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

They have further recognized him as one of the top 1% of the nation in his specialty (You can tell that by the little blue star next to his name on their website.)

Congratulations Dr. Feldtstein!

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.

Every year Dr. Neil A. Feldstein from the Pediatric Neurosurgery Center puts together a parting gift for the graduating residents.  Using digital tools like Photo Shop he creates a personalized poster presented to the residents at their year-end celebratory dinner.

Feldstein has done this for the last sixteen years and says he enjoys it more every year. Most recently he has been using a movie-poster theme.

Dr. Neil Feldstein

In this year’s poster (seen above) you can find departing Chief residents  Omar N Syed, MD, Robert Morgan Stuart,MD, and Andrew F Ducruet, MD.

According to Dr. Feldstein, “The theme is taken from one of the movie posters from Inception with the thought that the implantation of the idea that they had become neurosurgeons was not theirs but rather implanted.”

You can learn more about Dr. Feldstein’s annual picture in our previous blog, Dr. Feldstein’s Annual Picture Is Our ‘Macy’s Day Parade’

You can learn more about this year’s graduating residents here in our blog, Say Goodbye To The Chiefs.

"Super Doctors identifies top doctors as selected by their peers and the independent research of Key Professional Media"

We are proud to announce that once again, Columbia Neurosurgery has the most neurosurgeons named Super Doctors in the New York Metro area. Of the 32 doctors chosen in the category of Neurological Surgery we rated six spots.

The doctors listed this year are:

• Department Chair and Cerebrovascular specialist, Dr. Robert Solomon
• Dr. Jeffrey Bruce from the Brain Tumor Center
• Dr. Neil Feldstein, from the Brain Tumor Center and the Pediatric Neurosurgery Center
• Dr. Michael Sisti; from the Brain Tumor Center and the Gamma Knife Center
• Dr. Paul McCormick from the Spine Center
• Dr. Donald Quest from the Spine Center

This is not the first time we have been honored either.  See who The Most Neurosurgery ‘Super Docs’ In NYC in 2010 were.

We are very proud of all our doctors!

Related:

• Four Of Our Neurosurgeons Make NY Magazine’s 2011 Best Doctors List,
• More Of Our Doctors Voted “Top Doctors” NY Magazine Announces Best Doctors And We Made The List!
• 9 CUMC Neuro Doctors Voted Best By Peers
• America’s Top Doctors
• Dr. Sisti Named One Of America’s Top Doctors For 2011

One was authored by Dr. Paul Gigante, Dr. Neil Feldstein, and Dr. Richard Anderson and was in the format of a poster presentation.  The paper was entitled, C1-2 Instability from Os Odontoideum Mimicking Intramedullary Spinal Cord Tumor: Report of Two Cases.

The other was a presentation given by Dr. Christopher Kellner entitled, The Role of Aneurysms in Children with Arteriovenous Malformations. This was based on a paper authored by Kellner, Dr. Michael McDowell, Dr. Geoffrey Appelboom, Ivan Kotchetkov, Dr. Raqeeb Haque, Dr. Neil Feldstein, Dr. E. Sander Connolly, Dr. Robert Solomon, Dr. Philip Meyers, Dr. Sean Lavine, and Dr. Richard C.E. Anderson.

Dr. Feldstein's Avatar 'Movie Poster' for graduating residents from left to right Dr. Ricardo Komotar and Dr. Gaetan Moise

Every year in June when the chief residents graduate, before they leave (or stay on as attendings- as the case may be), the faculty host a dinner for them. It is a swank affair fitting the weight of their achievement. Glasses are raised and faculty toast their fledgling colleagues.

Dr. Neil Feldstein from the Brain Tumor Center and Pediatric Neurosurgery Center does something a little different each year. He presents them with a picture that he has spent the year, under a veil of secrecy, making especially for them.

In the early years, when he was a new faculty member, he didn’t speak at the dinner. He says, “I didn’t really know the residents well enough to make a speech. After a couple of years, I thought, if I’ve got nothing to say then maybe I’ll give them something.”

At that time, he was just getting into computer graphics, so he endeavored to make a picture for the graduating residents. He says, “in the early years, the pictures were actually fairly simple; but they seemed to catch on. The residents liked them and they became nice artwork for my office. So, each year I invested more and more time, more effort, more creativity, and sort of pushed the envelope to see what I could do, always trying to blend realism and fantasy.”

Picture inspired by M.C. Escher

In the beginning the pictures were often inspired by different artists such as pop icon Andy Warhol, American Gothic painter Grant Wood, or graphic artist M.C. Escher. As the time he put into these grew, he began to make just one picture for both graduating residents.

The first time he combined them he says, he was inspired by the picture of the two intertwined hands by Escher. Since there were two residents, it was perfect. Feldstein says, “The residents were going into two very different practices, one in the southwest  and the other in the northeast.”

For the last five years, he has been into what he calls his “movie-poster concepts” which allow him, he says, “to put more of the residents into the pictures than the earlier concepts.” He takes a popular movie of the year and turns it into a picture. He has done posters based on movies like Avatar, the Matrix, Lord of the Rings, and X-Men.

The first movie poster he did was inspired by the Matrix. Feldstein says, “So many of our residents and attendings loved that movie. Both of the residents in that year actually became faculty here and one actually joined me as a pediatric neurosurgeon; Dr. Richard Anderson. This is the only time both graduating members stayed on as full-time faculty.”

Last year he made a poster based on the movie Avatar.   He says, “The whole movie was based on a 3D world and I had to create a 3D montage.” Normally he has framers place a double mat around the picture. “Last year,” he says, “ the mats are actually incorporated into the picture itself and that gives it the depth I wanted.”

He has made posters now for the last fifteen years and he says he enjoys it more every year. Especially, he says, because now, by the time they graduate, he knows the residents very well. He says, “I can really think about what statement I am trying to make about either the chief residents that are graduating or any of the other members of the faculty or residency who end up in the pictures. There may be an event that occurred with the resident half way through their training that only some people know about; yet, it somehow shapes them and that, then, becomes incorporated into the picture. They know it- I know it- maybe a few others know it. But again, that is some of the fun of it.”

Dr. Feldstein spends many months in the design and creation of these pictures. He says, “It is much like the Macy’s Day Parade where they start working on the next year’s parade the day after this year’s.  After I present the poster in June, I am already thinking about what I want to do next year.”

He is constantly looking into the latest in graphic-art technology that he says, “may inspire, if not the whole piece, than some aspect of the piece.”   Each year is actually more complicated than the year before, often because of new photo-shop techniques. Sometimes I think that the residents may not know that; they may think that it looks simple. They are never simple.”

He begins a new picture by collecting graphic images that he’ll want; either from the internet or he’ll purchase books with the images he wants. Then he does rough drawings by hand. He lays out a grid and begins to get a sense of proportion, scale and position. Then, he says, “Photoshop allows me to use a technique called layering, where I can have 30-40 layers for just one small character before I decide that is a go, and then put it into the ultimate picture, and blend it all.”

In the most recent poster, he says, ”I used some of the new photoshop techniques for morphing images and changing joint angles to accommodate the monkey-like creatures leaping off a tree.”

He also says, he hides something in every picture.”For the longest time,” Feldstein says, “I always incorporated the logo for our medical center. Sometimes it was very obvious and sometimes not.” For example, in the Escher painting, he put the logos in the cuff links.  He says, “if you look around you can always find something hidden like that. You can’t always see them by the naked eye. If you take out a magnifying glass, you can usually find it.”

Feldstein says, “I always try to get done with it at least the month before the dinner, and just set it aside and think about it. Invariably I’ll want to add something, or tweak it a little bit more, even changing just one more pixel to make it a little better, but it is a really fun thing to do.”

He then has them professionally framed, wrapped and, under cloak and dagger, brings them to the graduates’ dinner. He says, “Everything is very hush hush. That is the first time anyone ever sees it.”

There is a nice sense of comradery in the department that comes out at these dinners. “We can all let our guard down, relax, let our shirt tails out and realize that we are all one family, and that these graduating residents are becoming members of that neurosurgical family,” says Feldstein.

He says, “I get an opportunity to talk about each resident, the picture, what I thought about while I was making it and why I chose it. Everyone gets to see it and then I’ll put up a framed copy in my office.”

Each one of his fifteen framed pictures hangs in his office. He says, “It helps me remember the residents. It’s also nice when I go into a graduating resident’s office, who is now an attending somewhere, and see my artwork on their wall.  All doctors have a montage of their diplomas, from college and medical school and residency, up on their walls, but these are unique. It is something that is a keepsake.”

Related: Chief Residents Leaving The Nest

That new baby’s brain is about to start an incredible growth spurt. In nine months it will double in size and by 36 months it will be three times as big.

The ‘soft spot,’ also called the fontanel, is one of several gaps between the bones of the skull that, in addition to allowing the skull to expand, are constantly producing new bone to keep up with this growth.

The gaps are arranged along the skull in a functional pattern that allows the brain to grow symmetrically. In addition to the fontanel, there are other long narrow, hinge-like gaps called sutures.

The largest is the Sagittal suture (see the image at right) which runs along the top of the skull from front to back.  It divides the two large Parietal bones.

The fontanel is located along the Sagittal suture between the Frontal and Parietal bones. In some rare cases, the sagittal suture fuses too early, causing sagittal synostosis – the most common form of Single-Suture craniosynostosis (SSC).

The brain still grows but because there is no longer a gap along the top of the head, the head can’t expand from side to side. This causes the brain to push out in front and in back, giving the baby a more elongated skull (This PICTORIAL guide shows the bone plates and sutures and explains how early fusion can cause skull deformity).

A small percentage of these children have developmental problems that can result from an increase in brain pressure. The most common problem however, and the reason most children have corrective surgery is skull and facial deformity.

In a recent paper published in the Journal of Neurosuregery: Pediatrics, authors* including Dr. Richard Anderson and Dr. Neil Feldstein from the Pediatric Neurosurgery Center say, “ Improvement of the cosmetic deformity associated with SSC not only eases parental anxiety but facilitates early parent-child bonding and will, in many cases, prevent damage to the growing child’s self image.”

There are a variety of tools that have been designed to objectively measure deformity but, the authors say that surgeons have not yet agreed upon which one to use routinely after surgery.

In their paper, they review a variety of these tools and urge that until a satisfactory method or group of methods is established it will be difficult to meaningfully compare the outcomes of the many types of surgery for SSC that are available today.

To learn more, you can read their paper Surgical treatment of single-suture craniosynostosis: an argument for quantitative methods to evaluate cosmetic outcomes in the Journal of Neurosurgery: Pediatrics (6:193–197, 2010).

In the meantime, be grateful you have to be careful of that precious ‘soft spot.’

*The authors of this study are: Todd  Hankinson, M.d., M.B.A.; Elizabeth Fontana, M.D.;Richard Anderson, M.D.; and Neil Feldstein, M.D.

Based on the evidence, Dr. Feldstein recommended nondural opening for all patients except those with: Rapid progression of scoliosis with underlying syrinx; Rapid progression of neurologic dysfunction; Recurrence after nondural decompression WITHOUT bone regrowth; or for those likely to require posterior occipital-cervical fusion.

Related Topics:

Docs Present at 2010 Congress of Neurological Surgeons Meeting

More Evidence That Riskiest Part Of Chiari Surgery May Not Be Necessary

Dr. Feldstein (left) and fellow presenter Phil Simms

Dr. Neil Feldstein from our Brain Tumor Center and Pediatric Neurosurgery Center addressed attendees at the 4th Annual Dinner & Auction to benefit the Matthew Larson Pediatric Brain Tumor Foundation (also called IronMatt) last month.

Dr. Feldstein’s concern for his patients was evident in his opening remarks to the audience of 660 attendees at Cipriani Wall Street. “I am very passionate about this disease and the need to cure it now, not next year or the year after.”

He stressed that there have been amazing strides in treating pediatric brain tumors. “In the last two to three decades we have seen marked improvement in the five year survival of many malignant tumors.

One of the most common pediatric brain tumors is medulloblastoma. We have gone from a 40 to 50% five year survival to upwards of 80 to 90% survival in some of the more favorable forms of medulloblastoma,” Dr. Feldstein shared.

Dr. Feldstein is a member of the Medical Advisory Committee of IronMatt, which evaluates competitive applications to award grant funds to research scientists at top academic medical centers throughout the United States. Because of the marked increase in survival, IronMatt also supports research toward quality of life after cure, not simply curing the disease.

“While there is some federal money available for basic and clinical research it is not enough for our small field and every dollar we can raise through private philanthropy and foundations like the Matthew Larson Foundation puts us that much closer to cures for these various malignant childhood brain tumors,” continued Dr. Feldstein. “Given the marked successes we have seen in the last decades there is continued optimism that we will get there. Unfortunately, for the children afflicted and their families as well as the myriad of care givers like me, it cannot be soon enough.”

This year’s event raised more than $500,000 with support from community groups, corporations, individuals, volunteers and the IronMatt Board of Directors.

The Matthew Larson Pediatric Brain Tumor Foundation (IronMatt) honors the valiant life of Matthew James Larson, who succumbed to a five-year battle with brain and spinal tumors at age seven. The foundation carries Matt’s spirit in its mission to wrap a caring arm around families and publicly commit to help children that are battling pediatric brain tumors through research.

For more information about how you can support the Matthew Larson Pediatric Brain Tumor Foundation, please visit www.IronMatt.org or contact Michelle Andryshak, at michelle@ironmatt.org .