeting.

He was Moderator at a Scientific Session on Cerebrovascular neurosurgery where the latest innovations were presented.

He was co-author of a paper, Variation in a Locus Linked to Platelet Aggregation Phenotype Predicts Intraparenchymal Hemorrhagic Volume, presented during that same session.

Dr. Connolly also had the distinction of presenting the Donaghy Lecturer, who happened to be our Department Chair Dr. Robert Solomon.

Co-Director of a Practical Clinic on Fundamental Techniques of Adult Spinal Deformity Surgery.

Co-Director of a Practical Clinic on Advanced Techniques of Adult Spinal Deformity Surgery.

Faculty at a Practical Clinic on Coding, Compliance and Revenue Issues in Spine Coding.

Panelist during a Seminar on Management of Adult Scoliosis.

Discussant for research entitled, Cost-utility and Comparative Effectiveness Analyses of Laminectomy Versus Comprehensive Medical management for Lumbar Stenosis, presented at a Plenary Session.

Panelist in a seminar on Principles and Techniques of Deformity Correction in Adolescents and Young Adults.

In addition, Dr. Angevine served on all six of these AANS committees:

• Membership Chair of the AANS/CNS Section on Disorders of the Spine and Peripheral Nerves
• Emerging Technology Committee
• American Medical Association Physicians Consortium for Performance Improvement
• Coding & Reimbursement Committee of the AANS/CNS
• Communications and Public Relations Committee
• Quality Improvement Workgroup

Whew! Way to go Dr. Angevine!

Derrick Rose

The NBA postseason could not have begun any worse for the Chicago Bulls and New York Knicks on Saturday afternoon. Reigning NBA MVP, Derrick Rose, suffered a torn ACL while driving to the basket in the last 90 seconds of the first NBA postseason game with the Philadelphia 76ers, while Knicks’ rookie sensation, Iman Shumpert, tore his ACL when dribbling down the court and attempting a sudden change of direction, in the middle of the third quarter of their matchup against the Miami Heat.

Unfortunately, within recent years, the increase in anterior cruciate ligament (ACL) tears has been more common, specifically in sports involving sudden changes of speed and direction, such as basketball and soccer. In fact, women are 6-8 times more likely to tear their ACL as compared to men, which has sparked the recent “injury prevention” push from many medical professionals. But, many questions as to the etiology and risk factors of such a devastatingly rising injury rate continue to present themselves.

Recent evidence shows that 70% of serious knee injuries involve the ACL, while 80% of these injuries occur without any contact from another player, which is the same mechanism of injury that Rose and Shumpert suffered on Saturday. Typically, non-contact ACL tears occur because of the excessive internal rotation of the knee as the foot is planted, such as what happens with sudden changes of direction or pivoting, decelerating when running, or landing from a jump. Contact ACL injuries also occur when the knee is violently hit from the side, also while the foot is planted, causing a valgus force, or twisting motion, to the knee.

There are other factors that compromise an athlete’s risk to suffering an ACL tear. Biomechanically, poor muscular control during dynamic activities such as landing from a jump with stiffer knees, or landing with knees collapsed inward, increases the risk for ACL tears. Similarly, a wide array of anatomic risk factors exists, such as larger Q angles, increased genu-valgum, increased genu-recurvatum, or hyper-pronated feet. Most recent literature suggests that poor trunk sway or trunk control during dynamic activities of cutting, pivoting, jumping or landing has a high correlation to ACL tears.

Iman Shumpert

Needless to say, professional athletes put a lot of demand on their bodies, during their respective seasons. Specifically, the NBA placed a lot more stress on their players by shortening their season to 66 games in less than 125 days, leaving little time to practice, recover from minor aches or pains, and rehabilitate more serious conditions. Players, old and young, suffered injuries that either kept them out for a week or the remainder of the entire season, begging the questions: Did these injuries have anything to do with the shortened preseason preparation time and strength & conditioning camps that they typically attend? Did they try to squeeze too much basketball in too little time? Did the minor aches, minor pains and general fatigue suffered throughout the year set the players up for a serious injury later on in the season because of the lack of recovery time?

Although we cannot definitively answer these questions, we do know that these risk factors play a role in many injuries, specifically ACL tears. As medical professionals, we must do our part in ACL injury awareness through injury prevention programs, patient-specific training programs, and education seminars to all athletes. Ultimately, prevention of the problem will help reduce the ACL injury rate and keep athletes, like Derrick Rose and Iman Shumpert, in the game, and not on the sidelines.

Rami Said, D.P.T., M.Eng.
Senior Physical Therapist, Spine Center