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St. Catherine of Siena Medical Center: A Comprehensive Approach to Neuroscience on Long Island

OFFERING A FULL RANGE OF CLINICAL NEUROSCIENCE SERVICES — FROM MEDICAL AND SURGICAL RADIATION TREATMENTS FOR TUMORS TO BACK AND SPINE SURGERY TO TRAUMA CARE — ST. CATHERINE OF SIENA MEDICAL CENTER AIMS TO PROVIDE TERTIARY-LEVEL CARE TO LONG ISLAND RESIDENTS.

THE MULTIDISCIPLINARY PROGRAM at St. Catherine of Siena Medical Center treats the central nervous system as a whole, treating diseases and injuries of the brain, spine and nerves throughout each patient’s body. Care includes every-thing from pain management strategies to the most delicate surgeries, and the medical team is likewise diverse. The neuroscience program consists of board-certified neurologists, neurosurgeons, oncologists, orthopedists and radiolo-gists, as well as pain management and rehabilitation specialists.

These physicians provide guidance for every level of acuity, from sud-den response to a stroke to ongoing conservative management of back or nerve pain. They perform minimally invasive procedures, as well as open craniotomies. Throughout their range of care, the team at St. Catherine of Siena aims to achieve the highest outcomes for their patients.

“We are pushing the envelope in terms of our ability to undertake difficult cases and obtain excellent outcomes for our patients,” says Magdy Shady, MD,

neurosurgeon and Chief of Neurosurgery at St. Catherine of Siena Medical Center. “The challenge is to offer the patient the best possible outcome.”

Members of Long Isla nd Spi ne Specialists (LISS), PC perform spinal cases at St. Catherine of Siena, says Thomas Dowling, MD, orthopedic spine surgeon and Assistant Clinical Professor in the Department of Orthopedics at Donald and Barbara Zucker School of Medicine at Hofstra.

“Our group of six spine surgeons, along with three physiatrists, use the hospital

Magdy Shady, MD, neurosurgeon and Chief of Neurosurgery at St. Catherine of Siena Medical Center

St. Catherine of Siena Medical Center: A Comprehensive Approach to Neuroscience on Long Island

and we perform the range of surger-ies you’d expect to find in a university hospital. We’re all board-certified and fellowship-trained, and our variety of backgrounds and approaches provides us a wide range of experience to draw upon.”

These LISS surgeons offer numerous procedures, services and techniques not often found at a community hospital. Spinal procedures include: deformity correction such as scoliosis surgery, fusion techniques such as anterior, posterior, lateral and oblique approaches that all may include various types of instrumentation, cervical laminoplasty, endoscopic discectomy, interspinous process decompression, kyphoplasty, laminectomy, and spinal cord stimula-tion. Many procedures are offered in a minimally invasive or endoscopic fashion, resulting in sma ller inci-sions, less pain and shorter hospital stays than would open surgery. Spinal revision surgeries, which are often especially challenging, are also offered at St. Catherine of Siena.

Brain and spine surgery are offered through Brain and Spine Surgery PC of Long Island. Brain procedures available at St. Catherine of Siena range from open craniotomies for the removal of malignancies to surgeries for blood clots. The array of brain and spine procedures performed at St. Catherine is quite comprehensive.

“Offering such a full range of spine sur-geries at a community hospital is rare,”

Dr. Shady (in the foreground) has expertise in surgically treating brain tumors and brain and spine injuries, as well as in radiosurgery for brain malignancies.

Hargovind DeWal, MD, orthopedic spine surgeon and Chief of Orthopedic Spine Surgery at St. Catherine of Siena, and Thomas Dowling MD, orthopedic spine surgeon and Assistant Clinical Professor in the Department of Orthopedics at Donald and Barbara Zucker School of Medicine at Hofstra, review AIRO images during a surgical procedure.

says Hargovind DeWal, MD, orthopedic spine surgeon and Chief of Orthopedic Spine Surgery at St. Catherine of Siena. “Typically, only large tertiary care centers offer a comparable range of services. We can provide as much as we do because of the advanced training and expertise of our surgeons.

“With the enhancements in technol-ogy and the advanced training of the

Meet the Physician: Magdy Shady, MDMAGDY SHADY, MD, neurosurgeon and Chief of Neurosurgery at St. Catherine of Siena Medical Center, obtained his medical degree at the Mansoura Faculty of Medicine in Egypt and served residencies at the University of Saskatchewan Royal Hospital in Canada, Lincoln Medical and Mental Health Center and NYU School of Medicine. He completed fellowships at Lincoln Medical and Mental Health Center and NYU Langone Medical Center, in additional to University of Maryland Hospital. A member of the faculty at Stony Brook School of Medicine, Dr. Shady has expertise in surgically treating brain tumors and brain and spine injuries, as well as in radiosurgery for brain malignancies.

Dr. Shady has practiced neurosurgery for more than 25 years and is a Diplomate of the American Board of Neurological Surgery. He has performed research in malignant brain tumors and commits a portion of his time to performing brain and spine surgeries in underserved areas abroad.

surgeons, there is generally no reason to refer patients to tertiary care centers that are located far away from home,” Dr. DeWal continues. “We can provide state-of-the-art technology and superior outcomes right here on Long Island.”

TECHNOLOGY FOR REFINING AND VISUALIZING SURGERYAs Dr. DeWal notes, one way in which St. Catherine of Siena is improving outcomes is through investment in the latest technologies for monitoring and refining neurological surgery. In fact, across the hospital, there is an emphasis on advanced imaging for diagnostic and procedural use. St. Catherine of Siena holds American College of Radiology accreditations in MRI, CT, ultrasound and nuclear medicine, the end result of a process that evaluates both the skill of the personnel performing and interpret-ing the images and the condition of the equipment itself.

“These organizations are interested in, and work on keeping the standard of practice high,” Dr. Shady says. “And when an institution, such as St. Catherine of Siena, is accredited by a reputable organization, it indicates that we provide the best quality and the best standard of care to our patients.”

This year, the case in point is — without doubt — the Airo Mobile Intraoperative CT, which was acquired through the efforts of Dr. Shady and funded by the neuroscience service line at Catholic Health Services (CHS). The Airo naviga-tion system allows surgeons to operate with “more accuracy and precision than ever before,” Dr. DeWal says.

“It offers real-time, three-dimen-sional operative feedback and navigation of instruments,” he continues. “With the Airo, we can more precisely place a wider range of instruments in a smaller incision, as well as precisely place implants. The Airo allows us to perform

m or e c omp l e x pr o c e d u r e s i n a community setting.”

Consisting of a removable operating table, a large-bore 32-slice CT scanner, X-ray tube and detachable touch screen controls, the Airo is highly adaptable to various surgical procedures and environ-ments. It can also be integrated with existing equipment, such as MRI imaging systems and various surgical toolsets.

“When a patient has an MRI before surgery, and then we scan the patient [with the Airo CT] in the operating room, the navigation system married to the Airo CT can fuse the CT scan and MRI together,” Dr. Shady explains.

Though navigation for neurosurgical procedures has been around since the 1990s, Dr. Dowling describes the Airo as the “4.0 in terms of evolution of spine navigation.” Several features define the evolution Dr. Dowling describes.

“First of all, the Airo integrates hard-ware and software,” he says. “Second, the system was not developed by a device company, a company that makes instru-mentation, but by a company with no financial ties to any one product, so it is independent of instrumentation. Not every instrumentation is appropriate for every case, and surgeons have different training and habits. The Airo allows for the accommodation of physicians’ requests for certain instrumentation for a particular case, rather than being restricted to the instrumentation attached to the navigation system. This flexibility helps maximize surgical accuracy.”

Meet the Physician: Hargovind DeWal, MDHARGOVIND DEWAL, MD, orthopedic spine surgeon and Chief of Orthopedic Spine Surgery at St. Catherine of Siena, obtained his medical degree at the State University of New York Downstate Medical Center. He completed his residency in orthopedic surgery at NYU Hospital for Joint Diseases. He finished a fellowship in spinal surgery at the Cleveland Clinic and another in musculoskel-etal research at NYU Hospital for Joint Diseases.

Board-certified in orthopedic surgery with additional training in neurosurgery, Dr. DeWal focuses on minimally invasive spine procedures, including surgery for herniation, scoliosis and stenosis, as well as athletic injuries of the spine.

Dr. DeWal and Dr. Dowling prep for surgery.

Meet the Physician: Thomas Dowling, MDORTHOPEDIC SPINE SURGEON Thomas Dowling, MD, is an Assistant Clinical Professor in the Department of Orthopedics at Donald and Barbara Zucker School of Medicine at Hofstra. He earned his medical degree from Boston University School of Medicine and served residencies at North Shore University Hospital Manhasset and the State University of New York at Stony Brook. He completed spine fellowships at North Shore University Hospital, Toronto General Hospital and Mount Sinai Hospital in Toronto.

Board-certified in orthopedic spine surgery, Dr. Dowling is a member of the board of directors of the New York State Society of Orthopaedic Surgeons and of CHS, Long Island. This July, Dr. Dowling will celebrate his 30th year in practice.

Operating Room Nurse Manager Stelanie Poalillo and staff transport Airo for use in surgery.

A TRANSFORMATIVE STORYTechnologies like the Airo are trans-forming neurological surgery. Dr. Shady illustrates with a story about one of the ea rliest procedures per formed at St. Catherine of Siena in which the Airo was utilized.

“One patient recently had a pituitary tumor pushing against the optic nerve,” he says. “She was going blind. The patient was 82 years old; her age made surgery more risky. For the surgeon, that means extra care is needed.

“The tumor was in a critical area. I asked myself, ‘Am I exposing the patient to a higher risk? Can I offer her a better outcome through operation? I can use other technology to treat the tumor, but without surgery, she will become blind.’ I went t hrough t he entire thought process.

“Because we have the Airo technology, I decided to operate. I was able to remove a majority of the tumor and decompress the optic nerve. A couple of weeks after the procedure, she was doing well. She said, ‘Dr. Shady, I can watch television now. My eyesight is much better.’”

Without the Airo, such a delicate case would have previously been beyond the scope of surgeons at St. Catherine of Siena, Dr. Shady emphasizes.

“It’s important, when operating on an elderly patient, that we avoid unneces-sary risk even as we strive for good outcomes,” he says. “In the past, cases like this one would have been referred to a tertiary care hospital. Today, we can perform them at St. Catherine’s with no issues.”

REDUCING THE RISK: REVISIONS AND OTHER CHALLENGING PROCEDURESSome surgical positionings are espe-cially well-served by using the Airo, Dr. Dowling says.

“The most useful cases are primarily posterior surgeries of the spine, whether cervical, thoracic or lumbar,” he explains. “It’s very useful in upper thoracic pro-cedures, where X-ray or f luoroscopic imaging may not be as clear, due to bodily habitus where arms may be in the way in upper thoracic surgery, for instance.”

A Long-Awaited TechnologyDESCRIBED IN A press release as the “Bentley” of intraoperative imaging, the Airo Mobile Intraoperative CT by Brainlab is designed for both diagnostic imaging and intraoperative use. The scanner can also be used to check work after a procedure.

Providing full imaging support for cranial and spinal procedures, the Airo provides high-resolution CT imaging to the surgeon in real time. Armed with this information, surgeons can perform more procedures in a minimally invasive fashion, as well as tackle surgeries they might not otherwise choose to perform. The Airo opens up brain and spine surgery to a range of patients who might not benefit from open surgery.

The Airo uses Hounsfield soft tissue imaging to measure radiodensity of tissue, an approach that, along with other tests and workup, has been found to help characterize the nature of various lesions. With a scan volume of 50 by 100 centimeters, the Airo allows a surgeon to visualize a large field at once — “the entire spine in a single scan,” according to Airo’s description of the product.

The large-bore scanner can accommodate patients of many sizes and a variety of patient positioning, while the system control, which can be accessed via a detachable touch screen, allows for ease of use. Unlike some intraoperative imaging systems, the Airo is device-agnostic; surgeons can perform minimally invasive operations with the tools most familiar to them, easily integrating their preferred surgical apparatus with the Airo’s control system.

Intra and postoperative scans with the Airo allow physicians to check their work, verifying each step and correcting any imperfections before closing the surgical site.

Using the Airo also benefits revision spine surgeries. These famously tricky procedures require the highest surgi-cal acumen.

“With a prior surgery, such as a fusion, the patient’s normal anatomy may be

changed,” Dr. Dowling says. “In a typical procedure, the surgeon may be guided by anatomic landmarks. When these landmarks are no longer present, the enhanced, continuous visualization of the Airo is invaluable.”

Operating Nurse Roberta Kant, Dr. Shady, Dr. Dowling, Dr. DeWal, Operating Room Nurse Manager Stelanie Poalillo and Director of Peri-operative Services Ann Luliano

Use of the Airo also means more proce-dures may be performed in a minimally invasive fashion.

“At St. Catherine’s, we perform numer-ous surgeries of both the neck and back, ranging from simple and complex, includ-ing minimally invasive fusion procedures,” Dr. DeWal says. “One challenge is that as we move to minimally invasive techniques, there is less visualization of the patient’s actual anatomy—we rely on enhanced imaging such as the Airo CT to safety and precisely place these implants.”

Minimally invasive surgeries have many benefits: They can result in shorter length of hospital stay and quicker return to full functionality, Dr. DeWal notes. Use of the Airo reduces the urgency of choosing between full visualization of the surgical site and performing the least invasive surgery possible.

“ We a r e s e ei n g mor e pa t ient s benef it  f rom m i n i ma l ly i nva sive s u r ger y a s   w e u s e t h e A i r o for these techniques,”  Dr. DeWal says. “In  these  surgeries, we need to use a wide range of instrumentation in smaller incisions.”

A COMMITMENT TO CAREThe acquisition of the Airo is just one indicator of St. Catherine of Siena’s commitment to offering high-quality care to Long Island patients. Though the hospital is highly invested in technol-ogy, it also maintains its mission to provide compassionate care to every patient who comes through the doors.

“CHS, of which St. Catherine’s is part, has an excellent neuroscience service line,” Dr. Shady says. “We are pushing the envelope in neurosciences,

especially in our six Long Island hospi-tals. We are advancing technology here and we have been doing extremely well in the past few years.”

“At St. Catherine’s, the level of sur-gical experience, combined with the available technology, is unequaled,” Dr. Dowling adds. “We have been per-forming neurosurgeries for so long that we’ve developed a highly experienced team, including strong perioperative and postoperative staff.”

“Send patients to us when they need care,” Dr. Shady advises area primary care providers. “They will receive the highest quality treatments with the most advanced technology available, while being cared for by skilled, compas-sionate nurses and surgeons.”

To learn more, visit stcatherines.chsli.org. n

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