CNS Founders Laurel Award

Honored to have been given this prestigious award from the Congress of Neurological Surgeons, for a legacy of leadership in organized Neurological Surgery.

Posted in Uncategorized |

Minimally invasive removal of brain hemorrhage

Keck/USC and LAC/USC Neurosurgery are contributing to an international study using an innovative technology to locate and more safely remove brain hemorrhages. These blood clots known as ICHs or intracerebral hematomas, are a relatively common cause of stroke in our older population, especially those who have hypertension or are on blood thinners. ICH produces paralysis or even coma as it forms rapidly inside the brain tissue. Since the pressure the blood causes can rapidly rise and cause death, timing of clot removal becomes critical. Further, a safe way to enter the brain causing the least amount of damage is necessary have a chance at a satisfactory recovery. The ENRICH trial uses the Brain Path Approach which is a precise surgical technique to safely enter the brain and quickly remove the blood clot with the least amount of trauma to normal structures. Computer and image guidance are used to accurately target the ICH taking a trajectory through the safest route. We have tested the Brain Path technology for the past year and have developed quite a track record for its effective use. That is why Keck/USC was invited to join the ENRICH trial. Our multidisciplinary team of stroke neurologists, neurosurgery and neurocritical care physicians care for one of the largest Stroke Centers in California.

Posted in ICH, Stroke |

High volume Brain AVM centers have better outcomes.

Our good friend and long distance colleague Michael Morgan and his coauthors from Australia, published a study on over 8000 patients treated for Brain arteriovenous malformations in US hospitals. They categorized low volume hospitals as those treating 2 or less cases per year and high volume as treating 16 or more per year. Our Cerebrovascular Disorders Center at Keck/USC treats over 30 AVMs per year. Patients treated in the high volume centers had shorter lengths of stay and lower mortality rates than those treated in low volume centers. When looking at specific surgeons, those who were high volume had much better patient outcomes. Brain AVMs are not only dangerous and complex lesions to treat, but require expertise in a relatively large number of technically challenging techniques such as microsurgery, stereotactic radiosurgery, neuroendovascular surgery and neurocritical care. It is calculated that if all brain AVM patients were treated in centers such as Keck/USC, there would be 27 less deaths per year and a cost savings of $51.6 million dollars.

Posted in Arteriovenous Fistula, AVM, Gamma Knife |

Meet Steven L. Giannotta, MD, Professor and Chair Of Neurological Surgery

Posted in Acoustic Neuroma |

Acoustic Neuroma Association Advisory Board

I am proud to have been recently elected to serve on the Acoustic Neuroma Association’s Medical Advisory Board.  I assume the position along side not only a number of our nation’s most prestigious practitioners, but in association with Kris Siwek.  Kris is the only former patient on the Advisory Board and serves as the patient navigator for our Acoustic Neuroma Center at Keck/USC Medical Center in Los Angeles.

The ANA was founded in 1981 and is one of the oldest and most effective patient support and medical information distributor for any neurologic disorder.  The organization currently serves over 5000 members and is governed by an all patient (or family member) BOD based in Atlanta, Georgia.  For more information contact: www.anausa.org

 

Posted in Acoustic Neuroma, Cranial Base Surgery |

Radiation for atypical meningioma

Unfortunately, not all brain meningiomas are completely benign or completely curable with surgery.  Bill Couldwell (former USC faculty member) and his colleagues reported on 59 patients who had atypical (grade 2 or 3) meningiomas resected or partially resected at their institution.  They found that if they used adjuvant radiation after the surgery, the recurrence rate was much delayed in comparison to those who did not get radiation.  Importantly they found that those patients who got radiation immediately after the surgery did better than those who got radiation after there was some evidence of regrowth on the MRI scan.  We use Gamma Knife and Cyber knife here at Keck/USC for all our patients with meningiomas that are not able to be surgically cured.  Further we believe that all atypical meningiomas need to have follow up imaging studies for the remainder of the patient’s life to insure that a recurrence is not missed and allowed to grow out of control.

Posted in Cranial Base Surgery, Gamma Knife, Meningioma |

Cavernous Angiomas and Seizures

Our Neurosurgical colleagues from Germany published a study in this month’s Journal on Neurosurgery on the management of seizures from cavernous malformations of the brain. Since there are two ways to treat epilepsy that occurs from the presence of cavernous angiomas, this is an important study.  They found that the seizures were more quickly and completely cured (88%) if the offending malformation were surgically removed, than if these patients were simply treated with anti seizure medications (32%).  Most importantly, the risk of the surgery was not increased in comparison to the risk of taking the anticonvulsant medications.  We continue our active and nationally recognized epilepsy program here at Keck USC, supplemented with one of the nation’s most prestigious neurovascular surgery service lines.  All vascular patients are seen by our entire team of vascular experts, to improve decision making and patient centered care.  The third party payers are gratified that resolution of complex diagnostic questions, as well as treatment decisions can be made with one visit to our Comprehensive Cerebrovascular Disorders Center.

Posted in Cavernous Malformation |

Surgical Options for Trigeminal Neuralgia

In conjunction with the Keck/USC Neurology Department, we put on a spectacularly successful symposium at the Mayer Auditorium on Saturday March 18, 2017.  The topic was “Headache Disorders, Neuralgias, And Concussive Syndromes.  Our Headache Service, led by Soma Sahai MD, is supremely expert at diagnosing and treating some of the most complex headache syndromes.  They are also expert in managing patients with trigeminal neuralgia or tic douleroux.  When all else fails in terms of medical management, the patients are referred to me for surgical or radio surgical options.  Over 120 participants attended and asked many expert questions, stimulating very high level discussions.

I spoke about my series of over 200 cases of microvascular decompressions for trigeminal neuralgia, and our excellent safety record.  The average length of stay is 2 days for the surgery, and the success rate for curing the syndrome is over 90%.  We have long term follow up on over 120 cases, with 85% sustained pain control.

Along with Gamma Knife radio surgery, my Neurosurgery department now offers Radiofrequency Rhyzolysis for trigeminal neuralgia.  This is do to the successful recruitment of Brian Lee MD, who by virtue of his fellowship, is expert in the minimally invasive procedure.  Our Perfexion Gamma Knife Center is one of the continually longest functioning units in southern California, and has treated over 100 cases of trigeminal neuralgia and other forms of facial pain.

Posted in Trigeminal Neuralgia |

Gamma Knife for Recurrent Acoustic Neuroma

Dade Lunsford and his group in Pittsburgh have reported in this month’s Journal of Neurosurgery their experience treating acoustic neuromas with stereotactic radiosurgery where the surgery has failed to remove all of the tumor.  They had 173 of such cases.  Previous reports have suggested that radio surgery for these tumors after attempt at surgical resection was less efficacious in controlling regrowth than primary treatment with SRS.  The Pitt report showed 90% control at 10 years follow up.  Some patients required more than one SRS treatment and a few required another surgery.  In our Keck Acoustic Neuroma Center at USC, we make every attempt to safely remove the tumor, so as not to require follow up treatments.  We too have an extremely active Stereotactic Radiosurgery Service using the Perfection model Gamma Knife and the Cyberknife.  For small residual tumors the cannot be removed, we have used radio surgery with great success, allowing control of the tumor, without damage to the facial nerve.  Our Center remains number one in surgeries for acoustic neuroma among US academic medical centers.

 

Posted in Acoustic Neuroma, Gamma Knife |

Spetzler Symposium

The Spetzler Symposium was a two day extravaganza in Los Angeles just prior to the annual American Association of Neurological Surgeons meeting.  There were over 50 speakers featured to acknowledge the contributions of Robert Spetzler to Neurological Surgery.  I was asked to speak on the current state of the nation as it relates to training of complex vascular neurosurgery in our residency and fellowship training programs.  The AANS meeting which followed, was the most well attended in history, having returned to Los Angeles for the first time since 1979.

Posted in Aneurysm |