VOL. 11 | ISSUE 1
NEUROSCIENCE OUTLOOK
NEWS AND RESEARCH FROM THE DEPARTMENTS OF NEUROLOGY AND NEUROSURGERY AT GEORGIA REGENTS NEUROSCIENCE CENTER
TELESTROKE AND TELENEUROLOGY Helping patients in remote locations when time is of the essence
FROM THE CHAIRMEN
DEPARTMENT NEWS Cargill H. Alleyne Jr., M.D., and David C. Hess, M.D.
Welcome to another issue of Neuroscience Outlook, the combined newsletter of the Neurosurgery and the Neurology departments. We offer many unique multidisciplinary programs. In the clinical spotlight we describe the innovative teleneurology program and a variety of endovascular procedures for acute ischemic stroke. Some additional unique programs and designations include: `` Joint Commission Advanced Comprehensive Stroke Center (first in Georgia and the second in the Southeast) `` Level 4 Epilepsy Center (one of only two in the state) `` National Parkinson’s Foundation Center of Excellence (the only one in Georgia and South Carolina) `` Hereditary Hemorrhagic Telangiectasia Center (one of 16 in the U.S. and approximately 40 worldwide) `` Tuberous Sclerosis Complex Clinic (one of about 40 in the nation) `` International spine program `` Comprehensive pediatric neurologic and neurosurgical services `` Multidisciplinary skull base program We are proud of the efforts of our faculty and staff in molding a first-class Neuroscience center. Cargill H. Alleyne Jr., M.D. Professor and Marshall Allen Distinguished Chair of Neurosurgery calleyne@gru.edu
David Hess, M.D. Professor and Presidential Distinguished Chair of Neurology dhess@gru.edu
NEUROSCIENCE OUTLOOK A publication of the Georgia Regents University Departments of Neurology and Neurosurgery Editor-in-chief: Cargill H. Alleyne Jr., M.D. Editor: Phil Malkinson Illustrations: Colby Polonsky, M.S. Contributors: Jeffrey A. Switzer, D.O., Scott Y. Rahimi, M.D., Cargill H. Alleyne Jr., M.D.
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SJC collaboration Neurology/Neurosciences expands in Savannah, Ga.
In July 2013, the department of Neurology began a collaboration with St. Joseph’s-Candler (SJC) Health System in Savannah, Ga., where the department has full-time faculty. SJC forms the backbone of the Medical College at the Georgia Southeastern Campus, and there are MCG students based in Savannah their entire third and fourth years of medical school. The first two hires were Shannon Stewart, M.D., who completed a vascular neurology fellowship at GRU. Dr. Stewart is a full-time inpatient vascular neurologist and neurohospitalist at St Joseph’s Hospital. St Joseph’s Hospital is the site of the SJC Neuroscience Center and a 12-bed dedicated Neurointensive Care Unit. Our second neurologist is Jill Trumble, M.D., who directs the outpatient program at SJC. Dr. Trumble completed a movement disorder fellowship at GRU, was the “Resident of the Year,” and is our Movement and Cognitive Disorders point person in Savannah. In January 2014, Mihaela Saler, M.D., former GRU stroke fellow and neurology resident, will join our faculty as the second vascular neurologist/ neurohospitalist at St Joseph’s Hospital. We have also hired Jonas Vanags, M.D., a former MCG medical student and now neuromuscular fellow at Duke, to head up our Neuromuscular/EMG Program at SJC in July 2014. We also have a commitment from another Duke neurology residency program graduate, Brian Raj, M.D., to join our faculty as a neurohospitalist in July 2015, bringing us to five full-time faculty by July 2015. We have plans to hire at least three more neurologists for our SJC Savannah campus. SJC has a well-developed clinical research infrastructure, and we are planning to perform clinical trials there. In January 2014, we transmitted our Grand Rounds to the Savannah campus by video. Our department has been providing telestroke calls at SJC and seven spoke hospitals since June 2013, demonstrating that we have a strong collaboration and integration with SJC and other hospitals in Southeast Georgia. Jonas Vanags, M.D.
Jill Trumble, M.D.
Shannon Stewart, M.D.
Transitions
We are delighted to welcome Kerry Cartledge as the new business manager of the Neurology and Neurosurgery departments. Cartledge received her M.B.A. from Brenau University and recently was employed as a Business Operations Specialist at GRU College of Dental Medicine. Prior to that, she worked as a sponsored accountant at GRU. In addition, we welcome Laurel Jones as the new Residency Program Coordinator in the department of Neurosurgery. Jones received her Associate degree (Medical Assistant) from Augusta Technical College. Most recently she was employed as an Implementation Specialist at McKesson Specialty Health, and prior to that, as Office Manager at Augusta Oncology Associates. Kerry Cartledge (left) and Laurel Jones
Neurosurgery department hosts Chinese neurosurgeon
As part of an institutional affiliation between GRU and the Department of Health in Jiangsu province, China, Cargill H. Alleyne Jr., M.D., hosted Xudong Zhao, M.D., a vascular neurosurgeon from Wuxi Second People’s Hospital affiliated with Nanjing Medical University. Dr. Zhao was one of a group of six Chinese physicians, each of whom was hosted by a department at GRU. Dr. Zhao observed a variety of endovascular and open procedures and attended departmental conferences during his four-week visit.
FACULTY & STAFF UPDATES Cargill H. Alleyne, Jr., M.D., (Department of Neurosurgery) was selected as one of the Castle Connolly Top Doctors and one of the Best Doctors in America for 2014. He was also co-investigator on an American Heart Association grant (PI: Sangeetha Sukumari Ramesh, Ph.D.) entitled “Molecular mechanisms of astrocyte proliferation after intracerebral hemorrhage.” In addition, he was issued a patent in November 2013: “Surgical apparatus for cutting tissue” (U.S. Patent no. 8,591,537, issued 11/26/13). Haroon F. Choudhri, M.D., (Department of Neurosurgery) was Visiting Professor at Majmah University, Majmah, Kingdom of Saudi Arabia, in December 2013. Krishnan Dhandapani, M.D., (Department of Neurosurgery) chaired the Veterans Administration Merit Review Neurobiology C Study Panel and the Brain 2 Study Panel, American Heart Association. He was also ad hoc grant reviewer for the American Heart Association Collaborative Sciences Award. Cole A. Giller, M.D., Ph.D., M.B.A., (Department of Neurosurgery) was selected one of the Best Doctors in America for 2014. He was also Visiting Professor at the Neurosurgery Department of the Universita degli Studi di Palermo in Palermo, Italy. In addition, one of his patients undergoing a functional hemispherectomy for epilepsy was featured in The Augusta Chronicle (http://chronicle.augusta.com/news/ health/2013-10-17/brain-disconnecthelps-little-girls-seizures).
Scott Y. Rahimi, M.D., (Department of Neurosurgery) passed the Neurosurgery Oral Board Examinations in November 2013. Suzanne Strickland, M.D., (Department of Neurology) was appointed to the Tuberous Sclerosis Alliance Professional Advisory Board. She was also successful in securing a TSC Clinic designation from the Board in October 2013. Sangeetha Sukumari Ramesh, Ph.D., (Department of Neurosurgery) was awarded a Scientist Development Grant from the American Heart Association entitled “Molecular mechanisms of astrocyte proliferation after intracerebral hemorrhage” (01/01/2014-12/31/2017). She was also runner-up for the Young Investigator award at the Southern Translational Education and Research (STAR) Conference conducted by the University of Georgia and GRU in September 2013. In addition, she co-chaired the Society for Neuroscience Nanosymposium on “Brain Injury: Therapeutic Strategies” in San Diego in November 2013.
Xudong Zhao, M.D.
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CLINICAL SPOTLIGHT
Endovascular treatment
SOLITAIRE
of acute ischemic stroke The development of mechanical thrombectomy devices extends the treatment time window Stroke is the greatest cause of disability and the third-leading cause of death in the United States. Every year, approximately 795,000 people are affected by strokes. Typically a disease process seen in older individuals, 75 percent of strokes occur in patients 65 years and older. A tremendous amount of resources and effort have been invested in the treatment of this disease, which affects an individual every 40 seconds. A major advance in stroke treatment was made in 1995. The National Institute of Neurological Disorders and Stroke study group reported that patients treated with intravenous (IV) alteplase within three hours of stroke-symptom onset fared better compared to patients who did not receive the therapy.1 The European Cooperative Acute Stroke Study III (ECASS III) extended the time window for IV thrombolysis to 4.5 hours in 2008.2 Because a considerable percentage of patients do not present for IV thrombolysis within a three-hour window, the role of intra-arterial (IA) prourokinase for stroke ISCHEMIC CLOT therapy was investigated in the PROACT II trial in 1999.3 The trial investigators showed successful recanalization of occluded vessels using IA thrombolysis over a six-hour window from the time of symptom onset. The natural progression of stroke care led to development of mechanical thrombectomy devices with the treatment time window extended to eight hours. Although tPA must be administered within three hours of Three devices warrant symptom onset for acute ischemic stroke, the natural progression mentioning in order of of stroke care led to development of mechanical thrombectomy their development. devices, which extend the treatment time window to eight hours. Scott Y. Rahimi M.D., Cargill H. Alleyne Jr., M.D.
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The Solitaire™ FR Revascularization Device is a mechanical thrombectomy device combining the ability to restore blood flow, administer medical therapy, and retrieve clots in patients experiencing acute ischemic stroke. In the SWIFT trial, the Solitaire was directly compared to Concentric’s Merci Retriever. The stent retriever achieved 37 percent better angiographic, safety, and clinical outcomes compared to the Merci device.
Concentric’s Merci Retriever was the first device introduced for mechanical thrombectomy following publication of their data in 2005.4 This device uses a system of catheters and snare devices to extract thrombus from occluded vessels and pull the clot through the catheter system. Although Concentric did not directly present data showing improvement in stroke outcome following embolectomy, they did obtain Food and Drug Administration approval for their device. The Merci trial showed a 46 percent recanalization rate compared to 18 percent control rates. Therefore, the Merci Retriever was approved for “removal of clot� and not necessarily for treatment of stroke. The Penumbra Pivotal stroke trial was published in 2009.5 The Penumbra device uses a variety of catheter systems connected to an aspiration device. Different-sized separator wires are used to mechanically dislodge the clot, which is then suctioned by the aspirator device connected to the catheter. (See Penumbra image, right.) The Pivotal trial showed an 81 percent revascularization rate with the use of the Penumbra device. More importantly, it provided an alternate method to the Merci device for embolectomy procedures. Three years following the introduction of the Penumbra aspirator system, the Solitaire stent retriever was approved for use in patients with acute strokes. The Solitaire stent retriever is a novel device that uses a retrievable stent to extract thrombus from an occluded vessel. (See Solitaire image, p. 4.) In the SWIFT trial, the Solitaire was directly compared to the Merci Retriever. The stent retriever achieved 37 percent better angiographic, safety, and clinical outcomes compared to the Merci device.6 As a result of all of these new treatment techniques, interventional stroke therapy has exploded over the past five to 10 years. Most recently, the Interventional Management of Stroke Trial III (IMS III) showed no difference in clinical outcome for patients treated with IV thrombolysis compared to IA thrombolysis.7 As we move forward with information from IMS III, to obtain successful results, care must be taken to select patients properly and treat stroke patients as quickly as possible. The Georgia Regents University Neuroscience Center was the first in Georgia to receive the Comprehensive Stroke Center designation from The Joint Commission. We are currently the only institution in the state with two dually trained endovascular neurosurgeons providing continuous stroke care. Our neurosurgery service works closely with our vascular neurologists and neurointensivist, as well as our stroke center nursing staff, to provide the highest level of care
PENUMBRA The 2009 Penumbra Pivotal stroke trial assessed the safety and effectiveness of the Penumbra System in the revascularization of patients presenting with acute ischemic stroke secondary to intracranial large vessel occlusive disease. The results of the trial suggest the Penumbra System allows safe and effective revascularization in patients experiencing ischemic stroke secondary to large vessel occlusive disease who present within eight hours from symptom onset. The Penumbra device uses a variety of catheter systems connected to an aspiration device. Different-sized separator wires are used to mechanically dislodge the clot, which is then suctioned by the aspirator device connected to the catheter. (Below): Normal blood flow is re-established.
NORMAL BLOOD FLOW for patients. We provide the entire spectrum of stroke therapy, including IV and IA thrombolysis, mechanical thrombectomy with devices such as the Penumbra aspirator and Solitaire stent retriever, and intracranial/extracranial stent placement. In this article, we present some representative cases illustrating the use of these devices at our institution.
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CLINICAL SPOTLIGHT
Endovascular Case Studies PATIENT 1:
A 40-year-old woman presented five hours following her last known normal exam. The patient had received IV tPA at an outside hospital prior to transfer to Georgia Regents Medical Center. She was an NIH Stroke Scale (NIHSS) of 15 on initial evaluation at our hospital. She was taken emergently for mechanical thrombectomy. Immediately following the procedure, her NIHSS improved to 4. On hospital discharge her NIHSS was 0.
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Right ICA injection (AP view) showing an M1 occlusion.
2
Right MCA injection (AP view) distal to occlusion.
PATIENT 3:
A 45-year-old man presented with a gradually worsening neurologic exam that began approximately 23 hours prior to his transfer to our institution. On our initial evaluation, the patient had an NIHSS of 16. A CTA of the head showed what appeared to be a small hypodensity in the brainstem, most likely representing a small area of infarct and an occluded basilar artery. The patient was emergently taken to our neuroangiography
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Right ICA injection (AP view) following thrombectomy showing TICI 3 reperfusion.
PATIENT 2:
A 39-year-old man was transferred to our hospital with an NIHSS of 14. The patient’s exam had progressively worsened over the previous 24 hours. He was taken to the angiography suite urgently for evaluation. A basilar artery dissection and occlusion was identified on the angiogram. He was treated with stenting of the basilar artery. He was discharged on hospital day eight with improvement in his NIHSS to 4. On his six-month follow-up angiogram, the previously identified vessel irregularity showed complete resolution.
suite for mechanical thrombectomy. On the left vertebral artery injection, the patient had an occluded vertebral artery immediately distal to the origin of the left posterior inferior superior cerebellar artery. Using the Penumbra reperfusion device, mechanical thrombectomy was successfully performed with patency of the vertebrobasilar system representing TIMI-3 reperfusion. The patient was later extubated and improved to an NIHSS of 4.
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Left vertebral artery injection (AP view) showing basilar dissection and pseudoaneurysmal dilatation with partial occlusion.
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Left vertebral artery injection (lateral view) with better visualization of the basilar dissection and vessel irregularity.
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Left vertebral artery injection (lateral view) demonstrating basilar artery stent deployment.
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Left vertebral artery injection (AP and lateral views) showing basilar artery thrombosis.
Left vertebral artery injection (AP and lateral views) showing reperfusion after mechanical thrombectomy.
Left vertebral artery injection at six-month follow-up (AP view) showing normal vertebrobasilar anatomy.
References: 1. The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. Tissue plasminogen activator for acute ischemic stroke. N Engl J Med 1995;333:1581–1587. 2. Hacke W, Kaste M, Bluhmki E, et al: Thrombolysis with alteplase 3 to 4.5 hours after acute
S, et al: Safety and efficacy of mechanical embolectomy in acute ischemic stroke: results of the MERCI trial. Stroke 2005;36:1432–38. 5. McDougall C, Clark W, Mayer T, et al. The Penumbra Pivotal Stroke Trial: Safety and effectiveness of a new generation of mechanical devices for clot removal in
non-inferiority trial. The Lancet 2012; 380:1241-1249. 7. Broderick JP, Palesch YY, Demchuk AM, Yeatts SD, Khatri P, Hill MD, et al: The Interventional Management of Stroke (IMS) III Investigators. Endovascular therapy after intravenous t-PA versus t-PA alone for stroke. N Engl J Med 2013;368:893–903.
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ischemic stroke. N Engl J Med 2008;359:1317–29. 3. Furlan A, Higashida R, Wechsler L, et al: Intra-arterial prourokinase for acute ischemic stroke: the PROACT II study—a randomized controlled trial. Prolyse in Acute Cerebral Thromboembolism. JAMA 1999;282:2003–11. 4. Smith WS, Sung G, Starkman
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intracranial large vessel occlusive disease. Stroke 2009;40:2761-8. 6. Saver JL, Jehan R, Levy EI, Jovin, TG, Baxter B, Nogueira RG, Clark W, Budzik R, Zaidat OO: Solitaire flow restoration device versus the Merci Retriever in patients with acute ischaemic stroke (SWIFT): a randomised, parallel-group,
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CLINICAL SPOTLIGHT
Patient with acute left hemispheric stroke with right arm weakness.
Telestroke and Teleneurology Telemedicine provides health care at a distance to help patients in remote locations when time is of the essence Jeffrey Switzer, D.O.
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In 1996, FDA approval of intravenous (IV) rt-PA for ischemic stroke changed the landscape of acute stroke care and offered the opportunity to reduce stroke-related disability. Unfortunately, in the years that followed approval, the benefits of IV rt-PA remained out of reach for many patients. In rural areas, treatment rates were particularly low, likely due to the timesensitive nature of treatment and the lack of access to neurologists who could rapidly distinguish stroke from mimics and weigh the risks and benefits of thrombolysis. In Georgia, for the roughly 4 million residents outside of metropolitan Atlanta, there was a
NEUROSCIENCE OUTLOOK Volume 11 | Issue 1
clear “geographic penalty” in acute stroke care. Spread across 159 counties, most rural Georgian residents receive their initial stroke care in small hospitals (less than 100 beds), including 34 federally designated critical access hospitals. In fact, as of 2003, none of the numerous small, rural hospitals surrounding the Medical College of Georgia (MCG) had ever administered IV rt-PA to a stroke patient. Patients with acute stroke presenting to these facilities were identified, perhaps inconsistently, and transferred out. By the time they arrived at MCG or another hospital, the therapeutic window for rt-PA had either closed or at best lessened the likelihood of rt-PA benefit.
In 2003, MCG began one of the nation’s first “experiments” in telestroke. Five small, rural emergency departments (spokes) were linked via a mobile cart to a consultant at MCG (hub) who provided real-time assessment of the patient and imaging results to make rapid decisions for or against thrombolysis. The Remote Evaluation for Acute Ischemic Stroke (REACH) network demonstrated the feasibility of telestroke and rt-PA administration in small and rural hospitals. Further, the “Drip and Ship” model of stroke care became commonplace, with the patient receiving rt-PA in the spoke hospital under telemedicine guidance followed by transfer to the hub for further assessment, treatment, and potential clinical trial participation. Over time, it became apparent that many larger suburban and urban hospitals suffered from the same deficits in neurology coverage as their smaller and more rural counterparts. In 2008, the MCG REACH network began to extend coverage to many of these larger facilities that required intermittent (nights, weekends) or round-the-clock emergency neurology coverage. Through partnership with MCG, these hospitals were often able to maintain or establish Primary Stroke Center status. Patients seen by an MCG teleneurology consultant overnight and receiving thrombolytic treatment could often be admitted locally (“Drip and Keep”), making telestroke cost-effective for the local hospital. The network has expanded throughout the state and across state lines to South Carolina. In 2013, MCG (now Georgia Regents Medical Center) became the first hospital in Georgia and the second in the Southeast to receive the Comprehensive Stroke Center designation from The Joint Commission, in part due to its extensive telestroke network. REACH now includes 30 sites and a more complex relationship of “sub-hubs,” including St. Joseph’s hospital in Savannah and St. Mary’s hospital in Athens (figure 1).
As one of the longest continuous running networks in the world, the Georgia Regents Medical Center REACH telestroke program has made several important contributions to the field, including determining the reliability of telemedically performed NIHSS, the feasibility of thrombolysis in small, rural emergency departments, the timeliness of telemedically guided thrombolysis, the application of telestroke for clinical trial recruitment, and the cost-effectiveness of telestroke.
Figure 1. REACH Telemedicine: development of a telestroke network with multiple hubs and spokes that includes 30 sites and a network of sub-hubs.
References 1. Bruno A, Lanning KM, Gross H, Hess DC, Nichols FT, Switzer JA: Timeliness of intravenous thrombolysis via telestroke in Georgia. Stroke 2013;44(9):2620-2. 2. Switzer JA, Demaerschalk BM, Xie J, Fan L, Villa KF, Wu EQ: Cost-effectiveness of hub-andspoke telestroke networks for the management of acute ischemic stroke from the hospitals’ perspectives. Circ Cardiovasc Qual Outcomes 2013;6(1):18-26.
al: A telestroke network enhances recruitment into acute stroke clinical trials. Stroke 2010;41(3):566-9. 7. Switzer JA, Levine SR, Hess DC: Telestroke 10 years later— telestroke 2.0. Cerebrovasc Dis 2009;28(4):323-30. 8. Switzer JA, Hall C, Gross H, et al: A Web-based telestroke system facilitates rapid treatment of acute ischemic stroke patients in rural emergency departments. J Emerg Med 2009;36(1):12-8. 9. Switzer JA, Hess DC: Development
et al: REACH: clinical feasibility of a rural telestroke network. Stroke 2005;36(9):2018-20. 13. Wang S, Gross H, Lee SB, et al: Remote evaluation of acute ischemic stroke in rural community hospitals in Georgia. Stroke 2004;35(7):1763-8. 14. Wang S, Lee SB, Pardue C, et al: Remote evaluation of acute ischemic stroke: reliability of National Institutes of Health Stroke Scale via telestroke. Stroke 2003;34(10):e188-91.
3. Switzer JA, Demaerschalk BM: Overcoming challenges to sustain a telestroke network. J Stroke Cerebrovasc Dis 2012;21(7):535-40. 4. Hess DC, Switzer JA: Stroke telepresence: removing all geographic barriers. Neurology 2011;76(13):1121-3. 5. Stewart SF, Switzer JA: Perspectives on telemedicine to improve stroke treatment. Drugs Today (Barc) 2011;47(2):157-67. 6. Switzer JA, Hall CE, Close B, et
of regional programs to speed treatment of stroke. Curr Neurol Neurosci Rep 2008;8(1):35-42. 10. Cho S, Khasanshina EV, Mathiassen L, Hess DC, Wang S, Stachura ME: An analysis of business issues in a telestroke project. J Telemed Telecare 2007;13(5):257-62. 11. Hess DC, Wang S, Gross H, Nichols FT, Hall CE, Adams RJ: Telestroke: extending stroke expertise into underserved areas. Lancet neurol 2006;5(3):275-8. 12. Hess DC, Wang S, Hamilton W,
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PUBLICATIONS & PRESENTATIONS
September–December 2013 PUBLICATIONS Meador KJ, Baker GA, Browning N, Cohen MJ, et al Fetal antiepileptic drug exposure and cognitive outcomes at age 6 years (NEAD Study): A prospective observational study. Lancet Neurology 3:244-252, 2013. Cohen MJ, Meador KJ, Browning N, May R, Baker GA, ClaytonSmith J, et al Fetal antiepileptic drug exposure: Adaptive and emotional/behavioral functioning at age 6 years. Epilepsy & Behavior 29:308-315, 2013. Liao TV, Forehand CC, Hess DC, Fagan SC Minocycline repurposing in critical illness: focus on stroke. Curr Top Med Chem 13:2283-90, 2013. Hoda MN, Bhatia K, Hafez SS, Johnson MH, Siddiqui S, Ergul A, Zaidi KR, Fagan SC, Hess DC Remote ischemic perconditioning is effective after embolic stroke in ovariectomized female mice. Transl Stroke Res 2014 [doi: 10.1007/ s12975-013-0318-6]. Duberstein KJ, Platt SR, Holmes SP, Dove CR, Howerth EW, Kent M, Stice SL, Hill WD, Hess DC, West FD Gait analysis in a preand post-ischemic stroke biomedical pig model.
PRESENTATIONS Physiol Behav 2013 Nov 25;125C:816 [doi: 10.1016/j. physbeh.2013.11.004, Epub ahead of print]. Prosser JD, Solares CA, Vender J, Alleyne C Transfacial approaches to the clivus. Operative Techniques in Otolaryngology— Head and Neck Surgery 24:213-217, 2013. Vender JR Retrosigmoid approach. Operative Techniques in Otolaryngology – Head and Neck Surgery 24:172-178, 2013. Woodall MN, Alleyne CH Microvascular decompression of the optic nerve. Neurology 81:e137, 2013 [doi: 10.1212/ WNL.0b013e3182a9f40f].
Yowtak J, Wang J, Kim HY, Lu Y, Chung K, Chung JM Effect of antioxidant treatment on spinal GABA neurons in a neuropathic pain model in the mouse. Pain 154: 2469-2476, 2013.
Alleyne CH Neurologic injury and neuroprotection after stroke. Visiting Professor, Division of Neurosurgery, University of Columbia-Missouri, Mo., September 2013
Yowtak J, Hughes D, Heger I, Macomson SD Intracranial calcified pseudocyst reaction to a shunt catheter: Case report. Journal of Neurosurgery: Pediatrics. 2013 Dec 13 [doi: 10.3171/2013.11. PEDS12405, Epub ahead of print].
Choudhri HF Complex cervical reconstruction: Principles and techniques. Maghreb American Health Forum, Casablanca, Morocco, September 2013 Choudhri HF Lateral transpsoas interbody fusion: tips & tricks. South Carolina Spine Society, Charleston, S.C., September 2013 Yu JC, Heger I, Yin H Craniofacial imaging indications and controversies. International Society of Craniofacial Surgery 15th Congress. Jackson Hole, Wy., September 2013
Woodall MN, McGettigan M, Figueroa R, Gossage P, Alleyne CH Cerebral vascular malformations in hereditary hemorrhagic telangiectasia. Journal of Neurosurgery. 2013 November [doi:10.3171/2013.10. JNS122402, Epub ahead of print]. Youssef PY, Alleyne CH Aneurysm associated with an accessory MCA. Neurographics 3:155158, 2013.
Example of a high retro sigmoid bone window, associated dural incision, and orientation of the underlying lateral cerebellar hemisphere and cranial nerves.
Dhandapani KM Neuro-immune interactions after traumatic brain injury: a role in the development of neurovascular injury? Department of Pharmacology and Neuroscience, University of North Texas Health Science Center, Fort Worth, Texas, October 2013
Names in blue indicate faculty members in the Georgia Regents University Neurosurgery or Neurology departments.
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NEUROSCIENCE OUTLOOK Volume 11 | Issue 1
Dhandapani KM Neuro-immune interactions after traumatic brain injury: a role in the development of neurovascular injury? Department of Oral Biology, College of Dental Medicine, Georgia Regents University, Augusta, Ga., October 2013 Woodall MN, Choudhri HF “Mini-open” lateral transpsoas interbody fusion. Congress of Neurological Surgeons Meeting, San Francisco, Calif., October 2013 Woodall MN, McGettigan M, Figueroa R, Gossage J, Alleyne CH Cerebral vascular malformations in hereditary hemorrhagic telangiectasia. Congress of Neurological Surgeons Meeting, San Francisco, Calif., October 2013 Woodall MN, Shakir B, Smitherman A, Choudhri HF Intraoperative electromyographic evidence of indirect decompression during lateral transpsoas interbody fusion; a report of two cases. Congress of Neurological Surgeons meeting, San Francisco, Calif., October 2013 Shields JS, Alleyne CH, Dhandapani KM Curcumin promotes hematoma resolution following intracerebral
hemorrhage via a CD36dependent mechanism. Society for Neuroscience Annual Meeting, San Diego, Calif., November 2013 Heger I Pediatric neurooncology opportunities. Pediatric Grand Rounds, Department of Pediatrics, Georgia Regents University, Augusta, Ga., November 2013 Sukumari Ramesh S, Alleyne CH, Dhandapani KM Suberoylanilide hydroxamic acid (SAHA) attenuates neurodegeneration and glial activation after intracerebral hemorrhage. Society for Neuroscience Annual Meeting, San Diego, Calif., November 2013 Switzer JA Translating evidence into excellent acute stroke management. Gwinnett Medical Center, Advances in Stroke Care 2013, Lawrenceville, Ga., November 2013 Switzer JA Evolution and current state of endovascular therapy. Gwinnett Medical Center, Advances in Stroke Care 2013, Lawrenceville, Ga., November 2013 Choudhri H Current concepts in spinal trauma surgery.
Majmah University, Majmah, Kingdom of Saudi Arabia, December 2013 Choudhri H Management of cervical deformity. Majmah University, Majmah, Kingdom of Saudi Arabia, December 2013 Choudhri HF Extreme cervical deformity. Third Spine Update Conference, Jeddah, Kingdom of Saudi Arabia, December 2013 Choudhri HF Tips & tricks for cervical spine surgery. Third Spine Update Conference, Jeddah, Kingdom of Saudi Arabia, December 2013 Choudhri HF Vertical distraction cages for ventral thoracolumbar reconstruction. Third Spine Update Conference, Jeddah, Kingdom of Saudi Arabia, December 2013 Choudhri HF Management of complex mass lesions at the craniocervical junction. Third Spine Update Conference, Jeddah, Kingdom of Saudi Arabia, December 2013 Choudhri HF Complex cervical reconstruction: Cadaver lab. Third Spine Update Conference, Jeddah,
Kingdom of Saudi Arabia, December 2013 Meador KJ, Baker GA, Browning N, Cohen MJ, et al Antiepileptic drug exposure during breastfeeding and cognitive outcomes at age 6 years. 67th Annual Meeting of the American Epilepsy Society, Washington, D.C., December 2013 Dhandapani KM Neuro-immune interactions after traumatic brain injury: a role in the development of neurovascular injury? Department of Medical Laboratory, Imaging, and Radiologic Sciences, College of Allied Health Sciences, Georgia Regents University, Augusta, Ga., December 2013 Dhandapani KM Neuro-immune interactions after traumatic brain injury: a role in the development of neurovascular injury? Department of Pediatrics, Medical University of South Carolina, Charleston, S.C., December 2013 Giller CA Updates in epilepsy surgery: How to hear the EEG. Universita’ degli studi di Palermo, Dipartimento di Biomedicina, Sperimentale e Neuroscienze cliniche, Palermo, Italy, December 2013
Kirov SA Window into the injured brain; single astrocytes, microglia and neurons during osmotic and ischemic stress. CaribeGLIA-3 Symposium and International IBRO Glial Workshop, San JuanBayamon, Puerto Rico, December 2013 King-Stephens D, Mirro E, Weber P, Laxer K, Van Ness P, Salanova V, Spencer D, Heck C, Goldman A, Jobst B, Shields W, Bergey G, Eisenschenk S, Worrell G, Rossi M, Gross R, Cole A, Sperling M, Nair D, Gwinn R, Park Y, Rutecki P, Fountain N, Wharen R, Hirsch L, Miller I, Barkley G, Edwards J, Geller E, Berg M, Sadler T, Sun F, Morrell M Lateralization of temporal lobe epilepsy with long-term ambulatory intracranial monitoring using the RNS™ system: Experience in 82 patients. 67th annual meeting of American Epilepsy Society, Washington, D.C., December 2013 Vender J Brain trauma. NURO 8082 Neuroscience Course. Graduate School, Georgia Regents University, Augusta, Ga., December 2013
Neurosurgery Interest Group, Augusta, Ga., December 2013 Woodall MN, Hamilton C, Vender J Gamma Knife radiosurgery for trigeminal neuralgia at the Medical College of Georgia. Georgia Neurosurgical Society Meeting, Greensboro, Ga., December 2013 Yowtak J, Woodall MN, Heger I, Gossage JR, Alleyne CH Cerebral vascular malformations in pediatric hereditary hemorrhagic telangiectasia. Georgia Neurosurgical Society Meeting. Greensboro, Ga., December 2013 Yowtak J, Woodall MN, Heger I, Gossage JR, Alleyne CH Cerebral vascular malformations in pediatric hereditary hemorrhagic telangiectasia. AANS/CNS Section on Pediatric Neurosurgery Meeting. Toronto, December 2013
Woodall MN Neurosurgery as a career. MCG at Georgia Regents University
Volume 11 | Issue 1 gru.edu/neuro
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March 20
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Neuro Critical Care
Feb. 20
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Meeting Schedule AANS/CNS Section on Cerebrovascular Surgery Feb. 10–11, San Diego, Calif.
American Association of Neurological Surgeons April 5–9, San Francisco, Calif.
International Stroke Conference Feb. 12–14, San Diego, Calif.
Comprehensive Stroke Management Update 2013 April 10–12, Hilton Head, S.C.
Southern Neurosurgical Society Feb. 19–22, San Juan, Puerto Rico AANS/CNS Section on Disorders of the Spine & Peripheral Nerves March 5–8, Orlando, Fla.
American Academy of Neurology April 26–May 3, Philadelphia, Pa.
As a regional referral center for the Southeastern U.S., the Georgia Regents Neuroscience Center of Excellence includes the area’s largest, most diverse team of adult and pediatric neurologists and neurosurgeons, including renowned experts in Parkinson’s disease, stroke, ALS, MS, functional and cerebrovascular neurosurgery, and complex spine surgery. To make an online referral, visit gru.edu/referral.