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

The paper he co-authored, Treatment of Medically Intractable Mesial Temporal Epilepsy with Responsive Brain Stimulation: Results of a Subset Analysis from the RNS® System Pivotal Investigation was chosen as one of the Top Ten Abstracts in the Section on Stereotactic and Functional Neurosurgery at this year’s meeting.

His research was also published in the journal, Neurosurgery in August.

Related News: Docs Present At 2010 Congress Of Neurological Surgeons Meeting

On Saturday, October 16, he was a course director in a practical course entitled, Operating in the Eloquent Cortex.

The next day he co-directed another practical course.  This one on Operative Indications, Options and Technique for Epilepsy.

His last presentation was part of a new symposium on neuromodulation, in which he spoke about neurostimulation for Epilepsy.

Language mapping is done during surgery while the patient is awake and interactive.  This is possible because the brain itself does not have pain receptors.

The patient is shown sequential pictures of common objects, while a region of the brain is electrically stimulated in one centimeter increments.

When the patient cannot successfully name objects during stimulation of a particular part of the brain, that brain area is concluded to be important for visual object naming.

The widely held belief is that visual object naming is primarily a function of the lateral [outermost] temporal lobe.

Mike actually had his first seizure earlier that year in his fourth period English Class. Lucky for him, his friend Rob stopped him from crashing to the floor.  Mike says, “They said it was a black out, no one even thought of epilepsy at that time.”

The year after that, he had a couple more seizures but when he started college the following year he began to average 4-5 seizures a month.  Mike says he never knew when a seizure was coming.  He would usually just wake up a couple of hours later and the people around him would tell him what happened.  Fortunately for him, he never got seriously injured during one of his seizures.  He once had a seizure while doing a presentation in American Studies and failed the class.

A couple of years into college, Mike went to see a neurologist, Dr. Nordli at Helen Hayes Hospital.  That is when he was finally diagnosed with Epilepsy. For several years, he and Dr. Nordli varied the type and dosage of the medications he took, but never got his seizures under control.  Finally  the Epilepsy Center team, including neurosurgeon, Dr. Robert Goodman , recommended that Mike consider epilepsy surgery here at Columbia Presbyterian Hospital.

Dr. Goodman worked closely with Dr. Nordli to map Mike’s seizures.  They were finally able to find the exact location in his brain called the seizure focus.  (This is the part of the brain where the seizures were originating).

In Mike’s case, this was found to be an area in the back part of his temporal lobe.  Fortunately this is an area of the brain that surgeons have had great success in treating.

During a more than six hour surgery, Dr. Goodman performed a temporal lobectomy.  The procedure began with careful mapping of the brain using computers, imaging technology and sophisticated software.  When the exact surgical location was targeted, Dr. Goodman removed a section of the skull over the area. (In Mike’s case, on the side, near the back of his head).  Then carefully, the section of his brain that was known to be the cause of the seizures was removed.

During the surgery, Dr. Goodman had to make an important decision.  He knew that the section he had to remove would affect Mike’s vision but it was a worthwhile sacrifice to enable Mike to be seizure free and live a normal life.

After the surgery, Mike’s seizures stopped completely.  As, Dr. Goodman had predicted, he did have some problems with his vision.  He couldn’t see things that were to his right, but Dr. Goodman knew that Mike could eventually compensate for that.

After being seizure free for a year, Mike was able to get his drivers license and his new life and independence kicked into high gear.  He got a part time job and because he could now drive, he enrolled in a paralegal program.  ”I always liked the law.  I saw it as a way I could help people,” Mike says. He learned to compensate very well for the vision loss, by turning his head or looking to the right

In 2000, exactly seven years after surgery, Mike told Dr. Goodman, “I am celebrating by going to work.”  Today, Mike has been working as a paralegal for AT&T for ten years.  He drives 35 miles to work every day and he just got back from a trip to Maine where he had to drive for eight hours straight both ways.

When asked what he would say to anyone with Epilepsy who is considering the surgery, his answer is simple,  ”Go see Dr. Goodman.”

Elekta, Inc. photo of new Perfexion® Gamma Knife.

Dr. Michael Sisti from the Gamma Knife Center tells us a multi-million dollar up-grade is coming to his Center this Summer.  They will be upgrading to a new state-of-the-art (5 million dollar plus) machine called the Gamma Knife Perfexion System.

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), and Epilepsy.

The upgrade to the Perfexion system expands this capability to include more treatment areas.  Also, an advanced planning system means surgery will be performed with even greater accuracy.

According to Elekta, the maker of the Perfexion System, “System benefits include faster set-up and treatment delivery to one or more tumors in a single session[.]”

Watch this video to learn more about the new Perfexion Gamma Knife.

Dr. Sisti is excited about his Center‘s upgrade.  He says, “We will then have the two ultimate radiosurgery systems: Trilogy and Gamma Perfexion in one place.”

Also of note is that the whole Radiation Oncology Department at Columbia is undergoing a $50 million upgrade.  This is important to our cancer patients because many of them will receive their radiation therapy there.

Learn more from our page on Gamma Knife Radiosurgery and our previous blogs: One Picture Speaks a Thousand Words-These Neurosurgeons use Two and Radiosurgery Trials Looking Good for Epileptics.

Dr. McKhann also served as a panelist at a breakfast seminar covering what is NEW in the surgical treatment of epilepsy.

Epilepsy is a general term for a group of disorders that involve regular seizures or electrical disturbances in the brain.  Epilepsy is highly variable from person to person, depending on the seizure type and location of their seizure onsets in the brain.

Many patients have seizures that are technically called complex partial seizures. These often seem to be “mild”, typically with patients stopping what they are doing and staring (often with minor physical movements). They typically last less than a minute and may occur no more than a few times a month.  However, having this type of seizure significantly affects a person’s ability to function independently and severely impairs quality of life.  In some cases they can even prove fatal.

A thorough neurological examination and highly sophisticated imaging technology is used to find the exact type and source of the seizure.  Once diagnosed, medication is typically the first line of treatment.

According to Goodman however, “Over 40% of patients with complex partial or temporal lobe type seizures do not have their seizures completely controlled by medication.  Many of these patients can be cured surgically.”

“Many of these patients,” he explains, “have seizures that have their focus (place where they originate) in a benign area of the temporal lobe.  Often, the diseased section isn’t critical to function and can be removed without significant impairment to the person.”

Surgical treatment for temporal lobe epilepsy has an exceptionally high cure rate, too.  One research study showed that 60% of patients at their one year check-up were completely free of seizures, compared with 8% of patients treated with medication only.  Some research also indicates that the cure rate may be even higher when the patients are more rigorously selected.

Dr. Goodman wants these kinds of epilepsy patients to know that this could be a possibility for them.  ”Surgery can change their lives,” he says, “make their lives normal, in fact, and unless their neurologist works with a major surgery center, they may not  know this is available either.”

Dr. Goodman says that to find out if surgery is an option, patients need to see a neurologist who, not only specializes in Epilepsy, but also has experience working with neurosurgeons who regularly perform this kind of surgery, typically at a large medical center where the diagnostic and surgical technology is available.

To learn more, see the Epilepsy Center‘s page on  Temporal Lobe Epilepsy.