U niversity Neurosurgery Brain & Spinal Column Volume 12 Summer 2015 Director of Gamma Knife Surgery and Assistant Professor Dr. Symeon Missios joined University Neurosurgery’s staff in September 2014. As Director of Gamma Knife Surgery, Dr. Missios frequently performs procedures at the first Gamma Knife Suite in Northwest Louisiana. Sen. David Vitter visited the Gamma Knife in April, commemorating the one-year anniversary of the Gamma Knife Perfexion, an updated, faster machine. Dr. Missios brings an expanded understanding of neuro- oncology to the University Neurosurgery team. He earned his medical degree from Dartmouth Medical School and completed his neurosur- gical residency at Dartmouth-Hitchcock Medical Center. Dr. Missios received specialized training in neurosurgical oncology and Gamma Knife radiosurgery through his fellowship at the Cleveland Clinic. Dr. Missios is heavily involved in the department’s research efforts, hav- ing authored over 40 peer-reviewed publications. He works closely with the department’s research fellows and residents. Dr. Missios’ goal is to establish a comprehensive, multidisciplinary approach to the treatment of both benign and malignant brain tumors at LSU Health Shreveport and focus on translational clinical research in conjunction with the Departments of Oncology and Radiation Oncology. University Neurosurgery Hosts Levy Conference Louisiana Senator Attends Department’s Gamma Knife Ribbon Cutting e Department of Neurosurgery hosted the annual Levy Confer- ence April 10, featuring Dr. Daniel Barrow. Dr. Barrow, Pamela Rollins Professor and Chairman of the Department of Neurosur- gery at Emory University, spoke on “e Current and Future Role of Microsurgery in the Management of Neurovascular Disorders.” More than 150 people attended the conference, including medical school faculty, residents, and medical students. e conference concluded with an evening reception at Professor and Chairman Dr. Anil Nanda’s home, honoring graduating resi- dent Dr. Justin Haydel. As a graduate of LSU Health Shreveport’s medical school and the Department of Neurosurgery’s seven-year residency program, the 2015 conference marked Dr. Haydel’s 11th Levy conference. Following graduation, Dr. Haydel is currently training in a spine fellowship at Stanford University. e conference is made possible by the Mary Louise and Ben Levy, Jr. Visiting Professorship, which the Levys established in 2004. e conference works to honor the memory of the couple by offering an educational opportunity for the Shreveport com- munity. (L to R): Robert Levy, Dr. Daniel Barrow, and Dr. Judith Levy (L to R): Dr. Daniel Barrow and Dr. Justin Haydel (L to R): Tabitha Ward, RN, Joe Miciotto, Dr. Christina Notarianni, Sen. David Vitter, Dr. Anil Nanda, Dr. Symeon Missios, and Rod Williams
Transcript
University NeurosurgeryBrain & Spinal Column
Volume 12 Summer 2015
Director of Gamma Knife Surgery and Assistant Professor Dr. Symeon Missios joined University Neurosurgery’s staff in September 2014.
As Director of Gamma Knife Surgery, Dr. Missios frequently performs procedures at the first Gamma Knife Suite in Northwest Louisiana. Sen. David Vitter visited the Gamma Knife in April, commemorating the one-year anniversary of the Gamma Knife Perfexion, an updated, faster machine. Dr. Missios brings an expanded understanding of neuro-oncology to the University Neurosurgery team. He earned his medical degree from Dartmouth Medical School and completed his neurosur-gical residency at Dartmouth-Hitchcock Medical Center. Dr. Missios received specialized training in neurosurgical oncology and Gamma Knife radiosurgery through his fellowship at the Cleveland Clinic.
Dr. Missios is heavily involved in the department’s research efforts, hav-ing authored over 40 peer-reviewed publications. He works closely with the department’s research fellows and residents.
Dr. Missios’ goal is to establish a comprehensive, multidisciplinary approach to the treatment of both benign and malignant brain tumors at LSU Health Shreveport and focus on translational clinical research in conjunction with the Departments of Oncology and Radiation Oncology.
University Neurosurgery Hosts Levy Conference
Louisiana Senator Attends Department’s Gamma Knife Ribbon Cutting
The Department of Neurosurgery hosted the annual Levy Confer-ence April 10, featuring Dr. Daniel Barrow. Dr. Barrow, Pamela Rollins Professor and Chairman of the Department of Neurosur-gery at Emory University, spoke on “The Current and Future Role of Microsurgery in the Management of Neurovascular Disorders.”
More than 150 people attended the conference, including medical school faculty, residents, and medical students.
The conference concluded with an evening reception at Professor and Chairman Dr. Anil Nanda’s home, honoring graduating resi-dent Dr. Justin Haydel. As a graduate of LSU Health Shreveport’s medical school and the Department of Neurosurgery’s seven-year residency program, the 2015 conference marked Dr. Haydel’s 11th Levy conference. Following graduation, Dr. Haydel is currently training in a spine fellowship at Stanford University.
The conference is made possible by the Mary Louise and Ben Levy, Jr. Visiting Professorship, which the Levys established in 2004. The conference works to honor the memory of the couple by offering an educational opportunity for the Shreveport com-munity.
(L to R): Robert Levy, Dr. Daniel Barrow, and Dr. Judith Levy
(L to R): Dr. Daniel Barrow and Dr. Justin Haydel
(L to R): Tabitha Ward, RN, Joe Miciotto, Dr. Christina Notarianni, Sen. David Vitter, Dr. Anil Nanda, Dr. Symeon Missios, and Rod Williams
Greetings from University Neurosur-gery and LSU Health Shreveport. The spring has brought forth productive change, including promoting Dr. Christina Notari-anni as our residency
program director. As a graduate of LSU Health Shreveport and our own residency program, no one is better qualified to lead the training of our budding neurosurgeons.
We’re delighted to have matched two new residents on Match Day. James Barry graduated from Baylor College of Medicine in Houston, and Cory Markham graduated from LSU Health Shreveport. They officially joined our team in July.
I am happy with the success of our Gray Matters conference in February. Partnering with the Department of Neurology, nearly 100 people attended the symposium, including physicians, physician assistants, nurses, medical students, and nursing students. Dr. Jean Regis, an inter-nationally recognized neurosurgeon and an au-
thority on Gamma Knife surgery, traveled from France to speak at the conference. We enjoyed showing Dr. Regis around LSU Health Shreve-port and our fine city.
After updating to the Gamma Knife Perfexion a year ago, we are doing more Gamma Knife procedures than ever before. Director of Gamma Knife Surgery Dr. Symeon Missios and our Gamma Knife nurse Tabitha Ward have done a wonderful job caring for and treating these patients.
With these additions and updates, we continue to provide neurosurgical care to the entire state and the Ark-La-Tex region. If you have any ques-tions, kindly feel free to call me. Thank you.
Wishing you a happy and productive summer!
Sincerely,
Anil Nanda, MD, MPH, FACSProfessor and Chairman Department of Neurosurgery
University NeurosurgeryBrain & Spinal Column
Medical Editor:Anil Nanda, MD, MPH, FACS
Designer/Writer:Tara BurtonLindsey H. Tison
Editors:Tara BurtonElizabeth WinklerBrain & Spinal Column is written for physicians and should be relied on for medical education purposes only. It does not provide a complete overview of the topics covered, and should not replace the independent judgment of a physician regarding the appropriateness or risks of a procedure for a given patient.
Page 2
Message from the Chairman
For information regarding articlereferences please email the University Neurosurgery Editorial Office at [email protected]
UNIVERSITY NEUROSURGERY FACULTY:
1. Kalakoti P, Ahmed O, Jacobsohn J, Nanda A. Symptomatic osteolipoma of the tuber cinereum masquerading as calcified retroclival mass: Case illustration and review of literature of ossified intracranial lipomas. Journal of Clinical Neuroscience. Published June 2015.
2. Missios S, Kalakoti P, Nanda A, Bekelis K. Craniotomy for glioma resection: a predictive model. World Neurosurgery. Published May 2015. [Epup ahead of print]
3. Nanda A, Javalkar V, Zhang S, Ahmed O. Long term efficacy and patient satisfaction of microvascular decompression and gamma knife radiosurgery for trigeminal neuralgia. Journal of Clinical Neuroscience. Published May 2015. 4. Bir, S. Ambekar, S., Kukreja, S., Nanda, A. Julius Caesar Arantius (Giulio Cesare Aranzi, 1530-1589) and the hippocampus of the hu-man brain; history behind discovery. Journal of Neurosurgery. Published April 2015.
5. Bir S, Nanda A. Factors Predictive of Im-proved Overall Survival Following Steretactic
Radiosurgery for Recurrent Glioblastoma. Neurosurgery Review. Published April 2015.
6. Maiti TK, Bir SC, Cuellar-Saenz HH, Nanda, A. Mirror aneurysms of the proximal segment of the anterior cerebral artery. Acta Neurochir (Wien). Published April 2015.
7. Dossani RH, Missios S, Nanda A. The legacy of Henry Molaison (1926-2008) and the impact of his bilateral mesial temporal lobe surgery on the study of human memory. World Neurosurgery. Published April 2015. [Epup ahead of print]
8. Bir S, Nanda A. Outcomes and Predictors of Improved Survival after Gamma Knife Radiosurgery for Metastic Brain Tumors originated from Breast Carcinoma. Neurosur-gery Review. Published April 2015.
9. Kukreja S, Kalakoti P, Murray R, Nixon M, Missios S, Guthikonda B, Nanda A. National trends of incidence, treatment, and hospital charges of isolated C-2 fractures in three different age groups. Neurosurgical Focus. Published April 2015.
Recent Publications
ANIL NANDA, MD, MPH, FACSProfessor Department Chairman
DONALD R. SMITH, MDClinical Professor
BHARAT GUTHIKONDA, MDAssociate Professor
ANTHONY SIN, MDAssociate Professor
CHRISTINA NOTARIANNI, MDAssistant Professor
HUGO CUELLAR, MDAssociate Professor
JESSICA WILDEN, MDAssistant Professor
SYMEON MISSIOS, MDAssistant Professor
GUOHONG LI, MD, PhDAssistant Professor of Research
Page 3
University Neurosurgery Alum Leads Residency Program
Neurosurgery Department Celebrates New Clinic SpaceThe Department of Neurosurgery celebrated its new clinic at Willis-Knighton Pierremont Medical Arts Building with an open house event Jan. 14. The clinic opened in May 2014.
University Neurosurgery’s nearly 11,000-square-foot clinic pro-vides an expanded and updated space for the faculty and patients. Chairman and Professor Dr. Anil Nanda, Clinical Professor Dr. Donald Smith, Chancellor Dr. Robert Barish, Interim Dean Dr. John Marymont and Willis-Knighton President and CEO James Elrod participated in the ribbon cutting ceremony.
Approximately 60 people attended the reception, including area physicians, nurses, and the University Neurosurgery faculty and staff.
Previously, University Neurosurgery’s clinics were held in different locations. Now, all University Neurosurgery physicians hold clinic at the Willis-Knighton Pierremont Medical Arts Building, creating a truly unified space.
To schedule an appointment, call 796-2638. For more information, visit universityneurosurgery.com and faceboook.com/University-Neurosurgery.
Assistant Professor and Chief of Pediatric Neurosurgery Dr. Christina Notarianni was promoted to residency program director. She will oversee the residents’ seven-year-long training, preparing budding neurosurgeons.
Dr. Notarianni is an alumna of LSU Health Shreveport and the Department of Neurosurgery’s residency program. She specializes in pediatric neurosurgery and completed a pediatric neurosurgery fellowship at the University of Tennessee Health Sciences Center in Memphis and St. Jude’s Children’s Research Hospital. Dr. No-tarianni is the only fellowship-trained pediatric neurosurgeon in Shreveport-Bossier.
University Neurosurgery boasts the largest neurosurgery residency program in Louisiana, accepting two residents a year for the com-petitive program.
Established in 2002, University Neurosurgery’s residency program was the first new residency program at LSU Health Shreveport in ten years.
On Match Day, March 20, the department welcomed its two new-est residents who began working in July. Dr. James Barry gradu-ated from Baylor College of Medicine, and Cory Markham gradu-ated from LSU Health Shreveport.
(L to R): Dr. Robert Barish, Dr. Donald Smith, Mr. James Elrod, Dr. Anil Nanda, and Dr. John Marymont
Dr. Christina Notarianni honors graduating resident Justin Haydel with a speech at the 2015 Levy reception.
The neurosurgery department at LSU Health Shreveport has seen several events worth celebrating throughout the past several months.
Dr. Christopher Storey, PGY-5, received the Top Poster award at the Congress of Neurosurgeons Annual Meeting Oct. 18-22, 2014. Dr. Storey presented a poster on “Outcomes in mechanical thrombectomy and preoperative intravenous tissue plasminogen activator.”
Dr. Richard Menger, PGY-5, was appointed to the Congress of Neurosurgeons Development Committee in February. Dr. Menger will serve a two-year term, representing LSU Health Shreveport at the national level. Dr. Menger was also accepted to the Harvard Kennedy School of Government to pursue a Master’s in Public Administration Degree.
Dr. Justin Haydel, recent residency graduate, married Beverly Moore in June in Aspen, Colorado.
Dr. Menarvia Nixon, PGY-6, married Justin Gaddis in the Baha-mas in May.
Assistant Professor Dr. Christina Notarianni has been promoted to Residency Program Director. Dr. Notarianni previously served as Residency Program Assistant Director.
Professor and Chairman Dr. Anil Nanda was invited to visit Ku-wait by the Kuwait Ministry of Health. Dr. Nanda operated and lectured while there.
Assistant Professor and Director of Stereotactic and Functional Neurosurgery Dr. Jessical Wilden was honored at An Evening for Healers, a ceremony sponsored by the LSU Health Foundation. The foundation honored three patients and three healing teams, including Dr. Wilden, University Neurosurgery Physician As-sistant Ashley Hamby, University Neurosurgery Registered Nurse Mike Shepard, and Dr. Richard Menger, PGY-5.
Associate Professor Dr. Anthony Sin was an invited speaker at the 3rd Annual Meeting for 4 University Spine Symposium hosted by Keio University in Tokyo, Japan.
Professor and Chairman Dr. Anil Nanda was invited as a visiting professor to Yale University and the University of California at Los Angeles.
Associate Professor Dr. Bharat Guthikonda served on the plan-ning committee for the North American Skull Base Society’s annual meeting. He also worked as Course Co-Director for the operative, hands-on courses before the conference.
Assistant Professor and Residency Program Director Dr. Chris-tina Notarianni was honored as one of the Top 40 Young Profes-sionals Under 40 by the Young Professionals Initiative.
LSU Health Shreveport (ACC)1501 Kings HighwayShreveport, LA 71103p: 318.813.2482, f: 318.813.1556
Willis-Knighton PierremontMedical Arts Building1811 E. Bert Kouns, Suite 200Shreveport, LA 71115p: 318.795-2638, f: 318.675.6861
Gamma Knife Radiosurgery1501 Kings HighwayShreveport, LA 71103p: 318.675.6195, f: 318.675.8944
NeuroInterventional Surgery1501 Kings HighwayShreveport, LA 71103p: 318.675.6195, f: 318.675.8944
Administrative Main Office
University NeurosurgeryLSUHSC - Shreveport, Dept. of Neurosurgery1501 Kings Highway, PO Box 33932Shreveport, LA 71130-3932p: 318.675.6404, f: 318.675.6867
University Neurosurgery’smultidisciplinary team is pleased to serve youand your patients in the following locations:
Department News:
Page 5
Woodard Series Showcases International NeurosurgeryUniversity Neurosurgery held its Third-Annual Woodard Sym-posium Wednesday, Oct. 24, 2014 at LSU Health Shreveport. The intercontinental colloquium brings together diverse figures of neurosurgery from across the globe.
Dr. Vladimír Beneš, Professor of Neurosurgery at Charles Uni-versity in Prague, Czech Republic, discussed “AVM: How I Do It.” Dr. Rashid Jooma, Professor of Neurosurgery at Aga Khan University in Karachi, Pakistan, lectured on “Can Health Cover Bring Equity in Access to Heal Care? The View from Pakistan.” Dr. Claudio Yampolsky, Chairman and Professor of Neurosur-gery at Hospital Italiano in Buenos Aires, Argentina, spoke about “Neuropathic Pain and Motor Cortex Stimulation.”
Approximately 75 people attended the symposium, including physicians, physician assistants, residents, nurses, physical thera-pists, medical students, and public health students.
The Woodard Symposium is made possible by the Scotty and Larene Woodard Woodard Professorship. Seven years ago, an aneurysm threatened Larene Woodard’s life. A coiling opera-tion at LSU Health Shreveport kept the aneurysm from bursting. Thanks to the Woodards, the physicians and staff at LSU Health Shreveport, as well as community members and other health professionals, have access to visiting lecturers’ knowledge and expertise.
(L to R): Dr. Anil Nanda, Dr. Rashid Jooma, Mr. Joe Miciotto, Dr. Claudio Yampolsky, and Dr. Vladimir Benes
The Departments of Neurosurgery and Neurology cohosted Gray Matters | Neuro Update 2015, an update in various areas of neurosciences, Feb. 7 at LSU Health Shreveport. Nearly 100 people attended the conference, with topics ranging from headache treatment to deep brain stimulation.
Dr. Jean Regis, an internationally recognized neurosurgeon specializing in stereotactic surgery, traveled from Marseille, France, serving as the featured speaker. Dr. Regis spoke on Gamma Knife radiosurgery, a minimally inva-sive surgery offered at University Neurosurgery. He heads the Department of Stereotactic and Functional Neurosurgery and Radiosurgery at Aix Marseille University. Dr. Alejandro A. Rabinstein, a critical care neurology specialist from the Mayo Clinic in Rochester, Minn., was the conference’s guest speaker, sharing updates in stroke and critical care. Dr. Rabinstein is a professor in the Department of Neurology at the Mayo Clinic.
Seven members of the University Neurosurgery faculty lectured, sharing their expertise with physicians, physician assistants, residents, nurses, and nursing students. Conference attendees from Shreveport-Bossier to Nachiotoches to Texarkana learned about updated techniques and treat-ments to better serve patients.
Gray Matters Offers Updates in Neurosurgery and Neurology
(L to R): Dr. Anil Nanda, Dr. Jean Regis, Dr. Alejandro Rabinstein, and Dr. Alireza Minagar
Save the DateWoodard Symposium September 25, 2015
Page 6
First described in the 1890s, Chiari malformations are a spectrum of congenital abnor-malities of the cerebellum and brainstem. There are 4 types of Chiari malformations and each are separate anatomic entities all involving the hindbrain. By far the most prevalent malfor-mation is the Chiari 1 malfor-mation.
Chiari 1 malformations are characterized by caudal dis-
placement of the cerebellar tonsils into the upper cervical spinal canal. The incidence of tonsillar ectopia and Chiari 1 malformations is reported to be 0.5-3%. There is a slight female predominance. Many Chiari 1 malformations are found incidentally on imaging performed for other reasons, often concussion. The presence of a Chiari 1 malformation does not necessarily mean a surgical intervention is needed; however, referral to a neurosurgeon for evaluation should be performed.
The best way to diagnose a Chiari malformation is with an MRI of the brain. This will show the degree of tonsil herniation as well as rule out any other pathology in the brain that could cause a Chiari malformation (i.e.: hydro-cephalus, tumor). Most neurosurgeons will also perform an MRI of the entire spine to evaluate for a syrinx in the spinal cord or other possible causes of a Chiari malformation (i.e.: tethered cord). Some patients with Chiari malformations will have a syrinx or dilation within the spinal cord itself. It is thought this is due to altered hydrostatic pressures at the foramen magnum.
Surgery is offered to patients who have symptomatic Chiari malformations or an asymptomatic Chiari malformation with the presence of a spinal cord syrinx. Symptomatic Chiari malformations are patients who are experiencing occipital headaches that are worse with Valsalva maneu-vers, neck pain, arm pain, numbness or tingling, difficulty swallowing, gagging, or coughing. Surgery is performed to decompress the cervicomedullary junction, making more room for the cerebellum and to restore normal CSF outflow at the foramen magnum. Most patients spend about 3-5 days in the hospital after surgery and are able to resume all normal activities at 6-8 weeks after surgery.
Pediatric Corner: Chiari Malformations
Christina Notarianni, MDAssistant Professor and
Chief of Pediatric NeurosurgeryDepartment of Neurosurgery
An MRI showing a brain without Chiari malformation
An MRI showing a brain with Chiari malformation (see arrow)
Page 7
Richard Menger, MDPGY-5 Resident
World War I catapulted the United States from historical isolationism to international involvement in a major European conflict. Woodrow Wil-son’s vision involved a permanent United States imprint on democracy in world affairs through partici-pation in the League of Nations.
Amidst these defining historical events, Woodrow Wilson suffered a major ischemic stroke on Oct. 2, 1919 leaving him incapacitated. His likely fourth and most devastating stroke was diagnosed and treated by his personal physician, United States Navy Admiral, and friend Dr. Cary Grayson. Grayson, who held tremendous personal and professional loyalty to Wilson, kept hidden the se-verity of the stroke from Congress, the American people, and even the President himself. Grayson, during a cabinet briefing, refused to formally sign a document of disability and was reluctant to ad-dress capacity for presidential succession. Wilson was essentially incapacitated and hemiplegic, yet he remained as an active Presi-dent and all presidential messages were relayed directly through the President’s wife, Edith Wilson. Patient-physician confidential-ity superseded national security amidst the backdrop of friendship and political power on the eve of a pivotal juncture in the history United States foreign policy.
It was because of the absence of Woodrow Wilson’s vocal and un-wavering support that the United States did not join the League of Nations and distanced itself from the international stage. The League of Nations would later prove powerless, without American support, and unable to thwart the rise and advance of Adolf Hitler. Only after World War II did the United States as-sume its global leadership role and Wilson’s visionary yet contentious groundwork for a Pax Americana was realized. In our work, we teamed up with Pulitzer Prize-nominated Wilson biographer John Milton Cooper to describe the events of Wood-row Wilson’s stroke, the historical implications of his health decline, and its impact on United States foreign policy.
“Woodrow Wilson’s hidden stroke of 1919: the impact of patient-physician confidentiality on United States foreign policy” by Dr. Richard Menger, Dr. Christopher Storey, Dr. Bharat Guthikonda, Dr. Symeon Missios, Dr. Anil Nanda, and John Milton Cooper will be published in Neurosurgical Focus.
History and Neurosurgery: President Woodrow Wilson
Department of Neurosurgery Graduates
President Woodrow WIlson
Richard Murray, MDFellowship in Microsurgery and
Skull Base Surgery
Justin Haydel, MDNeurosurgery Residency
Sunil Kukreja, MBBSClinical Fellowship in Spinal
Surgery
Department of NeurosurgeryLSU Health ShreveportPO Box 33932, Shreveport, LA 71130-3932Academic Office 318.675.6404Clinic Office 318.813.1555www.universityneurosurgery.com
Nonprofit OrganizationU.S. Postage
PAIDShreveport, LAPERMIT NO. 4
Please visit universityneurosurgery.com and facebook.com/UniversityNeurosurgery
Clinical Professor Dr. Donald Smith was honored at the Lou-isiana Neurosurgical Society Annual Meeting on Jan. 17 in New Orleans. Dr. Smith received an award for his leadership and contributions to organized medicine in North Louisiana.
Dr. Richard Menger, PGY-5, Assistant Professor Dr. Chris-tina Notarianni, and Susan Steen, Dr. Smith’s physician assistant, presented the award to Dr. Smith, sharing stories of his encouragement and teaching over the years.
Dr. Smith’s wife and daughter attended the ceremony.
Dr. Smith has served as a pivotal figure in Louisiana neuro-surgery since 1977. He first came to LSU Health Shreveport in 1977, working part time and in the private sector. He joined LSU Health Sciences Center full-time in 1996. He was part of the search team to hire neurosurgery leadership for the medical school, helping to recruit Dr. Anil Nanda in 1990.
Dr. Smith is a retired member of the U.S. Air Force Reserves, holding the rank of Colonel.
University Neurosurgery Professor Honored
(L to R): Elainea Smith, Dr. Donald Smith, and Kathy Smith
