Published on March 28th, 2014
St. Luke’s Center for Neuroscience: A Magnet for Excellence in Neurosurgery
By recruiting accomplished neurosurgeons, forging partnerships with respected peers in the state and securing early access to leading-edge technologies, the St. Luke’s Center for Neuroscience has become a focal point for research and patient care.
“St. Luke’s Center for Neuroscience offers a complete range of neurosurgical procedures for virtually any adult malady,” says Daniel K. O’Rourke, MD, FACS, Chief of Neurosurgery. “We have board-certified and board-eligible neurosurgeons who have completed fellowships in their specialties. We are committed to treating neurological disease in a state-of-the-art fashion.”
Delicate Surgical Innovations for Optimal Outcomes
Whether shoring up collapsed bones or removing tumors, surgeons at St. Luke’s Center for Neuroscience approach brain and spine surgery with nuance and precision. The advanced procedures they employ foster rapid recovery and limit tissue damage.
One of the techniques Dr. O’Rourke and his colleagues are pioneering is minimally invasive transnasal access to the skull base.
“Approaching through the nose, we can remove tumors in the region of the pituitary gland, and indeed the entire skull base, using endoscopes,” he says. “This permits us to remove the tumors through very small openings, which are not visible. We also use approaches through the eyebrow. Either technique avoids large craniotomies and lengthy hospital stays. Patients can go home and back to work more quickly.”
For trauma patients who require multiple surgeries in a short period of time, minimally invasive spine surgery holds an additional benefit, says Doron Rabin, MD, FRCSC, Director of the Neurosurgical Spine Program, because it reduces the time these patients will spend under anesthesia.
Increased use of cerebral endoscopes and stereotactic navigation via endoscope are other leading-edge techniques employed by the center. Advanced monitoring capabilities and dedicated operating suites support these technologies.
“We have dedicated neurosurgery rooms with multiple monitors so that we can coordinate the work of the anesthesiologist and the surgeon,” Dr. O’Rourke says. “The surgeon has six monitors providing updates about the condition of the patient and communicating with other members of the staff as to how the surgery is proceeding.”
That technology can be vital to patient safety in diverse surgical settings.
“In spine surgery, continuous electrophysiologic (EP) monitoring permits us to monitor spinal cord function in real time,” says Donald Zhang, MD, FRCSC, a neurosurgical spine surgeon. “This allows us to see if something has changed and initiate medical or surgical steps to correct it. This technology has enhanced our success rates and safety tremendously. I have never had a catastrophic event when using EP monitoring.”
Soon, the center’s capabilities will be augmented by a combined open/closed surgery operating room housing a dedicated angiogram suite, allowing information drawn from imaging to be integrated with surgery in real time. Using this operating room, surgeons will be able to transition seamlessly from minimally invasive to open surgery if necessary.
The Brain and Spine Tumor Center
Renowned beyond Eastern Pennsylvania, the Brain and Spine Tumor Center of St. Luke’s University Health Network attracts both domestic and international patients. According to Hugh D. Moulding, MD, PhD, Clinical Director of the Tumor Center, patients would have to travel to New York or Philadelphia to gain access to the variety of clinical trials available at the local facility.
The Tumor Center is active in trials of treatment for newly diagnosed glioblastoma, recurrent glioblastoma, high-grade gliomas and metastatic melanomas.
“We have a diverse panel,” Dr. Moulding says. “We have taken time and care to offer different trials covering the gamut of brain disease.”
Dr. Moulding, the only fellowship-trained neurosurgeon specializing in spine tumors in the region, is also deeply engaged in efforts to reduce and combat spinal metastases resulting from other cancers.
“Many people have an appreciation for the severity of brain tumors,” he says, “but often disregarded is how prevalent and frequent spine metastases are. Ninety percent of spine tumors are metastases, and some studies suggest that 90 percent of patients who die from cancer have spine metastases. This cancer often is undertreated and many patients present when it is almost too late.
“We are detecting these issues early to prevent their progression. In addition, I’ve given lectures to raise awareness of the prevalence of this problem.”
Complex Spine Surgery
With the addition of Dr. Rabin and Dr. Zhang, the St. Luke’s Center for Neuroscience has dramatically expanded its capabilities in complex spine surgery in recent years.
Though he uses medical interventions when possible, Dr. Zhang is an expert in surgical interventions for conditions such as cervical spinal stenosis. The most common of spinal cord injuries, this condition affects approximately 6.8 percent of people age 50 and older and 9 percent of people 70 and older, according to research in The Journal of Bone & Joint Surgery.
“To give a sense of how debilitating it can be, I have seen a patient reduced from a walker to a wheelchair within three weeks,” Dr. Zhang says. “Using posterior cervical decompression and fusion in conjunction with laminotomy, we were able to help this man walk again. Five weeks after surgery, he was ambulatory, using his walker, and could lift his arms with full power. He gave me a hug.”
The greatest obstacle to treating degenerative complex spinal disorders, says Dr. Zhang, is complacency.
“It’s assumed that clumsiness and weakness are part of normal aging,” he says. “They are not. Anytime patients exhibit weakness, clumsiness or difficulty with tasks such as dialing a phone or texting, their providers should consider spinal stenosis as a possible cause.”
Pioneering Work in Functional Neurosurgery
For some patients with intractable epilepsy or Parkinsonian disorders, brain and spinal cord stimulators provide a solution that offers a lower risk profile than certain medications and can enhance quality of life for a decade or more, says Steven Falowski, MD, functional neurosurgeon with St. Luke’s Center for Neuroscience.
In the new epilepsy monitoring unit, physicians temporarily halt patients’ medications to allow them to have seizures. Then they monitor patients’ brain activity in order to tailor surgical treatments for these patients. Medtronic’s StealthStation helps surgeons locate focal points in the brain with millimeter accuracy to allow precise implantation of electrodes for the control of seizures.
In addition, Dr. Falowski gains early access to advanced equipment for assessment purposes.
“I help medical technology companies evaluate new technology,” he says. “Often, we have access to new medical devices before other hospitals in the country.”
Among the innovations Dr. Falowski is helping pioneer are MRI-compatible electrodes made of platinum and titanium. The majority of medical-use electrodes are not MRI-compatible at present, so this new technology will provide clinicians additional imaging information.
Dr. Falowski is also a principal investigator in a multi-center trial comparing local to general anesthesia during the implantation of spinal cord stimulators.
“When patients are awake, the procedure is less comfortable,” he says. “When they are asleep, they tolerate the procedure better and it goes more quickly. Our initial results have shown equal, if not better, results when surgery takes place under general anesthesia.”
Partnerships for Treatment of Aneurysms, Traumatic Brain Injuries
The center’s reputation for academic excellence has engendered collaboration with formidable medical peers, enabling joint research ventures.
“We are working with partners such as Jefferson University Hospital on endovascular techniques,” Dr. O’Rourke says. “We just announced a joint endeavor for a biplane flat-panel angiosuite to be placed in our hospital, so we will be able to perform biplane procedures locally.”
Biplane angiography allows 3-D imaging of blood vessels in the brain. Using two separate arms to capture images of contrast dye in the vasculature, biplane imaging gives detailed information about the location and density of blood vessels, allowing more nuanced responses to aneurysms and arteriovenous malformations.
In addition, internal institutional collaborations allow the center to benefit thousands of patients throughout St. Luke’s University Health Network.
“We have invested tremendously in personnel and technology,” Dr. O’Rourke says. “We coordinate with the Stroke Center around aggressive use of tissue plasminogen activator to dissolve blood clots. We also work with our Level I Trauma Center, providing neurosurgical capabilities in the care of complex spine injuries and restoration of the spinal cord or spinal column following trauma.”
Even when no surgery is anticipated, the center’s neurosurgeons provide follow-up consultations for patients who experience traumatic brain injury (TBI), working with TBI programs throughout Eastern Pennsylvania.
“Delayed repercussions of spine and head injury may warrant further investigation,” Dr. Rabin says. “Patients with head or spine trauma may need surgical intervention, but even when that is not the case, we evaluate their imaging, assess them and refer them to others who can help them, such as headache or TBI specialists. It is our philosophy to take responsibility for the overall outcome of the injuries we treat. We help our patients on to the next stop, seeking always to achieve the optimal outcome for each person.”
Multidisciplinary Teams for Simplicity of Care
Patients find stability and clarity of purpose in the center’s multidisciplinary approach. In a firmly patient-centric structure, they meet with groups of physicians representing multiple specialties, rather than seeing a series of providers in a disjointed manner as they progress through treatment. That helps ensure patients understand from the beginning the nature of their conditions, their options for treatment and the stages through which treatment is likely to progress.
“We use coordinated teams, allowing physicians from different specialties to treat patients in a coherent, streamlined fashion,” Dr. O’Rourke says. “For instance, a patient may come in with a movement disorder, which requires the services of physicians of different specialties. We schedule the patient’s appointments in synchrony. Rather than visiting many different doctors’ offices, the patient visits one location, where physicians see him or her together. We coordinate modes of care so the patient leaves the office with a single treatment plan involving each physician’s specialty.”
That high level of collaboration has proved useful — and comforting — to patients.
“Many patients are struggling psychologically to come to terms with their disorders,” Dr. O’Rourke says. “They have experienced the increasing frustration of going from one provider to another and having interruptions or disconnects in communication between providers. Our coordinated care allows them to get all the information they need at one time. Our patient satisfaction scores have gone through the roof.”
To refer a patient to St. Luke’s Center for Neuroscience, visit sluhn.org or call 484-526-6000.