Dr. E. Sander Connolly

Dr. E. Sander Connolly from the Cerebrovascular Center spoke recently at the American Heart Association’s International Stroke Conference in New Orleans.  As Chair of the Writing Group, he presented the Subarachnoid Hemorrhage Guidelines.

Dr. Connolly is also Chair of the Joint Cerebrovascular Section of the American Association of Neurological Surgeons(AANS) and the Congress of Neurological Surgeons (CNS), which held their Annual Meeting in New Orleans just before the Stroke Conference this year.

Dr. Robert Solomon

Columbia University Medical Center has sent out a press release, For Stroke Prevention, Large 
Medical Centers May Have the Edge, where they announced the results of research done here at the Department of Neurosurgery. They interviewed Department Chairman Dr. Robert Solomon about the research and his comments appear in the article.

You can read the press release on multiple news sites.

The research, Technological Advances in the Management of Unruptured Intracranial Aneurysms Fail to Improve Outcome in New York State, was published in Stroke: a Journal of the American Heart Association.

Co-authors included Chairman Dr. Robert Solomon, Vice-Chairman Dr. E. Sander Connolly, Jr., along with department residents Brad E. Zacharia and Andrew F. Ducruet.

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 also asked Dr. Solomon a number of questions to help us understand the results of this research and the state of aneurysm treatment today which you can read about in our blog, Q & A With Chairman Solomon: Aneurysm Therapy Today.

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.”

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

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

Stay tuned for our next video…

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.

Images from this publication

A team of our doctors has published an interesting case study in the journal, Surgical Neurology International.

The article is entitled, Medial lenticulostriate artery aneurysm presenting with isolated intraventricular hemorrhage and the authors from our department include, Dr. Philip Meyers, Dr. E. Sander Connolly and New Jersey affiliate Dr. Dorothea Altschul.

Dr. Altschul says, “We were able to identify a rare type of cerebral aneurysm that had caused a brain bleed in a 71 year old woman.”

You can read more about this case study here on Pubmed.

“Endowed Professorships (Chairs) provide a steady source of funding for the faculty member who holds the endowed position, creating opportunities for the incumbent to spend additional time in research, providing clinical care, improving methods of treating patients, and overseeing the training of tomorrow’s leading neurological surgeons. Professorships also provide an excellent opportunity to recognize both faculty and donors. They are awarded to the most distinguished faculty in recognition for their contributions to the field, while celebrating the generosity of the donor in perpetuity. Presently no endowed chairs in the department provide funding for the named professor directly, rather the funds are used solely to advance crucial areas of research and patient care.”

Here at the Department of Neurosurgery we have six Endowed Chairs and occupying those chairs are six extraordinary neurosurgeons who work diligently to honor their endowment benefactors.

Our Endowed Chair holders are: Dr. Robert Solomon, Dr. E. Sander Connolly,Jr., Dr. Jeffrey Bruce, Dr. Michael Sisti, Dr. Donald Quest, and Dr. Paul McCormick.

An Endowed Chair is no small gift and a moment should be taken to appreciate those whose generosity has helped further the science and practice of neurosurgery.

Below is a listing of each Chair, who holds it, and a brief look at that Chair’s namesake:

Dr. Robert Solomon

Dr. Byron Stookey

Chairman and Director of Service, Dr. Robert Solomon holds the Byron Stookey Chair. Dr. Byron Stookey was Director of the Department of Neurosurgery from 1937 to 1939.  He has been called, “One of the most distinguished neurosurgeons of his time.”  He was not only an exacting neurosurgeon but also an authority and prolific writer on the subject of Revolutionary War era medicine.

Dr. Donald Quest

Dr. J. Lawrence Pool

Dr. Donald Quest from the Spine Center holds the J. Lawrence Pool Chair. Dr. J. Lawrence Pool is a legend in Neurosurgery. He was Head of the Department from 1949 to 1972.  A leading neurosurgeon of the 20th Century, Dr. Pool was brilliant, charming, innovative, and a gifted surgeon.  While at Harvard he was National Squash Champion. He was also an aviator, a colorful writer, and a talented artist.  He was truly a “man for all seasons”.

Dr. E. Sander Connolly

Dr. Bennett M. Stein

Dr. E. Sander Connolly, Jr. from the Cerebrovascular Center holds the Bennett M Stein Chair. Dr. Stein was the Chairman of the Department before Dr. Solomon. Among his many accomplishments, he is responsible for the unique subspecialization of the department as well as having trained and hand picked many of the neurosurgeons working here today. He had an encyclopedic knowledge of brain anatomy. Dr. Stein was an innovative and bold surgeon, and an outstanding motivator and role model for residents and medical students.

Dr. Michael Sisti

Dr. James G. McMurtry, III with opera star Cecilia Bartoli

Dr. Michael Sistifrom the Brain Tumor Center and Gamma Knife Center holds the James G. McMurtry Chair.  McMurtry successfully operated on the brother of opera star Cecilia Bartoli. He had a brain tumor and she was so pleased with the treatment he received that she funded what became the Bartoli Brain Tumor Lab.  Dr. McMurtry devoted his entire professional career to The Neurological Institute.  His legacy was that of a calm, patient, and revered teacher.

Dr. Jeffrey Bruce

Dr. Edgar Housepian

Dr. Jeffrey Bruce from of the Brain Tumor Center holds the Edgar M. Housepian Chair.  Dr. Edgar M. Housepian is currently Neurosurgeon Emeritus and has been a member of the Department of Neurological Surgery since 1955 when he began his residency at the Neurological Institute of New York.  He had an early interest in aneurysm surgery and deep brain ablation and stimulation techniques. He was appointed Special Advisor for International Affiliations to the Dean of the College of Physicians & Surgeons of Columbia University, serving in that capacity from 1996 until 2010.  He has received multiple encomiums for his humanitarian efforts internationally.

Dr. Paul McCormick

Herbert Gallen

Dr. Paul McCormick, Director of the Spine Center holds the Herbert & Linda Gallen Chair. Herbert Gallen was the founder and creative director for the multimillion dollar fashion house, Ellen Tracy, which was later sold to Liz Claiborn. He was a grateful patient of Dr. James McMurtrey.

Related: A History of the Neurological Institute of New York and Its Department of Neurological Surgery

Back in June we reported that we had the Most Neurosurgery ‘Super Docs’ Of Any NY Hospital AGAIN!.  At that time the list included six of our doctors: Dr. Robert Solomon; Dr. Jeffrey Bruce; Dr. Neil Feldstein; Dr. Michael Sisti; Dr. Paul McCormick; and Dr. Donald Quest.

Now let’s make that Eight Super Doctors!

We also had The Most Neurosurgery ‘Super Docs’ In NYC in 2010.

“Endowed Professorships (Chairs) provide a steady source of funding for the faculty member who holds the endowed position, creating opportunities for the incumbent to spend additional time in research, providing clinical care, improving methods of treating patients, and overseeing the training of tomorrow’s leading neurological surgeons. Professorships also provide an excellent opportunity to recognize both faculty and donors. They are awarded to the most distinguished faculty in recognition for their contributions to the field, while celebrating the generosity of the donor in perpetuity. Presently no endowed chairs in the department provide funding for the named professor directly, rather the funds are used solely to advance crucial areas of research and patient care.”

Here at the Department of Neurosurgery we have six Endowed Chairs and occupying those chairs are six extraordinary neurosurgeons who work diligently to honor their endowment benefactors.

Our Endowed Chair holders are: Dr. Robert Solomon, Dr. E. Sander Connolly, Jr., Dr. Jeffrey Bruce, Dr. Michael Sisti, Dr. Donald Quest, and  Dr. Paul McCormick.

An Endowed Chair is no small gift and a moment should be taken to appreciate those whose generosity has helped further the science and practice of Neurosurgery. Below is a listing of each Chair, who holds it, and a brief look at that Chair’s namesake.

Dr. Byron Stookey

Dr. Robert Solomon

Chairman and Director of Service, Dr. Robert Solomon holds the Byron Stookey Chair. Dr. Byron Stookey was Director of the Department of Neurosurgery from 1937 to 1939.  He has been called, “One of the most distinguished neurosurgeons of his time.”  He was not only an exacting neurosurgeon but also an authority and prolific writer on the subject of Revolutionary War era medicine.

 

Dr. Donald Quest

Dr. J. Lawrence Pool

Dr. Donald Quest from the Spine Center holds the J. Lawrence Pool Chair. Dr. J. Lawrence Pool is a legend in Neurosurgery. He was Head of the Department from 1949 to 1972.  A leading neurosurgeon of the 20th Century, Dr. Pool was brilliant, charming, innovative, and a gifted surgeon.  While at Harvard he was National Squash Champion. He was also an aviator, a colorful writer, and a talented artist.  He was truly a “man for all seasons”.

Dr. E. Sander Connolly

Dr.Bennett M. Stein

Dr. E. Sander Connolly, Jr. from the Cerebrovascular Center holds the Bennett M Stein Chair. Dr. Stein was the Chairman of the Department before Dr. Solomon. Among his many accomplishments, he is responsible for the unique subspecialization of the department as well as having trained and hand picked many of the neurosurgeons working here today. He had an encyclopedic knowledge of brain anatomy. Dr. Stein was an innovative and bold surgeon, and an outstanding motivator and role model for residents and medical students.

Dr. Michael Sisti

Dr. James G. McMurtry, III with opera star Cecilia Bartoli

Dr. Michael Sisti from the Brain Tumor Center and Gamma Knife Center holds the James G. McMurtry Chair.  McMurtry successfully operated on the brother of opera star Cecilia Bartoli. He had a brain tumor and she was so pleased with the treatment he received that she funded what became the Bartoli Brain Tumor Lab.  Dr. McMurtry devoted his entire professional career to The Neurological Institute.  His legacy was that of a calm, patient, and revered teacher.

Dr. Edgar M. Housepian

Dr. Jeffrey Bruce

Dr. Jeffrey Bruce from of the Brain Tumor Center holds the Edgar M. Housepian Chair.  Dr. Edgar M. Housepian is currently Neurosurgeon Emeritus and has been a member of the Department of Neurological Surgery since 1955 when he began his residency at the Neurological Institute of New York.  He had an early interest in aneurysm surgery and deep brain ablation and stimulation techniques. He was appointed Special Advisor for International Affiliations to the Dean of the College of Physicians & Surgeons of Columbia University, serving in that capacity from 1996 until 2010.  He has received multiple encomiums for his humanitarian efforts internationally. 

Dr. Paul McCormick

Herbert Gallen

Dr. Paul McCormick, Director of the Spine Center holds the Herbert & Linda Gallen Chair. Herbert Gallen was the founder and creative director for the multimillion dollar fashion house, Ellen Tracy, which was later sold to Liz Claiborn. He was a grateful patient of Dr. James McMurtry.

 

Related: A History of the Neurological Institute of New York and Its Department of Neurological Surgery