A Magazine for the Friends of Barrow Neurological Institute of St. Joseph’s Hospital and Medical Center
MedPresence
Teleconferencing system takes observers into OR
Stroke Prevention New stent for brain opens blocked arteries
KNIFELESS BRAIN SURGERY
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Volume 18, Issue 1, 2006
Opening thoughts his summer, we will move into the new Barrow Neurosciences Tower, a seven-story, 430,000-square-foot facility designed for the future of medicine. The new tower will provide patients more privacy, comfort and convenience—and it will support Barrow’s mission of advancing the neurosciences through excellence in patient care, medical education, and basic and clinical research.
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This impressive facility would not have been possible without the many benefactors who have contributed to the Pushing Boundaries Capital Campaign. More than $24 million has been pledged to this volunteer campaign, bringing the campaign within reach of its $31-million goal.
To all of you who have contributed to the campaign, I wish to extend my heartfelt thanks for making this long-held dream a reality. Special recognition goes to the campaign’s leadership—Michelle and Ed Robson, Julie Wrigley, Mary Jane and Warren Crist, Stevie and Karl Eller, Patty Boyd and Harrison Gentry, Linda and Bill Hunt, Terry and Bob Johnson, Kay and Bill Long, Monique and J.P. Millon, Sister Nancy Perlick, Jill and Wick Pilcher, and Daryl and Louis “Chip” Weil. To those of you have not yet contributed to the campaign, I encourage you to consider joining our efforts to push the boundaries of medicine.
What makes the Barrow Neurosciences Tower so exciting? Among its many features, the tower will have: • Eleven large operating suites built to accommodate the advanced technology for which Barrow is known. Each suite will be equipped with MedPresence video-conferencing capability.
• One “super-cool” surgery suite with the capability of being cooled to 55 degrees in three minutes. The cooler temperature slows the patient’s metabolism during brain surgery. • The first inter-operative MRI unit in Arizona, allowing neurosurgeons to view crucial brain images during surgery. • Forty-eight private Neuro Intensive Care Unit rooms designed for the care of critically ill patients.
People—not bricks and mortar—have made Barrow what it is today. Still, the new Barrow Neurosciences Tower will enhance the care we give our patients and support our efforts in research and medical education. For that, we are deeply grateful. Sincerely,
Robert F. Spetzler, MD Director, Barrow Neurological Institute
For information on contributing to the Pushing Boundaries Capital Campaign, call Barrow Neurological Foundation at 602-406-3041, Monday through Friday, 8 a.m.-5 p.m.
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4: MedPresence This new teleconferencing system will change the face of medical education and clinical care. 8: Brain stent Barrow is the second neuroscience center in the country to use a new stent designed specifically for use in the brain. 11: Why we give Nancy and Lee Hanley talk about their commitment to aneurysm research at Barrow. 14: Image guidance 3D images serve as a real-time road map during brain surgery. 16: Barrow Craniofacial Center Doctors work to bring normalcy to people with skull and facial deformities. 18: Developing better surgical approaches
Contents
20: Knifeless neurosurgery CyberKnife and Gamma Knife use targeted radiation to destroy brain lesions. 24: 2006 Barrow Grand Ball 26: Lasting impression A former Barrow patient remembers John Green, MD, Barrow’s first director. 28: John Bodensteiner, MD The William Pilcher Pediatric Neurology Chair has transformed his division. 31: Research news 34: What’s happening around Barrow 36: The Legacy Society
Catherine Menor Editor/Writer Catherine.Menor@chw.edu Justin Detwiler Art Director/Designer Steve Woods Printing
Philip Barnett, Sally Clasen, Debra Gelbart, Jennifer Kennedy, Sarah Padilla Contributing Writers Scott Baxter, Jeff Noble, Jackie Mercandetti Photography
Robert F. Spetzler, MD Director Barrow Neurological Institute® Mary Jane Crist, CFRE CEO, Barrow Neurological Foundation
• How to Reach Us • Barrow is published twice a year. We welcome your comments, suggestions and requests to be added to or deleted from our mailing list. Call 602-406-1041 or send mail to Barrow, Office of Philanthropy, St. Joseph’s Hospital and Medical Center, 350 W. Thomas Rd., Phoenix, AZ, 85013. Please include your name, address and daytime telephone number in all correspondence. Visit us online at www.StJosephs-Phx.com and www.PushingBoundaries.org.
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Remembering when the first patient was admitted to Barrow and when a donated $35 cream separator aided research at the new institute.
Jan. 16, 2006
The first Barrow admission—left to right, Margaret Sherwood, director of Nursing; Sister Mary Berathmaris; Charles Barrow; Betty Clements, MD; Dan Urea, MD, the first Neurology resident at Barrow; and Doris Rios, the first Barrow patient.
Dear Ms. Menor: As an interested observer of Barrow Neurological Institute through your publications, I am amazed and gratified by the enormous things being achieved. I am a brother of Betty G. E. Clements, MD, (now deceased) and follow your progress with pride. Betty was an intern at the old St. Joseph’s Hospital in 1952. She entered a residency there followed by a fellowship at Mayo in Rochester, MI, and additional training in England. She returned to Phoenix and became a partner of Drs. Green, Steelman and Pittman. During all of this time she was a friend of Sister Placida and had quite a bit to do with the establishment of the institute. The purpose of this letter is to send you some information that might sometime be of use to you. FIRST, a copy of the picture of the first admission to Barrow. SECOND, a story illustrating the difficulty in obtaining some needed equipment before adequate financing became available. Our small-town, mid-western family had a reputation for frugal innovation when the occasion required. One researcher needed a centrifuge, so Betty called
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me and asked that I send her a cream separator. I purchased a used one at a farm auction for $35.00 and had it shipped to Phoenix. A copy of the acknowledgement from Joseph Harris, PhD, is enclosed. I surmise that similar equipment is a bit more expensive now. Very truly yours, Dwight L. Clements Feb. 8, 1965 Dear Mr. Clements: We have received, by Continental Trailways, a cream separator which after a few minor replacements, e.g., V-belt, etc., has been put into service. I wish to express the sincere thanks of the Institute and especially for myself, for your gracious and generous help. I can assure you that the arrival of the cream separator has enormously aided and abetted the progression of our work. Prior to this we have consumed undue labor and days of time to achieve the results possible in a few hours with less effort. Hence, you can realize that our appreciation is exuberant and heart-felt. You may be interested to know that the separator is being used in our research on perfusion of the brain during cardiac arrest. We are ever hopeful that the results of our research will find applicability in cerebral-vascular and cardio-vascular diseases such as strokes and neurological sequellae. The Institute is indebted to your sister for her extensive participation in our work. Now, with your generous assistance, there appears to be a Clements family tradition established here at the Institute. We are grateful to you for this and are pleased to recognize and acknowledge it. Sincerely yours, Joseph Harris, PhD Laboratory of Neurochemistry Chief
Nov. 3, 2005
Gentlemen: I am pleased to have this opportunity to contribute to your foundation in deep gratitude for the wonderful help I received from Dr. John Green in 1954 that finally put a stop to my epileptic seizures. Since then I have been able to live a normal and productive life here in Phoenix. I feel that Barrow is doing very good work to ease the suffering of those with neurological disorders originating in the brain or the spine. Sincerely, Robert E. Olsen
Dear Dr. Spetzler, My husband, David, and I are delighted to send you this donation to commemorate the anniversary of the successful craniotomy you performed on me (and my craniophangioma) last year on November 29. We make this contribution in your honor to be used at your discretion. We also want to share exciting news with you—I’m pregnant and am expecting a boy on May 22, 2006! With continued gratitude and admiration, Stephanie Friedman
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better than being there Barrow’s MedPresence System ushers in new era in medical education
t’s a problem that has plagued the education of surgery residents for decades and that retired Phoenix business executive Karl Eller encountered during a tour of Barrow two years ago. “When I walked into the operating room, Dr. Spetzler was operating, and I couldn’t see a thing,” says Karl.
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But unlike Barrow’s Neurosurgery residents and multitudes of visiting surgeons and observers—who through the years have simply put up with straining for a good view—Karl had an idea to solve the problem. “I said to Dr. [Stephen] Papadopoulos there might be a way to use Destiny Conferencing’s technology so that people could sit in another room and watch what’s going on and even interact with Dr. Spetzler,” Karl recounts. “Dr. Papadopoulos and Dr. [Shez] Partovi just took the idea and ran with it.” The result is MedPresence, a $1.1 million video-conferencing system that provides an unsurpassed view of a Barrow operating room—from the comfort of leather chairs in a conference room three floors away. Observers in the new MedPresence Conference Room at Barrow can watch a live surgery from two perspectives—an overall view of the surgery suite and a view of what the surgeon sees through the surgery microscope. Video walls in the conference room and the surgery suite allow surgeons to interact with observers three floors away.
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The portable MedPresence unit, shown below, can be shipped to other academic medical centers for live surgery broadcasts from Barrow.
Karl Eller, left, says the MedPresence system came about because of neuroradiologist Shez Partovi, MD, and neurosurgeon Stephen Papadopoulos, MD. Sitting in the MedPresence conference room feels like being in the surgery suite. Large-screen monitors cover one wall of the room, offering live audio and video of the surgery suite. A similar “video wall” of screens mounted in the surgery suite enables surgeons, nurses and technicians there to see and interact with the people in the MedPresence conference room. But, the MedPresence conference room offers more than just an “insider’s” view of the surgery suite. Desk-sized computer screens mounted on tables throughout the room capture the surgeon’s view through the microscope. And that is the true beauty of MedPresence for Neurosurgery residents at Barrow. Now, they have a bird’s-eye view of each step the surgeon takes during an operation.
A bird’s-eye view of surgery
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“With Karl’s help, we wanted to create an environment that not only felt like you were standing shoulder to shoulder with the surgeon, but was actually better then being there,” says Dr. Papadopoulos. “All of us feel like this is the future of medicine,” says Linda Hunt, president of St. Joseph’s. “Now we can take our leading-edge patient care, medical education and research out to the world.” Besides improving the educational experience for residents, nurses and others, MedPresence can be used to make Barrow’s clinical expertise available globally. Barrow owns a portable MedPresence unit that can be shipped to another site and linked via the Internet to Barrow. Thus, neurosurgeons in Japan could watch a new procedure at Barrow. MedPresence developers predict that other teaching hospitals will be eager to acquire medical video
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Karl Eller, right, and Stevie Eller, above center with Robert Spetzler, MD, and Evelyn Higgins, provided funding for the MedPresence system.
conferencing and that eventually knowledge centers like Barrow will be linked through MedPresence. Barrow doctors envision many other uses for MedPresence—interactive patient consultations between physicians at Barrow and physicians in remote areas of the country; live interactive demonstrations at international medical conferences; and multi-center grand rounds for physicians. MedPresence will save time and money—and make life-saving patient care and medical education available to more people. Instead of flying to a distant city, for instance, Barrow specialists will be able to consult with physicians through MedPresence. “Why move matter when you can move electrons?” Dr. Partovi says.
Saving time and money
Destiny Conferencing systems are used in board rooms throughout the world, including those of TimeWarnerAOL and Capital One. Drs. Partovi and Papadopoulos worked with the Dayton, Ohio, company to adapt their conferencing product to the needs of medicine. Karl and his wife, Stevie, who have equity in Destiny Conferencing, funded the project. But it was more than the Ellers’ philanthropic generosity that made this project possible, says Dr. Papadopoulos. “It was that first spark of an idea, a dream, from Karl himself that really got us started.” Karl marvels at how far his idea has come. “The creativity of these doctors is phenomenal. You just have to see it to believe it.” “This is not an evolutionary step in medical education,” says Dr. Partovi. “This is a revolutionary step.” ■
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preventing strokes Barrow endovascular neurosurgeons second in U.S. to use new stent designed for the brain
Felipe Albuquerque, MD, and Cameron McDougall, MD. Dr. McDougall holds the Evelyn and Lou Grubb Neurovascular Research Chair. His research receives funding from Barrow Neurological Foundation.
Accumulated plaque in the fragile vessels of the brain restricts blood flow, putting the patient at risk of stroke. Patients with this condition typically take medicine, such as aspirin. But, medicine fails to help some of these patients. That’s why the new Wingspan Stent—the first stent ever developed for use in the brain—is such an important development in stroke prevention. The new stent holds the clogged artery open, restoring blood flow and reducing the risk of stroke.
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or 60-year-old Richard Fein, Nov. 17, 2005, was the day his flagging health took a dramatic turn for the better. On that day, Richard became the first patient at Barrow and the second in the U.S. to be treated with the new Wingspan Stent System. This is the first stent to be specifically designed and approved for use in the brain. The FDA recently granted the Wingspan Stent a humanitarian-device exemption, given when there are no other devices available for treating a condition. Endovascular neurosurgeons Cameron McDougall, MD, and Felipe Albuquerque, MD, used the stent to reopen a clogged artery deep in Richard’s brain and, thus, to prevent a future stroke. “I have more energy, I seem to be able to concentrate better, and I don’t get dizzy,” said Richard, who was referred by his neurologist to Barrow because it is the only Valley facility capable of treating his problem. “I feel a lot better now.” Even more important, says Dr. McDougall, Richard’s risk of a stroke has been reduced. “When Mr. Fein first came to my office, he had severe blockages in the major arteries of his brain—
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50 percent on the right side and 85 percent on the left. These blockages greatly restricted the flow of blood to his brain, and because of his symptoms, we were worried that he was at high risk for future stroke. Medicine alone could not resolve his problem.” For patients like Richard, Boston Scientific’s new Wingspan Stent System is a big step forward in stroke prevention. In recent years, neurosurgeons such as Drs. Albuquerque and McDougall have used stents designed for the heart to open narrowed vessels in the brain. But those devices were stiff and difficult to maneuver in the brain, where blood vessels are more fragile and have more curves. The Wingspan Stent—made of super elastic metal—is easier to maneuver and puts much less pressure on the blood vessel when it expands. In the two-hour procedure, Drs. McDougall and Albuquerque inserted a catheter into an artery in Richard’s upper leg. Using image guidance, the two endovascular neurosurgeons navigated the catheter through the blood vessels up to the site of the blockage in the brain. Then, the surgeons positioned an angioplasty balloon in the narrowed artery and inflat-
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ed the balloon to press the plaque against the vessel walls. Finally, they deployed the tiny, tubeshaped stent to hold the vessel walls open and restore blood flow. After just two days in the hospital, where the care was “top shelf,” Richard went home to his wife, Dolores, and the cat they share their home with—a Russian blue that Richard describes as an “angel with fur.” Richard was thankful that his renewed energy came just in time for Christmas, his favorite time of year. The retired Phoenix city bus driver—who used to give green bagels to his passengers on St. Patrick’s Day—wore his traditional holiday outfit throughout December: a red shirt, suspenders and Santa Claus hat. “This is the only way I dress in the month of December,” says Richard, who loves the reactions
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he gets from children, teens and adults. Richard and Dolores took a 15day cruise to Hawaii in January. ■
Christmas 2005 was a lot jollier for Richard Fein, who underwent stent surgery in November to open up a blocked artery in his brain.
The new Wingspan Stent System was designed to treat blockages in the brain caused by intracranial atherosclerotic disease (ICAD), a condition that causes strokes in about 60,000 Americans each year— 10 percent of strokes. ICAD is an accumulation of plaque in the fragile vessels of the brain. Until now, the only treatment option for ICAD patients was medical therapy, such as aspirin, but a National Institutes of Health study found that 22 percent of ICAD patients on medical therapy will have another stroke within the year. The Wingspan system is currently the only device available in the U.S. for the treatment of ICAD. Barrow was the second center in the country to use the new device.
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why we give Couple’s support of aneurysm research honors a loved one
ancy and Lee Hanley have been major sup-
porters of the Marguerite Clark Hobbs Ruptured
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three years ago. Robert Spetzler, MD, is the principal
investigator of the trial, which compares the out-
comes of two different approaches to correcting rup-
tured aneurysms—traditional neurosurgery and
endovascular neurosurgery. Recently, the Hanleys and Dr. Spetzler met to discuss the project.
For Nancy and Lee Hanley, supporting aneurysm research at Barrow is a way to honor Nancy’s mother Marguerite Clark Hobbs, shown with her husband in the framed photo above. Nancy is a member of the Women’s Board and co-chair of the 2006 Barrow Grand Ball, and Lee is a member of the Barrow Neurological Foundation Board of Trustees.
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Dr. Spetzler, what is the Marguerite Clark Hobbs many of the women on the Women’s Board and the Ruptured Aneurysm Trial attempting to learn? extraordinary fundraising they accomplished for BarDr. Spetzler: An aneurysm is a balloon on a blood row, so I was delighted to join the Board. vessel. This trial asks, “What’s the best way to get rid I thought it would be very meaningful to become of it?” When an aneurysm bursts, half of the patients involved, especially since my mother died of a ruptured will die, and of those who survive, half will have last- aneurysm in 1978. It’s something that is very close to ing neurological damage. The key is prevention—get my heart—that this kind of devastation can occur. it before it blows. We’ve chosen to support Two techniques for “By supporting this study, Lee the Marguerite Clark treating aneurysms have and I are able to remember and Hobbs Ruptured become standards of care. Aneurysm Trial to help In one, you place small pay tribute to someone who was prevent other people from wires inside the aneurysm very special to us both.” suffering this kind of trauand fill it. In the other, you ma and loss. put a clip at the base of Nancy Hanley Lee: Our involvement the aneurysm to seal off in the trial is principally to blood flow into it. remember Nancy’s mother and also to honor the docWhich technique is better in a particular case is a tors here who are saving lives everyday. My intromatter of enormous international debate. One study duction to Barrow was through back surgery by Dr. in Europe addressed this question, but fewer than 10 Volker Sonntag. The very successful outcome allowed percent of the patients who were eligible were treat- me to experience first hand the skill and expertise of ed, so it’s a study that doesn’t hold much water. the doctors at Barrow. Our study is entirely different because every patient who enters the hospital with a ruptured aneurysm Could you tell us a little more about your mother? gets entered into the trial. As of this morning, we’ve Nancy: We were all together at a party on a Saturhad 546 patients assigned to the study, which is a phe- day night. She was vibrant, happy and dancing. I nomenal number in such a short period of time. It thank God that we were with her because that was the just shows the extent of the problem and the number last time I saw her conscious. On Sunday she develof patients who are referred here for this treatment. oped a headache that became worse and worse. When the aneurysm ruptured in her brainstem, there was Nancy and Lee, how did you become interested in nothing that could be done. She lived just two more Barrow and in this trial? days. As you know, the medical diagnostic equipment Nancy: As a native of Phoenix, I have long been 27 years ago was not nearly what it is today. I think all aware of St. Joseph’s Hospital and Barrow. I also knew that was available was a CT scan.
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What does supporting this study mean to you? Nancy: By supporting this study, Lee and I are able to remember and pay tribute to someone who was very special to us both. I was talking to our daughter the other day and said, “Who would have thought that 28 years later we would be able to help in this way and by doing so, honor my mother at the same time?” Dr. Spetzler: It’s nice that you have the ability to help. It’s even nicer that you’re doing it. It’s a wonderful thing in our culture that we can give back to our communities. Lee: And Barrow seems to have attracted a great number of people from our community who are giving back substantially, and I think that’s a hallmark of our culture here in Phoenix.
How do you stay informed of the project? Nancy: Dr. Spetzler keeps us abreast. We have a meeting at least once a year where we are walked through what has transpired since our last update. Lee: Dr. Spetzler has been very forthcoming about what he has been able to achieve through the study and has shared that in personal meetings with us. Nancy and I are really encouraged and comfortable with this investment in important aneurysm research. Nancy: Recently you told me, Dr. Spetzler, just how vital this research is and how it has moved more quickly than you anticipated. That is so exciting! Soon I will be the same age as my mother was when she died. I think about that often. Fortunately, Dr. Spetzler encouraged me to have an MRI of my brain, and happily there is not a familial component. My mother was a vibrant, lovely and caring woman. She adored her children and grandchildren. It’s been 28
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years, and our children still remember her with great warmth. They have donated to the research fund as well and are thrilled to do it. It means so much to them.
Dr. Spetzler, what happens after the current study? Dr. Spetzler: What we’re going to obtain from this study is sufficient numbers to give us definitive answers for certain subgroups of patients. Then, we’ll have the data we need to do an NIH trial at multiple institutions across the U.S. Instead of entering hundreds of patients, we will be entering thousands of patients. But you can’t do that next step without this first step. Of all the studies we’ve been involved in—and there have been hundreds—this is one of the most important because it really gets at the essence of how we best treat a specific patient. Nancy and Lee, I can only thank you from the bottom of my heart for making that possible. ■
“Of all the studies we’ve been involved in—and there have been hundreds—this is one of the most important because it really gets at the essence of how we treat a specific patient.” Robert Spetzler, MD
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Image Guidance 3D images serve as real-time road map during brain surgery
by Debra Gelbart
f you or someone you love required intricate brain or spinal surgery, you might feel reassured to know that Barrow surgeons have even more than skills, experience and high-tech instruments to rely on. They have an edge that results in safer and less invasive procedures. Computerized high-resolution, three-dimensional anatomical images allow surgeons to precisely pinpoint the area that needs attention, thus protecting surrounding tissue. “Before image guidance,” says neurosurgeon Stephen Papadopoulos, MD, “we had to expose a significant amount of adjacent anatomy to know exactly where we were, because so many affected tissues in the brain are deep and microscopic. But image guidance lets us make much smaller incisions and rely on the most direct, least invasive route to the affected area.” He says image guidance has been in use at Barrow for more than 10 years. “But when we started, we were using two-dimensional images and less sophisticated localization tools. Now we're using 3D, and our accuracy is vastly improved.”
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Here’s how it works: images from a patient's CT or MRI scans are “stacked” by the computer, which then is programmed to build a three-dimensional model. “When surgeons look at the affected area in three dimensions, they can preplan surgeries with extraordinary precision,” says Roger Ruedisueli, an applications system analyst at Barrow. “A lot of the patient's normal anatomy is spared as a result.” “The 3D image is put onto a portable computer platform, rolled into the operating room and used as a guide and a road map,” says Dr. Papadopoulos.
Building a brain road map
Roger Ruedisueli, an applications system analyst, demonstrates Barrow’s image-guidance system.
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“Most importantly, our patients are the first to receive the benefit of the newest and most advanced technology.” Stephen Papadopoulos, MD
Stephen Papadopoulos, MD, right, has led the development of image-guidance systems at Barrow. These systems allow neurosurgeons to know precisely where the tip of their surgical instrument is at all times during an operation.
Barrow Neurological Foundation has supported the development of image guidance at Barrow.
Light-emitting diodes (LEDs) attached to the surgical instruments and a camera mounted above the operating table together enable surgeons to know precisely where their surgical instruments are in the body at every moment. “This gives us surgical accuracy down to a millimeter,” Dr. Papadopoulos says. “The 3D model is updated in real time,” Roger says, “based on the information from the LEDs. The computer lets a surgeon know exactly where the tip of the surgical instrument is.” The microscope used during surgery is connected to the computer, enabling the surgeon to precisely focus on key brain structures. Eight separate mobile computer-camera-LED systems are currently in use at Barrow, Dr. Papadopoulos says. When the new Barrow Neurosciences Tower opens later this year, “we will have 11 of the machines permanently fixed in all of the operating rooms.” Image guidance is used in most brain and several spine procedures at Barrow, Dr. Papadopoulos says.
Brain surgery before image guidance
That wasn't the case a decade ago, when surgeons used “an awkward mechanical arm with multiple joints, wrapped in sterile plastic,” Dr. Papadopoulos says. “Only in the past few years have we been using the light localization technology—the LEDs—on our surgical instruments. We are one of the first to test the newest magnetic field localization technology, a technology so lightweight
and small that the system is virtually transparent to the surgeon.” What was it like for neurosurgeons before image guidance was used at all? “In the 1980s and early '90s, reaching lesions in the brain was far more challenging,” he says. “Surgery typically required a larger exposure of tissue, because we had to rely on surrounding topography on the surface of the brain to help us determine exactly where we should enter the brain surgically. Before image guidance it was very difficult to find smaller lesions in the brain. All we could use were CT scans hanging on a view box.” Dr. Papadopoulos developed the initial image guidance program at the University of Michigan. “He really was, early on, an absolute visionary through all this,” says Roger, who worked with Dr. Papadopoulos in Michigan and who relocated with the neurosurgeon to Barrow in 2001. In the late 1980s, Dr. Papadopoulos was a Spine Fellow at Barrow. Today, even newer image-guidance systems are on the horizon. “We've been at the forefront of the design of new hardware, software, applications and improvements for more than 10 years,” says Dr. Papadopoulos. “Working with corporate research and development partners, we've developed and tested more novel technology in this field than almost anywhere else in the world. Most importantly, our patients are the first to receive the benefit of the newest and most advanced technology.” ■
‘A visionary’
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Craniofacial Center Barrow experts bring form and function to individuals with skull and facial deformities by Sally J. Clasen
adovan Alavanja came to the United States from Croatia with his parents six years ago to lead a better life—and to find something even more important: acceptance. The 28-year-old Serbian was born with skull and facial deformities that left him with awkward features and a difficult existence. Since childhood, Radovan, who also has cerebral palsy, has endured personal and public turmoil about his unusual appearance but he has never lost hope that one day he would “look normal.” Three years ago, plastic craniofacial surgeon Stephen Beals, MD, helped Radovan begin to realize his dreams with the first in a series of adult surgeries that will give him a look—and sense—of normalcy. Dr. Beals is medical director of the Barrow Craniofacial Center, formerly the Southwest Craniofacial Center, a volunteer organization that Dr. Beals founded 20 years ago to serve those of all ages with skull and facial abnormalities. In July 2005, Dr. Beals’ organization was renamed the Barrow Craniofacial Center. A team of professionals from diverse medical and allied health fields (see sidebar) provide comprehensive clinical, diagnostic, surgical, educational, genetic/clinical planning and support services. Dr. Beals is also the founder of the Craniofacial Foundation of Arizona (www.azcranio.com), which provides financial and emotional support to patients and their families.
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Radovan Alavanja
“All I have ever wanted is to look like a normal guy. I want to be happy and get on with my life.” Radovan Alavanja
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The most common craniofacial disorders are mostly congenital and include cleft lip and cleft palate, and craniosynostosis (premature hardening and closing of one or more sutures, or fibrous joints, in the head). Craniofacial disorders can affect function and appearance, so the involvement and input of a range of specialists is required for the best outcomes, according to Dr. Beals. “The problems faced by those with craniofacial disorders are complicated and span many areas of expertise,” he says. “Radovan’s case is typical of an extreme case in which a patient benefits from a cross-section of experts.”
Striking a balance
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The association with Barrow Neurological Institute enhances the work of the renowned craniofacial team, which has treated and evaluated thousands of patients from around the world for two decades. “Through Barrow, our infrastructure improves and we become more user-friendly,” Dr. Beals says. “It gives us more support, and allows us to expand and provide
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To schedule an evaluation with specialists of the Barrow Craniofacial Center, contact Florence Roque, CPNP, ND, program coordinator, at 1-800-227-7691.
The Barrow Craniofacial Center
undergone two surgeries performed by Dr. Beals—one to replace bone in the back of his head and another to correct facial scarring from childhood procedures. “The problems faced by those with Orthodontist craniofacial disorders are complicated Paul Serrano, and span many areas of expertise... DDS, a 20-year team consultant, We can’t completely remove the is currently treatstigma of abnormality, but we can ing Radovan’s reduce its effects.” dental issues with braces. Next, Dr. Stephen Beals, MD Beals will reconstruct the young man’s jaw, folmore timely and better care, parlowed by extensive nose surgery. ticularly in the areas of nutrition “His nose surgeries will be done in and psycho-social issues.” two or three stages, and probably Craniofacial specialists recomrequire additional work,” Dr. Beals mend that individuals start treatexplains of the lengthy and extenment as early as possible to correct sive process that won’t be comfunctional issues, such as swalpleted until 2008. lowing and chewing, and to prepare for multiple surgeries that will aid personal growth and development Creating a new in the pediatric years. “Typically, outlook most cases require a minimum of six While major face and skull surto eight surgeries over an 18-year gery and orthodontia are often period,” Dr. Beals says. involved, the mission of the cranRadovan, who had limited suriofacial team is to make significant gery as a child, was born with a changes that improve an individrare facial cleft that created extreme ual’s quality of life, not to create deficits to his skull, eyes, cheeks, visual perfection. jaws, nose, lips and teeth. He has “The goal is to bring a child from diverse difficulty to being a functional adult who is accepted by peers as normal. It is an issue of form and function. We can’t completely remove the stigma of abnormality, but we can reduce its effects,” Dr. Beals says. The surgeon emphasizes the depth of anxiety, stress and low self-esteem associated with such abnormalities. “Kids are extremely affected by looking different. In addition, countless surgeries, visits Stephen Beals, MD, director of the Craniofacial Center
to speech pathologists and orthodontists make this a very consuming medical issue with true pain and suffering.” Radovan’s attitude toward his complex medical challenges is remarkably positive, given his long wait to receive proper care. He believes acceptance—and a fulfilling future—is within his reach through the staff of the Barrow Craniofacial Center. “I’m extremely grateful to Dr. Beals and his team, but I’m anxious to finally get this over with. All I have ever wanted is to look like a normal guy. I want to be happy and get on with my life.” ■
Craniofacial Center Areas of Expertise Audiology Child psychology Craniofacial physical therapy Craniofacial plastic surgery Craniofacial surgery research Developmental pediatrics Genetics Neurology research Neuropathology Neuropsychology Neuroradiology Neurorehabilitation Nurse practitioner Nutrition Oral surgery Orthodontia Otolaryngology Pediatric dentistry Pediatric neurosurgery Pediatric ophthalmology Prosthodontia School liaison Social work Speech pathology
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new surgical approaches Barrow works to make ‘impossible’ cases possible
story by Sarah Padilla
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rain surgery has come a long way from the days Coming up with a new standard in brain surgery is when ancient healers drilled holes in patients’ not an overnight process. Once surgeons and skulls to help release evil spirits. And while the researchers have identified a possible solution, they thought of having one’s head cut open is daunting even head to the lab. There, they test its feasibility using in the 21st century, patients can take comfort from the cadaver heads and computerized software. Barrow has fact that neurosurgery has never been safer. even developed a software program that uses fourNew techniques that are more efficient and less dimensional images of real anatomy to help educate invasive are being perfected every day. It’s an excit- its physicians-in-training. ing era, and Barrow is at its forefront. Once a technique has been perfected in the lab, it Patients and surgeons alike look to Barrow to solve can be applied to patients. And after what could be some of neurosurgery’s greatest challenges. In fact, Bar- years of research and still more years of successful surrow receives referrals of complex cases from through- gical cases, the surgeons then share their knowledge out the world on a daily basis. The result, says Robert with colleagues worldwide by publishing in medSpetzler, MD, is more opportunities to forge ahead. ical journals and presenting at conferences. “The more you’re known for difficult problem Recently, Barrow has been sharing knowledge in solving, the more difficult cases you’ll get,” he says. a field of neurosurgery that doesn’t even take place “We try our best to manage the rare entity once. But in the operating room—endovascular neurosurgery when we start to see someor interventional neurorathing multiple times, we “The more you’re known for diology. Essentially a diftry to develop a new stan- difficult problem solving, the ferent way to treat the same dard.” cerebrovascular diseases more difficult cases you get.” from Many cases are referred inside the blood vesto Barrow after others have Robert Spetzler, MD sels using tiny catheters and declared them impossible. x-ray technology, endovasBut at Barrow, the focus shifts to what needs to be done cular neurosurgery is a relatively new, yet rapidly to make them possible. Sometimes, it’s a matter of evolving, field. tweaking an established technique. Other times, it Today, Barrow’s residents are trained in both tramight be developing an entirely new approach. Dr. ditional open surgical techniques and endovascular Spetzler says that this is an ongoing process—surgeons techniques, while many other institutions continue to are constantly looking for ways to make standard treat the fields as separate entities. This unique surgical approaches better. And often, they do. approach has attracted physicians such as Chief ResBarrow is known in the neurosurgical communi- ident Dr. Louis Kim, who will return to Barrow next ty for its contributions to several techniques that have year as an endovascular fellow. become standard. One of the most popular is known Dr. Kim believes that Barrow’s strength in this as the orbital zygomatic approach, a common cranial field comes from giving surgeons experience in both procedure used to access aneurysms and skull base angiography suites and operating rooms. tumors. In this procedure, an incision is made along “We’re debunking the myth that mastering both the hairline, and the bones that make up the orbit (eye techniques can’t be done,” he says. socket) are removed to provide access to the lesion. Both fields rely heavily on advanced imaging techRemoving bones as opposed to retracting tissue nology—intraoperative navigation and x-ray guidance, causes less potential damage to the brain. Barrow for example—to help navigate the anatomy of the surgeons have also helped develop less invasive ver- brain. Barrow will have a clear technological advansions of this procedure, such as the mini orbital zygo- tage when the new building unveils some of the most matic. This approach is now used in up to 75 percent modern equipment in the world. The ability to view of Barrow’s aneurysm cases. the brain’s complex vascular system from different oriAnother example is the contralateral transcallosal entations offers surgeons yet one more tool in deterapproach, in which a lesion is approached from the mid- mining the best approach. dle of the skull between the brain’s hemispheres. The In the end, it isn’t about technology, complex cases body is positioned to allow gravity to hold open the or even expertise. It’s about what’s best for the patient. intrahemispheric fissure, increasing exposure of the And by continuing to work toward surgical approachlesion. This procedure takes advantage of the brain’s es that are safer, less invasive and have fewer comanatomy to minimize retraction of brain tissue. plications, Barrow is making brain surgery better for patients throughout the world. ■
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neurosurgery without a knife CyberKnife and Gamma Knife use precisely targeted radiation to destroy tumors and other lesions by Debra Gelbart
Kathleen Clifford was able to care for her five children the same day as her CyberKnife treatment.
or Kathleen Clifford of Litchfield Park, a journey into the world of medical high technology began with a drooping eye, headaches and a numb face and ended with a non-surgical procedure that lasted only an hour a day for five days and left her feeling “fabulous.�
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“I feel so blessed to live in an area so close to a CyberKnife.” Kathleen Clifford
In July 2004, Kathleen, then seven months pregnant cedure, Dr. Porter says. “This is what keeps the patient with her fifth child, was diagnosed with a benign immobilized. Immobilization is required so that the brain tumor called a meningioma. It was located at the treatment can be precisely delivered.” base of her skull and was pressing on her brain stem. Kathleen, the mother of four boys and a girl, was “It was growing faster than usual because of the hor- surprised by how easy the treatment was. “You just mones of pregnancy,” she says. lie on a table, and this robotic arm overhead aims a Her neurosurgeon, Randall Porter, MD, at Barrow beam directly at the spot that needs treatment. AfterNeurological Institute, performs traditional neuro- ward I wasn’t even tired,” she says. “I was able to go surgery and also is the co-director of CyberKnife, a pain- right home and take care of my kids.” less therapeutic radiation system that precisely targets Today, her eye no longer droops, the pain she felt a benign or malignant lesion in behind her eye prior to surthe body and kills the cells of “You just lie on a table, and gery has disappeared, and the the lesion. There are about facial numbness she experithis robotic arm overhead three dozen CyberKnife sysenced is almost completely tems in use in the United aims a beam directly at the gone. “Every day more of the States. numbness goes away,” she spot that needs treatment. Barrow acquired Cybersays. “I feel so great compared Afterward I wasn’t even Knife in September 2003 and to last year at this time.” has treated more than 300 tired. I was able to go right patients with it, according to home and take care of my Gamma Knife CyberKnife co-director John kids.” and surgery— Kresl, MD, PhD, a radiation oncologist. a winning Kathleen Clifford “We can treat malignant or CyberKnife patient combination benign disease in the brain, Another leading-edge spine, lung, liver, kidney or pancreas,” Dr. Kresl says. technology at Barrow Neurological Institute may have “CyberKnife treatments consist of one to five outpa- saved Fred Donner’s life. Fred, 43, of Carefree, AZ, was tient sessions, each less than two hours long and all diagnosed with metastasized malignant melanoma completed in one week or less.” in July 2003. The disease had spread to his brain, causDr. Porter performed neurosurgery on Kathleen in ing several tumors there, including one that was as big March 2005. “As he expected,” Kathleen says, “only as a tangerine. 30 percent of the tumor could be removed because the Fred’s neurosurgeon, Kris Smith, MD, initially tumor was surrounded by so many blood vessels that planned to operate to remove excess blood and then it was impossible to remove all of it surgically.” treat the tumors with Gamma Knife, a radiation therTo destroy the rest of the tumor, Dr. Porter planned apy used for lesions in the brain. The surgery went as to administer a CyberKnife treatment after the surgery. planned, but when Fred returned a week later for Gamma Knife, Dr. Smith found that the tumors were bleeding and that Fred needed a second surgery. Three CyberKnife treatment Two months later, after Kathleen, 36, had healed weeks later, Fred underwent Gamma Knife to destroy from her surgery, she underwent CyberKnife treatment. any remaining cancer cells. A final surgery was done “First I went in so they could make a mask of my at the beginning of 2004 to remove scar tissue caused face,” she says. “That part of the process was relaxing by the Gamma Knife procedure. “The combination of surgery and Gamma Knife and soothing; it felt like a visit to a spa.” The mask, made of mesh, is a key part of the pro- treatment has extended his life,” says Dr. Smith, a B A R R O W
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Fred Donner and his fiancée, Kathy Habig. Fred underwent surgery and Gamma Knife for a brain tumor in 2004.
Staci Bentler was treated with CyberKnife for a meningioma.
neurosurgeon at Barrow and director of Gamma Knife. Although Fred’s case is not typical for patients with metastatic melanoma in the brain, “Gamma Knife has been effective for him,” says Dr. Smith.
and so far, a year after his last treatment, the tumors have not returned. “All things considered, he’s doing great,” says Kathy Habig, his fiancée. “He’s eating healthy, working out all the time, trying to go on with his life.” Barrow’s Gamma Knife Center opened in 1997 and has treated more than 3,000 patients. Gamma Knife is used to treat brain conditions such as trigeminal neuralgia, a painful, debilitating condition affecting the fifth cranial (trigeminal) nerve, and arteriovenous malformations or AVMs, abnormal tangles of blood vessels in the brain. “It’s also used to treat multiple metastases and multiple skull-based tumors,” says Dr. Smith. “With multiple lesions, it’s easier to use the Gamma Knife because we can treat them all in one day.”
During treatment with Gamma Knife, the patient must wear a stereotactic (precise positioning) head frame. Fred didn’t experience discomfort with the head frame or with the treatment. “You lie on a table, and gamma rays overhead are focused onto the tumor site. The treatment wasn’t unpleasant,” he says. Gamma Knife treatment can be completed in just one day. The patient arrives at the hospital early in the morning, is placed into a head frame, goes to MRI where images are taken and then waits while the treatment is being planned. The actual Gamma Knife treatment takes from one to six hours, depending on tumor size and complexity. Fred still suffers from short-term memory loss, nerve problems, difficulty walking and some vision loss. He returns to Barrow every three months for an MRI,
Gamma Knife treatment
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CyberKnife treatment of meningiomas is becoming the standard. In May 2005, Staci Bentler underwent the treatment for the remainder of a meningioma that had grown slightly since surgery three years earlier.
‘Awesome’ technology
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Gamma Knife and CyberKnife are performed without an incision or anesthesia, making treatment easier and recovery quicker than surgery. Gamma Knife is used for lesions in the brain, while CyberKnife can be used in treating lesions throughout the body. St. Joseph’s was the first hospital in the Southwest to acquire Gamma Knife and one of the first in the U.S. to acquire CyberKnife.
Knifeless surgery
CyberKnife and Gamma Knife are types of stereotactic radiosurgery. Stereotactic radiosurgery uses precisely focused beams of radiation to destroy unhealthy tissue in the body.
How does it work?
CyberKnife is a compact, but powerful linear accelerator mounted on a robotic arm. The robotic arm moves the linear accelerator to multiple precalculated positions around the patient. At each position, the linear accelerator fires a focused beam of radiation at the tumor or lesion. The convergence of all the beams—up to 1,320 beams—on the tumor or lesion results in a dose of radiation strong enough to destroy the abnormal cells while sparing surrounding normal tissue.
CyberKnife
The patient wears a helmet pierced with 201 holes. Gamma Knife delivers a series of focused beams of radiation through those holes. Each beam by itself is not strong enough to harm brain tissue, but when all 201 beams converge upon the lesion, enough radiation is delivered to destroy the diseased tissue while sparing nearby healthy tissue.
Gamma Knife
“I only had one treatment that lasted about two hours, and it was a relatively simple process,” the Scottsdale woman says. “Dr. Porter told me there’s now less than a five percent chance that the tumor will regrow.” Kathleen, for one, is thankful for CyberKnife. “I think the technology is awesome. I feel so blessed to live in an area so close to a CyberKnife.” ■
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the 2006 barrow grand ball 362 benefactors raise $2.2 million for Barrow
Victoria Budinger, Women’s Board chairman; Linda Hunt, president of St. Joseph’s; Robert Spetzler, MD, director of Barrow; and Bonnie Martin and Nancy Hanley, 2006 Barrow Grand Ball Co-Chairmen. ancy Hanley and Bonnie Martin, 2006 Barrow Grand Ball Co-Chairmen, should be pleased. Months of planning and preparation culminated in a magical evening for 362 friends of Barrow. The elegant décor, cuisine and entertainment created a perfect environment for the event, which was held Jan. 21 at the Arizona Biltmore. The 2006 Barrow Grand Ball raised $2.2 million for Barrow. Patricia Goldman and Robert Greening generously underwrote the Ball. Funds from the Ball will benefit a number of projects at Barrow Neurological Institute, including:
Annual Neurosurgical Fellowship Award, Horace W. Steele Chair for Neurosurgical Education—Dan and Pamela Cracchiolo
Major projects funded by 2006 Barrow Grand Ball
Alzheimer’s/Heart Disease Research Study—The Herbert H. and Barbara C. Dow Foundation
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Marguerite Clark Hobbs Ruptured Aneurysm Trial, Hanley Family Charitable Fund—Lee T. and Nancy Hobbs Hanley
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Image-guided Surgery and Surgical Informatics Training Lab—Mr. and Mrs. Karl Eller
Karen and Robert Hobbs and the Hobbs Family Fellowship for Multiple Sclerosis Research—Mr. and Mrs. Robert C. Hobbs Sr.
Spine Research Lab—Dellora A. and Lester J. Norris Foundation, Mr. and Mrs. Robert C. Norris Hyperspectral Imaging for Analysis of Cerebral Activation and Ischemia—Mr. and Mrs. John W. Dawson
Stroke Research Project—The Herbert H. and Barbara C. Dow Foundation
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Gabriele Schmitz-Schackert, MD, (second from left) attended the 2006 Barrow Grand Ball as the Sally Harrington Goldwater Memorial Fund Visiting Professor Honoree. Dr. Schackert, who is the chairman of the Department of Neurosurgery at the University of Technology in Dresden, Germany, led rounds at Barrow the week of the Ball. Since 1974, the Sally Harrington Goldwater Memorial Fund Visiting Professor Program has brought approximately 115 outstanding doctors to lecture residents at Barrow. Shown with Dr. Schmitz-Schacker are Robert Spetzler, MD, Victoria Budinger and Virginia Moore. Robert Greening and Pat Goldman generously underwrote the 2006 Barrow Grand Ball. Depression in Epilepsy Patients—Mr. and Mrs. Geoffrey H. Edmonds
Research Laboratories for Neurobiology Research— Mrs. Genevieve Allison-Bush
Hypothalamic Hamartomas Research Study—Mr. and Mrs. William A. Franke
Development of a Surgically Implantable MRI Marker—Paola and Mickey Schulhof
The Effects of Remote TBI on Structural Brain Integrity in Aging—Mr. and Mrs. Curt R. Feurer Laboratory for Translational Epilepsy Research—Mr. and Mrs. Gary J. Hewson
Developmental Neurogenetics Research Lab—Mr. and Mrs. Robert J. Lavinia
Scientific Enrichment Program for Students—Mr. and Mrs. Dennis H. Lyon
Epilepsy Research and Management—Mr. and Mrs. Robert H. McKee Microarray Analysis for the Barrow Meningioma Center—Mrs. Jane Wallace Thorne “Hemet Your Head” Educational Program— US Airways Cavernous Malformation Study—Mr. and Mrs. Louis A. Weil III
Intracranial Application of the Surgical Paintbrush — Julie Ann Wrigley Foundation
Dr. Bud Craig’s Nationally Published Studies on Pain Management—Mr. and Mrs. Jack C. Clifford Parkinson’s Research Laboratory—Shamrock Foods Company
“Coronary Artery Bypass Graft Surgery and Dementia in American Women”— Mrs. Newton Rosenzweig
Special Projects
“Cognitive Changes During Menopause: the Affects of Menopause on Brain Functioning”— Mrs. Thomas M. Churchill, Mrs. Peggy Crayton, Mrs. Lee T. Hanley, Mrs. Marilyn Harris, Mrs. Gary J. Hewson, Mrs. Evelyn Leonard Higgins, Mrs. Robert L. Matthews, Mrs. Scott M. Spangler, Mrs. Jane Wallace Thorne and Mrs. Robert L. Ward “Scientific Analysis of Meningiomas”—Mrs. DeBanks M. Henward III, Mrs. Evelyn Leonard Higgins, Mrs. Thomas M. Hudak, Mrs. R. David Martin, Mrs. Robert H. McKee, Mrs. A. Lee Moore, Mrs. Robin E. Parke and Mrs. James P. Simmons
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lasting impression ‘Because of Dr. Green, I was given a tomorrow.’ by Debra Gelbart
atthew Joseph Sepulveda of Chandler may have been destined to have a relationship with St. Joseph’s Hospital and Barrow Neurological Institute. “I was born on March 19—St. Joseph’s Day,” he says. “We are a deeply religious Catholic family, so being born on a day of religious observance was important to my parents.” Matthew Sepulveda underwent seven major surgeries at Barrow between the ages of two and seven.
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Matthew was born healthy just a year before Barrow Neurological Institute opened. His parents never dreamed he would end up having a life-changing relationship with the co-founder of Barrow, neurosurgeon John R. Green, MD. In 1963, when Matthew was two, he developed hydrocephalus—fluid on the brain. “My doctor thought it came from an infection, maybe chickenpox or mumps,” Matthew says. After he was treated by another doctor, his parents took him to Barrow for treatment, and he and his family were fortunate enough to meet Dr. Green. “I had seven major surgeries between the ages of two and seven,” says Matthew, now a marketing representative for a hospice corporation. “I spent a lot of time in the hospital, but I have wonderful memories of Dr. Green.” Matthew remembers him as “a very warm, very friendly person, one of the nicest, most compassionate people I’ve ever met. He had a warm smile and warm hands that reminded me of Santa Claus. To me, he was the epitome of a physician—a master surgeon and a friend.” Matthew believes that it was Dr. Green’s surgical skills that saved his life. “Brain surgery in those days was really, really risky,” he says. “The risk of death or severe impairment was huge. But my parents trusted Dr. Green, and I am so lucky they did. It amazes me now that this man was there to help me when I needed it. His surgical skill was phenomenal.”
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Matthew, who says he outgrew most of his medical issues by age seven, is today “an educated risk-taker, and that’s how I perceive Dr. Green. He knew the risks were high, but he knew the potential benefits were even greater.” Matthew holds a master’s degree in healthservices administration and has spent his entire career in health care. Two of his four brothers work in the health-care field, too. “I’m sure we chose health care because of my early experience,” he says. “My time in the hospital was so positive compared to what it could have been under other circumstances.” Matthew remembers a gesture of Dr. Green’s that was especially meaningful. “When I was about six, I remember waking up in the recovery room and finding money under my pillow. I had lost a tooth, and I found out later that Dr. Green had acted as the Tooth Fairy. He wanted to make sure that many rituals of childhood were preserved for me.” He also remembers Dr. Green saying to him from a very early age, “See you mañana.” “That was very symbolic. Even though I didn’t speak Spanish, I knew that he meant ‘tomorrow.’ Because of Dr. Green, I was given a tomorrow.” ■
Matthew Sepulveda is grateful for Dr. John Green’s impressive surgical skills—and also has some poetic inclinations. “I may not be able to float like a butterfly or sting like a bee,” Matthew says, with his own take on a memorable quote by boxing legend Muhammad Ali, “but I was given a tomorrow and that’s just fine with me.” He says he considers both Muhammad and Dr. Green to be his heroes. “St. Joseph’s and Barrow can be very proud of an affiliation with two of the greatest individuals—both very skilled with their hands and, even more importantly, both truly ‘Champions of Compassion’ with their hearts.”
John Green, MD, was the first director of Barrow Neurological Institute.
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John Bodensteiner, MD The Chief of the Division of Pediatric Neurology and William Pilcher Pediatric Neurology Chair finds the perfect job by Sally J. Clasen John Bodensteiner, MD, holds the William Pilcher Pediatric Neurology Chair. The chair was named in honor of Bill Pilcher, a long-time member of the Barrow Neurological Foundation Board of Trustees and the St. Joseph’s Hospital Board. Bill died last year. hen John Bodensteiner, MD, was a child growing up in a small town in northeastern Iowa, his father encouraged him to seek knowledge about things that he was interested in, not just what he was expected to learn. With that sage advice, the younger Bodensteiner chose to be a doctor and selected the most complicated organ in the body to study—a sense of inquiry that has led to an accomplished medical career in pediatric neurology.
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Attracting the stars of child neurology
Today Dr. Bodensteiner, who received his medical degree from the University of Iowa, is the chief of the Division of Pediatric Neurology at St. Joseph’s Children’s Health Center. When he came to Phoenix in 2001 from Indiana University where he was a professor of neurology, St. Joseph’s pediatric neurology “division” was a staff of one, Jack Kerrigan, MD. In five years, Dr. Bodensteiner has built the division into eight fulltime staff members serving children with a wide range of neuro-
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logical problems including neuromuscular diseases, epilepsy, degenerative diseases, headaches and movement disorders. While his intense recruiting effort shaped a team that rivals any top pediatric neurology program in the country, his renowned credentials also have been a major draw for leading pediatric neurologists to relocate here. “If it weren’t for John being here, I wouldn’t have come to St. Joseph’s Hospital,” says Vinodh Narayanan, MD, co-director of the Pediatrics Neurogenetics Center. Dr. Narayanan was formerly on staff at Children’s Hospital in Pittsburgh. “He has an established reputation around the world. Everyone respects him, his abilities and his honesty. He’s one of the leading clinical scientists and clinical educators in the country.”
In addition to his duties as chief of the Pediatric Neurology Division, Dr. Bodensteiner continues to be a major contributor to pediatric neurology research as the principal investigator of many studies. He is the author of hundreds of journal articles and is currently involved in analyzing a unique type of cerebral palsy in extremely premature infants. “Contributing to the understanding of what we do is our highest calling. It’s not enough to do it and do it well, but we must also advance our field,” Dr. Bodensteiner says of his commitment to science. His colleagues admire both his persistence and drive toward solving often frustrating pediatric neurology cases. “Our patient population is not an easy home run. John brings both compassion and “He has an established a tremendous amount of reputation around the world. experience to patients. He is bright, dedicated, high Everyone respects him, his very energy and focused,” Dr. Kerabilities and his honesty.” rigan says. That focus includes plans Vinodh Narayanan, MD to increase the number of facDr. Kerrigan, director of the ulty positions so he can attract physiEpilepsy Center, agrees. “His name cians to the field and help position is one instantly recognized by any- St. Joseph’s as a strong academic one in pediatric neurology. Under his center for pediatric neurology. leadership, we have become one of “We could be exactly where we the top 10 pediatric neurology pro- want to be as far as training, topgrams in the nation and one of the flight residents and grants, but at elite programs west of the Missis- the moment we suffer only from sippi.” being too few,” Dr. Bodensteiner says. He also aims to create a hospital Leading by example environment that benefits children Although Dr. Bodensteiner and by providing advanced care in one others in his division study and treat setting. “If we don’t get support, children with a wide range of neuthen we will not have accomplished rological issues, his clinical focus is our mission.” neuromuscular disorders. “The bulk of my research has been evaluating the subtleties and variations in the structure of the brain and the relationship to functional disturbances,” says Dr. Bodensteiner, who also is the co-director of the MDA Clinic at St. Joseph’s.
Administrative concerns aside, Dr. Bodensteiner has no regrets about choosing a career defined by complex mysteries and challenging outcomes.
The perfect choice
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Bits and pieces on Dr. Bodensteiner •Dr. Bodensteiner is the founding editor and current editorin-chief of Seminars in Pediatric Neurology, the senior associate editor of the Journal of Child Neurology and editor of the Child Neurology Society Newsletter. •A dedicated educator, Dr. Bodensteiner has received notable teaching honors, including Subspecialty Teacher of the Year - Pediatric Department, and Teacher of the Year - Pediatrics, Graduate Medical Education Department, in 2002 at St. Joseph’s. •He was named one of the “Best Doctors in Phoenix” by Phoenix Magazine in 2004, “America’s Top Pediatricians” by Consumers’ Research Council of America in 2004 and “America’s Top Physicians” by Consumers’ Research Council of America, 2004. •In addition to his role as chief of the Division of Pediatric Neurology at St. Joseph’s, Dr. Bodensteiner is professor of clinical pediatrics and neurology at the University of Arizona in Tucson. •On the surface, he is quiet and mild-mannered, but his colleagues say Dr. Bodensteiner is capable of delivering and telling a joke with great effect. “The field I’ve chosen is perfect. Nothing is more difficult to understand than the brain, and I have learned a great deal in studying its complexities. But those rewards are small in comparison to the children and their families I have treated.” ■
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Pediatric Neurology Division St. Joseph’s Children’s Health Center
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John B. Bodensteiner, MD Chief Pediatric Neurology Division Residency: LACH, University of Iowa Fellowship: Mayo Clinic Special interests: Neuromuscular diseases, General Pediatric Neurology
Stanley D. Johnsen, MD Residency: University of Minnesota Fellowship: Washington University and St. Louis Children’s Hospital Special Interests: Neonatal Neurology, Cerebral Palsy, General Pediatric Neurology
Kara Stuart Lewis, MD Director, Pediatric Neurology Residency Program Residency: St Joseph’s Hospital Fellowship: Barrow Neurological Institute Special Interests: Spasticity Management, Pediatric Headache, General Pediatric Neurology
John F. Kerrigan, MD Director, Pediatric Epilepsy and Intra-operative Monitoring Service Residency: UCSF Fellowship: UCLA Special interests: Pediatric Epilepsy
Vinodh Narayanan, MD Residency: Washington University and St. Louis Children’s Hospital Fellowship: Johns Hopkins University Research Interests: Neurogenetics Special Interests: Neurogenetics, General Pediatric Neurology
Yu-tze Ng, MD Residency: University of Texas, Houston Fellowship: University of Texas, Houston Special Interests: Pediatric Epilepsy
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Jong M. Rho, MD Associate Director, Division of Pediatric Neurology Director Pediatric Epilepsy Research Residency: UCLA Fellowship: UCLA Special Interests: Pediatric Epilepsy
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Research News by Jennifer Kennedy
Researchers resolve eye-movement controversy
For more than 40 years, a scientific controversy has raged over whether microsaccades, rapid eye movements that occur when a person’s gaze is fixated, are responsible for visibility. Research conducted at Barrow Neurological Institute has recently resolved the debate, establishing that microsaccades are indeed responsible for driving 80 percent of our visual experience. Even when eyes are fixated carefully on an object, they continue to make tiny movements called fixational eye movements. These movements cause nearly constant stimulation of the retina. “If our eye was perfectly still during fixation, the world would quickly fade from view due to the fact that the neurons in our eyes and brain quickly adapt to nonchanging stimulation,” says lead researcher Susana Martinez-Conde, PhD. There are three types of fixational eye movements: microsaccades, which are fast movements that travel in a straight line; drifts, which are slow curvy motions that occur between microsaccades; and tremors, which are very fast, extremely small oscillations of the eye superimposed on drifts. “It is critical that we know which of these fixational eye movements is primarily responsible for keeping the world from fading because in normal visual conditions we fixate our gaze 80 percent of the time,” says Dr. Martinez-Conde. Her lab
established the vital role of microsaccades in vision by measuring fixational eye movements in subjects whose gaze was concentrated on one object. Not only does this new discovery resolve a scientific debate, it also brings new hope to patients who are blind much of the time due to fixational eye movement problems. Dr. Martinez-Conde’s research receives funding from Barrow Neurological Foundation.
Discovery localizes visual awareness
How do you know when you see something? Barrow researchers have made a breakthrough discovery that puts scientists closer to understanding how visual awareness is generated. Stephen Macknik, PhD, a researcher in the Neurosurgery and Neurobiology departments, and his colleagues have discovered that awareness of simple visual objects is generated in a small portion of the occipital lobes of the brain.
Previous studies had ruled out lower stages of the visual system, such as the retina, as capable of generating visual awareness. Those studies left most remaining areas of the brain as potential candidates. The present study places, for the first time, boundaries within the visual system to localize a small area in which visual awareness is generated. “Visual awareness is the feeling that makes the world seem visible,” Dr. Macknik says. “In contrast to a visual reflex, like when our eyes change their focus, visual awareness describes the conscious experience of recognizing a stimulus as visible, rather than invisible.” The year-long study utilized functional Magnetic Resonance Imaging (fMRI) technology to scan the brains of 17 volunteers while they were exposed to simple visual objects that appeared either more visible or less visible. Functional MRI measures the position of deoxygenated blood within the brain, which indicates areas where energy
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Stephen Macknik, PhD is being used. When study participants saw the objects as more visible, the energy required to create the awareness was detected by fMRI, which led researchers to the area in the brain responsible for generating the awareness. The study was published in the Proceedings of the National Academy of Science. Barrow Neurological Foundation supports Dr. Macknik’s research.
Neuroimmunology Fellow receives $50,000 Award from Hobbs Family
Tempe resident Young-Huen Jee, PhD, a post-doctoral fellow at Barrow, recently received a $50,000 fellowship award from the Hobbs Family Fellowship for Multiple Sclerosis Research to support her research of treatment for multiple sclerosis (MS). This is the second consecutive year the Hobbs Family Fellowship has supported this program. Dr. Jee’s research focuses on action mechanisms of the MS drug Copaxone in experimental autoimmune encephalomyelitis (EAE), a form of MS. When she joined Barrow’s Neuroimmunology Labora-
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tory in March 2005, Dr. Jee began testing the effect of Copaxone in mice without specialized immune system proteins that help eliminate disease. Surprisingly, she found that the drug protected them from becoming afflicted with EAE. Her discovery challenged the prevailing view of the way Copaxone functions and prompted her to investigate alternative mechanisms of the drug’s action. Dr. Jee’s initial findings received enthusiastic comments from International Immunology and have been accepted for publication in this prestigious journal. Her current results suggest that Copaxone’s ability to prevent EAE occurs largely through its effect on regulatory T cells, which are specialized cells of the immune system. “In a very short time, Dr. Jee has uncovered a previously unrecognized mechanism underlying several important routes through which the immune system can modulate MS,” says Timothy Vollmer, MD, chairman of Barrow’s Neurology Department. “Her discoveries will pave the way for novel therapies based on targeting NKT cells to control disease.”
Neuroimmunology Fellow receives $135,000 Award
Ruolan Liu, MD, PhD, a post-doctoral fellow at Barrow, recently received a three-year career development fellowship of $135,000 from the Muscular Dystrophy Association. This prestigious award will fund Dr. Liu’s investigation of natural-killer-T (NKT) cell treatment for myasthenia gravis (MG) and other autoimmune diseases. Since joining Barrow’s Neuroimmunology Research Laboratory in 2004, Dr. Liu has focused on examining several strategies for treating MG and multiple sclerosis (MS). In her initial experiments, Dr. Liu discovered that an agent found in sea sponges can activate NKT cells, which are specialized cells of the immune system. Further research showed that the agent enabled NKT cells to produce a protein that allowed the cells to suppress MG when induced experimentally in mice. These research findings were published in December 2005 in The Journal of Immunology. With the Muscular Dystrophy Association fellowship award, Dr.
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“While PROPELLER technology continues to be refined, GE has already incorporated the novel method into new medical equipment. We believe that PROPELLER technology will help drive the future of MRI.” Jim Pipe, PhD
Liu will work over the next three years to identify key elements for optimizing therapy that will inhibit MG. Her work will build on her previous successful results with NKT cells. “Dr. Lieu’s discoveries will pave the way for novel therapies based on targeting NKT cells to control disease. This fellowship award from the Muscular Dystrophy Association will prepare Dr. Liu for an independent career as a neuroimmunologist,” says Fu-Dong Shi, MD, PhD, a staff scientist in Barrow’s Neurology Department. Jim Pipe, PhD
New technology developed at Barrow enhances MRI
Researchers at Barrow Neurological Institute in Phoenix have developed a new method that allows technicians to obtain clearer Magnetic Resonance Imaging (MRI) scans with less sensitivity to patient motion. PROPELLER is an acronym for “Periodically Rotated Overlapping Parallel Lines with Enhanced Reconstruction.” This method acquires data in a unique way that allows one to track the motion of the patient during the MRI scan. The motion can then be removed.
“While PROPELLER technology continues to be refined, GE has already incorporated the novel method into new medical equipment,” says Jim Pipe, PhD, senior staff scientist in the MRI Department at Barrow. “We believe that PROPELLER technology will help drive the future of MRI.” There are two major applications for this method. The first is motioninsensitive imaging. For the first time, high-quality MRI scans can be collected on many segments of the population who cannot hold still (children, Parkinson’s patients, etc.). This is leading the technology to a point where patient motion, which may be the biggest obstacle to good images, is no longer a factor. The second application for PROPELLER is stroke imaging. The technology used to detect and characterize strokes, called “Diffusion Weighted Imaging (DWI),” is extremely sensitive to even minute motion in a patient. Prior to PROPELLER, DWI images suffered in quality because the methods used to reduce this motion sensitivity also reduced image quality. With PROPELLER DWI, small strokes are much easier to detect, grade and follow during treatment. ■
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What’s Happening Around Barrow Karsten Solheim Dementia Research Chair awarded
Louise, Karsten Louis and Bonnie Solheim were on hand to see Patricio Reyes, MD, receive the new Karsten Solheim Dementia Research Chair, an endowed chair that the Solheim family funded. The chair was established to honor Karsten Solheim, the inventor of PING golf clubs, who died in 2000 after several years of struggling with dementia. Dr. Reyes is a top researcher and neurologist who specializes in Alzheimer’s disease and other cognitive disorders. He recently joined Barrow as the director of the Alzheimer’s Disease and Cognitive Disorders Center. The endowed chair will enable Dr. Reyes to continue his research into cognitive diseases.
The Solheim family—including Bonnie, Louise and Karsten Louis Solheim—funded the Karsten Solheim Dementia Research Chair at Barrow in honor of Louise’s late husband. The endowed chair enabled Barrow to recruit Patricio Reyes, MD, (far right), a leading expert on Alzheimer’s disease and other types of dementia.
Write-a-Will Seminar back by popular demand
On Tuesday, March 14th, the St. Joseph’s and Barrow Neurological foundations will again sponsor a seminar, “Writing or Amending A Will.” The seminar will be held in the Goldman Auditorium at three times— 7:30 a.m., 12 noon and 7 p.m. An experienced estateplanning attorney will speak for approximately 60 minutes, followed by 30 minutes of questions. There is no charge for attending, and parking in the Third Avenue Garage is free. Since seating is limited, please RSVP by calling Cindy Walland, 602-406-6333. “This is a great opportunity to learn about current laws regarding wills and to get information that might
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allow you to fine-tune a document already in existence,” says Philip Barnett, director of Planned Giving. “You will be given a good deal of informative literature— with no sales pitch.” More than 300 people have participated in the two previous groups of seminars.
Carl Zeiss MicroImaging, Inc. and Carl Zeiss Surgical, Inc., both based in Thornwood, New York, have made a $100,000 contribution to Barrow Neurological Foundation for use in research projects at Barrow. Carl Zeiss Surgical, Inc. has a long-standing relationship with Barrow and Robert F. Spetzler, MD. This relationship was a key driving force in the creation of the OPMI® Pentero™, a surgical microscope platform used in neurosurgery, spine surgery and neurotology. In 2004, OPMI Pentero received the International RedDot Design Award. In addition, Barrow researchers will be collaborating with Zeiss on applications for the company’s new PALM Laser Microdissection system, a laser-capture microscope that Barrow recently purchased. Barrow will be the first center in Arizona and one of only a few in the country with the Zeiss PALM system. Used in neuroscience, the PALM system is the most versatile laser microdissection microscopy system currently available. The PALM system will allow Barrow researchers to capture and dissect extremely small bits of genetic material such as chromosomes, capture cells from cryopreserved and fixed tissues, and isolate live cells from culture. Barrow scientists will use the PALM system in a wide range of neurological research activities, including research into brain cancer, benign meningiomas, Alzheimer’s disease, epilepsy, Parkinson’s disease, developmental genetics, multiple sclerosis and Lou Gehrig’s disease.
Zeiss donates $100,000
Crosstown Traffic to play at Lou Grubb Friends Fore Golf
The Lou Grubb Friends Fore Golf Committee is working to make their annual dinner-auction-dancetournament the Valley’s best value and most enjoyable fundraiser. Proceeds from Lou Grubb Friends Fore Golf benefit Barrow Neurological Institute and the Women’s Wellness Clinic at St. Joseph’s. The two-day golf fest begins on Thursday evening, April 20, with a dinner, auction and dance at the Ari-
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Curtis Dickman, MD, (front row, far left) founded Crosstown Traffic last year to have fun and raise money for charity. The band is playing at this year’s Lou Grubb event.
zona Biltmore. Music will be provided by Crosstown Traffic, a local band founded last year by Barrow neurosurgeon Curtis Dickman, MD, to raise money for charity. “We are passionate about playing our music, having fun, and giving gifts to enrich our community,” the band’s website says (www.Xtowntraffic.com). The annual Lou Grubb golf tournament is set for the next day, Friday, April 21. Golfers will compete at McCormick Ranch Golf Club for trophies and prizes. Once again, each golfer will receive a goody bag chocked full of fun items, and each foursome will be photographed for the event’s signature photo sculptures. For more information, contact Debbie Castaldo, director of Annual Giving, at 602-406-1031 or Debbie.Castaldo@chw.edu.
Celebrity Fight Night increases support of Barrow and MAPC
Celebrity Fight Night XII is sure to be a knockout. The star-studded celebrity event has raised more than $32 million in 11 years with a majority of the funding supporting the Muhammad Ali Parkinson Center at Barrow Neurological Institute. The 12th annual Celebrity Fight Night on March 18th at the JW Marriott Desert Ridge Resort promises to be the biggest smash yet, with confirmed attendance from Robin Williams, Magic Johnson and Tony Hawk to name a few. “This year is particularly special,” says Sean Currie, executive director of the Celebrity Fight Night Foundation. “In addition to the exciting line-up of celebrities and rocking entertainment, we are proud to announce that Barrow Neurological Institute will
receive all of the undesignated net proceeds of the event.” Celebrity Fight Night and the Muhammad Ali Parkinson Center team support Muhammad Ali’s vision of providing medical care, information and support to every patient with Parkinson’s disease, regardless of ability to pay. For more information about Celebrity Fight Night, call 602-956-1121 or visit www.celebrityfightnight.org.
Muhammad Ali's daughter to speak at Barrow symposia and promote new book
Rasheda Ali, the daughter of Muhammad Ali, will visit the Valley Wednesday, March 8, through Friday, March 10, to speak at the Muhammad Ali Parkinson Center's 2006 Mo Udall Educational Symposia, an annual Parkinson's disease conference for patients, families and healthcare providers. Rasheda is scheduled to speak about her book, I'll Hold Your Hand So You Won't Fall - A Child's Guide to Parkinson's Disease. Rasheda wrote the book after noticing the interaction between her two children and her father, who has Parkinson's disease. She hopes her book will help families who experience the disease. The Mo Udall Educational Symposia will provide an update on the latest treatments and developments of Parkinson's disease. The symposia is presented by the Muhammad Ali Parkinson Center at Barrow Neurological Institute and will be held at the Glendale Civic Center on Thursday, March 9, from 11:30 a.m. to 3:30 p.m. and at Mesa Centennial Hall on Friday, March 10, from 8:30 a.m. to 12:30 p.m. Family members, healthcare providers and those who suffer with Parkinson's disease are invited to attend. Please call 602-406-4921 to register. There is a $10 registration fee for each attendee. On Thursday, March 9, from 4 to 6 p.m., Rasheda will sign copies of her book at the Freedom Plaza in Peoria. The book will be available for purchase at the price of $20, and half of the proceeds will go to the Muhammad Ali Parkinson Center. Please R.S.V.P. for this event before Monday, March 6, by calling 602-9721776.
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the legacy society Honoring those whose planned gifts are ensuring Barrow’s future by Philip Barnett, director, Planned Giving
n the last three years, I have met many generous people who are helping ensure Barrow and St. Joseph’s future through a planned gift—a bequest, charitable gift annuity, charitable remainder trust, or beneficiary designation in an insurance policy or retirement plan, for example. Their thoughtful gifts will benefit many patients for generations to come. The income that planned gifts generate for the hospital helps provide financial stability for many important programs in the areas of research, medical education and patient care. And so, I am very pleased to announce that Barrow Neurological Foundation and St. Joseph’s Foundation are establishing a special organization to recognize these donors’ vital contributions to our hospital’s future—The Legacy Society. The Legacy Society will be launched on July 1, 2006. It will honor all benefactors who have contributed at least $10,000 to Barrow and/or St. Joseph’s through some type of planned gift. Members of The Legacy Society will receive spe-
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cial recognition in our annual report, on our donor-recognition wall in the hospital’s new lobby and at donor-recognition events. In the next few months, those of you who have notified us of your planned gift will receive a personal invitation to join The Legacy Society as charter members. I am delighted to be able to extend this invitation! Unfortunately, though, there are many donors who include St. Joseph’s or Barrow in their estate plans—but don’t tell us of their generosity until it is too late for us to thank them personally. I am hoping to hear from these silent benefactors so that we can recognize them through The Legacy Society. If you have made a planned gift to one of our foundations but have not notified us, I urge you to contact me. By making us aware of your gift, prior to the launch date, you will be inducted as a charter member of The Legacy Society and recognized as such (naturally we will honor the wishes of anyone who asks to remain anonymous). The future of Barrow and St. Joseph’s, and the quality of the med-
ical care that will be available to your children, grandchildren and the generations that follow them may well depend on our many benefactors who have included the hospital in their estate plans. Hopefully, your membership in The Legacy Society will inspire other people to take similar action. You deserve to hear our applause. Philip Barnett Director, Planned Giving
“If you have made a planned gift to one of our foundations but have not notified us, I urge you to contact me. You deserve to hear our applause.” Philip Barnett
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BARROW NEUROLOGICAL INSTITUTE Endowed Centers
A.B. & Anne-Merete Robbs Stroke Center Annette & Harold Noren Stroke Care Unit Golden Family Aneurysm Wing Ina Levine Brain Tumor Center Muhammad Ali Parkinson Center
Endowed Chairs
Alumni Spine Chair Volker K.H. Sonntag, MD
William Pilcher Pediatric Neurology Chair John Bodensteiner, MD
Evelyn and Lou Grubb Neurovascular Research Chair Cameron G. McDougall, MD J.N. Harber Neurological Surgery Chair Robert F. Spetzler, MD
John and Betty Van Denburgh Neurology Chair Timothy L. Vollmer, MD Karsten Solheim Dementia Research Chair Patricio Reyes, MD Kemper & Ethel Marley Neurology Chair William R. Shapiro, MD Newsome Neurology Chair David M. Treiman, MD
Newsome Neuropsychology Chair George P. Prigatano, PhD
Newsome Neurosurgery Research Chair Mark Preul, MD Spetzler Neuroscience Research Chair Robert F. Spetzler, MD
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D o y o u h av e a S t. J o s e p h ’ s S t o r y ? St. Joseph’s Hospital and Medical Center will celebrate its 111th anniversary with the opening of the new Barrow Patient Care Tower. As we get ready to celebrate, we’re looking for people who were born at St. Joseph’s or who have a special story to share. Please submit your story at bornatstjosephs.org. Participants will be invited to the opening of our new building in Spring 2006.
it’s about life.