Neuroscience outlook vol 13 iss 3

A Triannual Publication of Augusta University

NEUROSCIENCE OUTLOOK News and Research from the Departments of Neurology and Neurosurgery

VOL. 13 | ISSUE 3

VOL. 13 | ISSUE 3 NEUROSCIENCE OUTLOOK

FROM THE CHAIRMEN

DEAR READERS, We present you with noteworthy news from our respective departments. We strive to maintain excellence in all our clinical and research endeavors. Our Comprehensive Stroke Center continues to expand with the addition of more hospitals to our REACH telemedicine network and the recent recruitment of an additional neurointerventionalist and a new stroke coordinator. Another of our programs, the Movement Disorders program, recently won an award at the International Parkinson’s Disease and Movement Disorders conference. We feature this program in our clinical spotlight section. Also in the clinical spotlight,

From left:

we present a complex aneurysm treated with the aid of

Cargill H. Alleyne Jr., MD Professor and Marshall Allen Distinguished Chair of Neurosurgery

the advanced technology of 3D printing. Our newsletter continues to garner accolades, winning another award (“news from our departments”) and our faculty also continues to do the same (“faculty and staff update”). We

David C. Hess, MD Professor and Presidential Distinguished Chair of Neurology

celebrate the graduation of our respective residents and fellows and hail our new residents. Finally, we are grateful to our many donors who continue to support our mission.

Cargill H. Alleyne Jr., MD Professor and Marshall Allen Distinguished Chair of Neurosurgery David Hess, MD Professor and Presidential Distinguished Chair of Neurology

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IN THIS ISSUE DEPARTMENT NEWS__________________________ 4

VOL. 13 | ISSUE 3

SCHEDULES AND UPCOMING MEETINGS_______ 5 FACULTY & STAFF UPDATE_____________________ 6

Neuroscience Outlook is produced triannually by the Medical College of Georgia Departments

CLINICAL SPOTLIGHT: PARKINSON’S DISEASE_________________________ 8

of Neurology and Neurosurgery and the Augusta University Division of Communications and Marketing.

CLINICAL SPOTLIGHT: 3D PRINTING IN NEUROSURGERY ______________ 12

Please direct comments or questions to marketing@augusta.edu.

PUBLICATIONS & PRESENTATIONS_____________ 14

Editor-in-Chief: Cargill H. Alleyne Jr., MD

THE CLINICAL TEAM__________________________ 15

Assistant Editor: Julie Kurek, MD Medical Illustrations: Colby Polonsky, MS Design and Layout: Sergio Gallardo Contributors: Julie Kurek, MD; John Morgan, MD, PhD; Kapil Sethi, MD; Cole Giller, MD, PhD, MBA; Cargill H. Alleyne Jr., MD; Ian Heger, MD; Scott Rahimi, MD

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NEWS from the DEPARTMENTS (May-August 2016) Neuroscience Outlook wins another award Our very own newsletter, Neuroscience Outlook, won a Silver Target Award for Physician Relations from the Georgia Society for Healthcare Marketing and Public Relations, an affiliated society of the Georgia Hospital Association. The publication also won a Gold Award in the Internal category at the 33rd Annual Healthcare Advertising Awards earlier this year.

Movement Disorders Program wins award The Movement Disorders program at Augusta University won a gold medal at the 20th International Congress of Parkinson’s Disease & Movement Disorders in Berlin in June. Dr. Julie Kurek presented a case (prepared by Jennie Davis) of a patient with Jacob syndrome (XYY karyotype) with a movement disorder. The case was selected from 57 exotic cases submitted by the leading Movement Disorder centers around the world (including from Russia, Japan, U.K., Canada, India, Ireland and multiple U.S. sites.

3D printing meets Neurosurgery The technology of 3D printing has infiltrated the practice of medicine within the last several years. We present a complex aneurysm which was replicated on a 3D printer greatly facilitating its clip ligation (see clinical spotlight).

More Georgia hospitals join REACH telestroke network Trinity Hospital in Augusta, Georgia, and Sacred Heart Hospital in Royston, Georgia, joined the REACH telestroke network in August.

This brings the total number of hospitals in the network to 29.

Neurology department holds annual conference The Neurology Department held its 31st Annual Neurology for the Non-Neurologist Conference from July 14-16 at Kiawah Island, South Carolina. The course was directed by Drs. Ned Pruitt and Debra Tanece Moore-Hill.

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NEUROSURGERY CONFERENCE SCHEDULE September-December 2016 Sep 2 11 a.m. Oral Board Review 12 p.m Case Conference Sep 9 10 a.m. Anatomy 11 a.m. Business- Dr. Giller 12 p.m. Case Conference Sep 16 10 a.m. Radiology 11 a.m. Journal Club 12 p.m. Case Conference Sep 23 9 a.m.

10 a.m.

11 a.m.

12 p.m.

Pathology- Dr. Sharma Resident Meeting Neuro 101- Dr. Rahimi M&M

Oct 14 10 a.m. Radiology 11 a.m. Functional - Dr. Giller 12 p.m. Case Conference

Nov 24 Holiday

Oct 21 11 a.m. Neuro 101 - J. Kilianski 12 p.m. Case Conference

Dec 9 10 a.m. Neuro 101 - C Banerjee 11 a.m. Functional Giller 12 p.m. Case Conference

Oct 28 9 a.m.

10 a.m.

11 a.m.

12 p.m.

Pathology - Dr. Sharma Resident Meeting Journal Club M&M

Nov 4 10 a.m. Oral Board Review 11 a.m. Neuro 101 - Nathan Todnem 12 p.m. Case Conference

Sep 30 NO CONFERENCE

Nov 11 Resident Interviews

Oct 7 10 a.m. Anatomy 11 a.m. Oral board review 12 p.m. Case Conference

Nov 18 9 a.m.

10 a.m.

11 a.m.

12 p.m.

Dec 2

Dec 16 9 a.m.

10 a.m.

11 a.m.

12 p.m.

Resident Interviews

Pathology - Dr. Sharma Resident Meeting Journal Club M&M

Dec 23 NO CONFERENCE Dec 30 NO CONFERENCE

Pathology - Dr. Sharma Resident Meeting Journal Club M&M

NEUROLOGY GRAND ROUNDS SCHEDULE (September-December 2016)

Sep 1 Sep 8 Sep 15 Sep 22 Sep 29 Oct 6 Oct 13 Oct 20 Oct 27 Nov 3 Nov 10 Nov 17 Nov 24 Dec 1 Dec 8 Dec 15 Dec 22 Dec 29

Dr. Anthony Murro: Epilepsy Dr. Michael Rivner: ALS Dr. Tom Swift: Case Presentation Dr. Nancy McNair Dr. Fenwick Nichols: Stroke Dr. Alfredo Garcia: Neuro ICU Dr. Askiel Bruno: Stroke Dr. Ed Hartmann: Neuromuscular Dr. Tom Swift: Case Presentation Dr. Elizabeth Sekul: Child Neurology Dr. Julie Kurek: Movement Disorders Dr. Suzanne Smith: MS No Grand Rounds: Holiday Dr. Sam Tsappidi: Neuro ICU Dr. David Hess: Stroke Dr. Tom Swift: Case Presentation No Grand Rounds : Holiday No Grand Rounds : Holiday

UPCOMING MEETINGS (September-December 2016) Sept 24-28:

Congress of Neurological Surgeons San Diego, CA

Oct 16-18:

American Neurological Association Baltimore, MD

Oct 26-29:

North American Spine Society Boston, MA

Oct 14-16:

American Academy of Neurology Fall Session Las Vegas, NV

Oct 29-Nov 5: Research Update in Neuroscience for Neuro

surgeons, Woods Hole, MA Nov 7-9:

American Board of Neurological Surgery (Orals) Houston, TX

Dec 2-4:

Georgia Neurosurgical Society Greensboro, GA

Dec 5-8:

AANS/CNS Section on Pediatric Neurological Surgery, Orlando, FL

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FACULTY & STAFF UPDATE Cargill H. Alleyne Jr., MD (Department of Neurosurgery) was elected as a member of the Nominating Advisory Committee of the Society of Neurological Surgeons in June 2016. He also was invited to be an American Board of Neurological Surgeons Scholar, one of a group of individuals who will participate in a series of ABNS Oral Board Examinations over several years. In addition, he was granted a patent (US 9,371,263 B2) with Krishnan Dhandapani, PhD, Wen K, Ma M, Hu W, and Augusta University: Protective effects of curcumin against hemorrhagic stroke injury, US 9,371,263 B2, issued 6/21/16.

Krishnan Dhandapani, PhD (Department of Neurosurgery) served on the NIH, NINDS ZNS1 SRB-L (07) Center Without Walls for Collaborative Research in the Epilepsies Special Emphasis panel as an ad hoc grant reviewer. He also chaired the Neurobiology C study section for the VA. In addition, he was granted a patent (US 9,371,263 B2) with Cargill Alleyne Jr., MD, Wen K, Ma M, Hu W, and Augusta University: Protective effects of curcumin against hemorrhagic stroke injury, US 9,371,263 B2, issued 6/21/16.

David C. Hess, MD (Department of Neurology) delivered the 2016 Roxanna Todd Hodges Endowed Lectureship and Visiting Professorship at the Department of Neurology, Keck School of Medicine, University of Southern California, in August 2016. He also continues as chairman of the board of directors of REACH Health Inc., which announced the release of REACH 5.0 reachhealth.com. In addition, he was appointed to the American Heart Association Writing Group on Indications for the Performance of Intracranial Endovascular Neurointerventional Procedures and the American Heart Association Telemedicine Committee.

Sergei A. Kirov, PhD (Department of Neurosurgery) participated in NIH ZRG1 F03A (20), Fellowships: Neurodevelopment, Synaptic Plasticity, Neurodegeneration Study Section in June 2016.

Debra Moore-Hill, MD (Department of Neurology) assumed the directorship of the Neurology Residency Program in July 2016. Dr. Moore-Hill is a graduate of the Medical College of Georgia, the Neurology Residency Program and the Clinical Neurophysiology Fellowship at MCG/Augusta University and is board-certified in neurology and clinical neurophysiology (ABRN).

Yong Park, MD (Department of Neurology) served as chair of the Korean Epilepsy Preceptorship Program.

WELCOME NEW FACULTY AND STAFF

Sam Tsapiddi, MD, joined the Department of Neurology in August 2016. He completed his neurology residency, vascular neurology fellowship and neurocritical care fellowship at Emory University and then completed a three-year program in interventional neuroradiology under Dr. Jacques Dion at Emory University. Tsapiddi is board-certified in neurology (American Board of Psychiatry and Neurology, and Vascular Neurology) and in neurocritical care (United Council for Neurologic Specialties). Tsapiddi will complement the Stroke Interventional Program, joining Drs. Scott Rahimi and Cargill Alleyne in Neurosurgery, and work in the Neurointensive Care Unit and Vascular Neurology Program.

Shelley Nichols, MSN, RN-BC, SCRN, joined the Comprehensive Stroke Center as the stroke program manager in August 2016. Nichols is the chair of the GA-SPA Georgia Stroke Professional Alliance

Leslie Rudzinski, MD, is a board-certified neurologist (ABPN) and clinical neurophysiologist (ABPN) and a fellowship-trained epileptologist (Mayo Clinic, Rochester). She will join the Department of Neurology part time in July 2017.

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RESIDENT AND FELLOW UPDATES WELCOME NEUROSURGERY RESIDENTS This July, we welcomed our new PGY-1 neurosurgery resident Tyler Sparks, MD. Sparks completed his medical training at Charles E. Schmidt College of Medicine at Florida Atlantic University.

NEUROLOGY RESIDENTS NEW PGY-1 NEUROLOGY RESIDENTS ARE:

Laveena Singla, MD, Government Medical College, Patiala, India

Rafael Perez-Rodriguez, MD, UNIBE School of Medicine, Santo Domingo

Kenny Susanto, MD, Universitas Airlangga Fakultas Kedokteran

Amjad Abdallah, MD, Damascus University, Faculty of Medicine

Nicholas Yelverton, DO, Lake Erie College of Osteopathic Medicine

Chi (David) Dai, MD, (Child Neurology) Medical College of Georgia at Augusta University

FAREWELL NEUROSURGERY Michael Neil Woodall, MD, completed his seven-year neurosurgical residency in June. Dr. Woodall has started a cerebrovascular and skull base fellowship at the prestigious Barrow Neurological Institute in Phoenix, Arizona, under Dr. Robert Spetzler. Dr. Alleyne also completed his fellowship there in 1999-2000. Woodall will be Spetzler’s last fellow before his retirement next year.

NEUROLOGY RESIDENTS RESIDENTS COMPLETING THE NEUROLOGY PROGRAM IN JUNE WERE:

Andrew Erian, MD (Private Practice in New Jersey)

Shaun Shaker, MD (Private Practice in Aiken, South Carolina)

James Shou, MD (Movement Disorder Fellowship in Nebraska)

Puneet Dabas, MD (Clinical Neurophysiology Fellowship in Charleston, South Carolina)

Nitzmari Melendez-Vazquez, MD Child Neurology (Private Practice in Orlando, Florida)

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CLINICAL SPOTLIGHT

PARKINSONÔS DISEASE

Cole Giller, MD, PhD, MBA, Julie Kurek, MD, John Morgan, MD, PhD, Kapil Sethi, MD The faces of Parkinson’s disease are many — Pope John Paul II, Adolf Hitler, Muhammad Ali and the notable and beloved Michael J. Fox. It doesn’t discriminate, and its manifestations are myriad.

Parkinson’s disease (PD) affects roughly 1.5 million Americans, which is more than the combined number of people diagnosed with multiple sclerosis, muscular dystrophy and ALS. About 60,000 Americans are diagnosed annually. This number, of course, does not capture the cases that remain undiagnosed. PD is a progressive neurological disorder that affects not only a patient’s movements, but various other facets of functioning. It is not curable, but it is very treatable and manageable with rehabilitative exercise, medication, surgical interventions and with more therapies on the horizon.

Levodopa revolutionized the Parkinson’s scene when it was introduced in the 1960s. Captured in movies like Awakenings, hope emerged as good treatment appeared for a condition that would otherwise slowly plod along toward degeneration and disability. Since that time, over 50 years ago, levodopa remains the gold standard therapy, but new treatments are coming out with more in the pipeline. These new treatments harness new delivery techniques and technologies. Imagine going from taking a pill every day three times a day to getting a tiny subcutaneous injection once a week. It’s revolutionizing not being tied down to pills, schedules and timers.

RESEARCH More research is needed to help bring new therapies to fruition and increase hope to millions of sufferers.

We have much to learn regarding the pathogenesis of this disorder and, subsequently, how to either stop or slow its progression. The Parkinson’s field has long been dominated by the dopamine-centric hypothesis, and one of the big unmet needs in this disorder is a way to treat both the nonmotor symptoms and the symptoms of PD that do not respond to current medications, such as freezing of gait and balance. Nonmotor symptoms of PD include depression, anxiety, anosmia, constipation, REM sleep disorders, insomnia and blood pressure drops. Though many new drugs (such as Northera for orthostatic hypotension) continue to be developed, many needs remain unmet.

As required by the FDA, all current PD medications successfully passed through clinical trials, the majority of which our National Parkinson’s Foundation Center of Excellence has participated in.

When Dr. Kapil Sethi started working at MCG in 1985, a movement disorders center did not exist in the state of Georgia. His vision and passion for movement disorders led to the creation of an impressive clinical and research team that came to earn the status of the first National Parkinson’s Foundation Center of Excellence in Georgia or South Carolina, a designation that continues under the leadership of Dr. John Morgan. Obtaining this title was no easy feat. The Augusta University Movement Disorders Center is one of only 41 Centers of Excellence world-wide and, for some time, was the only center to hold this title in the state of Georgia. To achieve this title, a center must provide outstanding interdisciplinary care, research, and outreach and advance a comprehensive approach to the care of this disease. In addition, it must “provide patients access to experimental therapies through participation in clinical trials.”

Patients often have mixed reactions when asked about participation in trials. Some fear being a “guinea pig,” while others jump at the opportunity to have access to the newest therapies and potentially have an edge in the fight against PD. Many of our patients regularly travel two to four hours to our center simply for this advantage.

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PATIENT EXPERIENCE One such person is “Rose” Vaughn. She asked to go by this pseudonym as she has not revealed her Parkinson’s diagnosis to those around her, even some members of her own family. With minimal medication, at 62 years old, she functions well, working at her third career after two early retirements. She is on minimal medication, but one of them is a medication she is taking as part of a clinical trial.

“I feel great,” she says.

speech therapists are all trained in LSVT; i.e., the Lee Silverman methodologies aimed specifically at the needs of those with Parkinson’s. Too often patients go through physical therapy finding that it doesn’t help them. It’s important to recognize that many, if not most, therapists are trained to deal with disabilities such as poststroke weakness, whereas the needs of the PD population is much different. Our therapists focus on gait and balance issues, tricks to overcome freezing and avoiding falls, etc.

At our IDC clinics, patients are seen by Dr. Julie Kurek, one of the neurologists on the movement team, as well as a social worker, a physical therapist, an occupational therapist, and a speech and swallow therapist, all in one spot at one visit.

Rose lives in Aiken and has participated in numerous clinical trials here at MCG. When asked why she participated in so many studies, she simply answered, “Because I could.” She added, “I have this disease, and it’s very important to be involved as whatever is learned through this research could help someone in the future, if not me.” She was most recently involved in an exciting trial conducted by Drs. Raymond Chong, Chandramohan Wakade and John Morgan looking at the effect of extended release niacin, which is a B vitamin. She excitedly told me that this was one of the more rewarding studies she’s been in as the information from her and other participants provided compelling data that justified more funding money and an extension of the study. “It’s pretty exciting to know that [my participation] made a difference.” She feels a difference, and no matter what the outcome is of further study, she plans to continue the vitamin. “I have always gotten great care [at Augusta University] independent of the trials but, through them, have developed a deep connection to the team over there.”

As we are an academic center, our therapists such as occupational therapist Stephanie Johnson run studies on how to improve function in PD. Currently, she is examining the effects of Rock Steady Boxing, a therapy whereby PwPs (persons with Parkinson’s) punch, saunter and move their way in a boxing-like style. Many have enrolled, and all those who have finished have elected to continue of their own accord at a center in Evans, Georgia.

Indeed, we are lucky to have an accomplished outreach coordinator, Kathy Tuckey, who bridges the gap between our service and the community, and an experienced and caring social worker, Lilian Branch, who helps our patients successfully navigate through various insurance barriers to ensure patients receive the best possible care.

As implied earlier, we also have a dedicated team of research professionals including Buff Farrow, our research project manager, and research coordinators Paula Jackson and Dedi McLane. We have a physician assistant, three physicians, nurses and a fellow in training who also serves as part of the team.

CONNECTION Connection is definitely an important element in thriving in PD. Rose doesn’t attend PD support groups as her symptoms are manageable and she would rather “focus on other things like golf.” For many, support is important, and here in Augusta, we have the CSRA Parkinson’s Support Group, which meets downtown once a month.

A vocal member and vice president of the group is Joe Kelley who has partnered with Dr. Michael Diamond, vice president for research at Augusta University, to bring in more research projects focused on Parkinson’s while simultaneously advocating for patients in the research process. He acts as a liaison between our research group and the PD support group taking part in a Parkinson's Disease Foundation (PDF) initiative called PD PAIR (Parkinson's Advocates in Research). In addition, he listens and responds to group’s needs, as he did when assisting in the launch of a monthly support group created just for women to discuss their particular needs in a safe space.

As we are an academic center, our therapists such as Stephanie Johnson, occupational therapist, run studies on how to improve function in PD. Currently, she is examining the effects of Rock Steady Boxing, a therapy whereby PwPs punch, saunter and move their way in a boxing-like style. Many have enrolled, and all those who have finished have elected to continue of their own accord at a center in Evans, Georgia.

Indeed, we are lucky to have an accomplished outreach coordinator, Kathy Tuckey, and an experienced and caring social worker, Lilian Branch. We also have a dedicated team of research professionals including Buff Farrow, our research project manager, and research coordinators Paula Jackson and Dedi McLane. We have a physician assistant, three physicians, nurses and a fellow in training who also serves as part of the team.

OUR RESOURCES We are fortunate to have an Interdisciplinary Care (IDC) Team here at Augusta University with fantastic facilities at Wheeler Road where our physical, occupational and

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(Continued from page 9.)

TREATMENTS As mentioned earlier, we employ newer medications such as Duopa, which is levodopa-carbidopa (the “gold standard”), delivered continuously in gel form into the patient’s stomach by a pump worn outside the body, thus avoiding multiple daily dosing. We are also studying apomorphine as a subcutaneous infusion for constant delivery and, hopefully, smoother symptoms management.

Another remarkable treatment is deep brain stimulation (DBS), a surgical therapy that has been approved for Parkinson’s disease since 2002 through Medtronic. DBS is a technology that has been used safely since 1998 (over 20 years) and, for the right patient, can be revolutionary. In fact, at the end of September this year, St. Jude got a new DBS device approved that is not only wireless for patient comfort, but allows for current steering and conceivably better targeting of symptoms with fewer side effects. We work closely with neurosurgeon Dr. Cole Giller and his physician assistant Patrick Jenkins to identify good candidates. Once a candidate has been identified, we select the appropriate brain target for maximal benefit (please read inset about one such patient).

We have monthly DBS meetings to discuss candidates, follow up on the progress of past patients, and address any social, cognitive or psychiatric needs the candidates may have either before or after the surgery, thus taking a comprehensive approach.

On the horizon, is a new therapy called Exablate Neuro, which is the first focused ultrasound device approved by the FDA to treat patients with tremor. It is a noninvasive, image-guided thalamotomy, created through an intact skull that doesn't require any ionizing radiation, incisions or implants. This could conceivably be an option for those who don’t qualify as surgical candidates or are simply too scared to undergo DBS. Though it has more limitations, it is one more option in our armamentarium of weapons to fight the symptoms of PD. MEMORY & MOVEMENT Dr. Morgan spans both movement and memory disorders, and it is no surprise that at times the two overlap.

Our clinical trials extend not only to Parkinson’s, but psychosis, memory disturbances and so forth. In May of this year, the first medication to address PD psychosis, Nuplazid, hit the market. Prior drugs were troublesome as they blocked dopamine, the very chemical missing in Parkinson’s; this new drug, however, targets a different neurotransmitter. This is important as it prevents any worsening of physical symptoms that emerge secondary to a lack of dopamine.

The nice thing about working at a Center of Excellence is that we have at our disposal virtually all current therapies and those that are still in trials. Nearly any medication that exists or is in trials can be obtained here. In addition to the medication, we also offer services such as botulinum toxin injections for abnormal posture and cramping that can often accompany PD and extend this therapy to those suffering from dystonia and spasticity as well.

Many projects and studies are currently in the pipeline here at Augusta University: imaging studies with radioactive tracers, repurposing of medications used for gout and diabetes, new surgical technologies and new targets beyond the usual dopamine cells. Research has shown that the better we manage Parkinson’s today, the better life will be tomorrow. It’s an exciting time in Parkinson’s and an exciting time in PD research here at Augusta University.

To become a patient in our clinic, call us at 706-721-2798.

If you are interested in participating in a clinical trial or would like more information about them, contact Buff Farrow at 706-721-0619 or bfarrow@augusta,edu.

If you are interested in having us speak at your civic group or church, please let us know: ktuckey@augusta.edu.

If you would like to donate to our NPD Center, please contact Kathy Tuckey at ktuckey@augusta.edu.

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CASE REPORT A 29-year-old female presented with a three-year history of Parkinson’s disease beginning with a right-sided tremor, bradykinesia of her right leg and small handwriting. She later developed significant motor fluctuations requiring medication every one to two hours and severe bradykinesia interfering with activities of daily living. She improved with levodopa, but even small doses produced severe dyskinesias affecting her entire body, limiting the dose of medication that could be tolerated. Most of her day was spent with severe dyskinesias or profound rigidity and bradykinesia.

She underwent bilateral placement of globus pallidus internus (GPi) deep brain stimulators (DBS). Pallidal targets were chosen because stimulation of the subthalamic nucleus is known to aggravate preexisting dyskinesias.

When the DBS was activated, her bradykinesia and rigidity improved by 90 percent. Her gait improved with normal turns and arm swings. There was no tremor, and her bradykinesia and dyskinesias resolved.

Figure 1

Figure 2

Axial MRI of patient at level of anterior commissure.

Same slice as Figure 1 showing merged preoperative MRI with postoperative CT. Displayed are the left and right globus pallidus (red + green), GPi (red) and DBS electrode (yellow). Efficacy is greatest when the electrodes are placed in the posteroventral part of the GPi as shown.

Figure 3 Same slice as Figure 1 showing merged preoperative MRI with postoperative CT. Displayed are the left and right globus pallidus (red + green), GPi (red) and DBS electrode (yellow). Efficacy is greatest when the electrodes are placed in the posteroventral part of the GPi as shown.

Figure 4 Close-up view of Figure 3.

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CLINICAL SPOTLIGHT

3D PRINTING IN NEUROSURGERY Case Report:

Cargill H. Alleyne Jr., MD, Ian Heger, MD, Scott Y. Rahimi, MD

Recent advances in 3D printing have led to an increased utilization of this technology in Neurological Surgery (1, 2). Specifically, the ability to quickly and inexpensively print patient-specific lesions has the potential to enhance the preoperative planning process, the patient education process and the educational experience for our trainees (figure 1). We report a 54-year-old man who presented with a subarachnoid hemorrhage from a ruptured 1.8 mm left A1 aneurysm. He was also found to have an unruptured 1.6 mm left pericallosal aneurysm, a 6 mm, broad-necked unruptured left middle cerebral artery aneurysm (figure 2), and an unruptured 3.2 mm left ophthalmic segment aneurysm. The A1 and pericallosal artery aneurysms were coiled.

Following recovery from his SAH and four months after coil embolization, the left MCA aneurysm was clipped. As part of the preoperative planning, a 3D model of his MCA aneurysm was printed (figure 3).

This model was very helpful in devising intraoperative clipping strategies. The aneurysm was clipped and the MCA bifurcation reconstructed using four clips and without the use of any fixed brain retraction (figure 4). Intraoperative and postoperative angiography showed complete obliteration of the aneurysm with preservation of the M2 branches (figure 5).

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FIGURE 2a

FIGURE 2b

FIGURE 1 Figure legends

Figure1: 3D printer used to create the model

Figure 2a and b: 2D and 3D angiogram obtained at time of presentation Figure 3a and 3b: 3D model of left MCA aneurysm

Figure 4: Intraoperative image showing exposure of the aneurysm

Figure 5: Postoperative angiogram showing complete obliteration of aneurysm

FIGURE 5

FIGURE 4

FIGURE 3a

FIGURE 3b

1. Ryan JR, Almefty KK, Nakaji P, Frakes DH: Cerebral aneurysm clipping surgery simulation using patient-specific 3D printing and silicone casting. World Neurosurg. 2016 Apr;88:175-81. doi: 10.1016/j.wneu.2015.12.102. Epub 2016 Jan 22.

2. Klein GT, Lu Y, Wang MY: 3D printing and neurosurgery—ready for prime time? World Neurosurg. 2013 SepOct;80(3-4):233-5. doi: 10.1016/j.wneu.2013.07.009. Epub 2013 Jul 16.

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PRESENTATIONS: PUBLICATIONS & PRESENTATIONS (MAY-AUGUST 2016) Gupta R, Vender J, Dhandapani K, Alleyne C: SUMOylation inhibitor ginkgolic acid decreases Murro A: Differential diagnosis of episodic loss of consciousness. 31st Annual T98G cell survival and overcomes temozolomide chemoresistance in vitro.

Neurology for the Non-Neurologist Conference, Kiawah Island, SC, July 2016.

American Association of Neurological Surgeons Meeting, Chicago, IL, May 2016.

Pruitt JN: When do I think about multiple sclerosis? 31st Annual Neurology for the Non-Neurologist Conference, Kiawah Island, SC, July 2016.

Marchan, EM, Cantrell R, Mourad WF, Figueroa R, Vender JR, Alleyne Jr CH: Long-term outcomes after Gamma Knife stereotactic radiosurgery for Pruitt JN: Headache – Diagnosis and management. 31st Annual Neurology for cerebral arteriovenous malformations in patients with hereditary hemorrhagic the Non-Neurologist Conference, Kiawah Island, SC, July 2016. telangiectasia. International Leksell Gamma Knife Society Meeting, May 2016.

Pruitt JN: Multiple sclerosis – Workup and the state of management. 31st Alleyne CH: Treatment of vascular malformations. Complication management Annual Neurology for the Non-Neurologist Conference, Kiawah Island, SC, July and avoidance in vascular neurosurgery. American Association of Neurological 2016.

Surgeons Meeting, Chicago, IL, May 2016.

Sekul E: Common neurological problems in children. 31st Annual Neurology Nguyen KD, Woodall MN, Macomson SD: Avoiding shunt dependence in for the Non-Neurologist Conference, Kiawah Island, SC, July 2016. external ventricular drain management. American Association of Neurological Surgeons Meeting, Chicago, IL, May 2016.

Sekul E: Attention deficit and hyperactivity disorder. 31st Annual Neurology for the Non-Neurologist Conference, Kiawah Island, SC, July 2016.

Choudhri HF: Should Neurosurgeons Perform Scoliosis Surgery? Georgia Neurosurgical Society Meeting, Sea Island, GA, May 2016.

Sethi KD: Neurobowl quiz show for the non-neurologist. 31st Annual Neurology for the Non-Neurologist Conference, Kiawah Island, SC, July 2016.

Marchan EM, Rahimi SY, Vender J, Alleyne CH: Long-term outcomes after stereotactic radiosurgery for cerebral arteriovenous malformations in patients Sethi KD, Murro A: Psychogenic problems in neurology. 31st Annual with hereditary hemorrhagic telangiectasia. Georgia Neurosurgical Society Neurology for the Non-Neurologist Conference, Kiawah Island, SC, July 2016.

Meeting, Sea Island, GA, May 2016.

Switzer JA: Diagnosis and management of acute stroke 2016 – the first 3 hours Rahimi SY, Alleyne CH: Management strategies for stroke intervention.

– the first 3 days. 31st Annual Neurology for the Non-Neurologist Conference, Georgia Neurosurgical Society Meeting, Sea Island, GA, May 2016.

Kiawah Island, SC, July 2016.

Todnem N, Tuttle J, Heger I: Occipito-cervical fixation using the occipital condyles in a 10-year-old patient after Chiari decompression. Georgia Neurosurgical Society Meeting, Sea Island, GA, May 2016.

Switzer JA: Secondary stroke prevention. 31st Annual Neurology for the NonNeurologist Conference, Kiawah Island, SC, July 2016.

Heger I: Complex Chiari malformations and connective tissue disorders.

Mercer University Department of Pediatrics, Macon, GA, August 2016.

Viers A, Heger I: Morphological analysis of the occipital condyle for instrumentation in infants and children. Georgia Neurosurgical Society Meeting, Sea Island, GA, May 2016.

Woodall MN, Alleyne CH: Microvascular decompression of the optic nerve.

Georgia Neurosurgical Society Meeting, Sea Island, GA, May 2016.

Woodall MN, Nguyen KD, Macomson SD: A catheter over wire technique for laparoscopic-assisted peritoneal shunt insertion. American Association of Neurological Surgeons Meeting, Chicago, IL, May 2016.

Alleyne CH: Compensation plan at Augusta University. Practice compensation models panel. Society of Neurological Surgeons Meeting, Indianapolis, IN, June 2016.

Hess DC: Lectured in Internal Medicine Update, Kiawah Island, SC, Augusta University Continuing Education, June 2016.

Park Y: Update in new epilepsy managements. 21st Korean Epilepsy Congress Annual Meeting, Seoul, Korea, June 2016.

Park Y: New Biomarkers in Diagnosis of Epilepsy. 21st Korean Epilepsy Congress Annual Meeting, Seoul, Korea, June 2016.

Alleyne CH: A career in neurosurgery. Kids Mini-Med, Augusta University, July 2016.

Heger I: Complex Chiari malformations and connective tissue disorders.

Augusta University Department of Pediatrics, July 2016.

Hess DC: Critical Care Medicine, Kiawah Island, Augusta University Continuing Education, July 2016.

Hess DC: New therapies in acute stroke management. 31st Annual Neurology for the Non-Neurologist Conference, Kiawah Island, SC, July 2016.

Kurek J: Tremors – differential diagnosis and management. 31st Annual Neurology for the Non-Neurologist Conference, Kiawah Island, SC, July 2016.

Kurek J: Concussion assessment and management – children, teens and adults. 31st Annual Neurology for the Non-Neurologist Conference, Kiawah Island, SC, July 2016.

Members of the Augusta University Neurology and Neurosurgery departments are shown in bold

Kirov SA: Spreading depolarization and hypo-osmotic challenge trigger distinct mechanisms of cellular swelling and water transport in the brain. 11th International Congress on Cell Volume Regulation and Fluid Homeostasis: Implication for Hydration and Nutrition in Health and Disease, Chicago IL, August 2016.

Kirov SA: Spreading depolarization and hypo-osmotic challenge trigger distinct mechanisms of cellular swelling in the brain. 11th International Congress on Cell Volume Regulation, Chicago, IL, August 2016.

PUBLICATIONS: Woodall MN, Alleyne CH: Comment on Lower risk of intracranial arteriovenous malformation hemorrhage in patients with hereditary hemorrhagic telangiectasia. Neurosurgery 78:693, 2016.

Bonsack F 4th, Alleyne CH Jr, Sukumari-Ramesh S: Augmented expression of TSPO after intracerebral hemorrhage: a role in inflammation? J Neuroinflammation 13(1):151, 2016, Jun 17 [doi: 10.1186/s12974-016-0619-2].

Hartings JA, Shuttleworth CW, Kirov SA, et al: The continuum of spreading mass depolarizations in acute cortical lesion development: redefining Leão’s legacy. J. Cereb Blood Flow Metab [Epub ahead of print; Jun 21], 2016.

Dreier JP, and COSBID study group (Kirov S): Recommendations of the COSBID study group on recording and analysis of spreading depolarizations in neurointensive care. J Cereb Blood Flow Metab [Epub ahead of print; Jun 17], 2016.

Ezepue C, Hess DC: Remote Ischemic Conditioning: A Highly Translatable Therapy for Acute Stroke in Paul Lapchak and John H. Zhang (Eds): Neuroprotective Therapy for Stroke and Ischemic Disease, Springer, 2016.

Lees KR, Khatri P2 STAIR IX Collaborators (Hess DC): Stroke treatment academic industry roundtable recommendations for individual data pooling analyses in Stroke. Stroke Aug;47(8):2154-9, 2016.

Penwell-Waines L, Lewis K, Valvano A, Smith S, Rahn R, Stepleman L: Testing the health promotion model for adherence and quality of life in individuals with multiple sclerosis, Psychology, Health & Medicine, [DOI:10.1080/13548506.20 16.1226506, 2016].

Levine SR, Switzer JA: Acute stroke in the field: iTREAT, you treat, we all one day will treat … better. Neurology 87(1):13-4. Epub 2016 Jun 8, 2016.

14

THE CLINICAL TEAM ALS CLINIC Michael H. Rivner, MD

MEMORY DISORDERS John C. Morgan, MD, PhD

NEUROLOGISTS Askiel Bruno, MD James Carroll, MD K. Alfredo Garcia, MD J. Edward Hartmann, MD David C. Hess, MD Julie A. Kurek, MD Gregory Lee, PhD Debra Moore-Hill, MD John C. Morgan, MD, PhD Anthony M. Murro, MD Fenwick T. Nichols III, MD Yong Park, MD J. Ned Pruitt II, MD Michael H. Rivner, MD Elizabeth Sekul, MD Kapil D. Sethi, MD Suzanne H. Smith, MD Thomas Swift, MD Jeffrey A. Switzer, DO Sam Tsapiddi, MD

MOVEMENT DISORDERS Cole A. Giller, MD, PhD Julie A. Kurek, MD John C. Morgan, MD, PhD Kapil D. Sethi, MD

NEUROMUSCULAR DISEASES J. Edward Hartmann, MD J. Ned Pruitt II, MD Michael H. Rivner, MD

MULTIPLE SCLEROSIS CENTER Suzanne H. Smith, MD

NEUROSURGEONS Cargill H. Alleyne Jr., MD J. Dan Dillon, MD Cole A. Giller, MD, PhD Ian Heger, MD S. Dion Macomson, MD Scott Rahimi, MD John R. Vender, MD

EPILEPSY CENTER Cole A. Giller, MD, PhD Mary Gregory, MD, PhD Debra Moore-Hill, MD Anthony M. Murro, MD Yong Park, MD Gregory Lee, PhD GAMMA KNIFE CENTER Cargill H. Alleyne Jr., MD Cole A. Giller, MD, PhD John R. Vender, MD

PEDIATRIC NEUROSCIENCES James Carroll, MD Morris Cohen, EdD Mary Gregory, MD, PhD Ian Heger, MD Yong Park, MD Elizabeth Sekul, MD SKULL BASE TUMOR CENTER Cargill H. Alleyne Jr., MD John R. Vender, MD SLEEP MEDICINE Anthony M. Murro, MD Yong Park, MD SPINE CENTER Cargill H. Alleyne Jr., MD Ian Heger, MD S. Dion Macomson, MD Scott Rahimi, MD John R. Vender, MD STROKE AND CEREBROVASCULAR CENTER Cargill H. Alleyne Jr., MD Askiel Bruno, MD David C. Hess, MD Fenwick T. Nichols III, MD Scott Rahimi, MD Jeffrey A. Switzer, DO

NEURO CRITICAL CARE K. Alfredo Garcia, MD Sam Tsapiddi, MD

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