Columbia Neurosurgery » Endovascular

Altschul & Meyers Moderate at AIM Symposium

Department Author — Thu, 15 Dec 2011 08:17:41 +0000

Dorothea Altschul, MD

New Jersey Affiliate, Dr. Dorothea Altschul and Dr. Philip Meyers from the Endovascular Center served as moderators at the Advanced Interventional Management (AIM) Symposium in NYC recently.

The AIM symposium is an international meeting that provides an overview of the latest advanced interventional radiology and surgical techniques and technologies. One of the components of the meeting is the 4th Annual Multidisciplinary Acute Stroke Management meeting.

Philip Meyers, MD

There, Drs. Altschul and Meyers moderated the scientific panel discussion on State-of-the-art Triage Issues of Stroke Patients. In addition, Dr. Altschul served as a moderator during the session on Subarachnoid Hemorrhage Management.

Daniel Sahlein, M.D.

Department Author — Sat, 01 Oct 2011 05:09:51 +0000

Dr. Sahlein specializes in the endovascular treatment of intracranial, skull base/neck, and spinal vascular disease using advanced minimally invasive, image-guided technologies. Particular areas of interest include intracranial aneurysms, brain arteriovenous malformations, and dural arteriovenous fistulas of the skull base and spinal cord. Working closely with Columbia University Medical Center’s world-renowned neurovascular team including Drs. Robert Solomon, E. Sander Connolly, Philip Meyers, and Sean Lavine, Dr. Sahlein & the neurovascular specialists offer unparalleled multidisciplinary care. Dr. Sahlein is tripled-boarded in Neurology, Radiology, and Diagnostic Neuroradiology, and completed subspecialty fellowship training in Interventional Neuroradiology as well. Research interests include brain arteriovenous malformations and complex aneurysms.

Board Certified:	American Board of Radiology, American Board of Neurology, American Board of Diagnostic Neuroradiology
Medical School:	The Albert Einstein College of Medicine, M.D.
Residency Training:	Combined Neurology/Radiology/Diagnostic Neuroradiology at NYU Medical Center. Neurology: July 2004-June 2006; Radiology: July 2006-June 2008
Fellowship Training:	Diagnostic Neuroradiology July 2008-June 2010; Interventional Neuroradiology July 2010-June 2011

Lavine Speaks at Joint Section Meeting in Los Angeles

Department Author — Mon, 25 Apr 2011 06:58:40 +0000

Dr. Sean Lavine from the Endovascular Center spoke recently at a session on the Management of the Incompletely Treated Aneurysm during the joint AANS and CNS Cerebrovascular Section 2011 Annual Meeting in Los Angeles.

Lavine was one of three speakers during this session. The other two were invited guests: Mika Niemela form Helsinki, Finland; and Christian Raftopoulous from Belgium. They each presented a lecture and then participated in a panel discussion of selected cases.

Lavine’s talk was entitled, Endovascular Options for the Incompletely Treated Aneurysm and he says, “the case studies generated a lively discussion about treatment options for cerebral aneurysms.”

Solomon’s Stroke Management Conference Sparks Lively Discussion

Department Author — Wed, 15 Dec 2010 06:33:24 +0000

Department Chair Dr. Robert Solomon directed a special program on stroke management earlier this month at the new state-of-the-art Education and Conference Center at the Vivian and Seymour Milstein Family Heart Center.

The program, entitled Current Management of Ischemic and Hemorrhagic Stroke, provided an “up-to-date appraisal of the evaluation and treatment of acute stroke, carotid disease, intracranial vascular disease, arteriovenous malformations (AVMs), and aneurysms.”

The one-day course was co-directed by Dr. E. Sander Connolly Jr. from the Cerebrovascular Center, and Dr. Joshua Z. Willey from the Department of Neurology.

According to Dr. Solomon, “The conference was a service for the medical community by the Neurological Institute to optimize patient care in the community; to update their knowledge base on the latest information about diagnosis and treatment of cerebrovascular diseases.”

The department of Neurological Surgery at Columbia puts on some form of continuing medical education at least once a year on various topics of interest to outside practitioners.

In addition to Dr. Solomon and Dr. Connolly from the Cerebrovascular Center, several other members of our department spoke at this event: from the Endovascular and Cerebrovascular Centers - Dr. Sean Lavine, Dr. Philip Meyers, and Dr. Dorothea Strozyk; and from the Gamma Knife Center - Dr. Steven Isaacson. A list of our doctors and their presentation topics is below:

Robert Solomon, M.D.- Microsurgery for AVMs
E. Sander Connolly Jr., M.D. – Microsurgery for Aneurysms
Sean Lavine, M.D. – Endovascular Treatment of Aneurysms
Philip Meyers, M.D. – Endovascular Treatment of AVMs
Dorothea Strozyk, M.D. - Endovascular Treatment of Acute Ischemic Stroke
Steven Isaacson, M.D. - Radiosurgery for AVMs in eloquent areas

According to Dr. Solomon, “The conference was a great success. About 150 local neurologists, nurses, and neurosurgeons got together to discuss management of ischemic and hemorrhagic stroke. As well, all forms of surgical treatment of cerebrovascular diseases were covered.”

He also said, “There was a lively group discussion during the lunch hour with many members of the audience given a chance to voice their opinions and ask for advise from the faculty panel.”

Lavine and Whiting featured in news from The Valley Hospital

Department Author — Mon, 04 Oct 2010 08:38:59 +0000

Left to Right: Dr. Jobyna Whiting, Dr. Sean Lavine, & Dr. Daniel Walzman

Our own Endovascular Surgeons Dr. Sean D. Lavine and Dr. Jobyna Whiting are featured in an article about a new upgrade for The Valley Hospital in Ridgewood, New Jersey.

The hospital has just acquired a new neurointerventional biplane angiography system.

Both Lavine and Whiting are quoted in the article that is featured both on the hospital’s website and in their newsletter. The newsletter is circulated to about 280,000 homes.

Read the article Neurointerventional Biplane Angiography System: First in Bergen and Passaic Counties to learn more.

Lavine Talks Endovascular vs Surgery at AANS

Department Author — Tue, 08 Jun 2010 11:33:13 +0000

Dr. Sean Lavine from the Endovascular Center presented at two sessions during the recent American Association of Neurological Surgeons (AANS) meeting. He was a panelist and speaker in a seminar comparing surgical and endovascular treatment methods for patients with high-risk Carotid Artery Disease.

Then, he spoke about research he co-authored with Dr, Philip Meyers from the Cerebrovascular Center and others entitled High-Dose Intra-Arterial Verapamil for the Treatment of Cerebral Vasospasm after Subarachnoid Hemorrhage: Prolonged Effects on Hemodynamic Parameters and Brain Metabolism

Dr. Lavine is also active on the AANS/CNS Guidelines Committee with other members of the Department of Neurosurgery including, Peter D. Angevine, M.D., M.P.H., Anthony L. D’Ambrosio, M.D., and Christopher J. Winfree, M.D.,

Solomon and Lavine’s First Operation in New Family Heart Center

Department Author — Thu, 01 Apr 2010 17:01:27 +0000

Drs. Robert Solomon and Sean Lavine perform the first vascular neurosurgical operation in the new Vivian and Seymour Milstein Family Heart Center at New York-Presbyterian/Columbia University Medical Center last month. The procedure was done in the hybrid open surgical and fully angiography-capable operating room that houses the Artis Zeego system made by Siemens healthcare. This angiography-capable operating room allows for simultaneous open and endovascular treatment of neurovascular disease with industrial robotic technology. Real-time evaluation of surgeries performed on cerebral aneurysm, arteriovenous malformation and vascular occlusive disease will be performed in this room to reduce operative time and improve the safety of these sophisticated and delicate neurovascular procedures.

Endovascular Surgery: To Clot or Not to Clot

Department Author — Thu, 21 Jan 2010 05:25:21 +0000

Normally, when any kind of surgery is performed, or even when you cut your finger, your blood clots. This is caused by a whole cascade of events beginning with blood platelets clumping together. This is a good thing because it stops blood loss and in the case of that cut finger, it provides the first step to forming a protective scab, ultimately enabling wound healing.

In some people, blood clots can actually be a problem. Clots form on the inside of blood vessel walls that can break loose and cause a heart attack or stroke. These patients are often given anti-clotting drugs or anti-platelet agents to prevent these events.

These patients usually have hardening of their arteries predisposing them to form these clots, and are likely to be the same kind of people that end up having endovascular surgery. This is a special kind of surgery that uses thin tubes and tiny instruments to operate inside a blood vessel. When someone has a blocked artery for example, endovascular surgeons can go in through the blood vessel and clear a path for blood to flow again. They can also put an expandable tube or intravascular stent in the vessel to keep it from getting blocked again. This kind of surgery is a good alternative to an open procedure because it is quicker to do, less invasive, and has a much faster recovery. Endovascular surgery repairs the blood vessel from the inside and requires only a needle puncture to gain access for treatment.

Because the work is done within the vessel, the devices are exposed to the bloodstream. Anti-clotting agents are used during the procedure to prevent problems, and patients respond to these agents differently. In patients that require stents to treat their disease, anti platelet drugs are required to limit clotting.

Dr. Sean Lavine from the Endovascular Center recently spoke to neurosurgeons on the use of anti-platelet agents in neurosurgery at the Congress of Neurosurgeons Meeting in New Orleans. He said that these kinds of drugs are “the mainstay for a myriad of medical conditions” but that doctors need to be well informed to use them. Some patients have a resistance to them or are taking another drug that can render the anti-platelet agent ineffective. These drugs include some acid reducers and those to lower cholesterol. It is also important to determine the correct dose for the patient with sophisticated testing. This can all be done by a taking a thorough history and physical of each patient, and performing these procedures at an experienced neuro-endovascular center. Dr. Lavine emphasized that it is critical to find the right balance between too much clotting and too much bleeding during open and endovascular surgery for the best outcome.

A Place for Brain Surgeons to Debrief

Department Author — Tue, 29 Dec 2009 09:44:34 +0000

Science and technology have advanced by leaps and bounds in the last ten years and no where is this more true than in the field of cerebrovascular surgery. This branch of neurosurgery deals with problems with the blood vessels that supply the brain. New microsurgical and endovascular techniques have enabled these surgeons to help more people and to deal with increasingly complicated problems. New technologies, techniques, and tricks of the trade are fast evolving as each new complication is tackled.

Several years ago physicians, scientists and engineers at the top of this field had the brilliant idea to get together and talk about what they are learning from these complications. They called this meeting the Cerebrovascular Complications Conference (3C Meeting). Part of their mission statement was, “Through open dialogue, 3C hopes to enhance physician education, stimulate progress in the field of cerebrovascular surgery, and improve patient care.”

For this year’s annual 3C meeting in Jackson Hole, Wyoming, our own Dr. Sean Lavine from the Endovascular Center was part of the planning team. About this year’s conference he said, “The conference provided a unique opportunity for both traditional open vascular neurosurgeons and endovascular neurosurgeons to learn from the candid discussion of complications experienced by an international group of neuro-endovascular specialists of all levels of experience.” The conference lasted 3 full days and featured a multitude of case presentations as well as state of the art medical education methods like 3-D anatomy and surgical simulation.

Galbraith Award Given to New York Aneurysm Study

Department Author — Tue, 15 Dec 2009 18:31:37 +0000

Lead author Dr. Brad Zacharia with Dr. E. Sander Connolly from the Cerebrovascular Center and colleagues received the Galbraith Award at this year’s annual meeting of the Congress of Neurological Surgeons (CNS) for their study of the treatment of brain aneurysms in the State of New York.

An aneurysm is a bulge in a blood vessel that is caused by weakening of the vessel wall. Aneurysms can be life threatening if they burst and often require surgical treatment. There are two types of surgery that are performed and it remains controversial which is best. Clipping has been the treatment of choice for the last 40 years. This involves a craniotomy and placement of a tiny clip at the base of the aneurysm. With the advent of endovascular surgery coiling has become another option. A small flexible coil is passed through blood vessels into the brain where it is placed in the aneurysm to keep it from bursting. Recent studies have suggested that endovascular coiling has a better outcome.

The authors used the New York Statewide Planning and Research Cooperative System (SPARCS) to look at all the patients that were discharged from a hospital in New York State that had a primary diagnosis of brain aneurysm between the years 2005 and 2007. They found about 3,000 patients with that diagnosis, discharged from over a hundred hospitals. They divided the hospitals into high and low volume based on the number of these kinds of patients treated. Then they looked at the general outcome for these patients and correlated it to whether the hospital was high volume or low and to the type of surgery the patient had.

The authors found that between surgical treatments, the best outcome was found in the group that had undergone endovascular coiling. Between high and low volume hospitals they found that more low volume medical centers were performing this procedure but, independent of surgical treatment a better outcome was found in the large volume medical centers.

When they compared the data during this three year period (2005-2007) to a previous five year period(1995-2000) they actually found no overall improvement in outcome despite the fact that the use of endovascular coiling (the procedure with a better outcome) had increased since 1995. The authors surmised that this is likely because more low volume centers (which overall had poorer outcomes regardless of procedure) are performing this kind of surgery. This result is of concern and the authors recommended that more research be done to look into this further.

A poster presentation of this research: Trends in Outcome for the Treatment of Intracranial Aneurysms in New York State: A 3-year Population Based Study

This study can be found in the August 2009, Vol. 65, issue 2 of Neurosurgery

More about Brain Aneurysms and their treatment.