UNIVERSITY NEUROSURGERYBrain and Spinal Column

Spring 2016

The Road to a Seizure-Free LifeEPILEPSY SURGERY

Epilepsy is one of the most common serious neurological disorders affecting 1% of the population by age 20 and 3% of the population by age 75. The mainstay treatment of epilepsy is anticonvulsant

medications, pos-sibly for a person’s entire life. About 30% of people, however, continue to have seizures despite anticonvul-sant treatment and become medically intractable. Among this group of pa-tients, some may

benefit from surgical treatments of epi-lepsy. University Neurosurgery is the only provider of epilepsy surgery in the Ark-La-Tex, and our team is ready to help.

Assistant Professor and Director of Epi-lepsy Surgery Dr. Hai Sun joined Univer-sity Neurosurgery’s faculty in September

2015 to expand epilepsy treatment within our practice and throughout the state and region. Born in China, Dr. Sun came to the U.S. in 1994 and enrolled at St. John’s College in Annapolis, Maryland. He then went on to obtain a combined MD-PhD de-gree from Dartmouth College in Hanover, New Hampshire. His PhD is in biomed-ical engineering, and his PhD research sparked his interested in neurosurgery. He completed his neurosurgery residency at Oregon Health & Science University in Portland, Oregon. He then completed fellowship training in Epilepsy Surgery at University of Washington in Seattle and in Skull Base and Cerebrovascular Sur-gery at Barrow Neurological Institute in Phoenix, Arizona. In addition to epilepsy surgery, Dr. Sun also treats patients with cerebrovascular disorders, carotid steno-sis, brain tumors, and spinal disorders.

Epilepsy surgery can help provide a life-style will less medication for many and a seizure-free lifestyle for some.

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University NeurosurgeryBrain & Spinal Column

Brain & Spinal Column is written for physicians and should be relied on for medical education purposes only. It does not provide a complete overview of the topics covered, and should not replace the independent judgment of a physician regarding the appropriateness or risks of a procedure for a given patient.

For information regarding articlereferences please email the University Neurosurgery Editorial Office at 318.675.5392

UNIVERSITY NEUROSURGERY FACULTY

ANIL NANDA, MD, MPH, FACSProfessor Department Chairman

DONALD R. SMITH, MDClinical Professor

BHARAT GUTHIKONDA, MDAssociate Professor

ANTHONY SIN, MDAssociate Professor

CHRISTINA NOTARIANNI, MDAssociate Professor

HUGO CUELLAR, MDAssociate Professor

HAI SUN, MD, PHDAssociate Professor

GUOHONG LI, MD, PHDAssistant Professor of Research

RONG JIN, PHD Assitant Professor of Research

ALICE EDWARDS, PA-CPhysician Assistant, Clinic Manager

SUSAN STEEN, PA-CPhysicaian Assistant

TIFFANY BOYCE, PA-CPhysician Assistant

MICHELLE LEACHMAN, PA-CPhyscian Assistant

FROM THE

Chairman’s DeskGreetings from University Neurosurgery and LSU Health Shreveport. Our team is proud to expand our services for our patients with the addition of Dr. Hai Sun to our faculty. He performed the first epilepsy surgery in recent history at LSU Health Shreveport this year, and I am thrilled to see the impact he will make in the state and region.

We’re delighted to have matched three new residents on Match Day. Racheal Wolfson from the University of Miami, Jared Brougham from Oakland University, and Devon LeFever from the University of Toledo, will official-ly join our team in July.

I am happy with the success of our Levy conference in April and our Wood-ard Symposium in September. For Levy, Dr. William T. Couldwell, a nationally recognized neurosurgeon from the University of Utah, visited and educated our faculty, residents and medical students on the ever-developing field of skull base surgery. Woodard brought together three neurosurgeons, representing Europe and Asia, allowing LSU Health Shreveport to serve as a global intersection in education.

With these additions and updates, we continue to provide neurosurgical care to the entire state and the Ark-La-Tex region. If you have any questions, kindly feel free to call me. Thank you.

Anil Nanda, MD, MPH, FACS

Recent Publications1. Bir, Konar, Maiti, Nanda, Guthikon-da. Neuromodulation in retractable pain management: Outcomes and Predictors of Revisions of Spinal Cord Stimulators. Journal of NeuroInter-ventional Surgery. 2016 Feb;8(2):216-20. 2. Maiti T, Bir S, Bollam P, Nanda A. Alfred J Lussenhop and the dawn of new superspecialty endovascular neurosurgery. Journal of NeuroInter-ventional Surgery. 2016 Feb;8(2):216-20. 3. Bir S, Maiti T, Bollam P, Nanda A. Management of recurrent trigeminal neuralgia associated with petro-clival meningioma. Journal of Neurologi-cal Surgery Part B Skull Base. 2016 Feb;77(1):47-53.4. Konar SK, Maiti TK, Bir SC, Kala-koti P, Bollam P, Nanda A. Predictive factors determining the overall out-

come of Primary Spinal Glioblastoma Multiforme: An integrative survival analysis. World Neurosurgery. 2016 Feb;86:341-48.5. Nanda A, Filis A, Kalakoti P. Mytho-logical Origins of Neurosurgery. World Neurosurgery. Accepted 2016 Feb.6. Kalakoti P, Murray R, Segerlind J, Smeds H, Nanda A. Revisiting non-ionizing radiofrequency-electro-magnetic field induced causation of brain tumors: Cochlear implants in the etio-pathogenesis of glioblastoma: an interesting observation or an indepen-dent finding. Acta Neurochirurgica. 2016 Jan 22.7. Bir SC, Maiti TK, Konar S, Nanda A. Overall outcomes following early interventions for intracranial arteriove-nous malformations with hematomas. Journal of Clinical Neuroscience. 2016 Jan;23:95-100.

Clinics

An International Crossroads in Neurosurgery

Fourth Annual

WOODARDSYMPOSIUM

University Neurosurgery hosted the fourth-annual Woodard Symposium Sept. 25, 2015 at LSU Health Shreveport. Three international neurosurgeons delivered updates in neurosurgery, representing two continents.

Dr. Andreas Raabe, Chairman and Professor of Neuro-surgery at Inselpital University of Bern in Switzerland, discussed “Game Changers in Surgery of Motor El-oquent Gliomas.” Dr. Ugur Türe, Chairman and Pro-fessor of Neurosurgery at Yeditepe University School of Medicine in Turkey, presented “The Paramedian Supracerebellar-Transtentorial Selective Amygdalohip-pocampectomy.” Dr. Eka J. Wahjoepramono, Chairman

and Professor of Neurosurgery at Siloam Hospitals in Indonesia, lectured on “Surgery of Brainstem Cavern-ous Angioma.”

The Woodard Symposium is made possible by the Scotty and Larene Woodard Woodard Professorship. Seven years ago, an aneurysm threatened Larene Woodard’s life. A coiling operation at LSU Health Shreveport kept the aneurysm from bursting. Thanks to the Woodards, the physicians and staff at LSU Health Shreveport, as well as community members and other health professionals, have access to visiting lecturers’ knowledge and expertise.

University Neurosurgery Resident Publishes Op/Ed in The Wall Street Journal

Dr. Richard Menger, PGY-5 resident for the Depart-ment of Neurosurgery, wrote an opinion/editorial, “Getting Military Surgeons the Practice They Need to Stay Sharp” for the Wall Street Journal. The piece was published March 11.

Read Dr. Menger’s article here: http://www.wsj.com/articles/getting-military-surgeons-the-prac-tice-they-need-to-stay-sharp-1457737653

Dr. Menger is pursuing a Master in Public Admin-istration at Harvard University’s Kennedy School of Government, where he is the recipient of the Hale Champion Public Service Fellowship, a full

tuition, merit-based fellowship. The Harvard Ken-nedy School of Government’s Master’s in Public Administration program includes alumni such as former White House Chief of Staff Pete Rouse and eight presidents from around the world.

Dr. Menger is completing the research com-ponent of his residency at Harvard, exploring healthcare economics and the military healthcare system. This piece stemmed from his work in policy analysis. Dr. Menger is also a lieutenant in the United States Navy (Reserve) Medical Corps.

This publication marks Dr. Menger’s second Wall Street Journal piece. His letter to the editor, “Don’t Treat Doctors Like Exchangeable Com-modities,” was published in 2013.

LSU Health Shreveport (ACC)1501 Kings HighwayShreveport, LA 71103p: 318.813.2482, f: 318.813.1556

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Administrative Main OfficeUniversity NeurosurgeryLSUHSC - Shreveport, Dept. of Neurosurgery1501 Kings Highway, PO Box 33932Shreveport, LA 71130-3932p: 318.675.6404, f: 318.675.6867

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University Neurosurgery’smultidisciplinary team is pleased to serve you and your patients in the following loctions:

DEPARTMENT NEWSThe neurosurgery department at LSU Health Shreveport has seen several events worth celebrat-ing throughout the past several months.

Professor and Chairman Dr. Anil Nanda was honored as the William Henry Hudson Lecturer at the South-ern Neurosurgical Society Annual Meeting March 2-5 in San Antonio, Texas. The award is the highest hon-or the society bestows and honors a nationally-recog-nized neurosurgeon. He spoke on “Skull Base Sur-gery: Why the Owl of Minerva Flies at Dusk.”

Associate Professor and Residency Program Director Dr. Christina Notarianni was promoted to Associate Professor.

Dr. Marc Manix, PGY-6 resident, is engaged to Leah Romero. They will marry this summer.

Associate Professor Dr. Hugo Cuellar-Saenz earned his Ph.D. degree in neuroscience from the University of Santiago de Compostela in Spain.

Chairman and Professor Dr. Anil Nanda lectured at the IX International Congress of Neurosurgery meet-ing in Tegucigalpa, Honduras Jan. 21-23, 2016.

Associate Professor and Residency Program Director Dr. Christian Notarianni spoke on “Double Keystone (‘Butterfly Flaps’) for the Closure of Myelomeningo-cele” at the American Society of Pediatric Neurosur-geons Annual Meeting Jan. 31-Feb. 5, 2016 in Palm Beach, Aruba.

Professor and Chairman Dr. Anil Nanda was invited as a visiting professor to the University of Zurich in Zurich, Switzerland, Barrow Neurological Institute and the University of Wisconsin.

Assistant Professor and Director of Epilepsy Surgery Dr. Hai Sun earned his certification in Gamma Knife radiosurgery. He can now treat patients with this mini-mally-invasive procedure.

Dr. Elizabeth Wild, PGY-3 resident, is engaged to Michael Mumaugh.

13th Annual

LEVY CONFERENCEA Visiting Professorship in Neurosurgery

University Neurosurgery hosted the 13th Annual Mary Louise and Ben Levy Visiting Professorship in Neurosurgery April 8, 2016. University of Utah Professor and Chairman Dr. William T. Couldwell lectured on the “Evolution of Skull Base Surgery.” Approximately 150 guests were in attendance, in-cluding physicians, nurses and medical students.

Dr. Couldwell has contributed to over 350 peer-reviewed publications. His clinical interests include surgical management of skull base tu-mors, neuro-oncology, pituitary tumors and cere-brovascular neurosurgery.

The Levy lecture recognizes graduation for the Department of Neurosurgery’s residents. Dr. Shi-hao Zhang and Dr. Osama Ahmed were honored at the annual Levy reception and Dr. and Mrs. Nanda’s home. Dr. Zhang and Dr. Ahmed will complete their seven-year-long training in June.

The annual lecture is made possible by the Mary Louise and Ben Levy, Jr. Visiting Professorship, which the Levys established in 2004. The confer-ence works to honor the memory of the couple by offering an educational opportunity for the Shreveport community.

University Neurosurgery Professor Earns Subspecialty Certification Associate Professor Dr. Hugo Cuellar was recent-ly granted subspecialty certification in neuroen-dovascular surgery by the Society of Neurolog-ical Surgeons and the Committee on Advanced Subspecialty Training.

Neuroendovascular surgery uses minimally inva-sive catheter-based technology, radiological im-aging and clinical expertise to diagnose and treat vascular diseases of the central nervous system, as well as other disorders of the head, neck and spine and their vascular supply.

Dr. Cuellar specializes in neuroendovascular procedures, as he has trained in radiology, neu-roradiology and interventional radiology.

Earning subspecialty certiciation means that

University Neurosurgery is on track to eventually begin a neuroendovascular surgery fellowship program. University Neurosurgery currently offers a skull base surgery fellowship.

For more information on the types of procedures Dr. Cuellar performs, visit his website: vascularneuro.com.

CASE SPOTLIGHTArteriovenous Malformation (AVM)

Devi Patra, MD Research Fellow

A 45-year-old male, on evaluaion of his seizure disorder, was found to have a left frontal arteriovenous malformation (AVM) of size 3.5 x3.1 cm (Figure 1A).A diagnostic angiogram showed feeders from pericallosal and callosomariginal branches of left anterior cerebral artery (ACA)(Figure 1B&C) and superficial drainage to superior saggital sinus(Fig-ure 1D&E) (Spetzler Martin Grade 2). Af-ter discussing various treatment options, the patient was taken for surgery. Under frameless stereotactic guidance, a left frontal craniotomy was performed. The AVM was seen near to falx, on the medi-al edge of hemisphere with large draining veins (Figure 1F). Meticulous dissection was per-formed under microscope, initially anteriorly. Feeders from ACA were identified and clipped. Then, circum-ferential dissection was done to isolate the nidus with preservation of the draining veins, and the nidus was excised. However, brisk oozing from the bed raised the suspicion of residual lesion (Figure 2A). Intra-op-erative arteriogram showed a small residual AVM on the lateral aspect of the cavity (Figure 2B&C). It was subsequently excised successfully (Figure 2D) and was confirmed on post-operative angiogram (Figure 2E&F). The patient had an uneventful post-operative course and was discharged in stable condition. The ultimate aim of AVM surgery is complete excision of the lesion to abolish the risk of bleeding. Intra-

operative subtraction angiogram is a useful adjunct to document complete obliteration. In addition, it is helpful in localizing small AVMs, en-passage vessels and delineation of the AVM during emergency sur-gery for hematoma evacuation without preoperative angiography.1 Recently, fluorescent angiography with indocyanine green has shown comparable results and sometimes is preferred for its non-invasive value.2 However, the downside is it can identify lesions only in the area that are exposed in surgical field and is not useful in deep seated lesions. Intra-operative angio-gram is a valuable tool to ensure complete excision and thereby avoids risk of rebleeding from residual le-sion and subsequent need of retreatment. A high false negative rate mandates a post-operative angiogram to document complete excision.

References: 1. Munshi I, Macdonald RL, Weir BK. Intraoperative angiography of brain arte-riovenous malformations. Neurosurgery. 1999 Sep;45(3):491-7; discussion 497-9.2. Bilbao CJ, Bhalla T, Dalal S, Patel H, Dehdashti AR. Comparison of indocy-anine green fluorescent angiography to digital subtraction angiography in brain arteriovenous malformation surgery. Acta Neurochir (Wien). 2015 Mar;157(3):351-9.

CONDITIONS TREATED

AVM

Aneurysm

Brain Tumor

Cervical Stenosis

Degerative Disc

Epilepsy

Herniated Disc

Scoliosis

Spinal Stenosis

Spine Trauma

Traumatic Brain Injury

Trigeminal Neuralgia

For a complete list of treatment conditions, please visit our website or speak with our clinical staff.

Associate Professor Dr. Christina Notarianni and PGY-4 resident Dr. Rimal Hanif operate. Dr. Notarinni serves as Residency Program Director, developing education opportunities for University Neurosurgery residents.

SAVE THE DATE5th Annual Woodard Symposium:An International Colloquium in Neurosurgery

September 22, 2016LSU Health Shreveport

Department of NeurosurgeryLSU Health ShreveportPO Box 33932, Shreveport, LA 71130-3932Academic Office 318.675.6404Clinic Office 318.795.2638www.universityneurosurgery.com

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