the montlake cut - uw department of neurological surgery

A View From Puget Sound

ThefieldofNeurologicalSurgeryremainsadynamicandevolvingefforttoimprovepatientoutcomesthroughinnovation,technologicalsophistication,basicresearch-andhardwork.Oursuperbanddedicatedyoungfacultyandresidentsareoftenattheforefrontoftheseefforts,andinthisissueofthenewsletterwepresentsomeoftheiraccom-plishments.

ThemoreestablishedfacultyremainjustashardatitasdemonstratedbyProfessorLaligamSekhar’seffortstorefinethetreatmentforunrupturedAVMs.EventhoughheisofficiallynowaProfessorEmeritus,JohnSilbercontinuestobeveryengagedinbothclinicalandbasicresearch,andBobRostomilyandhislabarestillgatheringnewgrantsaimedatbettertreatmentsfortheeverdifficulttomanageglioblastomas.

Wealsointroducesomeofourremarkablemid-levelpractitionerteam,withoutwhomtheacutecareserviceatHarborviewcouldnotfunction.Readerswillbebothsurprisedanddelightedbythedepthandbreadthofexperiencesthesepeoplebringtoourdepartment.

After24yearsandmanyresidentscomeandgone,SharonAndrewshasretiredfromtheUWMCofficeandwillbesorelymissed.SharonwasthegluethatheldtogethertheUWMCservice.Wewillalsomissawonderfullywarm,skilledneurologicalsurgeonwhograduatedourprogram,Dr.CharlieKuntz,aProfessorattheMayfieldClinicinCin-cinnatiwhodiedunexpectedly,andfartooyoung.Last,weheldourFirstAnnualConversationwiththeCommunity,andlookforwardtothisdynamicexchangeofideasinfutureyears.

Sincerely,RichardG.Ellenbogen,MD,FACSProfessor&Chairman,DepartmentofNeurologicalSurgery

The Montlake Cut

A Publication of the Department of Neurological Surgery UW Medicine Health Care

Richard G. EllenbogenM.D., F.A.C.S.

In Memorium: Dr. Charles KuntzNeurovascular Group Publishes New Study Dr. Andrew Ko - Deep Brain StimulationDr. Christoph Hofstetter/Dr. Christine Mac DonaldDr. John Silber Dr. Roberty Rostomily/Spotlight:Practitioner Team

In This Issue - Spring 2015

Practitioner Team ContinuedSharon Andrews Calls It A CareerAnnouncementsFirst Annual Community ConversationPuzzler

123456

7 8 91011

Oneofourbrightlightsandclosefriendshasdiedunexpectedly.OurformerresidentCharlieKuntzpassedawaysuddenlyonFebruary26,2015.Dr.KuntzwasbornandraisedinCincinnati.Hewasarisingsuperstarevenasahighschoolstudent.HegraduatedwithhonorsfromCincinnati’sXavierHighSchoolandwasachemistryscholarattheCollegeoftheHolyCrossinWorcester,Mass.graduatingMagnaCumLaudeandPhiBetaKappa.HereceivedhismedicaldegreefromCaseWesternReserveUniversitySchoolofMedicinein1991andwasinductedintoAlphaOmegaAlpha,thenationalmedicalhonorsociety.HewasaresidentattheUniversityofWashingtonandcompletedorthopedicandneurosurgicalfellowshipsinLondonandSeattle.Hisyearsofmedicaltrainingcomplete,hejoinedtheMayfieldClinic,theUCCollegeofMedicine,andtheNeurotraumaCenterattheUCNeuroscienceInstitutein2000.

Hewasaformidablespinesurgeontakingcareofthemostchallengingdeformitypatientswhotraveledlongdistancestoseekhisexpertise.Hewouldlabortirelesslyonpatientswiththegoalofchangingtheirlifetooneofpro-ductivityandlesspain.Hewasbelovedbyhisfriends,hismentorsandhispatients.HeroserapidlytoheightsoffullProfessorattheMayfieldClinicandwassoughtthroughouttheworldasaVisitingProfessor.Andhewasextremelyactiveonthenationalscene.AsPraveenMummaneni,MD,ChairoftheAANS/CNSJointSectiononDisordersoftheSpineandPeripheralNervesnotedinhistribute:

“CharliewastheChair-electoftheAmericanAssociationofNeurologicalSurgeons/CongressofNeurologicalSurgeonsJointSectiononDisordersoftheSpineandPeripheralNerves.Hispassingisagreatlossforthisnationalorganization.Heservedablyasanofficerofourboardformanyyears.”HismanyfriendsattheAANS/CNSSpineSectionhavecreatedanddonatedtotheCharlesKuntzFundoftheNeurosurgeryResearchandEducationFoundation(NREF)inhishonor.…CharliewillbehonoredwiththeKuntzMemorialSessionatourannualmeetinggoingforward.

AsenseofDr.Kuntz’characterandimpactcanbefoundinthedozensofmovingcommentsfromhiscolleaguesandpatientscollectedontheMayfieldClinic’sveryfinememorialpage“RememberingDr.CharlesKuntz:ReflectionsfromPatientsandColleagues”-Readthetributeshere:http://www.mayfieldclinicblog.com/remembering-dr-charles-kuntz-reflections-from-patients-and-colleagues/

WewillmissCharlie.Asourcolleague,GavinBritz,MD,Chair,HoustonMethodistHospitalremindedus,hewasatalented,warm,compassionateandkindhumanbeing.Hisfamily,friendsandpatientswillmisshim.Hewillalwaysberememberedforthegoodnesshebroughttoourlives.HisfellowUniversityofWashingtonResidentAnthonyAvellinospeaksforallofuswhenhewrites:

“Charliewasaremarkableandcompassionatesurgeon,colleague,friend,andfather.Hecareddeeplyaboutothersandwillbemisseddearly…”

ImageCredit:TheMayfieldClinicwww.mayfieldclinicblog.com/remembering-dr-charles-kuntz-reflections-from-patients-and-colleagues/

In Memorium: Charles Kuntz, MD

Neurological Surgeon Extraordinaire

1 neurosurgery.washington.edu

Neurovascular Group Publishes New Unruptured AVM Study

2 neurosurgery.washington.edu

Thedesignandconclusionsof“A Randomized Trial of Unruptured Brain Arteriovenous Malforma-tions”(ARUBA)trialremaincontroversial,anditsstructurelimitsanalysisofpotentiallytreatablepatients.

Inanefforttoevaluatetheresultsofaconsecutiveseriesofpatientswithunrupturedbrainarteriovenousmalformations(BAVMs), includingasubgroupanalysisofARUBA-eligiblepatients,wetreatedonehundredfivepatientswithunrupturedBAVMsoveran8-yearperiod.Fromthisseries,thestudyretrospectivelyreviewed90adultpatientsandasubgroupof61patientsdeterminedtobeARUBAeligible,includingasubgroupanalysisforSpetzler-MartingradesI/II,III,andIV/V.ThestudyemployedthemodifiedRankinScaletoassessfunctionaloutcome.

Persistentdeficits,modifiedRankinScalescoredeterioration,andimpairedfunctionaloutcomeoccurredlessfrequentlyinARUBA-eligiblegradeI/IIpatientscomparedwithgradeIIItoVpatientscombined.Twenty-twoof39patients(56%)unrupturedgradeIandIIBAVMsweretreatedwithsurgerywithoutandwithpreopera-tiveembolization,andallhadamodifiedRankinScalescoreof0to1atthelastfollow-up.Allpatientstreatedwithsurgerywithoutandwithpreoperativeembolizationhadradiographiccureatthelastfollow-up.

TheresultsofARUBA-eligibleandunrupturedgradeI/IIpatientsoverallshowthatexcellentoutcomescan be obtained in this subgroup of patients, especiallywith surgicalmanagement. Functional outcomes forARUBA-eligiblepatientswere similar to thoseofpatientswhowere randomized tomedicalmanagement inARUBA.Onthebasisofthesedata,inappropriatelyselectedpatients,thestudyfavorstreatmentforlow-gradeAVMs.

Wehavetreatedover250rupturedandunrupturedAVMsatHMCoverthelast10years.Managementwasmultidisciplinaryconsistingofobservationonly,embolizationwithONYX,microsurgicalresection,orra-diosurgery.Twoneurosurgeons,twoneuroradiologists,andoneradiationoncologistcomprisedtheteam.JohnNerva,aNeurologicalSurgeryresident,andJasonBarber,abiostatisticianmanagedanalysis.

TheARUBAtrialconditionswereverydifferentfromtheapproachtakeninmajorneurologicalsurgerycentersintheUSA,whichconsistedmainlyofembolizationonlywithaviewtocure,surgerybeingperformedasthelastresort.Thisledtoaveryhighcomplicationrateintheirpatientcohort,andwasamajorreasonthattheARUBAtrialdidnotshowapositiveresultforthe“treatmentarm.”HighlyskilledmicrosurgeryandtargetedembolizationwithamajoraimtomaketheAVMamenableforfurthertreatmentwithoutproducingmajorcom-plicationswastheimportantdifferenceinthecohortofpatientstreatedatUW-HMC.

ThegroupofpatientswithrupturedAVMs,andalargeseriesofpediatricpatientswithAVMsarebothbeingcurrentlyanalyzed.

Dr. Andrew Ko - Deep Brain Stimulation

ThislastMay,Smithsonianmagazineprintedanarticleentitled,“Inside the Science of an Amazing New Surgery Called Deep Brain Stimulation.”Init,theauthordescribesanoperationinwhichanawakepatientundergoeselectrodeimplantationforessentialtremor,laudingitas“themostfuturisticmedicaltreatmenteverimagined...” Intruth,DeepBrainStimulation(DBS)hasbeenperformedroutinelysincethe1970s,andthehistoryofsurgeryformovementdisordersisasoldasmodernneurologicalsurgeryitself.Inthe1890s,SirVictorHorselysuc-cessfullytreatedathatosiswithextirpationofmotorcortex,achievinganadmittedlyPyrrhicvictoryovertremoratthecostofhemiparesis.Refinementofdestructiveproceduresoverensuingdecadesdidleadtothesymptomaticreliefofmovementdisorderswithoutdebilitatingneurologicaldeficits.PriortotheadventofadvancedimagingsuchasCTorMRI,suchprecisionreliedonthetechniqueofmicroelectroderecording(MER).Bypassingathinelectrodemultipletimesthroughthebrain,theneurosurgeoncouldascertaintheoptimallocationatwhichtocreateasmalllesionbymappingtheactivityofsingleorsmallgroupsofcells.Thistechniquerequiresanawakeandbehavingpatient,aswellasspecializedequipmentandtheexpertisetouseit. Concurrentadvancesinhardwareallowedthedevelopmentofreliableneuromodulationwithelectricalcur-rent,andbythe1990s,ablativetherapiesformovementdisorderswaslargelysupplantedbytheputativelyreversibletherapyprovidedbyhigh-frequencystimulationknownasDBS.Eventoday,however,mostneurosurgeonsrelyonthepracticeofMERtolocalizetargetsforstimulation,continuingthetraditionofpassingwiresseveraltimesthroughbraintissue. Imagingtechnologyhasprogressedtothepointwherehigh-resolutionMRIcanidentifytargetsforDBS.Itisnowpossibletoobtainhigh-resolutionimagingwithCTinsideanyoperatingroom,whichallowsfordirectidentifica-tionofreal-timetargetswithinthebrainduringsurgery.Techniquesandprotocolsforperformingimage-guidedim-plantationofDBSelectrodeshavebeendevelopedandvalidatedinrecentyears. WearenowimplantingDBSelectrodesusingthesenewimage-guidedtechniquesattheUWMCandHarbor-view.Adoptingthesetechniquesisnotembracingtechnologyforitsownsake.Image-guidedDBSpermitspatientstobeasleepduringtheprocedure,enhancingtheircomfort,andmakingthistherapyavailabletopatientswhomightoth-erwisebeunwillingorunabletoparticipateinawakesurgery.TheuseofintraoperativeCTscanningtoprovidereal-timeimagingallowspreciselocalizationofintracranialelectrodes,anddoesnotnecessitatemultiplebrainpenetrationstoconfirmelectrodeposition.Thisreducestheriskofpotentiallycatastrophichemorrhageduringelectrodeimplanta-tion. Moreover,continuingadvancesinimagingsuchasdiffusion-tensortractographyandrestingstatefunctionalconnectivityarealsocontributingtoourunderstandingofhowDBSaffectsthenetworkarchitectureofthebrain.TheseimagingmodalitiesarebeingincorporatedintosurgeryattheUWtomoreaccuratelypredictclinicaloutcomeandsideeffectsofstimulation.Thisnotionof“connectomic”surgeryisrevealingnewtargetsforstimulationtotreatdiseasessuchasOCDanddepression.AstudyattheUWtestingnewtechnologythatmakesitpossibletotailorDBStopatientactivity,providingstimulationonlywhenneeded,hasbeenrecentlyapprovedbytheIRB,potentiallychang-inghowthistherapyisemployedforthefirsttimesincethe1990s. So,whileDBSmaynotbenew,thistherapycontinuestobeamazing,andtheUWispoisedtohelpensurethatitwillbewellintothefuture.

Andrew Ko, MD

3 neurosurgery.washington.edu

Christoph Hofstetter, MD, PhD

Christine Mac Donald, PhD

4 neurosurgery.washington.edu

Christoph HofstetterandcolleagueswillsoonpublishaproofofefficacypaperintheJournal of Clinical Neuroscienceconcerningendoscopictreatmentofforaminalste-nosis.Suchnarrowingisthoughttocauseradiculopathyinapproximately10%ofpatientssufferingformlumbardegenerativespondylosis.Adecreaseindischeight,osteoarthriticdegenerationoffacetjoints,cephaladsublaxationofthesuperiorarticularprocess,buck-lingoftheligamentumflavum,orprotrusionoftheannulusfibrosusmayallcontributetoforaminalstenosisandlimbpain.Surgicaldecompressionofstenoticlumbarforaminare-

quirespartialresectionoftheosteophytes,hypertrophicsuperiorarticulateprocess,andsuperiormarginoftheadjacentcaudalpediclewhichformsthebordersoflumbarforamina. Excellentclinicaloutcomefollowingendoscopicforaminotomyhasbeenpreviouslyreportedin12patientsbyAhnetal.Atameanfollow-upperiodofaboutoneyear,10patients(83.3%)reportedexcellentorgoodreliefofsymptoms.However,noquantitativedataontheamountofforaminaldecompressionhavebeenreportedtodate.Thus,thereisaneedtoinvestigatetheefficacyofendoscopicdecompressiveproceduresinthelumbarspine.Inthisstudy,Hofstetterevaluatedtheradiographicoutcomeofendoscopiclumbartransforaminaldecompressionincadavericspeci-mens.Amarkedincreaseinthecrosssectionalforaminalareawasnotedatallthestudiedlevels.

WearepleasedtointroduceDr. Christine Mac Donald,whojoinedourdepartmentin2014asanAssistantProfessor.BornandraisedinCalifornia,shewaspreviouslyaMe-chanicalEngineerworkingintheAerospaceindustryinSiliconValleybeforecompletingherMaster’sandDoctorateinBiomedicalEngineeringatWashingtonUniversityinSaintLouis.ShedidapostdoctoralclinicalresearchfellowshipincivilianbraininjuryandinitiallywasappointedtoafacultypositionintheDepartmentofNeurologyalsoatWashingtonUniver-sity.There,shemanagedanddirectedclinicalresearchstudieswithActiveDutyUSMilitaryfollowingcombat-relatedbrain injury,exploringnew imaging techniques forutilization intheacutecriticalcareenvironment.ShethenlivedandworkedatLandstuhlRegionalMedicalCenterinGermany,theprimarytriagesiteforallcasualtiesofwarbeforecompletinga2012studywithcolleaguesdirectlyinthecombattheatreatKandaharAirFieldandCampLeatherneckinAfghanistan.

HerresearchisfocusedonadvancedMRmethodsfortheevaluationoftraumaticbraininjurybothinthecivilianandmilitarypopulations.Shebringscreativeneuroimagingexpertisetoourdepartmentandawealthofcomputation-allymindedinformationasitpertainstobothpreclinicalmodelsandtheclinicalapplicationofnewimagingmethodstobraininjuryandotherneurodegenerativediseases.Anavidcommutercyclist,runnerandtriathlete,whensheisnotintheoffice,youcanfindherexploringtheoutdoorsandenjoyingthemountaintrailsalloverourEvergreenstate.ShehasalreadyengagedinsynergisticcollaborationswithmanyofourcliniciansandhasobtainedbothDepartmentofDefenseandNIHfundingforherworksincejoiningourdepartment.WeenthusiasticallywelcomeDr.MacDonaldandanticipateherfurthercontributionsinmanyareasofresearch.

Duringherfirstyearwithus,shereceivedamajorawardforaneffortentitled,EvaluationofLongitudinalOut-comesinMildTBIActive-DutyMilitaryandVeterans-TheEVOLVEStudy.ThegoalofEVOLVEistoevaluatethelongtermimpactofconcussiveTBIonUSmilitaryservicemembersandleverageexistingearlyclinicalandimagingdataintheseindividualstodevelopmodelsofpredictiveoutcome.Thisisafiveyear$3Mawardfortheperiod04/04/2015-03/31/2020.CongratulationstoDr.MacDonaldandhercollaborators.

John R. Silber, PhD

ResearchProfessorEmeritusDr. John Silberisabraintumorbiologistwithalongandproductivehistoryinourdepartment.Althoughofficially“retired”hecontinuestomakesubstantialcontributionstoourresearchandteachingmission,andwearegrateful,notonlyforhispastservice,butalsohisongoingcontributions.

AfterreceivinghisBSinPhysicsfromtheUniversityofFloridain1971Dr.SilbercompletedhisPhDinRadia-tionBiologyandMicrobiologyfromthesameinstitutionin1977.Afterbeginninghispost-doctoralworkattheFoxChaseCancerCenterinPhiladelphia,hemovedwithhismentorLawrenceLoebtotheUniversityofWashingtonin1978tocontinueworksupportedbyFellowshipsfromNIHandNIA.From1986-1990hewasaSeniorAssociateattheHowardHughesMedicalInstituteattheUniversityofWashingtonandthenjoinedourDepartmentasaResearchAssistantProfessortobegintranslationalworkinbraintumorbiologyincollaborationwithDr.MitchelBerger.HehasbeenanactiveresearcherwhohasdevelopedanationalreputationbycharacterizingthecontributionofindividualDNArepairactivitiestoresistancetoradiationandchemotherapyinadultandpediatricgliomas.Thelong-termgoalofthesestudieswastoidentifypotentialtargetsfornovelstrategiestoovercomeresistancetocontemporarystandardsofcareformalignantgliomas.Tothatend,Dr.SilberisnowcollaboratingcloselywithcolleaguesintheDepartmentofMaterialsSciencestodevelopnanoparticlescapableofdeliveringchemicalandgeneticinhibitorsofessentialDNArepairproteinsspecificallytogliomas.Healsocontinuesmorebasicstudiesaddressingtheroleofthemutatorphenotypeingliomagen-esis,theevolutionoftumoraggressiveness,andassociationoftumorproliferationandoxidativestressonDNArepaircapability.Overtheyears,hisworkhasbeensupportedby10NIHandfoundationawardsonwhichhewasPrincipalInvestigatorandhasresultedin55peerreviewedpublicationsinhighvaluejournalsand6bookchapters.Hisnationaland international responsibilities include invitedpresentationsatconferencesandotheruniversities,participationonnumerousadhocstudysectionsandservingasareviewerforleadingoncologypublications.

John’semeritusstatushasbeennobarriertohisongoingscientificproductivity.Hehasmaintainedlong-termcollaborationswithfacultyatUWandotherinstitutions,routinelyattendstheweeklyNeuro-OncologyTumorBoardandcollaboratesextensivelywithcliniciansandscientistsinourdepartment.Hetakesparticularinterestintheeducationofundergraduatestudentsinwhomhetriestoinstillanappreciationforthemolecularbasisofdisease.Forthelast25yearshehasservedasthePrincipalInvestigatoroftheNeuro-OncologyTissueBankandisresponsibleformaintain-ingtissueassociatedclinicaldatafromapproximately2,000patientsasadedicatedresourceforNeurologicalSurgeryfacultyandtheircollaborators.

Dr.SilberhashadaproductiveandrewardingcareerintheDepartmentofNeurologicalSurgery.Heisexcep-tionallywelllikedandhisongoinginvolvementinourtrainingprogram,mentoringjuniorfacultyaswellasresearchactivitiesbringsgreatdepthtoourdepartment.

5 neurosurgery.washington.edu

Professor ofNeurologicalSurgery,Robert C. Rostomily, has just received anNIHR01(concurrentlyhis 3rd)forhisprojectentitledTherapeutically Relevant Targets of Twist1 Dimers in Glioma.Thisisa5-year,$2Mstudyfortheperiod02/15/2015-01/31/2020.

Glioblastoma(GBM)isamongthemostlethalhumancancers,butdespiteextensiveeffortsovermanydecades,mediansurvivalsremainatoneyear,orless.Newtreatmentapproachesareneededtoaddressthisincurablebraincancer.Inthisresearch,Dr.Rostomily’steamwilldeveloptherapeuticstrategiestotargetatranscriptionfactor,TWIST1,whichplaysacentralroleintheinvasionandsurvivalofglioblastomastemcells,uniquetumorformingcellswhicharehighlyresistanttotherapyanddrivetumorprogression.ThisresearchinvestigatesanovelapproachtotargetingtheTWIST1transcriptionfactorinGBM.DrRostomily’slabwasthefirsttoidentifyTWIST1asanovelmediatorofgliomainvasionandgliomastemcellphenotypes.HeandhiscolleagueshaveextensiveexperiencewithhumanGBMstemcellchar-acterization,molecularmanipulationandxenograftmodelstostudyinvasionandtumorphenotypes.Withthisresearchaward,Dr.RostomilyandhisexceptionalteamofinvestigatorshopetoidentifypromisingnewapproachestoGBMtherapy,whichmightalsohaveimplicationsformanyothercancers.

Robert C. Rostomily, MD

The Practioner Team Overthecourseofthepasttenyears,thestructureofthein-andout-patientHar-borviewmid-levelpractitioner teamhaschangedandgrown,both in termsofFTEandresponsibilities.Therearenowsome12FTEdedicated, skilled,andveryhardworkingpractitionerswhomanagetheneurologicalsurgerywardandclinicpatientsalongwiththeresidents,neurohospitalistsandneurosurgeons. Ingeneral, theyareanamazing,accom-plishedgroupwithavarietyofskillsandinterests.Wearetakingtheopportunityinthisissueofthenewslettertointroduceafewofthemtoyou;therewillbemoreintroductionsinthefuture.Weareallluckytohavethemonourteam.

Katie Moore, RN, Helicopter Pilot

KatieMoorewasraisedinPortAngeles,ontheOlympicPeninsulaandworkedfortheOlympicNationalParkinhelicopterandemergencymanagementforfiveyearsduringcollege.Initiallyshewenttocollegeonafulltuitionpianoperformancescholarship,butthendecidedtobecomeahelicopterpilot.Shetookfixedwingandrotarylessonsuntilhergrandmother(andcollegefinancier)suggestedthiswasan“unladylike”profession.Katiethenfoundherwaytoabachelor’sdegreeinnursingfromtheUWandaMaster’sinnursingfromSeattleUniversity.Shereportsthatshestillplayspiano,mostrecentlyaccompanyingtheSeattleGayYouthChoir;butthatotherwiseherskillsaremostlyutilizedinsing-a-longswithfriends.Earlyinhernursingcareer,shetooktimeoffforinternationalaidwork:missionstoCambo-dia,tsunamidisasterresponseinSriLankaandeventuallyasemi-permanentpositionforWorldVisioninDarfur,Sudan.ShewasevacuatedbytheUNafter4monthsduetoescalatingviolenceagainstNGOemployees.ShehasworkedatHMCfor11years,thelast5asanARNPforNeurologicalSurgery.KatieismarriedtoSean,andtheirsonColinisnow4.SeanworksfortheUWFosterSchoolofBusiness(campaigndevelopment)andColinworksplayinggarbagetrucksandridinghistricycle.

6 neurosurgery.washington.edu

Amyisaboard-certifiedFamilyNursePractitionerwiththeAmericanAcademyofNursePractitionersandisamemberoftheSigmaThetaTauInternationalHonorssociety.ShewasbornandraisedonthePugetSoundinOlym-pia,Washington.SheattendedtheEvergreenStateCollegeasanundergraduate,andbalancedcourseworkinCulturalAnthropologywithFineArtstudiesandtravelingabroad.Aftercollege,sheworkedinvariousareasofhealthcarein-cludingEmergencyMedicineandOncology.FollowingseveralyearsworkingasanEMTandEmergencyDepartmentTechnician,sheearnedanadvanceddegreeinNursing.ShereceivedherRNandMastersofScienceinNursingfromSeattleUniversity.

Amyenjoystravelingwithherhusband,snorkeling,swimming,readingandpainting.Shelovesspendingtimewithher7year-oldstepson,andwelcomedherownbabyboyinJuneof2014.HerfavoriteaspectofNeurologicalSurgeryacutecareistheopportunitytosupportpatientsthroughthecomplexitiesoftheirhospitalstayandoptimizepost-operativerecovery.

Amy Diaz BA, RN, MSN, FNP-C

The Practioner Team, Continued

JennywasbornandraisedinSeattle,andearnedherBachelor’sdegreeinnursingfromSeattlePacificUniversity,andherMaster’sdegreeanddoctoratefromtheUniversityofWashington.ShehasexperienceworkinginprimarycareaswellasNeurologicalSur-gery.JennyoriginallyjoinedtheNeurologicalSurgerypractitionerteamasanewgradin2007,leftforotheradventuresfortwoyears,andthenreturnedin2013(andwe’reverygladshedid).Sheisahikingandyogaenthusiast,andlastyearwentonmissiontoNorthKoreawhere,thankfully,shewasnotarrested.

Jenny Choi, DNP, ARNP

CharlesVaughanisaNursePractitionerwithseveralyearsofexperienceasaCriti-calCareRNatUWMC.HeobtainedhisMNandBSNattheUniversityofWashington.HisexperienceatHarborviewincludesvolunteeringintheEmergencyDepartmentandPioneerSquareClinicpriortohisacademicprogressioninNursing.Inhisfirstlife,hecompletedasuccessful30-yearcareerasanengineerwithworkinaerospaceandbiomedicalengineer-ing,andholdsaPhDinMechanicalEngineeringfromColoradoStateUniversitywithaspecializationinbiomedicalengineering.Charlesismarried,has3daughters,andisanavidoutdoorsman,anactivescubadiver,skier,cyclist,hikerandclimber.

Charles Vaughan, ARNP

7 neurosurgery.washington.edu

InJulyof1988,ourfamilymovedtotheNorthwestfromSanDiegowhereIhadworkedintheDepartmentofAnesthesiologyattheUniversityofCalifornia,LaJolla.Myhusbandwasanelementaryschoolspecialeducationteacher.FortwoyearsIworkedinAnesthesiologyatUWandthenacceptedapositionasasupervisorinourdepart-mentatUWMC.InthosedaystheRR744officewastwoshadesofcompetingorange,andanorangeshagcarpetofathirdhuegracedthefloor.Thestaffwasalltemporary,exceptforme,whichwaschallenging.ItwasmypleasurethentoworkwithDrs.GeorgeOjemann,JohnLoeser,BasilHarris,andalsoFrankWebster,theadministratoratthattime.IalsoworkedwithMarcMaybergandhadtheopportunitytoattendtheCNSmeetingstwicewhenhewasPresidentandPastPresident.DanSilbergeldwasthenaresidentandIhaveenjoyedsupportinghimashisassistantforoveradecade.IhavebeenaskedhowIcouldworkinthesameplacefor24years,butourdepartmenthasneverbeenboringtome.Infact,adjustingtochangesinstaffandadministrationhasbeeninterestingandmuchlikefamilydynamics.

Ourtwodaughtershavegrownupduringtheseyearsandbecauseofthisinfluencetheyhavechosenhealth-careprofessions.LauraisaNursePractitionerMidwifeatSwedishHospitalinIssaquah,andErinisaCRNAattheUWMC.Afterretiring,Iwillchangemytitlefrom“ProgramOperationsSpecialist”to“Gigi”andjoinmyhusband,Doug,incaringforourgrandchildrenwhiletheirparentswork,inhopesofgivingthemspecialrelationshipsthatneitherofusexperienced.Weplantotravelandalreadymadesomedefiniteitineraries.I’malsoplanningtowriteabookaboutourfamilyheritage.

Itreasuremytimehere,thelifelongfriendsI’vemade,andfeelblessedtohavebeenapartofsuchawonderfulgroupofpeople!Thankyou!

Dr. Richard Ellenbogen: Sharon, until we see you again. Thank you for your years of dedicated service.

Sharon Andrews Calls It A Career

A Personal Message from Sharon

8 neurosurgery.washington.edu

SusanGangerhasjoinedtheDepartmentofNeurologicalSurgeryasAssistanttotheChair,supportingDr.Ellen-bogen.HerbackgroundincludesworkingforLoyolaUniversity,TheGatesFoundationandmostrecently,Micro-soft,whereshesupportedateamofover200people.Wearelookingforwardtotheadditionofthewealthofherexperienceandabilitiestoourfirst-rateadministrativeteamatHMC,UWMC,andSCH.SusanislocatedintheNeurologicalSurgeryofficesofthe14thfloorofNJBandcanbereachedat:206-744-9321orsganger@uw.edu

Welcome Susan Ganger!

Inhonorofhismagnificentteachingability,ClinicalProfessorJohn HowewaselectedbythefinalyearUWstudentsgraduatingAOAtomembershipinthatsociety.John’steachingabilitiesmayhavecomefromhismother,alongtimeProfessorofEnglish.Thisisarareandwonderfulrecognitiontoasuperbneurologicalsurgeonandteacher.

Dr. John Howe Elected to AOA

Wearebothoverjoyedandbereft toannounce thatourmore thanwonderfulResidencyProgramAdministrator,Aubriana Ard,hasbeenacceptedtotheUniversityofWashingtonSchoolofMedicine.Shehasmanagedtheresidentsadministrativelyforthepastseveralyears,andshehasbeentheirguide,friend,andsometimestaskmasterinshepherdingthemthroughtheoftendifficult,demanding,andoftenconfusingrulesconcerningBoardrequire-mentsaswellastheirday-to-dayresponsibilities.WhileweallknowthatAubrianawillbeaswonderfuladoctorasshehasbeenacolleague,shewillbegreatlymissedinthedepart-ment.

Department of Good News/Bad News

Western Neurological Society Annual MeetingGrand Hyatt Resort and Spa • Kaua’i, Hawaii • September 10 - 13, 2015

Forthe61stannualmeeting,theWesternreturnstotheGrandHyattResortandSpaontheHawaiianIslandofKaua’i.DirectflightstotheLihueairportonKauai(17milesfromtheresort)areavailablefrommanymajorairports.

Moredetailsaboutthemeetingandthemealvenuesandafternoonactivitieswillbeforthcoming.Theonlineroomres-ervationlinkishttps://resweb.passkey.com/go/wns2015

Thisyear,ClinicalProfessorEmeritusDavePitkethlyistheincomingVicePresidentoftheWNS,andurgestheresi-dentstosubmitabstractsfortheseveralprizesandforthejuniorfacultymemberstojointhissplendidlocalorganiza-tion:http:www.westnsurg.org/default.asp

9 neurosurgery.washington.edu

The Department of Neurological Surgery’s First Annual Community Conversation

TheDepartmentofNeurologicalSurgery’sFirstAnnualCommunityConversation-RevolutionizingBrainRe-searchandCare-washeldattheUW’sSouthLakeUnionfacilityonFebruary5th,2015andreceivedpositivereviewsfromattendeesandparticipantsalike.InadditiontointroductoryremarksbyProfessorandChair,Dr.RichardEllenbogen,NeurologicalSurgeryfacultypresentersincluded:

AssistantProfessorChristine L. Mac Donald, PhD, whodiscussedherongoingTBIresearchinatalkentitled:Brain Injury and Psychological Health following Combat Deployment: The Invisible Wounds of War.

AssociateProfessorSamuel R. Browd, MD, PhD,whospokeonInnovation and CommercializationandhowweimpactpatientcarethroughinnovationintheareasofHydrocephalus,BrainCatheters,Concussion,andepilepsyamongothers.

AssociateProfessorLouis J. Kim, MD,whospokeonPredicting Aneurysm Treatment Success with Endovascu-lar Flow MeasurementsandnotingthatUW-Harborviewischangingthefutureofaneurysmtreatment.

AssistantProfessorManuel Ferreira Jr. MD, PhD,whose talk entitledAneurysm Genome Project: Lessons from the Human and Cancer Genome Projects,reviewedwhatisknownnowaboutthegeneticsofaneurysmsandhowincreasedresearchmayprovidenewtherapeuticsdirectedtowardcustomizedtreatmentsforeachpatient’saneurysm.

Wearepleasedtocommunicatenewdevelopmentsinthefieldpioneeredbyourfaculty,andnextyearlookforwardtobringingyouareportontheSecondAnnualCommunityConversation.

From left to right: Manuel Ferreira Jr., MD, PhD, Samuel R. Browd, MD, PhD, Christine L. Mac Donald, PhD, Richard G. Ellenbogen, MD, FACS, Louis J. Kim, MD

10 neurosurgery.washington.edu

We remain eager to publish stories and photos about all aspects and activities of the Department.Pleaseshareyourmemories,ideasandsuggestionsforstoriesandnewsitemsthatexpandourcommonground.Pleasecontactusattheseemailaddresses:

Editor-in-Chief Richard G. Ellenbogen, M.D. rge@uw.eduEditor Richard Rapport, M.D. rappor@uw.eduAssociate Editor James Pridgeon, MHA pridgeon@uw.eduDirector Jana Pettit, MBA jmpettit@uw.eduPublications Specialist Christina Buckman cbuckman@uw.eduThe Puzzler-in-Chief Minku Chowdhary, MD

Puzzler

New Puzzler:New Puzzler: How do you connect leprosy, a “fair pitcher,” and neurosurgery?

Previous Puzzler: The“Neurosurgery’smanoftheCentury”hasneverboatedontheMoodusReservoir, butwhatistheiractualconnection?

Answer: HestudiedatBaselUniversityinBaselSwitzerlandwhichisthebirthplaceofWillyBurgdorfer, whofoundthecauseofLymeDiseasewhichisnamedforthetownofLyme,CT,

wheretheMoodusReservoirislocated.

http://www.nytimes.com/2014/11/20/health/willy-burgdorfer-who-found-bacteria-that-cause-lyme-disease-is-dead-at-89.html?ref=health

Dr. Minku ChowdharyChief, NeurosurgeryOverlake Hospital

We invite you to visit our Facebook page at facebook.com/uwneurosurgery

Share a story, tell us about your experience. We’d love to hear from you!

Thispublicationdoesnotconstituteprofessionalmedicaladvice.Althoughitisintendedtobeaccurate,neitherthepublishernoranyotherpartyassumesliabilityforlossordamagefromrelianceonthismaterial.Ifyouhavemedi-calquestions,consultyourmedicalprofessional.

www.neurosurgery.washington.edu

twitter.com/UWNeurosurgery

www.youtube.com/UWNeurosurgery

11 neurosurgery.washington.edu