Chapter Fifteen Neurological Disorders. CHAPTER 15 NEUROLOGICAL DISORDERS.
The Montlake Cut - UW Department of Neurological Surgery
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A View From Puget Sound The field of Neurological Surgery remains a dynamic and evolving effort to improve patient outcomes through innovation, technological sophistication, basic research - and hard work. Our superb and dedicated young faculty and residents are often at the forefront of these efforts, and in this issue of the newsletter we present some of their accom- plishments. The more established faculty remain just as hard at it as demonstrated by Professor Laligam Sekhar’s efforts to refine the treatment for unruptured AVMs. Even though he is officially now a Professor Emeritus, John Silber continues to be very engaged in both clinical and basic research, and Bob Rostomily and his lab are still gathering new grants aimed at better treatments for the ever difficult to manage glioblastomas. We also introduce some of our remarkable mid-level practitioner team, without whom the acute care service at Harborview could not function. Readers will be both surprised and delighted by the depth and breadth of experiences these people bring to our department. After 24 years and many residents come and gone, Sharon Andrews has retired from the UWMC office and will be sorely missed. Sharon was the glue that held together the UWMC service. We will also miss a wonderfully warm, skilled neurological surgeon who graduated our program, Dr. Charlie Kuntz, a Professor at the Mayfield Clinic in Cin- cinnati who died unexpectedly, and far too young. Last, we held our First Annual Conversation with the Community, and look forward to this dynamic exchange of ideas in future years. Sincerely, Richard G. Ellenbogen, MD, FACS Professor & Chairman, Department of Neurological Surgery The Montlake Cut A Publication of the Department of Neurological Surgery UW Medicine Health Care Richard G. Ellenbogen M.D., F.A.C.S. In Memorium: Dr. Charles Kuntz Neurovascular Group Publishes New Study Dr. Andrew Ko - Deep Brain Stimulation Dr. Christoph Hofstetter/Dr. Christine Mac Donald Dr. John Silber Dr. Roberty Rostomily/Spotlight:Practitioner Team In This Issue - Spring 2015 Practitioner Team Continued Sharon Andrews Calls It A Career Announcements First Annual Community Conversation Puzzler 1 2 3 4 5 6 7 8 9 10 11
Transcript of 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
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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
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Neurovascular Group Publishes New Unruptured AVM Study
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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
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Christoph Hofstetter, MD, PhD
Christine Mac Donald, PhD
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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.
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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.
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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
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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
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SusanGangerhasjoinedtheDepartmentofNeurologicalSurgeryasAssistanttotheChair,supportingDr.Ellen-bogen.HerbackgroundincludesworkingforLoyolaUniversity,TheGatesFoundationandmostrecently,Micro-soft,whereshesupportedateamofover200people.Wearelookingforwardtotheadditionofthewealthofherexperienceandabilitiestoourfirst-rateadministrativeteamatHMC,UWMC,andSCH.SusanislocatedintheNeurologicalSurgeryofficesofthe14thfloorofNJBandcanbereachedat:[email protected]
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
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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
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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. [email protected] Richard Rapport, M.D. [email protected] Editor James Pridgeon, MHA [email protected] Jana Pettit, MBA [email protected] Specialist Christina Buckman [email protected] 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
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Share a story, tell us about your experience. We’d love to hear from you!
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