“When I was a child, I loved to build models: cars, ships, airplanes. That type of detail work always intrigued me. The preferred tools were borrowed medical instruments. I could work on models for hours and hours.”
It is the same today for Dr. Philip Meyers, Associate Professor of Radiology and Neurological Surgery and Clinical Co-Director of Neuroendovascular Services at Columbia Presbyterian.
He says, “The time in a complex procedure really does slip away. I can look at the clock at 8 AM when we’re beginning a procedure. What seems like five minutes later, I look at the clock and it’s already 1 PM. During periods of intense concentration, the time still flies by.”
Now, of course, the stakes are higher; he uses much more sophisticated and modern tools, and the models have been replaced by the delicate blood vessels inside the human brain.
“I like working with my hands. I have always been interested in science and technology, ” says Dr. Meyers. There were doctors in his family but they were mostly psychiatrists.
“My grandfather had been a popular figure in psychiatry, during the golden age of psycho-analysis,” he says. “He had studied at Johns Hopkins with Adolf Meyer, and in Vienna in the school of Sigmund Freud. He and Freud’s daughter Anna became close friends.
When I was young, I visited one of my uncles who was a psychiatrist performing research at the National Institute of Mental Health. He showed me his primate laboratory,” he says. “It was fascinating. He was part of the transition from Freudian psychoanalysis to modern psychiatry studying the biological basis of psychiatric illness.”
These early glimpses of medicine and particularly the brain sparked an interest in Philip Meyers that was later set aflame at Harvard. “During my undergraduate education at Harvard College,” he says. “I took a neurobiology course directed by Nobel Prize winners for their work on the biology of vision.
We studied the neuronal systems in the retina and how the nerves interact to make vision. I was fascinated by the organization of the brain down to the cellular level. That was 30 years ago! There have been great advances in the understanding of the brain and its function since that time. Still, there are so many areas to explore.”
After graduating from Harvard, Dr. Meyers went on to medical school at Case Western Reserve University in Ohio. “I grew up in Ohio and was still a resident of the State,” he says. “It had the first integrated curriculum, and the education was State subsidized. When we started to study the nervous system, I first memorized an atlas of the major neuronal pathways. Many illnesses are caused by an injury to a specific area of the brain or spinal cord. Based on the atlas, I could figure out what the signs and symptoms of the illness should be. I really felt like the subject matter spoke to me. It was fun, and it came easily. I knew fairly early in Medical School I would specialize in the neurosciences.”
At that time, the 1980s and 1990s, the field of neuroscience was exploding. Incredible strides were made in the understanding of the brain particularly in genetics and neurochemistry.
There was also a proliferation of new technology and the specialty of interventional neuroradiology was starting to emerge; sophisticated imaging and the miniaturization of catheters and devices enabled physicians to operate, through a 1-2 millimeter incision in the leg, within tiny blood vessels deep inside the brain.
“In 1990, the Chairman of my department said to me, ‘Phil, I would learn to work those catheters.’ And, that is what I did,” says Dr. Meyers. “At that time, this kind of surgery wasn’t performed by neurosurgeons at most medical centers. It was a specialty of radiology.
I returned to Cincinnati where I grew up to help my father through a serious illness and studied Radiology and Neuroradiology at the University of Cincinnati Medical Center.” Robert Lukin was Chief of Radiology there, an outstanding neuroradiologist, and President of the American Society of Neuroradiology.
The first neurointerventionalist Dr. Meyers worked with was Dr. Thomas Tomsick, Radiology Professor and Director of Neuroradiology at Cincinnati. “He is a brilliant man, and he was really my first mentor in interventional neuroradiology,” says Dr. Meyers. Dr. Tomsick recalls the exceptional talent of his young protege, “He was one of the best residents we have ever had and a terrific guy. My only regret is that we couldn’t get him to join our department.”
After his residency, Dr. Meyers accepted a Fellowship in Interventional Neuroradiology and Endovascular Neurosurgery at the University of California San Francisco (UCSF). “I wanted to go to the highest volume program in the US, and at that time (in the late 1990’s) San Francisco was the place,” he says. “Started when Grant Heishima moved from UCLA to UCSF, the program is still run by his disciples: Randy Higashida, Van Halbach, and Chris Dowd. This fellowship was a compelling experience, really the moment I had been waiting for. I loved every second of my time in San Francisco.”
Dr. Meyers continues, “Patients came from all over the United States and from around the world. We saw thousands of patients with neurovascular diseases. The new endovascular treatments for complex cerebrovascular diseases were saving people where there had been no hope only a few years earlier.
These were very exciting times, and it was clear a new medical discipline was forming. Sometimes, the same minimally-invasive technologies could be applied to non-neurological diseases with spectacular results.”
Dr. Meyers remembers one of the most exciting procedures he ever participated in was during his time in San Francisco and outside of neuroscience. At that time, surgery on the unborn child was developing at UCSF and other leading pediatric medical centers. They were innovating an operation to save the lives of babies with congenital diaphragmatic hernia whose lungs weren’t developing in the womb.
“In these cases, the baby underwent surgery inside the mother’s uterus,” says Dr. Meyers. “Using ultrasound guidance and a laparoscope, I would pass one of our brain microcatheters tipped with a small balloon into the baby’s mouth and down into its breathing passage way, and then inflate the balloon. The blockage caused by the balloon would force the lungs to develop. When the baby was born the balloon was removed, so that the baby could breathe normally. Not my area of primary expertise, but what a wonderful digression!”
This kind of crossover from the brain into other areas of medicine is not uncommon for neurointerventionalists like Dr. Meyers, especially those with training in radiology. Using modern imaging tools, radiologists diagnose illness and guide treatment throughout the body. “Techniques I learned in general radiology, are directly applicable to neurointerventional procedures on the brain and spine,” says Dr. Meyers. “Using each imaging modality to advantage while limiting a patient’s exposure to ionizing radiation is one of radiology’s main goals.”
After so many years of intensive training, Dr. Meyers took a job here at Columbia University in the Departments of Neurosurgery and Radiology.
“It was between Columbia and Mass. General,” says Dr. Meyers. “I am so glad I made the choice. The super specialization at Columbia is unique. It makes this department more special than any other center I have worked in. Here, there are specialists who just treat brain tumors while others only perform spine surgery. High specialization is valued and it creates an opportunity for the kind of techniques and experience that I can bring. It also creates an environment rich in collaboration. It is truly a multi-disciplinary endeavor. This is the model of the future.”
Today he works with vascular neurosurgeons, stroke neurologists, and neuro-intensivists. “When someone has a stroke,” says Dr. Meyers. “over a million neurons are lost every minute (according to one estimate) so we move as quickly as possible to help them.”
Dr. Meyers also collaborates with other services at Columbia, often Cardiology, Pediatric Surgery, Vascular Surgery, and Dermatology. “Many of the same blood vessel abnormalities that occur in the brain also have effects on other parts of the body and require a comprehensive treatment approach,” says Dr. Meyers.
“I assist the interventional cardiologists when our neurovascular devices are needed to treat complex heart diseases. I also work very closely with the pediatric surgeons and dermatologists in a Vascular Anomalies Clinic at the Childrens Hospital of New York (CHONY). There are important areas of overlap in the treatment approach to these children that require a multi-disciplinary care team. I am fortunate to have wonderful people here too, leaders in their fields, with whom to collaborate.”
Despite all the cross pollination, Dr. Meyers says his passion remains neuroscience. “I am interested in how the brain responds to injury and how it adapts to stresses,” he says. “Neuroplasticity is a term that describes how the brain compensates for injuries while maintaining vital functions. Greater understanding of neuroplasticity is one of the many exciting developments that will come in the next years as we learn to better enable people to recover from their injuries.”
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