He also co-authored the preface and two articles in this issue:  With Dr. Steven Isaacson from the Gamma Knife Center he wrote, Radiosurgical Management of Brain Metastases; and with resident Dr. Christopher Kellner he wrote, Surgical Management of Brain Metastases.

Also of note, Dr. Paul McCormick from the Spine Center is a consulting editor for this journal.

To learn more see Neurosurgery Clinics of North America,Volume 22, Issue 1, Pages 1-110 (January 2011). You can also read the preface of that issue written by Dr. D’Ambrosio and Dr. Ganesh Rao.

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.

First he was spotlighted as the 2009 NREF/Spine and Peripheral Nerves Section Research Fellow for his paper entitled, A Novel Approach for Convection Enhanced Delivery of Nerve Growth Factors in a Peripheral Nerve Bridge Model to Bypass Spinal Cord Injury.

Dr. Sisti with Dr. Haque

He also won the Leksell Radiosurgery Award, which, according to the AANS website is for, “the best paper on stereotactic radiosurgery related to brain tumors.”   His paper was called, Efficacy of Facial Nerve-Sparing Microsurgery and Stereotactic Radiosurgery with Gamma Knife in Preserving Facial Nerve Function in Patients with Recurrent Acoustic Neuroma.

Finally, Dr. Haque was recognized as one of the authors of the AANS Medical Student Summer Research Fellowship paper entitled, Neural Proliferation of Bone Marrow Derived Cells in a Murine Model of Intracerebral Hemmorrhage.

Dr. Haque joined by his parents, Dr. Bruce and Dr. Sisti

Way to go Dr. Haque!

A Gamma Knife isn’t really a knife. It is a large, stationary machine that can generate a highly concentrated beam of radiation to target a specific location in the brain. It is often used in the treatment of brain tumors. The Gamma rays are painless and the procedure is most often done in an outpatient visit. Typically only one treatment is needed. In this trial the treatment was specifically directed to a location on one side of the brain where the seizures occurred.

Thirty people with epilepsy that have at least three seizures a month were asked if they wanted to be part of this trial. In the end, 26 patients completed the course of the study. These patients were each treated at one of 15 different centers across the country, including our Epilepsy Center here in New York. The patients were divided into two groups: one that received a high intensity dose and one that received a low intensity dose.

They were observed over a period of three years and about 60% of all these patients were completely seizure free by the end. This is comparable to the results of open brain surgery. The differences between the two groups were minimal but the high intensity group tended to have a higher chance of achieving seizure freedom.

What is interesting about the results using the Gamma Knife compared to open surgery is the time it takes to get results. With open surgery, seizures and accompanying auras are immediately stopped. With Gamma Knife Radiosurgery, it can take up to a year for the seizures to go away and in this study, the auras intensified for a brief time even after the seizures stopped.

In some cases, the Gamma Knife patients had an increase in headaches and slight decreases in verbal memory. Over all though, there were no significantly adverse effects from the procedure and the outcome was comparable to the results of open brain surgery without all the risks and complications that entails.

To learn more look for the paper: A Multi-Center, Prospective Pilot Study of Gamma Knife Radiosurgery for Mesial Temporal Lobe Epilepsy: Seizure Response, Adverse Events, and Verbal Memory in the online journal Annals of Neurology Volume 65, Issue 2.

At the Gamma Knife Center they like to be thorough. Before they perform radiosurgery on someone’s brain they do exhaustive tests to locate the problem. One of the problems they treat is called Cerebral Arteriovenous Malformation, AVM for short. An AVM happens when small blood vessels in the brain form a tangled mass. This mass can cause brain cells to die, it can start bleeding, and it often causes headaches and sometimes seizures.

Gamma Knife Radiosurgery (GKR) has become a good alternative to open brain surgery for these patients. A 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.

While the treatment itself is quick and painless, the planning that goes into it is elaborate and takes a team of neurosurgeons and physicists. They must determine the exact location of the AVM, how big it is, and how much radiation to use without causing any unnecessary damage to healthy parts of the brain. To do this they have to take an image of the brain that visualizes the AVM.

Dr. Steven Isaacson from the Gamma Knife Center and his colleagues recommend doctors use not one but two imaging sources in planning for radiosurgery. They described their methods in the International Journal of Radiation Oncology Biology and Physics. They looked at ten cases of AVM that were treated at their center and compared the planning method used to the patient’s outcome. They concluded that the results of two tests in particular should be combined to best locate the AVM.

These tests are Magnetic Resonance Angiography (MRA) and Digital Subtraction Angiography (DSA). Both tests use Angiography, that is they rely on IV driven contrast dye to make the blood vessels in the brain more visible. In MRA, 3D images are taken using a Magnetic Resonance Imaging (MRI) machine. In DSA, 2D X-Rays are taken. When combined, these tests together form a more accurate picture of the size, shape and location of the AVM.

Dr. Isaacson and his colleagues emphasize that, though small, human error can also come into play when these tests are interpreted and therefore should be taken into account. At the Gamma Knife Center they use a mathematical formula that combines all these factors in planning for radiosurgery. A plan that is this in-depth, they report, increases the accuracy of the radiosurgical treatment and more importantly, patients do better.

To learn more, see the article, Incorporate Imaging Characteristic into an Arteriovenous Malformation Radiosurgery Plan Evaluation Model, in the April 2008 Issue of the International Journal of Radiation Oncology Biology and Physics

The Neuroscience Center of Columbia University Medical Center has also developed global leadership in the treatment of vascular or blood vessel malformations. Treatment options include endovascular embolization to plug the problem blood vessels with medical “glue”, insertion of tiny platinum coils to prevent bleeding, and high-dose radiosurgery using our 3-D state-of-the-art gamma knife — one of less than 100 such devices in use worldwide.

As a resident, Dr. Ogden pursued research in central nervous system tumor immunology and the relationship between neural stem cells and central nervous system tumors, for which he received the American Academy of Neurological Surgeons’ annual award for research in 2006. In 2007, He received the American Association of Neurological Surgeons/Congress of Neurological Surgeon’s Cloward Award to support research in computer modeling of spine biomechanics.

Upon completion of his fellowship in 2008, Dr. Ogden joined the faculty of Columbia University to direct its program in minimally invasive spine surgery. His clinical interests include minimally invasive spine surgery, spinal tumors, complex spine, and spinal radiosurgery. His current research involves clinical trials of minimally-invasive spine surgery, development of new minimally invasive spine surgeries, study of the relationship between stem cells and spinal tumors, and comparisons of traditional and minimally invasive spine surgery using computer modeling.

Dr. D’Ambrosio’s practice is devoted to brain tumors, skull base tumors, meningiomas, acoustic neuromas, pituitary tumors, microvascular decompression for trigeminal neuralgia and hemifacial spasm, cerebral aneurysm treatment, degenerative spine disease, and intervertebral disc disease.

He uses state-of-the-art technology such as frameless image guidance systems, awake craniotomy, and stereotactic radiosurgery (i.e. GammaKnife, BrainLab, Tomotherapy) for the treatment of primary and metastatic brain tumors.  He has particular expertise in the use of endoscopic techniques to remove complex intracranial tumors at the base of the brain.

Dr. D’Ambrosio directs our Northern New Jersey practice based in Ridgewood, NJ.  He is the Director of Neuro-Oncology – Disease Management Team at the Luckow Cancer Center of The Valley Hospital in Ridgewood, NJ.  Dr. D’Ambrosio is also the Director of Neurosciences for the St. Joseph’s Healthcare System in Paterson and Wayne, NJ.  He sees patients at The Valley Hospital, St. Joseph’s Regional Medical Center, St. Joseph’s Wayne Hospital, Chilton Memorial Hospital, and Mountainside Hospital.  With his main office in Ridgewood, New Jersey, Dr. D’Ambrosio has helped to establish a center of excellence for Columbia Neurosurgery in the communities of Bergen, Passiac and Essex counties.

Learn more here: The Making of a Neurosurgeon: Dr. Michael Sisti

Dr. Sisti’s Bio featured in The Cooper Union Summer 2010 Issue

They Walk in the Shoes of Giants and Even Sit in Their Chairs

Video

2010 Columbia University Medical Center Attending Physician of the Year Award

Dr. Sisti on Senator Kennedy’s brain tumor

Interview with Katie Couric

Interview with Meredith Vieira

Links

• Dr. Sisti’s Bio featured in The Cooper Union Summer 2010 Issue

Patient Story:  Waiting For Michael

Dr. Isaacson is a Clinical Professor of Radiation Oncology (Neurological Surgery) at Columbia University. In that position he has served many years as an educator and mentor. Dr. Isaacson has participated in the design and implementation of the newest strategies for the management of central nervous system and body tumors using state-of-the art radiation therapy equipment. Dr. Isaacson has also provided thousands of patients with formal radiation oncology consultations. As a radiosurgical specialist for over twenty years, Dr Isaacson and the team with whom he works provide a clinically and professionally mature approach to the most difficult of cases (brain, skull base and spinal tumors) requiring radiation therapy.

Dr Isaacson has received recognition in New York Magazine as one of the “Best Doctors in New York” as well as one of America’s “Top Doctors for Cancer”.